Implementation Of Care Program Research Articles

Implementation of Supportive Care Program to Decrease CLABSI in a Middle East Pediatric Hematology and Oncology Inpatient Unit.

Background: Central venous catheters (CVCs) support the administration of chemotherapy and other medications, blood products, fluids, and nutrient infusions, and reduce the need for peripheral blood sampling in children with cancer. CVC use is also associated with the risk of central-line-associated bloodstream infection (CLABSI). Despite the implementation of CLABSI care bundles, CLABSI prevention remains challenging. Method: This project implemented supportive preventive care interventions to decrease CLABSI in pediatric hematology/oncology patients in a tertiary hospital in the Middle East region. Interventions included bathing or skin care once daily, oral care twice daily, and ambulating patients three times daily. Parent and staff education materials were developed. The project moniker was Step 1-2-3, inspired by successful implementations of such measures in a U.S. cohort showing reduced CLABSI rates. The project used a mixed methods approach. We report outcomes through August 2022. Results: Pre-project (12/2019-05/2020) five CLABSIs occurred in the inpatient unit. Following the implementation of Step 1-2-3, Pediatric Oncology achieved 492 CLABSI-free days. Six CLABSIs then occurred over a short period of time between October 2021 and January 2022, which was associated with high levels of patient acuity and staff sick leave. The inpatient ward remained CLABSI-free from January 9, 2022, through August 2022. Discussion: Extended periods of CLABSI-free care in a pediatric hematology/oncology unit are achievable. A variety of factors contribute to the sustainability of being CLABSI-free. Data collection and analysis are important factors which aided in our understanding of our own CLABSI events.

Assessment of the Impact of Social Care on Local Consumption in Kwara State, Nigeria

This paper examines the impact of social care on local consumption in Kwara State, Nigeria. The study employed quantitative research methods and primary data were obtained by means of a well-structured questionnaire. Analytical Techniques Descriptive statistics were used to describe the socio-economic characteristics of the respondents. In analyzing the determinants of variables in the study area, regression analysis was adopted. The target population includes beneficiaries of social care programs in Kwara State who were captured in National Social Register for the poor and vulnerable. A multi-stage sampling technique was employed and 150 beneficiaries were identified. The findings revealed that social assistance programs play a vital role in enhancing local consumption and fostering economic development in Kwara State. The study recommended that government should allocate adequate funding to the implementation of social care programs and ensure their long-term viability and effectiveness.

Barriers to the implementation of virtual care programmes for patients with chronic wounds: Qualitative empirical research.

To assess the barriers to the implementation of virtual care for patients with chronic wounds from wound therapists' perspective. A qualitative study. The study was conducted in two consecutive phases: (1) literature review, (2) descriptive qualitative study. In the first phase, texts published in English until 2023 were identified using international databases. The entire text of the selected studies was evaluated independently by two reviewers. Data analysis was carried out using textual content analysis. In the second phase of the study, twelve participants from Iranian wound care clinics participated. Data were collected through focus group discussion and analysed using conventional content analysis. Integration of both phases was conducted in the data analysis stage. The most important barriers in providing virtual care to patients with chronic wounds were identified into five categories including lack of policymaking in virtual care, ethical challenges in virtual information and communication technology, social, economic and cultural issues, IT users' insufficient knowledge and limitation of virtual care scope of practice. The findings of the present study identified different barriers in the implementation of virtual care for patients with chronic wounds. In order to successfully develop a virtual care programme, it is necessary to adopt suitable policies regarding information and communication technology, provide the necessary legal frameworks, assign an adequate budget and consider the ethical, cultural, social and social issues. Identifying barriers to developing a virtual care programme will help manage patients with chronic wounds at home. This study accurately identifies barriers to providing virtual care for patients with chronic wounds and helps plan to address these barriers and facilitate the development of a virtual care programme for these patients at home. This research has adhered to the SRQR reporting guideline. The involvement of patients or the public in the design, or conduct, or reporting, or dissemination plans of this research was not suitable.

