Health Care Coordination Research Articles

Older People with Urinary Incontinence: A Nurse Practitioner’ Role in the Assessment and Management

Urinary incontinence is a common problem symptom of urination, an inability to control the urinaryexcretion on its own, causing a loss of the ability to control urination. Most often, this happens in situationswhere urination is not ready and accidentally slips out. The symptoms will cause hygiene problems, suchas a wound rash, or red marks on the wrong skin until the subsequent infection problem is also a problemfor physical health, impacting the mind, economy, and society. It is a health problem that affects physical,mental, emotional, and social aspects lead to reduced quality of life. Older people with urinary incontinenceproblems, it is caused by several reasons and factors that can cause various issues. This article aims to describeurinary excretion mechanisms, meaning, types and effects, method for assessing urinary incontinence, andprimary care guidelines for the older people and their families providing home and hospital care. Therefore,nurse practitioners’ action plays a significant role in helping older people with urinary incontinence. It is aservice through four dimensions: prevention, medical treatment, and nursing care, health promotion, andrehabilitation. Furthermore, medical history taking by interviews, physical examination, and self-assessmentthose are the service nurse roles: health care provider, health educator, counselor, coordinator, and advocatorin the follow-up and contact for improving caring to receive quality care and reasonable to continue to bringan as good quality of life.

Поправки в Конституцию Российской Федерации: продиктованная необходимость и последствия в условиях современного мира

The subject of this article is Law of the Russian Federation on Amendments to the Constitution of the Russian Federation (14.03.2020 No. 1-Federal Constitutional Law) «On improving the regulation of certain issues of the public power organization and functioning», namely, aspects of «coordination of health care» and «protection of the family, motherhood and childhood». The authors analyzed the issues of the medical care provision centralization, the impact of these amendments on the legal capacity of citizens. For a more in-depth analysis, the experience of foreign countries (Canada and Germany) was used. Despite the fact that the health care systems of the countries cited as an example differ in their essence and organization, nevertheless, they influence the formation of the availability of medicine for the population. As a result of the study of this experience, it was concluded that the delegation of freedom in the provision of medical care to lower levels of government allows to provide to the population affordable and high-quality medical care. It is noted that at present it is necessary to review the degree of participation of local governments in ensuring the availability of medical care in accordance with the federal law.

Chronic pain and cardiovascular disease prevention in primary care: a review of Australian primary health network needs assessments

Objective Chronic pain and cardiovascular disease (CVD) have a high disease burden. This research aimed to understand whether Australian primary health networks (PHNs) are recognising the need for the prevention of these conditions by investigating what local health and service issues have been identified. Methods Separate sets of needs assessments were analysed for chronic pain and CVD for all 31 PHNs using a document analysis approach. Framework analysis was undertaken to ascertain the types of health and service issues, prevention-related issues and supporting data sources identified, as well as to quantify the number of PHNs identifying these issues. Results Fewer PHNs identified health issues for chronic pain (n = 13) compared with CVD (n = 30), with the most common being disease prevalence and burden supported by National Health Survey data. Service issues were identified by fewer than half the PHNs (n = 13 for each disease), which were largely informed by stakeholder consultation and related to service integration, service accessibility and health professional training. Prevention-related issues were frequently identified for CVD (n = 26), but not chronic pain (n = 3). Conclusions This paper highlights the need for a greater focus on chronic pain- and CVD-related issues by PHNs. This could be supported nationally by recognising chronic pain and risk factors in national datasets and PHN performance frameworks, and locally via greater stakeholder consultation to inform PHN population health planning. What is known about the topic? Chronic pain and CVD are the two leading causes of total disease burden in Australia. PHNs are well positioned to address prevention locally through population health planning, supporting primary healthcare providers, health care integration and coordination and commissioning necessary services. What does this paper add? This paper highlights gaps in data availability, the proportion of PHNs identifying local service issues for both chronic pain and CVD and health- and prevention-related issues for chronic pain. What are the implications for practitioners? Although PHNs are constrained by government priorities and funding, greater stakeholder consultation is one potentially promising strategy to overcome local data gaps to identifying and prioritising chronic pain and CVD prevention.

