Nontraditional Care Research Articles

Traditional treatment for diastasis rectus abdominis in postpartum mothers: a phenomenological study

Background/Aims Diastasis rectus abdominis is common in postpartum mothers but few studies have examined its traditional treatments. This study's aim was to explore postpartum mothers' experiences of abdominal care and Javanese cultural care. Methods This phenomenological study was conducted in rural Yogyakarta, Indonesia from May to December 2022. A total of 13 purposively selected postpartum mothers were interviewed using a semi-structured in-depth guide. Data were analysed thematically. Results The five main themes were symptoms interfere with activities and appearance, traditional and non-traditional abdominal care, benefits of and barriers to traditional care, regular use of traditional care and the need for more effective, comfortable and practical tools. Conclusions Both traditional and non-traditional care for postpartum abdominal issues present challenges. There is a need for more effective, comfortable and practical treatment for the abdominal area. Implications for practice Further research is needed to develop tools for abdominal care for postpartum women that are effective, comfortable and practical.

EP236: TeleKidSeq: Incorporating telehealth into clinical care of children from diverse backgrounds undergoing clinical genome sequencing

The global pandemic required healthcare institutions and clinical research programs to adapt quickly to non-traditional care models. TeleKidSeq is a pilot study that emerged from the NYCKidSeq program, an NIH-funded Clinical Sequencing Evidence-Generating (CSER) Consortium site focused on incorporating genomic medicine into the care of diverse New York City children with suspected genetic disorders. Embracing the opportunity to study the use of telehealth in delivering genomic results, TeleKidSeq will examine the impact of innovative remote genetic counseling modalities in medically underserved populations.

Outpatient Primary Care Practitioner Access: Gender-Based Preferences.

Background: Primary care practices are evolving under the pressure of modern-day challenges, with some clinics now introducing the choice of new nontraditional care models designed to maximize patients' needs with practitioner efficiency. These changes include team models consisting of advanced practitioners and physicians, as well as new care delivery formats such as virtual care. With a growing number of options for care, it is unclear whether patients' gender affects their visit preferences; therefore, we surveyed patients presenting to an outpatient internal medicine clinic in Arizona to understand how practice variations impact patient satisfaction of their primary care.Methods: Patients seen in an outpatient internal medicine clinic were surveyed. Multivariable models adjusting for age, marital status, education level, and income were used to evaluate gender-based care preferences.Results: Of 796 total participants (446 women, 350 men), women were more likely to prefer continuity of care with the same health care practitioner (90.2% women vs. 85.0% men, p = 0.028) and allied health staff (AHS) (36.3% women vs. 28.0% men, p = 0.0031) over convenience of appointment or quicker response time than men. However, after multivariable analysis, no statistically significant relationships remained.Discussion: Women favored both continuity of care with the same health care provider and AHS over faster access to primary care. A large majority of men had similar preferences for continuity of care. To provide the highest level of care with greatest patient satisfaction, understanding individual preferences for care delivery will be important.

Is Tailoring of PrEP Programs Needed to Overcome Racial Disparities in PrEP Uptake in Local Health Departments? A Mixed-Methods Evaluation of PrEP Implementation in Virginia.

African American and Hispanic adults share a disproportionate burden of HIV infections in the United States but continue to experience suboptimal uptake of HIV pre-exposure prophylaxis (PrEP). Increasing PrEP accessibility in nontraditional care settings is a potential strategy to increase PrEP uptake in these high-risk groups. PrEP implementation in local health departments (LHDs) is not well characterized. To evaluate HIV PrEP implementation for African American and Hispanic adults receiving medical care in Virginia's LHDs. We conducted a retrospective, mixed-methods evaluation of PrEP services implementation at LHDs completing their first PrEP program year between June 1, 2016, and June 30, 2019. Using pharmacy records, we estimated PrEP coverage and adherence using PrEP to need ratios (PnRs) and medication possession ratios (MPRs), respectively. Thematic analysis was used to identify barriers to PrEP delivery in interviews with 6 multidisciplinary LHD workers. Of the 433 PrEP clients receiving an emtricitabine/tenofovir disoproxil fumarate (Truvada) prescription in year 1, 52.0% self-identified as African American and 8.9% self-identified as Hispanic. PnRs were greater for White adults in 50.0% of clinics. The average MPR (0.79) was consistent with protective medication adherence levels; however, 25.0% of clients filled only one prescription in the program year. Qualitative findings suggest incompatibilities between health PrEP services delivery and community preferences for African American and Hispanic adults; however, LHDs in one health region were able to link communities of color to PrEP at similar rates as Whites. Incorporating a metric sensitive to racial/ethnic differences in the burden of HIV infection improved recognition of PrEP disparities; however, population-specific targets are needed to enhance use of the PnR for program evaluation. Tailoring of PrEP services to communities with the greatest local PrEP burden may be needed to optimize the effectiveness of PrEP programs in LHDs.