Improving serious illness communication: a qualitative study of clinical culture

ObjectiveCommunication about patients’ values, goals, and prognosis in serious illness (serious illness communication) is a cornerstone of person-centered care yet difficult to implement in practice. As part of Serious Illness Care Program implementation in five health systems, we studied the clinical culture-related factors that supported or impeded improvement in serious illness conversations.MethodsQualitative analysis of semi-structured interviews of clinical leaders, implementation teams, and frontline champions.ResultsWe completed 30 interviews across palliative care, oncology, primary care, and hospital medicine. Participants identified four culture-related domains that influenced serious illness communication improvement: (1) clinical paradigms; (2) interprofessional empowerment; (3) perceived conversation impact; (4) practice norms. Changes in clinicians’ beliefs, attitudes, and behaviors in these domains supported values and goals conversations, including: shifting paradigms about serious illness communication from ‘end-of-life planning’ to ‘knowing and honoring what matters most to patients;’ improvements in psychological safety that empowered advanced practice clinicians, nurses and social workers to take expanded roles; experiencing benefits of earlier values and goals conversations; shifting from avoidant norms to integration norms in which earlier serious illness discussions became part of routine processes. Culture-related inhibitors included: beliefs that conversations are about dying or withdrawing care; attitudes that serious illness communication is the physician’s job; discomfort managing emotions; lack of reliable processes.ConclusionsAspects of clinical culture, such as paradigms about serious illness communication and inter-professional empowerment, are linked to successful adoption of serious illness communication. Further research is warranted to identify effective strategies to enhance clinical culture and drive clinician practice change.

A rapid review of implementation frameworks underpinning Aboriginal and Torres Strait Islander children’s health and social care programs

ObjectiveThis rapid review aimed to identify (1) key frameworks and components underpinning the effective implementation of Health and Social Care (HSC) programs for Aboriginal and Torres Strait Islander children; and (2) participatory and co-design frameworks guiding the implementation. MethodsFour databases were searched for peer-reviewed English-language articles published between 2015 and 2021. The focus was on HSC models, frameworks, projects or services with an implementation focus for Aboriginal and Torres Strait Islander children aged 0–12 years. ResultsSeven studies identifying components supporting effective implementation of Aboriginal and Torres Strait Islander HSC programs were included. Continuous Quality Improvement was the most widely applied approach. Most studies described participatory and co-design approaches to ensure suitability for Aboriginal and Torres Strait Islander children and families. ConclusionsThere remains a paucity of evidence on the effective implementation of Aboriginal and Torres Strait Islander children’s HSC programs. Implementation approaches that foster cultural safety and Aboriginal and Torres Strait Islander leadership, support diverse partnerships and promote localised application may facilitate the effective implementation of HSC programs. Implications for Public HealthFuture research in this area would benefit from greater consideration of appropriate implementation frameworks and co-design approaches, and emphasis on reporting interventions, implementation frameworks and co-design approaches for HSC programs for Aboriginal and Torres Strait Islander children.

Cancer Survivor Preferences for Models of Breast Cancer Follow-Up Care: Selecting Attributes for Inclusion in a Discrete Choice Experiment.

It is critical to evaluate cancer survivors' preferences when developing follow-up care models to better address the needs of cancer survivors. This study was conducted to understand the key attributes of breast cancer follow-up care for use in a future discrete choice experiment (DCE) survey. Key attributes of breast cancer follow-up care models were generated using a multi-stage, mixed-methods approach. Focus group discussions were conducted with cancer survivors and clinicians to generate a range of attributes of current and ideal follow-up care. These attributes were then prioritised using an online survey with survivors and healthcare providers. The DCE attributes and levels were finalised via an expert panel discussion based on the outcomes of the previous stages. Four focus groups were held, two with breast cancer survivors (n = 7) and two with clinicians (n = 8). Focus groups generated sixteen attributes deemed important for breast cancer follow-up care models. The prioritisation exercise was conducted with 20 participants (14 breast cancer survivors and 6 clinicians). Finally, the expert panel selected five attributes for a future DCE survey tool to elicit cancer survivors' preferences on breast cancer follow-up care. The final attributes included: the care team, allied health and supportive care, survivorship care planning, travel for appointments, and out-of-pocket costs. Attributes identified can be used in future DCE studies to elicit cancer survivors' preferences for breast cancer follow-up care. This strengthens the design and implementation of follow-up care programs that best suit the needs and expectations of breast cancer survivors.

