Medical Care Management Research Articles

Management of medical care, a fundamental tool for resident doctors.

In the area of medical education, and particularly in our country, medical residencies are the best educational programs for a graduated physicians; however, when young medical doctors begin a residence at hospitals, they hardly possess knowledge about the way medical services work as well as the processes they involve, which directly affects the fulfillment of their tasks, their process of learning and more importantly, it interferes in the services provided by the hospital. Therefore, it is imperative to immerse residents in the management of medical care and let them know that its main function is to harmoniously articulate every medical-administrative process related to patients as well as human, material and financial resources. One of the main goals is to achieve the fulfillment of the hospital's mission and vision with operational efficiency and humanism. This path will help physicians to make the best decisions, as well as achieving an adequate management of resources always remembering that quality in medical services and patient's safety are important.

Management of medical care, a fundamental tool for resident doctors.

In the area of medical education, and particularly in our country, medical residencies are the best educational programs for a graduated physicians; however, when young medical doctors begin a residence at hospitals, they hardly poses knowledge about the way medical services work as well as the processes they involve, which directly affects the fulfillment of their tasks, their process of learning and more importantly, it interferes in the services provided by the hospital. Therefore, it is imperative to immerse residents in the management of medical care and let them know that its main function is to harmoniously articulate every medical-administrative process related to patients as well as human, material and financial resources. One of the main goals is to achieve the fulfillment of the hospital's mission and vision with operational efficiency and humanism. This path will help physicians to make the best decisions, as well as achieving an adequate management of resources always remembering that quality in medical services and patient's safety are important.

Clinician preferences for computerised clinical decision support for medications in primary care: a focus group study

BackgroundTo improve user-centred design efforts and efficiency; there is a need to disseminate information on modern day clinician preferences for technologies such as computerised clinical decision support (CDS).ObjectiveTo describe clinician...

Pharmacists in Public Health: Scope in Home and Abroad

In the course of recent years, the job of pharmacists has advanced alongside the human services needs of our populace. Notwithstanding dispensing medications and guaranteeing persistent security, the present pharmacists are playing a bigger job as medical instructors, teachers and advocates. They are integral part of the health care team, and are among the most trusted and accessible health care professionals. This accessibility permits them to show more patient care activities, including counseling, medication management, and preventive care screenings. Beyond the care gives to individual patients, pharmacists have developed their reach to influence the public health of communities. A pharmacist is uniquely positioned to gives disease state management through appropriate medication therapy management that has been reveal to improve patient outcomes and decrease overall health care costs. This job could easily compare to ever as nature is demanding new practice and installment models that are required to additionally enhance care and results while tending to the unsustainable increments in medicinal services costs.

Polypharmacy and drug-drug interactions among older and younger male prisoners in Switzerland.

The purpose of this paper is to determine the prevalence of polypharmacy and drug-drug interactions (DDIs) in older and younger prisoners, and compared if age group is associated with risks of polypharmacy and DDIs. For 380 prisoners from Switzerland (190 were 49 years and younger; 190 were 50 years and older), data concerning their medication use were gathered. MediQ identified if interactions of two or more substances could lead to potentially adverse DDI. Data were analysed using descriptive statistics and generalised linear mixed models. On average, older prisoners took 3.8 medications, while younger prisoners took 2.1 medications. Number of medications taken on one reference day was higher by a factor of 2.4 for older prisoners when compared to younger prisoners (p = 0.002). The odds of polypharmacy was significantly higher for older than for younger prisoners (>=5 medications: odds ratio = 5.52, p = 0.035). Age group analysis indicated that for potentially adverse DDI there was no significant difference (odds ratio = 0.94; p = 0.879). However, when controlling for the number of medication, the risk of adverse DDI was higher in younger than older prisoners, but the result was not significant. Older prisoners are at a higher risk of polypharmacy but their risk for potentially adverse DDI is not significantly different from that of younger prisoners. Special clinical attention must be given to older prisoners who are at risk for polypharmacy. Careful medication management is also important for younger prisoners who are at risk of very complex drug therapies.

Do dietary factors significantly influence tinnitus?