Factors predicting staging and treatment initiation for patients with chronic hepatitis C infection: insurance a key predictor.

BackgroundChronic hepatitis C (HCV) infection affects over 2.4 million Americans and accounts for 18 000 deaths per year. Treatment initiation in this population continues to be low even after introduction of highly effective and shorter duration direct-acting antivirals. This study assesses factors that influence key milestones in the HCV care continuum.MethodsRetrospective time-to-event analyses were performed to assess factors influencing liver fibrosis staging and treatment initiation among individuals confirmed with chronic HCV infection at University of Illinois Hospital and Health Sciences System between 1 August 2015 and 24 October 2016 and followed through 28 January 2018. Cox regression models were utilized for multivariable analyses.ResultsIndividuals tested at the liver clinic (hazard ratio [HR] = 2.03; 95% confidence interval [CI]: 1.19–3.46) and at the federally qualified health center (HR = 3.51; 95% CI: 2.19–5.64) had higher instantaneous probability of being staged compared with individuals tested at the emergency department (ED) or inpatient setting. And probability of treatment initiation increased with advancing liver fibrosis especially for Medicaid beneficiaries (HR = 1.64; 95% CI: 1.35–1.99).ConclusionsThe study demonstrates a need for improving access for patients with early stages of the disease in order to reduce HCV-related morbidity and mortality, especially those tested at nontraditional care locations such as the ED or the inpatient setting.

Helping Fill That Gap: Aging in Place After Disaster Through the Lens of Home-Based Care

During a disaster, home-based care is intended to continue to function using existing care delivery models. Home-based care providers (HBCP) are often the closest contact with their clients—even during a disaster, seeing them in non-traditional care settings including shelters and hotels. This closeness and commitment to clients, gives HBCP unique insights into strategies to promote aging in place. The purpose of this study was to identify the individual and community-level support needs of older adults after a disaster through the lens of home-based care. Five focus groups were conducted with HBCP (n=27) in two disaster-affected settings: 2017’s Hurricane Irma in Florida and Hurricane Harvey in Texas. Participants were identified by contacting home health agencies listed in an open-source database of agencies receiving Centers for Medicare and Medicaid Services funding. Data was manually coded using an inductive approach and themes were iteratively identified. Forty-nine codes were identified in the preliminary analysis, which were distilled into ten themes describing factors that influence care provision during and after disasters: patient autonomy/dependence, disaster-induced trauma, reluctance to evacuate, chronic disease exacerbation, unpreparedness, systemic inequality, provider preparedness actions, strong sense of community, mistrust of governmental authority, and the uniqueness of the patient and home-based care provider relationship. The perspective offered by HBCP illustrates the complexities of community-level preparedness and informal community support for chronically ill older adults surrounding disasters. Diverse groups involved in aging and disaster response can learn from strategies employed by HBCP during disasters to improve aging in place.