Stakeholders’ Tolerance-based Linear Model for Home Health Care Coordination

Abstract With aging populations and increasing life expectancy, Home Health Care (HHC) has become an alternative treatment modality for the elderly who want autonomy and well-being as they live longer and longer. Facing this rise in demand, the organisation and coordination of HHC institutions has become increasingly complex and difficult. This paper addresses a short-term Home Health Care Routing and Scheduling Problem (HHCRSP), formulated by Mixed Integer Linear Programming (MILP). The proposed model considers tolerance-based soft constraints in view of both patients and caregivers, with the aim of maximising the total satisfaction of all HHC stakeholders. The problem is solved by the commercial solver CPLEX. We adopt a real dataset extracted from an existing HHC institution. The numerical result on 10 generated instances shows the efficient computing performance for an optimal solution for small and medium-large sizes.

Collaboration and guidelines for the coordination of health care for frail older persons with intellectual disability: A national survey of nurses working in municipal care.

AimsTo describe and compare perceptions of collaboration between care providers on the part of three groups of Registered Nurses working in municipal care and having particular responsibility concerning the care of frail older people with intellectual disability (ID); and, furthermore, to investigate the presence of and compliance with guidelines for the coordination of care.DesignNational survey study with cross‐sectional design.MethodsNurses (N = 110) with key positions concerning people with ID answered a national questionnaire about collaboration, guidelines and coordinated individual plans. Descriptive and comparative statistical analyses were applied.ResultsThe meetings on cooperation and coordination of interventions were attended most frequently by nurses, and least frequently by social workers. The nurses were overall satisfied with the collaboration but perceived shortcomings in the case of inpatient and outpatient psychiatric care. Only in about half of the meetings for making care plans participated the people with intellectual disability and next of kin.

Breaking healthcare coordination boundaries in response to migrants precariousness: the case study of a healthcare network in the Parisian suburbs

Although the mechanisms underpinning health inequalities associated with migration are increasingly well described by social epidemiology and health sociology, the operations of health care systems involved in the assistance of migrant populations in precarious situations remain largely unexplored. Based on the study of a precariousness and healthcare network and its two main partner institutions located within the greater Paris region, this article exposes the coordination ch...

Multidisciplinary Community-Based Investigation of a COVID-19 Outbreak Among Marshallese and Hispanic/Latino Communities - Benton and Washington Counties, Arkansas, March-June 2020.

By June 2020, Marshallese and Hispanic or Latino (Hispanic) persons in Benton and Washington counties of Arkansas had received a disproportionately high number of diagnoses of coronavirus disease 2019 (COVID-19). Despite representing approximately 19% of these counties' populations (1), Marshallese and Hispanic persons accounted for 64% of COVID-19 cases and 57% of COVID-19-associated deaths. Analyses of surveillance data, focus group discussions, and key-informant interviews were conducted to identify challenges and propose strategies for interrupting transmission of SARS-CoV-2, the virus that causes COVID-19. Challenges included limited native-language health messaging, high household occupancy, high employment rate in the poultry processing industry, mistrust of the medical system, and changing COVID-19 guidance. Reducing the COVID-19 incidence among communities that suffer disproportionately from COVID-19 requires strengthening the coordination of public health, health care, and community stakeholders to provide culturally and linguistically tailored public health education, community-based prevention activities, case management, care navigation, and service linkage.

Here’s something I prepared earlier: a review of the time to publication of cross-sectional reviews of smartphone health apps

ObjectivesAcross a range of health conditions, apps are increasingly valued as tools for supporting the delivery and coordination of healthcare. Research-led cross-sectional reviews of apps are a potential resource to...