Tinnitus is a common and multifactorial condition that requires careful medical assessment and management. Many people with tinnitus believe foods can exacerbate or reduce their perception of the condition, but the research on the relationship between diet and tinnitus islimited. The aim of this article is to review the available literature on the efficacy of a healthy diet, use of dietary supplements, caffeine restriction and salt restriction against tinnitus. There is very weak evidence that dietary quality affects tinnitus symptoms, and further high-quality analytical studies are needed. On the other hand, the research is clear that dietary supplements are ineffective in reducing the symptoms of people with tinnitus and should therefore not be recommended by clinicians. There is also no supporting empirical scientific evidence for the commonly advocated restriction of caffeine and dietary salt for tinnitus patients.

Reducing Medication Errors in Home Hospice to Improve Patient Safety (QI714)

1.Reduce medication errors in the home hospice setting by focusing on performance improvement efforts in nurse practice and patient/caregiver practice.2.Develop patient- and family-centered educational tools for safe medication practices in a home hospice setting. Gilchrist Hospice Care’s average daily census is 433 in the home care setting, representing 49% of the total served. In FY15, our medication error rate was 0.61, with 55% in home care. A Medication Safety Team uncovered root causes and focused efforts on nurse centered medication reconciliation practices and patient/caregiver education. To reduce medication errors in home hospice service by 20% by FY18. The Medication Safety Team includes our home care Medical Director, Clinical Nurse Specialist, and nurses from home care, triage, admissions, and after-hours teams. Using the IHI model, the team developed new educational tools for medication safety: Syringe Tool, Medication Record, PRN Medication Tracker. Feedback about the ease of use during a crisis to prevent medication errors was collected from patients, family caregivers, and clinicians. The Patient and Family Advisory Council consulted on the visual representation of the tools. A double check process was initiated in the new First Dose Protocol, providing families 24/7 access to our nurse help line. Our Medical Director trained nurses in polypharmacy, to improve crucial conversations about reducing the number of medications taken. The nurses and family members surveyed reported over 90% satisfaction with use of new education tools. The FY18 medication error rate is 0.34, representing a 44% decline over a three-year period. The errors in home care decreased 9% during the same period. The new tools are integrated into the hospice Caregiver Handbook and provide cues about when to administer medications, how to safely check dosing, and provide clinicians a clear picture of medication usage between visits. The double check process in triage has led to countless ‘great catches’. These simple improvements to nurse practice and patient education have made a lasting impact at the frontline of care to improve patient safety and overall caregiver confidence.

The Excellence of Pharmacy Service: Past, Present and Future

Pharmacy education continues to evolve to better prepare pharmacists for their roles and responsibilities in an increasingly complex health care environment with advanced patient health needs. Another important factor is the pharmacists themselves. Over the past 50 years, the role of pharmacists has evolved along with the health care needs of our population. In addition to dispensing medications and ensuring patient safety, today’s pharmacists are taking a larger role as medical counselors, educators and advocates. They are integral part of the health care team, and are among the most trusted and accessible health care professionals. This accessibility allows them to perform more patient care activities, including counseling, medication management, and preventive care screenings. Beyond the care provided to individual patients, pharmacists have expanded their reach to influence the public health of communities. A pharmacist is uniquely positioned to provide disease state management through appropriate medication therapy management that has been demonstrated to improve patient outcomes and decrease overall health care costs. This role is more important than ever as the environment is demanding new practice and payment models that are required to further optimize care and outcomes while addressing the unsustainable increases in health care costs. All people who take medications are at risk of actual or potential drug therapy problems. These problems are a significant source of morbidity and mortality when left undetected and unresolved and drive huge costs across the health system. As drug therapy experts, pharmacists provide drug therapy management services built around a partnership between the pharmacist, the patient (or his or her caregiver), physicians and other members of a patient’s health care team.