Comprehensive emergency management of obstetric and newborn care program implementation at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia, 2021: an evaluation study

BackgroundMaternal healthcare service is the care given for the woman during her gestation, delivery and postpartum period. The Maternal Mortality Ratio (MMR) was remains high and a public health problem in Ethiopia. Sub-Saharan African (SSA) countries account two-thirds of the global total maternal deaths. To curb such high burden related with child births, comprehensive emergency obstetric care is designed as one of the strategies for maternal healthcare services. However, its implementation status was not well investigated. This study aims to evaluate the implementation of comprehensive emergency obstetric and new born care program in terms of Availability, compliance and acceptability dimensions at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.MethodsA single case study design was employed from 01 to 30 April 2021. A total of 265 mothers who gave birth at University of Gondar Comprehensive Specialized Hospital (UoGCSH) during the data collection period for acceptability, 13 key informant interviews (KIIs), 49 non-participatory observations (25 observations during C/S performance and 24 assisted spontaneous vaginal deliver) and 320 retrospective document review were conducted. Availability, compliance and acceptability dimensions were evaluated using 32 indicators. Binary logistic regression model was fitted to identify factors associated with acceptability of the services. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) and p-value < 0.05 were also used to identify associated variables with acceptability. The qualitative data were recorded using tape recorder, transcribed in Amharic and translated to English language. Thematic analysis was done to supplement the quantitative findings.ResultsThe overall implementation of comprehensive emergency obstetric and newborn care (CEmONC) was 81.6%. Moreover, acceptability, availability and care provider’s compliance with the guideline accounted 81, 88.9 and 74.8%, respectively. There were stocked-out of some essential drugs, such as methyldopa, nifidipine, gentamycin and vitamin K injection. CEmONC training gaps, inadequate number of autoclaves, shortage of water supply and long-distance delivery ward to laboratory unit were also the barriers for the CEmONC service. Short waiting time of clients (AOR = 2.40; 95%CI: 1.16, 4.90) and maternal educational level (AOR = 5.50, 95%CI: 1.95, 15.60) were positively associated with acceptability of CEmONC services.ConclusionThe implementation status of CEmONC program was good as per our judgment parameter. Compliance of healthcare providers with the guideline was fair and needed improvement. Essential emergency drugs, equipment and supplies were stocked-out. The University of Gondar Comprehensive Specialized Hospital was therefore had better to give great emphasis to expand maternity rooms/ units. The hospital had better to avail the resources and provide continuous capacity building for healthcare providers to enhance the program implementation.

Association of an Emergency Critical Care Program With Survival and Early Downgrade Among Critically Ill Medical Patients in the Emergency Department.

To determine whether implementation of an Emergency Critical Care Program (ECCP) is associated with improved survival and early downgrade of critically ill medical patients in the emergency department (ED). Single-center, retrospective cohort study using ED-visit data between 2015 and 2019. Tertiary academic medical center. Adult medical patients presenting to the ED with a critical care admission order within 12 hours of arrival. Dedicated bedside critical care for medical ICU patients by an ED-based intensivist following initial resuscitation by the ED team. Primary outcomes were inhospital mortality and the proportion of patients downgraded to non-ICU status while in the ED within 6 hours of the critical care admission order (ED downgrade <6 hr). A difference-in-differences (DiD) analysis compared the change in outcomes for patients arriving during ECCP hours (2 pm to midnight, weekdays) between the preintervention period (2015-2017) and the intervention period (2017-2019) to the change in outcomes for patients arriving during non-ECCP hours (all other hours). Adjustment for severity of illness was performed using the emergency critical care Sequential Organ Failure Assessment (eccSOFA) score. The primary cohort included 2,250 patients. The DiDs for the eccSOFA-adjusted inhospital mortality decreased by 6.0% (95% CI, -11.9 to -0.1) with largest difference in the intermediate illness severity group (DiD, -12.2%; 95% CI, -23.1 to -1.3). The increase in ED downgrade less than 6 hours was not statistically significant (DiD, 4.8%; 95% CI, -0.7 to 10.3%) except in the intermediate group (DiD, 8.8%; 95% CI, 0.2-17.4). The implementation of a novel ECCP was associated with a significant decrease in inhospital mortality among critically ill medical ED patients, with the greatest decrease observed in patients with intermediate severity of illness. Early ED downgrades also increased, but the difference was statistically significant only in the intermediate illness severity group.

Evaluating a novel hospital-based online health community to address palliative and psychosocial care factors for chronically ill adolescent and young adult patients.