Medical heuristics and action-research: professionalism versus science

BackgroundProfessional knowledge aims at improving practice. It reduces uncertainty in decision-making, improves effectiveness in action and relevance in evaluation, stimulates reflexivity, and subjects practice to ethical standards. Heuristics is an approach to problem-solving, learning, and discovery employing a practical methodology that, although not optimal, is sufficient for achieving immediate goals. This article identifies the desirable, heuristic particularities of research in professional, medical practice; and it identifies what distinguishes this research from scientific research.Main textWe examine the limits of biomedical and sociological research to produce professional knowledge. Then, we derive the heuristic characteristics of professional research from a meta-analysis of two action-research projects aimed at securing access to essential generic drugs in Senegal and improving physicians’ self-assessment and healthcare coordination in Belgium.To study healthcare, biomedical sciences ignore how clinical decisions are implemented. Decisions are built into an articulated knowledge system, such as (clinical) epidemiology, where those studied are standardisable - while taking care of patients is an idiosyncratic, value-based, person-to-person process that largely eludes probabilistic methodologies. Social sciences also reach their limits here because descriptive, interpretative methods cannot help with gesture and speech quality, while the management of the patient’s suffering and risks makes each of them unique. Research into medical professionalism is normative as it is intended to formulate recommendations. Scientific data and descriptions are useful to the practitioner randomly, only from the similarities in the environment of the authors and their readers. Such recommendations can be conceived of as strategies, i.e., multi-resource and multi-stage action models to improve clinical and public health practice. Action learning and action-research are needed to design and implement these strategies, because their complexity implies trial and error. To validate a strategy, repeated experiences are needed. Its reproducibility assumes the description of the context. To participate in medical action-research, the investigator needs professional proficiency - a frequent difficulty in academic settings.ConclusionSome criteria to assess the relevance of publicly funded clinical and public health research can be derived from the difference between scientific and professional knowledge, i.e. the knowledge gained with real-life experience in the field.

The professional contribution of chiropractors to Danish elite football clubs: a qualitative exploration of role and perceived value in an interprofessional service provision context

BackgroundInterprofessional team-based care has been widely adopted in elite level athletic health and performance practice. Chiropractors can claim some penetration as health care service providers in high level sport. However, their position as valued members of interprofessional health care teams, especially those built around traditional medical organisational structures, is unclear. This investigation sought to explore the perceived role and value of chiropractors as service providers in elite Danish football clubs.MethodsA comparative qualitative case study was conducted. Six Danish premiere league (Superliga) clubs were purposively sampled to compare and contrast instances where chiropractors were both present and absent from the health care team. Triangulated responses were solicited from healthcare coordinators, chiropractors and athletes within each club’s organization through semi-structured individual interviews. The audio-recorded responses were transcribed verbatim and thematically analyzed using a framework approach.ResultsData were collected September and November 2019. A coding framework of 14 codes and 4 code families emerged, centering around the role of chiropractors, benefits of utilizing chiropractic care and facilitators and barriers to interprofessional practice. From this framework, three themes were abstracted, these being: “Broadening horizons”, “In-house preferred to take-away” and “Already covered, or even necessary?”ConclusionIn this practice context, chiropractors fill the role of musculoskeletal health care service providers. Their perceived value stems from additional expert disciplinary knowledge, improved diagnostic triage and increased treatment flexibility. However, where not utilized, the role of a spinal health expert is questioned and when acknowledged, is limited to that of a technician/therapist. It is unclear from this investigation whether chiropractors can claim core provider status. Further exploration of this interesting context of interprofessional practice is warranted.

Understanding how health systems facilitate primary care redesign.

To understand how health systems are facilitating primary care redesign (PCR), examine the PCR initiatives taking place within systems, and identify barriers to this work. A purposive sample of 24 health systems in 4 states. Data were systematically reviewed to identify how system leaders define and implement initiatives to redesign primary care delivery and identify challenges. Researchers applied codes which were based on the theoretical PCR literature and created new codes to capture emerging themes. Investigators analyzed coded data then produced and applied a thematic analysis to examine how health systems facilitate PCR. Semi-structured telephone interviews with 162 system executives and physician organization leaders from 24 systems. Leaders at all 24 health systems described initiatives to redesign the delivery of primary care, but many were in the early stages. Respondents described the use of centralized health system resources to facilitate PCR initiatives, such as regionalized care coordinators, and integrated electronic health records. Team-based care, population management, and care coordination were the most commonly described initiatives to transform primary care delivery. Respondents most often cited improving efficiency and enhancing clinician job satisfaction, as motivating factors for team-based care. Changes in payment and risk assumption as well as community needs were commonly cited motivators for population health management and care coordination. Return on investment and the slower than anticipated rate in moving from fee-for-service to value-based payment were noted by multiple respondents as challenges health systems face in redesigning primary care. Given their expanding role in health care and the potential to leverage resources, health systems are promising entities to promote the advancement of PCR. Systems demonstrate interest and engagement in this work but face significant challenges in getting to scale until payment models are in alignment with these efforts.