Advocating for the pharmacy profession through involvement in a type 1 diabetes day camp as a pharmacy residency learning experience

ObjectiveDiabetes summer camps have the common objectives of providing children with diabetes a safe environment to have fun and develop skills to manage diabetes in the presence of variable physical activity and nutritional intake. Historically, the American Diabetes Association (ADA) has relied on nurses, dietitians, and physicians to serve as medical staff, whereas pharmacists served in educational roles. This commentary describes the experience of postgraduate year-2 (PGY-2) ambulatory care pharmacy residents participating as medical staff in the management of children with type 1 diabetes (T1D) at a week-long, summer day camp in an elective learning experience. DescriptionTwo PGY-2 residents volunteered at ADA-sponsored camps in July and August 2017, in which they were responsible for performing and documenting blood glucose measurements, dosing and administering insulin, overseeing the use of insulin pumps and continuous glucose monitors, and managing cases of hypo- and hyperglycemias in children aged 4-9 years. They facilitated interprofessional education of other medical staff members, including discussions regarding pharmacokinetic profiles and formulations of various insulin products and performing advanced insulin dosing adjustments. SummaryThe perceived benefits of this residency learning experience included increased self-confidence regarding the management of T1D, insulin administration techniques, and interprofessional collaboration. Performing advanced clinical management of children with T1D increased awareness of pharmacists’ skill set in diabetes care. Demonstrating this value in nontraditional care settings may increase the likelihood that pharmacists are recruited to interdisciplinary health care teams to participate in autonomous direct patient care. ConclusionThe PGY-2 ambulatory care pharmacy residents autonomously practiced as recognized medical staff in the management of pediatric patients with T1D. This experience advocates for pharmacists’ and their trainees’ involvement in service-learning and team-based medical care outside the traditional health care setting.

1314. HOME CARE: Reaching Our Lost to Follow-up Patients and Overcoming Barriers to Care Utilizing Nontraditional Care Models

BackgroundOf the 11098 people living with HIV in southeast Michigan, over 30% are out of care, with transportation being the most commonly identified barriers. To address this barrier and re-engage patients into care, we introduced an HIV homecare program. The objective of this study was to describe the implementation of the homecare program and document the outcomes of patients enrolled.MethodsIn 2016, WSUPG ID clinic saw 1990 patients and had additional 95 clients who were virally unsuppressed and lost to care for 12 months. We called all 95 of these clients and offered homecare. We also advertised our program internally, to the Detroit Public Health Departments’ Data to Care Program (Link up Detroit), and to community-based organizations. Referred patients were seen by a NP/MA team supervised by an infectious disease attending. HIV medical care delivered in home utilized same standards of care as for outpatient setting, including lab draws and counseling. Patients also had the ability to text/call provider directly on the program cell phone. This project was funding through a Part A Ryan White MAI grant.ResultsOf the 95 clients out-of-care, 38 (40%) were unreachable, 41 (43%) were reachable and 16 (17%) did not qualify (relocation, incarcerated, deceased, in-care at the time of call). 5 (5%) enrolled in homecare and additional 29 patients were referred to our program. A total of 34 patients enrolled from September 20, 2017 to September 20, 2018. Among the 34 clients, mental health barriers were the most frequently reported (depression in 20, schizophrenia or bipolar in 7, anxiety in 23, and history of trauma in 11). Of the 34 clients, 24 have achieved virologic suppression at least once during their enrollment. Among the 26 clients with 6+ months of follow-up, 17 have achieved virologic suppression.ConclusionHomecare offers a new, innovative healthcare delivery system which is effective at achieving viral suppression in a challenging patient population and is a successful strategy to re-engage patients in care.Disclosures All authors: No reported disclosures.

The internet bias toward nontraditional first line prostate cancer treatments.