Chronically ill adolescent and young adult (AYA) patients experience barriers to accessing psychosocial care. AYAs who receive palliative and psychosocial care experience numerous benefits from these services. However, we still lack research investigating age-appropriate programs targeting AYAs' psychosocial needs that are delivered virtually and extend beyond the hospital setting. Streetlight is a palliative care program designed for chronically ill AYAs that offers the Streetlight Gaming League (SGL), an online health community (OHC) combining peer-based support, online gaming, and community events. We evaluated the usefulness, acceptability, and potential effectiveness of SGL through an assessment of chronically ill AYAs' lived experiences. We used a qualitative evaluation approach grounded in hermeneutic phenomenology. Questionnaires and interviews were conducted with 9 chronically ill AYAs to elicit in-depth accounts of their lived experiences of using SGL. Descriptive statistical analysis was performed on questionnaire data. Phenomenological data analysis, informed by hermeneutic analysis, was used to analyze interviews. AYAs reported positive experiences with SGL and valued the ability to engage in various content while having few participation expectations. They also described psychosocial benefits, including reprieve from illness, sense of community, and solidarity through mutual understandings and shared experiences. Findings highlight the usefulness and acceptability of a virtual palliative psychosocial care program for chronically ill AYAs. Findings also suggest the effectiveness of SGL and support using an OHC to meet the psychosocial needs of AYAs. This study can guide future programming and implementation of online palliative psychosocial care programs in other hospital settings, resulting in similar beneficial and meaningful experiences.

A Peer-to-Peer Approach to Implementation of a Chronic Disease Management Program

Background: Peer-to-peer (P2P) learning occurs when individuals from similar social groups or professions help each other to learn new knowledge skills or problem solving. Peer-to-peer learning is used across many disciplines but has not been widely studied in primary care or chronic disease management. This study explored the use of an interprofessional P2P approach to support the implementation of a chronic disease management program in primary care for patients with chronic obstructive pulmonary disease (COPD), known as Best Care COPD (BCC). Methods and findings: A single descriptive case study design was used to explore P2P learning implementation approach. Focus groups and key informant interviews were held with providers involved in implementation (n = 26). Three key components of the P2P approach were identified: 1) an interprofessional team, 2) iterative peer-led training, and 3) continuous peer connection. Three recommendations are provided to support future P2P efforts: 1) enlist a champion in each profession, 2) build a P2P community, and 3) implement succession planning. Conclusion: This article provides an empirical example of the use of a P2P approach in primary care program implementation. The results will inform the future implementation of programs for chronic disease management as well as the continued sustainability of the BCC program.

Investigating the effect of family-centered care program implementation on fatigue and depression of teenage girls with iron deficiency anemia

Introduction:Today, one of the most common health problems in the world is iron deficiency anemia. The present study was conducted with the aim of determining the effect of family-centered care program implementation on fatigue and depression of teenage girls suffering from iron deficiency anemia. Family-centered care is a method that is controlled through mutually beneficial partnerships between caregivers, patients, and families. Family-centered care is systematically organized so that the dynamics and complexities of different aspects of individuals and families are taken into consideration.&#x0D; Methods: The present study is a quasi-experimental study of a practical type that was conducted in 1399 with the selection of 70 adolescent girls with iron deficiency anemia studying in high school in Mahmudabad through non-random sampling. Research tools include Questionnaire. After collecting the information obtained from the pre-intervention stage, the family-centered care program for the sample adolescents in the performance test group. It was performed three month after the intervention. The obtained data were analyzed using Paired-Samples T Test.&#x0D; Results: The comparison of the total score of fatigue and depression of adolescent girls with iron deficiency anemia before and after the intervention in the test group showed a significant difference in the direction of decreasing scores (P&lt;0.001), but there was no significant difference in the control group (P&gt; 0.05). Comparison of total fatigue scores of adolescent girls with iron deficiency anemia before and after the intervention in the experimental group showed a significant difference in reducing scores (P &lt; 0.001), but in the control group, there was no significant difference (P = 0.182); Also, comparison of total depression scores of adolescent girls with iron deficiency anemia before and after the intervention in the experimental group showed a significant difference in reducing scores (P &lt; 0.001), but in the control group, there was no significant difference (P=0.667).&#x0D; Conclusions: The results showed that the rate of fatigue and depression in adolescent girls with iron deficiency anemia who receive a family-centered care program has decreased compared to the control group.