Transfer anxiety in critical care patients and their caregivers

Introduction: Both admission and discharge in the critical care units can cause anxiety in the patients and their family caregivers. Coordination and integration of primary and secondary healthcare is important for those individuals. The aim of the study was to investigate the transfer anxiety in patients and their caregivers due to being transferred from the intensive care unit (ICU).Methods: This is a descriptive study that was carried out through interviewing with the patients and their caregivers who were hospitalized in the ICU and then transferred out due to the improvement of their general condition. The data of the study were carried out by using a Questionnaire Form and the State-Trait Anxiety Inventory (STAI).Results: A total of 170 individuals (85 patients and 85 family caregivers) were involved in the study. The patient’s anxiety scores were higher than their caregivers and the difference was statistically significant (p<0.001). The patients and their caregivers’ mean anxiety scale scores after the transfer were higher in comparison with the mean scores before the transfer and the difference was statistically significant (p<0.001). Conclusions: Patients and their caregivers experience transfer anxiety due to being transferred from the ICU. Therefore, healthcare professionals are encouraged to make the necessary adjustments to prevent transfer anxiety. In this process, the involvement of primary healthcare professionals, in particular family physicians and nurses, who know them closely is crucial.

Low Rates of Preventive Healthcare Service Utilization Among Adolescents and Adults With Down Syndrome

People with Down syndrome have health risks that require specific lifelong preventive health care. With increasing life expectancy, people with Down syndrome also face health conditions typical of their unaffected peers and thus need coordinated health care. The purpose of this study is to describe rates of age/sex- and Down syndrome-specific preventive healthcare activities among adolescents and adults with Down syndrome. Using Medicaid claims (2006-2010) in California, Colorado, Michigan, and Pennsylvania, the cohort was defined as people with Down syndrome aged ≥12 years seen by primary care providers and enrolled in Medicaid for ≥45 of 60 months without dual Medicare enrollment (n=3,501). Age focus-consistent primary care providers were defined as having a focus concordant with a patient's age: 12-17 years, child or mixed-focus; ≥26 years, adult or mixed-focus; 18-25 years, any focus. Differences in healthcare activities were evaluated using Pearson's chi-square, Fisher's exact, and Kruskal-Wallis tests. Analyses were performed in 2015-2017. Of the cohort, 79% had an age focus-consistent primary care provider. However, 40% of adults aged ≥26 years received care from a child-focused primary care provider. Only 43% with an age focus-consistent provider had ≥1 well examination (age focus-inconsistent primary care provider: 35%, p<0.001). Most preventive activities had poor rates (<50%) regardless of age focus consistency between provider and patient age or whether they were age/sex- or Down syndrome-specific (well examinations; vaccinations; sleep apnea; hearing; and breast, cervical, and colon cancer screenings). Lipids, vision, and thyroid screenings reached moderate levels (50% to <80%). Rates of age/sex- and Down syndrome-specific preventive recommendations were low among adolescents and adults with Down syndrome, regardless of the age focus consistency of their primary care provider. This represents a significant opportunity to improve primary care in this vulnerable population.

A decade of public long-term care insurance in South Korea: Policy lessons for aging countries

South Korea proactively introduced public long-term care insurance (LTCI) in 2008 when older people were only about one-tenth of the total population. At that time, Korea switched from a tax-based, local-government-operated LTC program targeting low-income older people to the current universal public LTCI run by the National Health Insurance Service, the single public insurer. The LTCI program provides a comprehensive package of home- and institution-based care mainly targeting older people who need assistance in daily living. Over the past decade, the program has continued to expand its population and service coverage: older people in high need have been covered, and an infrastructure for service provision has been established. Future agendas include financial sustainability, care coordination, and the role of local governments. Korea’s experiences suggest having an LTCI separate from the NHI has the benefit of potential de-medicalization of LTC, which, in turn, creates challenges for the coordination of health care and LTC. A centralized LTCI system with a single payer has the benefit of bigger risk-pooling, but this may become a barrier to designing integrated community care systems at the local level. There is a tradeoff between population coverage, benefits/cost coverage, and fiscal sustainability.