e16594 Background: Despite relegation to relapsed localized disease per National Comprehensive Cancer Guidelines, we have noticed upticks in cryotherapy and High-intensity focused ultrasound (HIFU) as initial therapy for prostate cancer in Orlando. We believe internet advertisements play a role in this. When directly questioned, patients confirm our belief. We conducted internet searches to analyze the information available to patients. Methods: Utilizing common search engines, Google and Bing, searches were conducted using the terms “cryotherapy prostate cancer” and “HIFU”. The first three pages of general results and sponsored results were broken into categories. The categories include verified information (VI) properly describing the therapies and their indications, advertisement for traditional care (TC) centers, centers that promote nontraditional care (NTC), or information that is unclassifiable/ misleading (other). A final search was done for “alternative prostate cancer treatments”. The results that mentioned HIFU or cryotherapy were counted manually. Results: Cryotherapy Google general search In total, unverified information or advertisements for centers practicing outside of traditional norms were represented in: General search combined: 26/82: 32% Sponsored searches: 54/75: 73% The general search term “alternative prostate cancer” search including HIFU or Cryotherapy General Search: 3/55 (0.05%) Sponsored Search: 8/39 (21%). Conclusions: Using general search terms, it seems that there is a wealth of information that can influence a patient’s decision making on prostate cancer treatment. While there is more information promoting HIFU/ cryotherapy on sponsored searches, general searches have potential for misunderstanding and abuse in nearly a third of cases.[Table: see text][Table: see text][Table: see text][Table: see text][Table: see text][Table: see text][Table: see text][Table: see text]

Using the Two-Minute Assessment With Debriefing to Optimize Traditional Patient Care Clinical Experiences.

Traditional patient care clinical experiences present numerous challenges to faculty in prelicensure nursing education. This article presents an adapted nontraditional clinical activity for use in patient care clinical experiences. The Two-Minute Assessment With Debriefing incorporates peer collaboration and attributes of debriefing, including assimilation, accommodation, and anticipation. Nursing students in acute care facilities are assigned to either traditional or nontraditional care, with the group ideally split in half. The use of nontraditional clinical activities with reflection has been supported as a strategy to engage higher order thinking about patient care while allowing focused faculty time with students in traditional patient care.

"Add It to the Parking Lot": Safe Patient Handling and Mobility in the Emergency Department.

Nelson and Baptiste noted that a standard approach to safe patient handling and mobility (SPHM) cannot be generalized to all patient care areas because the unique, high-risk tasks of each area require specific intervention. Matching the SPHM program to the setting, tasks, and roles is important in developing a program that will prevent harm. However, there is little evidence related to the use of SPHM programs in nontraditional care environments, such as emergency departments (EDs). A such, there is no standardized method for training ED nurses in safe patient handling. An SPHM challenge unique to the ED is extricating patients out of vehicles. There are several ways to extricate patients from vehicles, with some requiring more resources, people, and equipment than others. These resources vary depending on the patient's level of activity and acuity. The purpose of this article is to articulate the importance of SPHM programs in EDs and the unique challenges and workflows that complicate implementation in this chaotic environment through a review of manual and equipment-assisted methods of extricating patients from the vehicle.

The Medical Social Aspects of Health and Satisfaction of Parents with Medical Care of Children with Oncologic Diseases

The article presents analysis of social economic health determinants of parents of children with oncologic diseases. The evaluation of their satisfaction with accessibility of qualitative medical care was carried out. The questionnaire covered issues concerning medical social aspects of health and satisfaction with quality of medical care. the sampling included 284 parents of children with oncologic diseases receiving treatment in the profile departments of Krasnodar, Stavropol, Volgograd, Makhachkala, Grozny, Cherkessk, Nalchik and Astrakhan in August-September 2015. The parents answered to questionnaire independently. The filled questionnaires handed over to the responsible physician. The responsible physician was fully instructed how to proceed with survey. The study established that oncologic disease of child effects quality of life of parents in 33.2% of cases. The relationships within family deteriorate in 19.7% of cases. According opinion of parents, they have high level of literacy in health issues. Only every second parent trusts official medicine and certain percentage of respondents resorts to non-traditional care including psychic individuals and priests. The analysis of answers permitted to derive that hospitalization provides no difficulties though dissatisfaction with treatment costs and attitude of medical personnel remains.It is established that parents of children with oncologic diseases suffer from anxiety and depression on clinical and sub-clinical level that requires implementation of complex of measures of psychological support. The direct dependence is established concerning between presence of anxiety and depression and also presence of depression and physical indisposition of respondents.