Assessment of psychological parameters, psychomotor speed, and quality of life in pre-hypertensive women

Background: Individual is considered as pre-hypertensive when the blood pressure is between 120 and 139/80–89 mmHg. There is an increase in the prevalence of pre-hypertension in Indian population. Hence, early diagnosis of pre-hypertension helps to prevent these diseases and increase the quantity and quality of life. Aims and Objectives: The present study was undertaken to observe the psychological parameters, psychomotor speed, and quality of life in pre-hypertensive women. Materials and Methods: Thirty cases of pre-hypertensive women between the age of 25 and 50 years and 30 age-matched non-pre-hypertensive women were included in the study. Depression, anxiety and stress, self-esteem, negative affectivity (NA) and social inhibition (SA), and quality of life were assessed using standard questionnaires. Visual and auditory reaction time (RT) was assessed using RT apparatus. Results: There was a significant (P&lt;0.001) lower physical health score, psychological score, social relationships score, and environmental scores pre-hypertensive women when compared to healthy individuals. There was significantly (P&lt;0.05) longer visual and auditory RT for the right and left responses in pre-hypertensive women when compared to healthy individuals. Significantly higher (P&lt;0.05) levels of depression, anxiety, and stress and significantly lower self-esteem scores were observed in pre-hypertensive women when compared with healthy individuals. NA and SA were significantly higher (P&lt;0.001) in pre-hypertensive women when compared with healthy individuals. Conclusion: Pre-hypertension has strong negative impact on psychological parameters, RT and quality of life. It is the need of time to increase awareness of pre-hypertension in general population. We recommend planning and implementation of special care programs for these individuals.

Sleep disorders and effectiveness of various methods of insomnia therapy in pregnant women (Literature review)

Sleep disorders (dyssomnia) during pregnancy are of high prevalence and may be associated with negative peri- and postnatal outcomes. However, these conditions are often not effectively diagnosed and treated. In this review a systematic evaluation of the effectiveness of different methods of therapy to improve the quality of sleep and in the presence of insomnia during pregnancy was conducted.Systematic search in PubMed, Psycinfo and Medline databases was conducted without limiting the publication date till November 3, 2022. The relevant studies included pregnant women of any age and gestation; they included the clinical intervention schemes aimed at improving sleep quality; the data before and after treatment for one or more sleep-related results were reported. 16 studies were selected with a total of 988 pregnant women. According to the results of researches the effectiveness of different types of interventions was established: cognitive-behavioral therapy for sleep disorders, pharmacotherapy, acupuncture, yoga, relaxation and phytotherapy. The recent publications have determined that sleep disorders have a connection with the adverse pregnancy outcomes, including fetal growth restriction, premature births, weakness of uterine labor activity and high delivery frequency of caesarean section.There is an extremely high relevance and need for high-quality randomized controlled studies about sleep disorders during pregnancy and implementation of effective standard obstetric care programs. There is a necessity to improve psychological care and sleep care during pregnancy to maintain a positive pregnancy course, childbirth and postpartum period. Future clinical studies should be randomized and include a sufficient number of women for statistical efficacy, including checking the effectiveness of cognitive-behavioral insomnia therapy to prevent pregnancy/childbirth complications and somatic diseases in the long-term period.

Enablers and inhibitors of community participation in Ghana’s Community-based Health Planning and Services programme: a qualitative study in the Builsa North Municipality

BackgroundCommunity participation is essential for the successful implementation of primary health care programmes across the globe, including sub-Saharan Africa. The Community-based Health Planning and Services (CHPS) programme is one of the primary health care interventions in Ghana which by design and implementation heavily relies on community participation. However, there is little evidence to establish the factors enabling or inhibiting community participation in the Ghanaian CHPS programme. This study, therefore, explored the enabling and inhibiting factors influencing community participation in the design and implementation of the CHPS programme in the Builsa North Municipality in the Upper East Region of Ghana.MethodsA qualitative approach, using a cross-sectional design, was employed to allow for a detailed in-depth exploration of the enabling and inhibiting factors influencing community participation in the design and implementation of the CHPS programme. The data were collected in January 2020, through key informant interviews with a stratified purposive sample of 106 respondents, selected from the 15 functional CHPS facilities in the Municipality. The data were audio-recorded, transcribed and manually analysed using thematic analysis.ResultsThe results showed that, public education on the CHPS concept, capacity of the community to contribute material resources towards the construction of CHPS facilities, strong and effective community leadership provided by community chiefs and assembly persons, the spirit of volunteerism and trust in the benefits of the CHPS programme were the enablers of community participation in the programme. However, volunteer attrition, competing economic activities, lack of sense of ownership by distant beneficiaries, external contracting of the construction of CHPS facilities and illiteracy constituted the inhibiting factors of community participation in the programme.ConclusionExtensive public education, volunteer incentivization and motivation, and the empowerment of communities to construct their own CHPS compounds are issues that require immediate policy attention to enhance effective community participation in the programme.

