Levels Of Care Providers Research Articles

Specialists' management of permanent dentition traumatic dental injuries in 7-16-year-olds: A qualitative study.

Specialist paediatric dentists are integral to dental trauma care pathways. General dentists rely on specialist input, more so in complex cases. Little is known about specialists' role in these pathways or the perceived barriers they face. The aim is to explore specialists' role in managing traumatic dental injuries in the permanent dentition in children. Face-to-face (remote video) online semi-structured interviews were undertaken. All UK specialists were invited by email. Purposeful sampling aimed to investigate representation from the devolved nations, presence/absence of working within a managed-clinical network and level of care provision. Interviews were audio-recorded and transcribed verbatim. Transcripts were thematically analysed. Data saturation was reached after nine interviews. Three main themes established were: inconsistent access to care; the need to formalise traumatic dental injuries care pathways; educationally upskilling general dentists. Geographical variation in provision of specialist and out-of-hours/emergency department care meant patients risked not receiving care by the most appropriate individual. Formalizing care pathways by clearly defining the role of each stakeholder (specialist, dentist, medical professionals and parents) and developing a method to assess complexity was perceived to be essential to improving treatment outcomes. Upskilling general dentists in trauma management appeared essential. A potential lack of engagement was raised, with a suggestion that trauma management education should become core continuing-professional development. Specialist input should be available in the management of traumatic dental injuries. Current access to specialist care is inequitable across the UK. Formalizing care pathways and upskilling general dentists could ease inconsistencies.

Inequalities in unpaid carer's health, employment status and social isolation.

Providing higher-intensity unpaid care (higher care hours or care within the household) is associated with negative impacts on people's paid employment, mental health and well-being. The evidence of effects on physical health is mixed and carer's social and financial outcomes have been under-researched. The biggest evidence gap, however, is on how outcomes vary by factors other than type or level of care provision, in particular socio-demographic factors. Our study used two waves of data (2017/19 and 2018/2020) from the United Kingdom Household Longitudinal Study for people aged 16 and older. We investigated the effects of providing care for 10 or more hours a week or within the household in interaction with people's socio-demographic characteristics. Outcomes included mental and physical health, social isolation, employment status and earnings. We found that caring responsibilities interacted with gender, ethnicity, socio-economic status (as measured by highest educational qualification), or age to affect carers differentially in a number of areas of their lives leading to, and exacerbating, key disadvantages and inequalities.

Factors associated with strain among informal care providers of patients with traumatic brain injury in Malaysia.

Purpose:This study aims to investigate the level of strain and various influencing factors among informal care providers of traumatic brain injury (TBI) patients.Methods:A cross-sectional study was conducted in a single center in Malaysia via recruiting care providers of patients with TBI. The modified caregiver strain index (MCSI) questionnaires were utilized to ascertain the level of strain. The demographic data of informal care providers were also obtained. Independent sample t-test, analysis of variance (ANOVA), and a linear regression model were processed for data analysis.Results:A total of 140 informal care providers were included in the study. More than half of informal care providers claimed to have strain (54.3%). Factors associated with increased strain include receiving tertiary education, being of Chinese background, and employed experience higher strain level. Informal care providers with characteristics such as being single, retired and provided care for 5 years experienced a lower level of strain.Conclusion:Guidance on integrating the TBI knowledge into practice, assessing the care provider's level of strain regularly and providing supportive measures may aid in supporting informal care providers at risk.

Validation of Ultrasound Guidance Targeting Tasks: Relationship of Performance and Clinical Experience.