Hubungan Kepatuhan Tim Bedah dalam Penerapan Surgery Safety Checklist dengan Infeksi Luka Operasi dan Lama Rawat Inap pada Pasien Seksio Sesarea di Rumah Sakit Umum Daerah Kabupaten Barru

Background: Surgical Patient Safety is essential to be carried out in operating theatre to prevent mortality and surgical complication. Patient safety is the basic principal in medical care and a major component of medical care management in hospital (WHO, 2009).Objective: To investigate association between SSC implementation among surgical team, surgical site infection and duration of hospital stay.Method: This is an analytical cross sectional study. Population of this study was women who underwent cesarean section with live birth in Barru general hospital during 1 December 2016-30 April 2017. This study was carried out in Barru general hospital, 137 samples met inclusion and exclusion criteria. Data was obtained from medical records. Maternal outcome were duration of hospital stay, surgical site infection, and maternal mortality. Besides, this study also assesed knowledge and compliance of surgical team in implementation of SSC. The result of this study was analysed with computer statisctics analysis program.Result adn Discussion: One-hundred thirty seven patients met study criteria. Compliance of surgery team in SSC was 64%,. SSC was not implemented precisely in 36% patients (49 patients). There is no significant association between surgical team compliance with surgical site infection in cesarean section patients (p=0.078). A significant association was found between surgical team compliance with duration of hospital stay (p=0.006).Conclusion: The surgical team compliance in implementation of SSC was not yet optimal. An intensive socialization is needed to improve compliance of team in order that SSC implementation run promptly. This was part of efforts to reduce post operative complication and shorten hospital stay.Keywords: SSC, cesarean section, compliance, infection, duration of hospital stay

Pediatric Epilepsy Readmissions: The Who, When, and Why

BackgroundPrior studies have demonstrated a pediatric epilepsy readmission rate of 6% to 10% but have not described details of the readmitted patients. We report the characteristics of pediatric patients admitted for epilepsy who were readmitted to the hospital within 30 days of discharge. MethodsAn interdisciplinary team was established to individually review and characterize the 30-day readmissions of patients admitted for epilepsy from May 2014 to October 2016. The team contained both inpatient and outpatient neuroscience nurses, care managers, a quality outcomes manager, and child neurology physicians. ResultsOver a 30-month period we had an all-cause 30-day readmission rate of 8.0%, which was 219 pediatric epilepsy readmissions from 169 patients. We found that 21.5% of readmissions were scheduled, 37% were for progression of chronic epilepsy, 9.6% were for recently diagnosed epilepsy, and 14.6% were for unrelated diagnoses. We classified 21.5% of readmissions as preventable and 64.9% as not preventable. Thirty-five percent of readmissions occurred within seven days of the initial discharge, including 29 of 47 (61.7%) preventable readmissions. The most common reasons for preventable readmissions were problems with the discharge care plan or medication management. ConclusionsWe demonstrate that 21.5% of pediatric epilepsy readmissions were scheduled and 21.5% were judged to be preventable. The majority of preventable readmissions occurred within seven days of index discharge. Characterizing epilepsy readmissions is the first step in being able to reduce readmissions.

Acceptance and Resistance of New Digital Technologies in Medicine: Qualitative Study.

BackgroundThis study discusses the acceptance of new medical technologies in health care settings and resistance to these technologies from hospitals, doctors’ surgical centers, electronic health (eHealth) centers, and related institutions. We suggest a novel method of identifying factors that influence the acceptance of, and resistance to, new technologies by medical staff and patients.ObjectiveThe objective of this study was to determine and evaluate the factors that influence acceptance and resistance to achieve a successful implementation of new technologies.MethodsThe target group was patients residing in Brandenburg and major stakeholders in the local health care structure, for instance, medical institutions and medical professionals. The process relies on 3 models: the technology acceptance model, the unified technology acceptance and use of technology model, and the theory of technical innovation diffusion. Qualitative methodology was employed in this study, and an exploratory design was adopted to gain new insights into a poorly understood phenomenon in the German context. This enabled the researcher to take a flexible approach toward exploring a wide range of secondary data and to choose a different approach when unexpected information emerged. Content analysis was used to identify and interpret the data, and the researcher assured that the meaning associated with the information has concurred with that of the original source.ResultsThis study confirmed that adoption of new technologies in health care depended on individual opinions of the factors relating to them. Some medical professionals believed that technology would interfere with their ability to make independent diagnoses and their relationships with patients. Doctors also feared that technology was a means of management control. In contrast, other medical staff welcomed technology because it provided them with more opportunities to interact with patients and their carers. Generally, patients were more enthusiastic about technology than medical professionals and health care managers because it allowed them to have greater autonomy in selecting health care options. The need for all groups to be involved in the development of the new health care approach was an important outcome, otherwise resistance to it was likely to be greater. In other words, the strategy for change management was the indicator of success or failure. Therefore, following our analysis, a number of practical precepts emerged that could facilitate user acceptance of digital solutions and innovative medical technologies.ConclusionsThe acceptance of digital solutions and innovative medical technology by patients and professionals relies on understanding their anxieties and feelings of insecurity. The process will take time because individuals accept change at different rates. Hence, the development of an extensive user community to fully and successfully implement eHealth is less likely in the short term; however, this should not prevent the push for changes in health care technology.