“Am I Going to Die?”: Delivering Serious News to Patients With Liver Disease

“Am I Going to Die?”: Delivering Serious News to Patients With Liver Disease

Types of health-related procrastination in patients with type-2 diabetes: a qualitative content analysis.

Background and objectives:Health-related procrastination refers to a delay in the performance of health-related activities, which is a rather neglected subject despite being critical. Due to the adverse effects of procrastination on the care and treatment of patients with type-2 diabetes, it is necessary to explore procrastination among this group of patients through in-depth studies. The present research was conducted to explain different types of health-related procrastination in patients with type-2 diabetes.Materials and methodsThis qualitative study applied content analysis with 13 patients with type-2 diabetes selected via purposive sampling. Data were collected through individual and semi-structured interviews. The data were then analyzed using Lundman and Graneheim content analysis method.Findings:Based on the analysis of the data, instances of health-related procrastination in patients with type-2 diabetes were classified into six main categories, including minimizing self-care, poor adherence to treatment, poor nutritional habits, poor adherence to drug regimen, disregard for disease monitoring, and a sedentary lifestyle.ConclusionsThe results of this study provide an in-depth understanding of the various forms of health-related procrastination in patients with type-2 diabetes. These findings can be employed in the design, implementation, and monitoring of treatment and care programs targeting these patients.

CKD Care Programs and Incident Kidney Failure: A Study of a National Disease Management Program in Taiwan

Rationale & ObjectiveTaiwan implemented national pay-for-performance programs for chronic kidney disease (CKD) care in 2006 and 2011; however, it is unknown whether this affected trends in maintenance dialysis. This study assessed the temporal trends in the incidence, prevalence, and mortality of individuals treated with maintenance dialysis from 2002-2016 in Taiwan.Study DesignFollow-up study using Taiwan Renal Disease System Databases.Setting & ParticipantsParticipants who received dialysis for ≥90 days.PredictorsAge, sex, and calendar year.OutcomesIncidence, prevalence of maintenance dialysis, or death, ascertained using the National Death Registry database.Analytical ApproachThe estimated annual percentage change was assessed by a generalized linear model, and the association of the programs with changes in the incidence of maintenance dialysis was evaluated using an age-period-cohort model.ResultsA total of 144,258 incident cases with a follow-up of 346 million person-years were analyzed during the observed periods. The estimated annual percentage change of the expected crude incidence rate was slightly reduced by 0.41% (95% CI, −1.06 to 0.24) and was more obvious in women and patients aged greater than 70 years; whereas, it was significantly increased in those aged greater than 75 years. After disentangling age and cohort effects, the implementation of the care programs was associated with an overall net drift of −1.09% (95% CI, −1.65 to −0.52) per year and a significant linear reduction in the period rate ratio from 1.06 (95% CI, 1.02-1.09) in the years 2002-2006 to 0.95 (95% CI, 0.92-0.98) in 2012-2016, using years 2007-2011 as reference.LimitationsThe findings of the study may have limited inferences to other countries with different health care systems.ConclusionsThe implementation of universal CKD care programs in Taiwan has significantly reduced the long-term trends in the incidence of maintenance dialysis; hence, devoting governmental resources to CKD care and prevention is advocated.

Implementation of diabetes care and educational program via telemedicine in patients with COVID-19 in home isolation in Thailand: A real-worldexperience.