To assess whether health care provider performance on a novel task trainer and a set of newly created ultrasound guidance targeting tasks relates with their level of clinical experience. In a prospective cohort study, two assessment sessions were carried out in which inexperienced (n=21 and n=15) and experienced (n=14 and n=10) health care providers completed five previously described ultrasound guidance targeting tasks. Raw completion time, number of targeting errors, and error-adjusted completion time for each task were compared between groups with a t test for independent measures. Receiver operating characteristic analyses were performed to estimate whether error-adjusted completion time or number of errors could accurately differentiate between groups. Raw completion time was similar between groups. The number of errors and error-adjusted completion time were significantly lower in the experienced health care providers in all but the out-of-plane dowel task. The receiver operating characteristic analyses of number of errors demonstrated very high areas under the curve (0.93-0.98), sensitivities (100%), specificities (76-86%), positive likelihood ratios (4.2-7.0), and negative likelihood ratios (<0.001) indicating excellent differentiation between experienced and inexperienced health care providers. These values were notably lower in the receiver operating characteristic analyses of error-adjusted completion times. Task performance related well with a health care provider's level of clinical experience providing evidence of construct validity. For each task, we were able to determine a cutoff for number of errors that categorized experienced and inexperienced health care providers with very favorable sensitivity, specificity, positive likelihood ratios, and negative likelihood ratios. Our findings suggest it may be possible to use these cutoffs to objectively classify trainees as competent or not competent.

The relationship between outpatient department utilisation and non-hospital ambulatory care in Austria.

Background : Coordinated health service utilisation in the ambulatory care sector is of major interest from a health policy perspective. This ecological study investigates the interplay between medical care utilisation in hospital outpatient departments and in freestanding physician practices by drawing on the example of the Austrian healthcare system, which is standing out due to three features: ambulatory care is provided by both free-standing public (contract) and private (non-contract) practitioners; medical specialists operate in free-standing physician practices and in hospital outpatient departments; essentially, no gatekeeping is in place. As the ongoing health care reform aims to strengthen the primary care sector, we investigate whether in the current system care in general practitioner and specialist physician practices is in a substitutive, complementary or independent relation with medical care in outpatient departments. Methods : Hypotheses were tested using ordinary least square regression analysis based on administrative data of all Austrian districts with a hospital department in 2010, including a proxy for actual utilisation rather than physician headcount. Results : Controlling for socio-demographic and geographic characteristics and inpatient activity, we find that a higher level of care provision by contract GPs is associated with lower use of hospital outpatient departments on the district level. In contrast, a higher level of care by non-contract specialists is related to a higher utilization in outpatient departments. Conclusion : While care by non-contract specialists seems to be in a complementary and potentially demand-inducing relation with outpatient departments, primary care by contract GPs appears to be capable of replacing care in outpatient departments.

Clinical Pathways: The Care Link Between Primary Health Services

The continually changing health environment requires service providers to review constantly the way services are provided. It is important that effective and sustainable service partnerships are developed to ensure that the primary health needs of Victorians are met. The aim of these partnerships is to provide a coordinated approach to health care and achieve the best health outcomes. Services will need to develop innovative processes and systems to ensure that coordinated care is achieved in a way that ensures Victorians receive the best primary health care. Clinical pathways are an innovative process that provides a framework around which coordinated care can be managed. Effective management is achieved by organising and integrating all levels of health care delivered by different providers from a number of different disciplines. They are management plans, which identify desired client outcomes and provide the sequence of events necessary to achieve these outcomes. Clinical pathways provide a framework for clinicians to guide them in the provision of care through the identification of interventions and measurable outcomes along a timeline. Within the changing health environment, service providers must develop systems at all levels that will enable the concept of integrated and coordinated care to be operationalised. At the level of care provision to individual clients, clinical pathways are a system that is worthy of consideration. They provide a coordinated care approach, a documentation system, a teaching tool, and a resource for quality management and research. They create a client-focused link between service providers, which is otherwise difficult to achieve. Coordinated and integrated care thus becomes a lived reality for the clinician and for the client.

Training home health aides to work with persons with AIDS

The authors of this article present a grass-roots approach to the instruction of home health care aides in caring for PWAs. Much of the information presented could be applied to other care providers as well. The goal of the educational process, which advocates facilitating the learning process rather than lecturing, is to better prepare the aides to care for their patients with AIDS. Early emphasis is placed on breaking down barriers to the topic. The curriculum includes "AIDS 101," which begins a determina tion of the home care provider's level of knowledge and comfort as to the disease. Immunologic principles are presented in a simple manner. Infection-control procedures are taught and rational fears are dealt with openly. Symptom management is taught by paralleling the care of the PWA with that of patients with other, more familiar diagnoses. Finally, the issue of caregiver isolation is addressed.