Auditing Hand Hygiene Compliance in Non-Traditional Care Areas

Many hospitals perform hand hygiene (HH) observations at entry to and exit from most inpatient rooms. In non-traditional care areas (e.g., psychiatric units, procedural areas and ambulatory clinics), this method of observation is impractical, as these areas may not have well defined patient rooms and fewer healthcare workers (HCW) to observe at any given time. We developed a process for observation HH compliance in these areas using the World Health Organization’s (WHO) 5 Moments for HH. An audit tool was developed for HH observations at the point of care, monitoring compliance with “before” (before patient contact and performing clean/aseptic tasks) and “after” (after risk for body fluid exposure and after contact with the patient or their environment) moments. The tool was trialed for 4 months in several areas. We modified the tool based on user feedback, and in August of 2013, the tool was implemented in 29 areas. The roll-out included staff HH education and in-depth observer training. Each observation set lasted 20 minutes or had a minimum of 10 observations, whichever came first. The results were shared monthly with each area. Between August 2013 and October 2014, 29 participating areas completed > 6 months of observations. Overall HH compliance was 85.2% (n= 4,486 observations). Compliance with the “before” moments was 85.4% (n=2,225) compared to 83.9% compliance (n= 2,261) with the “after” moments. Observed HH compliance for nurses (87.8%; n=2,006) was similar to observed compliance for other HCWs (83.1%; n=2,480 [P=0.2]). No statistical difference was noted in compliance between the areas (Ambulatory clinics =82.1%; n=1,062, psychiatric units =91.9%; n=1,006, Procedural areas = 84.6% n=2,695). This audit tool allowed efficient hh observations to be completed in non-traditional patient care areas.

Community-Created Programs: Can They Be the Basis of Innovative Transformations in Our Health Care Practice? Implications from 15 Years of Testing, Translating, and Implementing Community-Based, Culturally Tailored Diabetes Management Programs

D iabetes prevalence is predicted to rise dramatically during the next 20 years, and associated spending is expected to increase threefold.1–3 Cultural barriers contribute to this burden by preventing optimal care among diverse ethnic groups that are at elevated risk for high-cost complications.4–10 Culturally appropriate, clinically sound, and cost-effective models are needed to respond to the growing and diverse populations affected by diabetes worldwide. Chronic disease now accounts for 75% of the $2 trillion in annual medical costs in the Untied States, and adherence to prescription regimens among those with chronic conditions is estimated to range from 20 to 50%.11,12 Nonadherence to medications accounts for ~ $100 billion in annual health care costs.13,14 Health care reform is a driving force to identify low-cost and clinically effective interventions to improve health care quality and reduce costs. Nontraditional care management models, innovative technologies to improve patient adherence to prescribed medical regimens, and use of adherence-enhancing strategies in clinical practice would greatly enhance the health impact of efficacious treatments and prevention efforts and consequently reduce the burden of nonadherence-related health care costs. The most recognized approach for improving care through the current health care delivery system is the Chronic Care Model (CCM) developed by Ed Wagner et al.15–18 This model recognizes that a substantial portion of chronic care management takes place outside of formal health delivery settings. Patient self-management, delivery system design (including information systems and decision-support tools), and community resources are crucial components of this model. The CCM has been used successfully in staff-model health maintenance organizations, large group practices, and community health clinics, and its implementation has been shown in numerous studies to improve care in diabetes and other chronic diseases.19 The medical home model …

Contraception in Drug-Dependent Women: A Novel Approach

The goal for providers treating drug-dependent women is to break the cycle of addiction, poverty, and disability. The provision of contraceptive care within nontraditional care settings may provide such an opportunity. The Family Planning Initiative was a four-year project (2005–2009) that delivered contraceptive services to women within a pediatric clinic within a drug treatment facility. The program consisted of group and individual sessions ante- and post-partum that reviewed contraceptive choices and addressed barriers to care. This program demonstrated the clinical and cost effectiveness of integrated, accessible, and continuous health care for this vulnerable population. Health care providers should consider the institution of family planning services into nontraditional health care settings, which requires the extension of traditional health care boundaries, in the provision of comprehensive care that addresses critical population needs.