BackgroundThe coronavirus disease (COVID‐19) outbreak in Bangkok led to a shortage of hospital capacity, and a home isolation system was set up. We described the process of diabetes self‐management education and support (DSMES) and glycemic management via telemedicine, along with outcomes in home‐isolated patients with COVID‐19 infection.MethodsA retrospective chart review of glucose values, insulin and corticosteroids use, and outcomes was performed.ResultsA volunteer group of 21 endocrinologists and 21 diabetes educators/nurses formed the consultation team. Patients with diabetes or at high‐risk of diabetes and receiving corticosteroids were referred by primary volunteer physicians. Glucometers and related supplies, and insulin were donated, and delivered via same‐day delivery services. A chat group of an individual patient/their caregiver, diabetes educator, endocrinologist, and primary physician was formed (majority via LINE® platform) to assess the patient's clinical status and need. Real‐time virtual DSMES sessions were performed and treatments were adjusted via smartphone application or telephone. There were 119 patients (1,398 service days), mean (SD) age 62.0 (13.6) years, 85.7% had a history of type 2 diabetes, and 84.0% received corticosteroids. Insulin was used in 88 patients; 69 of whom were insulin‐naïve. During the first 10 days, there were 2,454 glucose values. The mean glucose level on day 1 was 280.6 (122.3) mg/dL, and declined to 167.7 (43.4) mg/dL on day 10. Hypoglycemia occurred in 1.4% of the values. A majority of patients (79.5%) recovered at home.ConclusionDiabetes care and DSMES delivered via telemedicine to patients on home isolation during COVID‐19 pandemic was safe and effective.

Evaluating the Implementation of Child Development and Care Program in Isfahan Comprehensive Child Development Center

Background: The Comprehensive Child Development Center was established in 2012 in the center of Isfahan province to rapidly identify and intervene in the developmental problems of children. The aim of this study was to evaluate the implementation of this program.&#x0D; Methods: This was a descriptive-analytical study conducted based on the framework for evaluating public health programs established by the Center for Disease Control and Prevention of United States of America with regard to evaluation of infrastructure, process and outcome. The infrastructure’s checklist included an area of land, equipment, workforce and equipment completed with presence of researcher at the center. Process and outcome evaluation was performed for 127 registered children during 2019. A satisfaction questionnaire was completed in person or remotely by parents of 144 children referred to the center in 2019 and 2020. Data were analyzed using descriptive statistics and independent t-test, and one-way ANOVA was carried out through SPSS 16 software.&#x0D; Results: The overall compliance of infrastructure with standards was 75.42%, with the highest compliance related to the equipment and the lowest related to the specialized workforce. The degree of compliance of the process compared with the standard one varied in different dimensions. 6.30 % of the children were cured and 76.38 % quit treatment. The most common reasons for treatment discontinuation were lack of appointment (29.53 %) and long distance (18.12 %). The overall satisfaction score was 83.90 ± 14.08. The satisfaction of the parents who completed the questionnaire in person was higher than those who completed the questionnaire remotely.&#x0D; Conclusion: The results of this study revealed that the rate of complete cure is low and the rate of treatment discontinuation is high, whose main reasons were the lack of appointment to admit children with developmental disorders and long distance. It is suggested that, in order to solve the problem, the Ministry of Health establish more centers and provide the required workforce.&#x0D;

A Missed Opportunity? How Health Care Organizations Engage Primary Care Clinicians in Formal Social Care Efforts.

Health care organizations increasingly recognize the impact of social needs on health outcomes. As organizations develop and scale efforts to address social needs, little is known about the optimal role for clinicians in providing social care. In this study, the authors aimed to understand how health care organizations involve clinicians in formal social care efforts. In 2019, the authors conducted 33 semi-structured interviews with administrators at 29 health care organizations. Interviews focused on the development and implementation of formal social care programs within the health care organization and the role of clinicians within those programs. A few administrators described formal roles for primary care clinicians in organizational efforts to deliver social care. Administrators frequently described programs that were deliberately structured to shield clinicians (eg, clinicians were not expected to review social risk screening results or be involved in addressing social needs). The authors identified 4 ways that administrators felt clinicians could meaningfully engage in social care programs: (1) discuss social risks to strengthen relationships with patients; (2) adjust clinical care follow-up plans based on social risks; (3) modify prescriptions based on social risks; and (4) refer patients to other care team members who can directly assist with social risks. Administrators were hesitant to increase primary care clinicians' responsibilities by tasking them with social care activities. Defining appropriate and scalable roles for clinicians along with adequate support from other care team members may increase the effectiveness of social care programs.