Glycemic control and diabetes complications among diabetes mellitus patients attending at University of Gondar Hospital, Northwest Ethiopia.

BackgroundDiabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia due to either insulin deficiency or resistance or both. Hyperglycemia induces tissue damage through mitochondrial superoxide production, affecting retina, glomerulus, and neurons. It requires continuing medical care and ongoing self-care management to prevent and delay acute and long-term complications. Therefore, our study was designed to assess glycemic control and diabetes complications among diabetes patients attending at University of Gondar Hospital.Materials and methodsA cross-sectional study was conducted among DM patients attending at University of Gondar Hospital diabetes follow-up clinic during February–March 2017. Five milliliters of blood was collected using aseptic technique. Levels of fasting blood sugar (FBS), triglycerides, and cholesterol were measured using MINDRAY BS-200E machine. FBS ≥152 mg/dL was taken as poor glycemic control. Binary and multivariable logistic regression models were used to evaluate associated risk factors for the outcome variable. A P-value of <0.05 was considered as statistically significant.ResultThree hundred sixty-seven diabetes patients were included in this study. About 222 (60.5%) of them had poor glycemic control (FBS ≥152 mg/dL). The proportion of poor glycemic control was slightly higher among type 1 DM patients (61.4%) than type 2 DM patients (59.8%). Age ≥65 years (adjusted odds ratio [AOR]: 0.070; 95% CI: 0.016–0.308), being divorced (AOR: 0.226; 95% CI: 0.064–0.8000), and increased waist circumference (AOR: 0.361: 95% CI: 0.181–0.720) were factors that significantly reduce poor glycemic control. Diabetes complications were slightly higher in insulin- and tablet-only users, 72.5% and 64.5%, respectively. DM complications were also higher in patients who had poor glycemic control (61/222) and type 2 diabetes (78 [37.3%]).ConclusionPrevalence of poor glycemic control and DM complications was high, which indicate that appropriate intervention is required to improve glycemic control and prevent or control complications among DM patients.

Unintended consequences of the electronic medical record on physicians in training and their mentors

For physicians in training and their mentors, the process of learning and teaching clinical medicine has become challenging in the electronic medical record (EMR) era. Trainees and their mentors exist...

The application effect of prospective care quality management model in pediatric emergency medical care management and its effect on SF-36 score of children

Objective To explore the effect of prospective care quality management model in pediatric emergency medical care management and its effect on SF-36 score of children. Methods A total of 100 cases of all kinds of emergency children admitted to this hospital were selected.They were randomly divided into the control group and the study group, 50 cases of each group.The control group received routine emergency care.The study group received prospective care.The nursing effect of the two groups was compared. Results The satisfaction of the children in the study group was significantly higher than that in the control group, and the difference was statistically significant(P<0.03). In addition, the satisfaction of nurses, doctors and related departments in the study group was higher than that of the reference group, and the difference was statistically significant(P<0.03). The total nursing efficiency of the study group was higher than that of the reference group, while the incidence of disputes and complaints in the study group was significantly lower than that of the reference group, and the differences were statistically significant(P<0.05). The time of first aid in the study group was significantly shorter than that in the control group, and the difference was statistically significant(P<0.02). The scores of physiological function, energy, mental health, general health and emotional function of the study group were better than those of the reference group, while the scores of somatic pain were lower than those of the reference group, and the differences were statistically significant(P<0.02). Conclusions The application effect of prospective care quality management mode in the nursing management of pediatric emergency department is ideal, which can effectively shorten the time of first aid, improve nursing efficiency and satisfaction, reduce disputes and complaints, and promote the rehabilitation of children. Key words: Prospective; Pediatric emergency medicine; Nursing management; SF-36 score

Cost estimation of medical care management of lung cancer in Tunisia.