Latest thinking in the planning arena for retirement housing, assisted living and C2 uses

This paper provides a summary briefing of the planning considerations for non-traditional care and retirement developments for older people. It considers whether some forms of retirement developmen...

Using community triage centres or non-traditional care facilities during a flu pandemic or other infectious disease outbreak

One assumption of pandemic planning is that, during an influenza outbreak, acute care facilities may be quickly overrun with patients and as such must prepare in advance. In order to operationalise one component of a pandemic plan, Capital Health in Edmonton, Alberta, piloted a mobile triage centre facility (portable isolation containment systems) and tested pandemic influenza triage and assessment guidelines in the winter of 2006–07. The mobile model provided emergency department surge capacity for communicable disease emergencies with scalable deployment capabilities. The deployable module has several advantages over a fixed structure like a community facility. The triage facility is a location for short-term treatments, such as intravenous therapy, prescriptions, medication distribution, and self-care education, which are needed during a pandemic influenza outbreak. Decanting infectious patients away from the emergency department protects a highly-vulnerable hospitalised group from viral transmission. Based on the pilot, it is found that community triage centres are a viable support option for emergency departments in an urban setting during pandemic influenza.

Child Care Needs and Work-Life Implications

The need for child care is a work-life issue that affects families across all income levels. These issues are particularly challenging in rural areas, where nontraditional child care services may be more limited. Using data from a rural county in Virginia, this article examines income level differences in parents’ reported child care needs. We compare income groups along six variables. Our results suggest that lower income households have significantly more child care needs than moderate or upper income households along three of the variables: need for different hours, need for child care closer to home, and need for special-needs child care. These findings have implications for human resource managers as they consider work-life policies in their organization.

Prevalence of the use of complementary and alternative medicine for glaucoma

ObjectivesTo estimate the prevalence of complementary and alternative medicine (CAM) for glaucoma, explore possible demographic and disease-related associations, and inquire about the perceived benefit of these treatments. DesignCross-sectional study. Setting and ParticipantsOne thousand twenty-seven consecutive patients from two urban, referral glaucoma practices. Main Outcome MeasureUse of CAM specifically for glaucoma. ResultsThe response rate was 97.4%. The percentage of people reporting use of CAM for glaucoma was 5.4% (54 of 1000 subjects) with 32 of these 54 (59%) having used more than one type. The percentages of those using the various types of nontraditional medicine were: megavitamin therapy (62.9%), herbal therapy (57.4%), exercise (24.0%), diet modification (22.2%), meditation, (1.8%), acupuncture (1.8%), faith healing (1.8%), and homeopathic remedies (1.8%). Patients who used CAM were more likely to be educated beyond high school (P = 0.0014) and less likely to be retired (P = 0.0053). Use of nontraditional therapy was not strongly associated with race (P = 0.044), age (P = 0.062), gender (P = 0.24), length of diagnosis (P = 0.91), or number of glaucoma medications (P = 0.58). Of those using nontraditional therapy, 52% believed that it was helpful, 39% were unsure, and 9% considered it not helpful; 72% discussed their use with an ophthalmologist. Seventy percent discovered it from sources other than providers of either traditional or nontraditional care. ConclusionsThe prevalence of CAM use for glaucoma was 5.4% (95% confidence interval, 4.0%–6.4%). Most glaucoma patients currently cared for by ophthalmologists do not use nontraditional medicine.

Primary and Proximate

This article examines the influence of specific characteristics of the caregiving relationship, including coresidence and being the primary provider of care, on sons' filial care involvement. This work focuses on the gendered nature of care by classifying tasks as traditional or nontraditional for men. Data for this research come from the Work and Family Survey (1991-1993) conducted by the Work and Eldercare Research Group of CARNET: The Canadian Aging Research Network, and is based on a sample of 440 men who provide some type of assistance to only one older parent or parent-in-law. The framework that guides this work is structured on concepts related to family obligations or motivations to provide care. This research finds that coresiding predicts greater involvement in nontraditional care; being the primary provider of care predicts greater involvement in traditional care. Results are discussed in relation to the conceptual framework that guides this research.