Punctuating the equilibrium: an application of policy theory to COVID-19

COVID-19 has taught us that, when inadequately addressed, preexisting policy problems (e.g. weak coordination of healthcare and gaps in income supports) exacerbate the cost of crises (including deaths) and make policy responses more difficult. On a more hopeful note, the pandemic has also revealed that policymakers and bureaucrats, reputed as defenders of the status quo and glacially paced, are capable of moving nimbly when seized with necessity. This manuscript draws on Baumgartner and Jones’ punctuated-equilibrium theory to analyze and demonstrate how policy responses to the pandemic, largely in Canada but also globally, were shaped by preexisting problems (periods of equilibrium). It then raises the question: Will future policy reflect lessons learned through COVID-19, to not only mitigate risks from further crises, but also tackle many other policy challenges? It would seem we can no longer accept the excuse that problems are too complex or time-consuming to tackle.

Community Care Facility-A Novel Concept to Deal With the COVID-19 Pandemic: A Singaporean Institution's Experience.

The coronavirus disease 2019 (COVID-19) pandemic has placed a strain on health care systems worldwide. Many hospitals experienced severe bed shortages; some had to turn patients away. In Singapore, the widespread outbreak, especially among the dormitory-based population, created a pressing need for alternative care sites. The first massive-scale community care facility (CCF) was started in Singapore to address the pandemic. It served as a low-acuity primary care center that could isolate and treat COVID-19-positive patients with mild disease. This allowed decompression of the patient load in hospitals, ensuring that those with more severe disease could receive timely medical attention. Various groups from the private and public sectors, including health care, construction, security, hotel management, and project coordination, were involved in the setup and operations of the CCF. A large exhibition center was converted into the care facility and segregated into zones to reduce cross-contamination. State-of-the-art technological infrastructure for health management was used. Several paraclinical services were made available. The CCF was a timely and robust response that fulfilled several crucial functions, including cohort isolation, triage, basic medical care, and timely reviews and escalation of patients. It placed a unique focus on promoting patient ownership, responsibility, and mental well-being. It was largely successful, with a low hospital transfer rate of 0.37%. The success of the CCF could be attributed to the use of a facility of opportunity, strong interorganizational and cross-sector cooperation, an integrated and robust clinical system, and clear communication channels. It allows for efficient resource utilization and is valuable in future pandemics with similar disease characteristics.

Community Health Centers Primary Care Physicians' Asthma Management Perception of Uninsured Patients.

Explore the perceptions of primary care physicians (PCPs) from community health care centers (CHCs) in Franklin County, Ohio, regarding factors that contribute to their inability to consistently provide sustainable asthma management services to their uninsured patient population. Asthmatic patients are not consistently receiving sustainable asthma management in CHCs in Ohio. Primary care physicians in CHCs play a pivotal role in closing health care gaps for asthmatic patients. To minimize the barriers that impede the efforts of PCPs to control asthma for their uninsured patients, asthma disease management programs that include case management services in CHCs in Franklin County, Ohio, are needed. A convenience sample of 4 PCPs from 2 CHCs in Franklin County, Ohio, was interviewed face-to-face. Interviews, direct observation, and previously published research were the sources of data utilized for this study. Results indicated that 75% of participants did not use standard guidelines while treating their patients. Physician time constraints and access to affordable medication were identified as some of the barriers to providing sustainable asthma management services. Asthma is a complex chronic disease. Disease case managers not only are capable of coordinating health care services for a variety of patient populations but are also effective in managing complex diseases such as asthma for disadvantaged populations. Evidence-based case management models are needed to support PCPs in CHCs. Without the inclusion of asthma-specific case managers as part of the care delivery structure, CHCs may continue to provide subpar disease management services for uninsured asthmatic patients.

The relationship between having a regular general practitioner (GP) and the experience of healthcare barriers: a cross-sectional study among young people in NSW, Australia, with oversampling from marginalised groups