Lung cancer management is very expensive for the Tunisian healthcare system. The aim of this study was to evaluate the direct costs of treating lung cancer in Tunisia, and to identify the main treatment of high expenditure. A retrospective study was conducted in 2012 including all patients admitted between 2008 and 2010 for lung cancer management. The hospital payment system was used to estimate the direct costs of the medical care management of lung cancer. We collected 549 patients and the majority of patients were diagnosed with advanced stages of the disease: 60 % in stage T4 and 59 % in stage M1. 26 % of patients underwent surgery and 44.1 % chemotherapy. The total direct costs of lung cancer management were estimated to be TND 3900 (US$ 1980) per patient. Chemotherapy accounted for the largest percentage of direct costs (46 %) followed by the cost of the hospital stay. Primary prevention, based on the application of policies to control tobacco, is the best strategy to reduce this morbidity.

Multimorbidity, a challenge for medical treatment, research and health care management

Multimorbidity is a highly prevalent phenomenon in the elderly and of growing public health impact in aging societies due to rising life expectancies, more effective medical treatment and comprehensive social care facilities, resulting in longevity[1-3]. The increasing number of patients at an age of 60 and more are expected to have between 5 to 7 active diagnoses with multiple conditions and pathological states, varying recommendations for therapy and diverse personal wishes and contextual factors influencing. Disease-disease interactions have an impact on patient management processes, disease-disease medication interactions must be considered and balanced and potential medication-medication interactions kept in mind and avoided. Furthermore the interaction between somatic and psychiatric diseases is a completely underestimated field of conflicts and misjudgements. Multimorbidity is an important field of research as well. Thusthe lack of guidelines covering multimorbidity is more the rule than an exemption if not explicitely addressing old age. Multimorbidity is going along with multiple changing of medical consultations, the need for a comprehensive care by different professions with time-consuming and strenuous transitions and communication routes, repeated hospital treatments, polypharmacy with frequently undesired mutual actions of drugs, unnecessary or redundant examinations and conflicting instructions for therapy resulting in accumulating complications unless rationally analyzed. Multimorbidity is more than an addition of different diseases. It is a complex net of mutually influencing factors like physical functioning, mental well-being, social relationships and environmental factors. Thereforetherapy of multimorbidity is more sensitive for contextual factors, needs multimodal and multidisciplinary support with attention for the patients’ resources and an increasing need for prevention, therapy, rehabilitation, assistive technologies and social care at the place of residence or nearby [4].

Management of Prader-Willi Syndrome (PWS) in adults - what an endocrinologist needs to know. Recommendations of the Polish Society of Endocrinology and the Polish Society of Paediatric Endocrinology and Diabetology.

Prader-Willi syndrome (PWS) is a complex genetic disorder characterised by a set of phenotypic traits, which include infantile hypotonia, short stature, and morbid obesity. Over the last 12 years, visible progress has been made in medical care management of PWS patients in Poland. Increasing awareness of the disorder in neonatal and paediatric care has led to early identification of the condition in neonates, followed by the institution of an appropriate dietary regime, introduction of physiotherapy, and early-onset recombinant human growth hormone (rhGH) treatment. Growth hormone (GH) therapy in Poland is conducted within the nationwide framework of the Therapeutic Programme: "Treatment of Prader-Willi Syndrome". The therapeutic interventions initiated in the paediatric centres need to be continued in multidisciplinary adult care settings. The main aim of PWS clinical management in adulthood is prevention of obesity and its comor-bidities, treatment of hormonal disorders, mental health stabilisation, nutritional guidance, as well as on-going physiotherapy. Integrated multidisciplinary therapeutic intervention is necessary if patients with such a complex genetic condition as PWS are to not only achieve an average life expectancy but also to enjoy higher quality of life.

Psychotropic medication use during pregnancy

AbstractGlobally, mental health‐related issues are a growing concern. Pregnant women with mental health‐related illnesses present a unique challenge to health professionals. During pregnancy, the decision to withhold, modify or continue psychotropic medication requires consideration of both maternal and infant outcomes. Health professionals must be aware withdrawal of these medications during pregnancy can often lead to symptom relapse. Decisions around medication management during pregnancy can be challenging due to the lack of data and occasionally conflicting data regarding safety. It is essential that women do not receive conflicting information from health professionals because this can lead to confusion and both intentional and unintentional non‐adherence. Recently, it has been suggested that pharmacists may help optimise medication management and patient outcomes in perinatal care. This review outlines the use of psychotropic medications in pregnancy and discusses key considerations for those involved in providing clinical care to pregnant women with mental illness.

Cost-Effectiveness of a Pharmacogenetic Test to Guide Treatment for Major Depressive Disorder.

Recent clinical trials indicate that pharmacogenetic-guided treatment of major depressive disorder (MDD) results in higher treatment response rates by genetically matching patients to medications and avoiding a trial-and-error process. To evaluate the cost-effectiveness of a pharmacogenetic test (IDGx) that has demonstrated effectiveness compared with standard of care (SOC) medication management among patients with varied MDD severity. Data from a large prospective, randomized controlled trial of treatment-naive patients or patients with inadequately controlled MDD in general practice and psychiatric treatment settings were used to build a Markov state-transition probability model. Analyses were conducted from the societal perspective. Treatment response rates, mortality rates, direct and indirect medical costs, and utility inputs were derived from the reference study and published scientific literature. The cost of the pharmacogenetic test was $2,000. A 3% discount rate was used to discount costs and effects. Univariate one-way sensitivity analyses were performed to determine the effect of input parameters on net monetary benefit. For moderate to severe MDD, the model estimated a cumulative effect over 3 years of 2.07 quality-adjusted life-years (QALYs) for the pharmacogenetic-guided treatment group and 1.97 QALYs for the SOC group, including a lower probability of death from suicide (0.328% and 0.351%, respectively). Total costs over 3 years were $44,697 (IDGx) and $47,295 (SOC). This difference includes a savings of $2,918 in direct medical costs and $1,680 in indirect costs. Results were more pronounced when only severely depressed patients were evaluated. Pharmacogenetic testing among moderate to severe MDD patients improved QALYs and resulted in cost savings. Sensitivity analyses supported the robust nature of the current findings of the dominant IDGx test to guide treatment. Funding for this analysis was provided by AltheaDx, which is the manufacturer of the IDgenetix test. AltheaDx personnel assisted in the study design, data collection, and review of the manuscript. Maciel and Garces are employed by AltheaDx. Groessl has received funding as a consultant from American Specialty Health.

Health supports needed for homeless persons transitioning from hospitals.

Being homeless has a negative effect on health and the health needs of individuals experiencing homelessness are complex and challenging to address. As a result of limited access to and use of primary healthcare, the main point of entry into the healthcare system for individuals experiencing homelessness is often hospitals and emergency departments. Persons experiencing homelessness are commonly discharged from hospital settings to locations that do not support recovery or access to follow-up care (e.g. shelters or the street). This can be costly to both the healthcare system and to individuals' health and quality of life. We conducted a scoping review of the literature published between 2007 and 2017 to identify the types of health supports needed for persons experiencing homelessness who are discharged from the hospital. Thirteen literature sources met inclusion criteria and thematic data analyses by two researchers resulted in the identification of six themes related to the types of health supports needed for persons experiencing homelessness who are transitioning (i.e. being discharged) from the hospital. Using a community consultation approach, the scoping review themes were validated with 23 health and shelter service providers and included in our integrated findings. Themes included: (a) a respectful and understanding approach to care, (b) housing assessments, (c) communication/coordination/navigation, (d) supports for after-care, (e) complex medical care and medication management, and (f) basic needs and transportation. These themes were found to resonate with participants of the community consultation workshop. Recommendations for trauma-informed care and patient- or client-centred care approaches are discussed.