BackgroundYoung people (12–24 years) visit general practice but may not have a ‘regular’ general practitioner (GP). Whether continuity of GP care influences experiences with, and barriers to, health care among young people is unknown. This paper explores the association between having a regular GP and experience of healthcare barriers and attitudes to health system navigation among young people in New South Wales (NSW), Australia.MethodsThis study was a cross-sectional survey administered either online or face-to-face in community settings. Young people living in NSW were recruited, with oversampling of those from five socio-culturally marginalised groups (those who were Aboriginal and Torres Strait Islander, homeless, of refugee background, in rural or remote locations, sexuality and/or gender diverse). In this analysis of a larger dataset, we examined associations between having a regular GP, demographic and health status variables, barriers to health care and attitudes to health system navigation, using chi-square tests and odds ratios. Content and thematic analyses were applied to free-text responses to explore young people’s views about having a regular GP.ResultsOne thousand four hundred and sixteen young people completed the survey between 2016 and 2017. Of these, 81.1% had seen a GP in the previous 6 months and 57.8% had a regular GP. Cost was the most frequently cited barrier (45.8%) to accessing health care generally. Those with a regular GP were less likely to cite cost and other structural barriers, feeling judged, and not knowing which service to go to. Having a regular GP was associated with having more positive attitudes to health system navigation. Free-text responses provided qualitative insights, including the importance of building a relationship with one GP.ConclusionsGeneral practice is the appropriate setting for preventive health care and care coordination. Having a regular GP is associated with fewer barriers and more positive attitudes to health system navigation and may provide better engagement with and coordination of care. Strategies are needed to increase the proportion of young people who have a regular GP.

Use of mental health supports by civilians exposed to the November 2015 terrorist attacks in Paris

BackgroundThe use of mental health supports by populations exposed to terrorist attacks is rarely studied despite their need for psychotrauma care. This article focuses on civilians exposed to the November 2015 terrorist attacks in Paris and describes the different combinations of mental health supports (MHSu) used in the following year according to type of exposure and type of mental health disorder (MHD).MethodsSanté publique France conducted a web-based survey of civilians 8–11 months after their exposure to the November 2015 terrorist attacks in Paris. All 454 respondents met criterion A of the DSM-5 definition of post-traumatic stress disorder (PTSD). MHD (anxiety, depression, PTSD) were assessed using the PCL-5 checklist and the Hospital Anxiety and Depression Scale. MHSu provided were grouped under outreach psychological support, visits for psychological difficulties to a victims’ or victim support association, consultation with a general practitioner (GP), consultation with a psychiatrist or psychologist (specialist), and initiation of regular mental health treatment (RMHT). Chi-squared tests highlighted differences in MHSu use according to type of exposure (directly threatened, witnessed, indirectly exposed) and MHD. Phi coefficients and joint tabulations were employed to analyse combinations of MHSu use.ResultsTwo-thirds of respondents used MHSu in the months following the attacks. Visits to a specialist and RMHT were more frequent than visits to a GP (respectively, 39, 33, 17%). These were the three MHSu most frequently used among people with PTSD (46,46,23%), with depression (52,39,20%), or with both (56,58, 33%). Witnesses with PTSD were more likely not to have RMHT than those directly threatened (respectively, 65,35%). Outreach support (35%) and visiting an association (16%) were both associated with RMHT (Phi = 0.20 and 0.38, respectively). Very few (1%) respondents initiated RMHT directly. Those who indirectly initiated it (32%) had taken one or more intermediate steps. Visiting a specialist, not a GP, was the most frequent of these steps.ConclusionOur results highlight possibilities for greater coordination of mental health care after exposure to terrorist attacks including involving GP for screening and referral, and associations to promote targeted RMHT. They also indicate that greater efforts should be made to follow witnesses.

Engaging nurses in health policy in the era of COVID-19.

Nurses have a unique place in redesigning the future of healthcare, particularly after experiencing health policy failures with the coronavirus disease 2019 pandemic. Nurses consistently outperform other professions to enjoy a decades‐long reputation as the most trusted profession. Nevertheless, the nursing voice is missing at a public level; representation in governments and boardrooms negligible. While nurses carry out health policy, rarely are they involved informing policy. While substantial dialog on health system reform, regulatory changes, care coordination, and health information technology occurs, nursing's presence is absent. The barriers are many: a lack of political sophistication, family, and work demands limiting time, and a lack of confidence. Using the Yoder‐Wise Framework for Planned Policy Change, opportunities for engagement at each step in the process are made clear. Workplace opportunities provide entry‐level representation and exposure to the machinations of governance. Nursing professional associations provide similar opportunities. For many nurses, social media, while not without its risks, offers a familiar and accessible platform by which to engage patients, the public, and policymakers in planned, strategic steps to create policy change and improve healthcare for patients.