Poor Continuity Of Care Research Articles

Understanding, beliefs and perspectives of Aboriginal people in Western Australia about cancer and its impact on access to cancer services.

BackgroundDespite a lower overall incidence, Aboriginal Australians experience poorer outcomes from cancer compared with the non-Aboriginal population as manifested by higher mortality and lower 5-year survival rates. Lower participation in screening, later diagnosis of cancer, poor continuity of care, and poorer compliance with treatment are known factors contributing to this poor outcome. Nevertheless, many deficits remain in understanding the underlying reasons, with the recommendation of further exploration of Aboriginal beliefs and perceptions of cancer to help understand their care-seeking behavior. This could assist with planning and delivery of more effective interventions and better services for the Aboriginal population. This research explored Western Australian (WA) Aboriginal peoples' perceptions, beliefs and understanding of cancer.MethodsA total of 37 Aboriginal people from various geographical areas within WA with a direct or indirect experience of cancer were interviewed between March 2006 and September 2007. Interviews were audio-recorded, transcribed verbatim and coded independently by two researchers. NVivo7 software was used to assist data management and analysis. A social constructionist framework provided a theoretical basis for analysis. Interpretation occurred within the research team with member checking and the involvement of an Aboriginal Reference Group assisting with ensuring validity and reliability.ResultsOutcomes indicated that misunderstanding, fear of death, fatalism, shame, preference for traditional healing, beliefs such as cancer is contagious and other spiritual issues affected their decisions around accessing services. These findings provide important information for health providers who are involved in cancer-related service delivery.ConclusionThese underlying beliefs must be specifically addressed to develop appropriate educational, screening and treatment approaches including models of care and support that facilitate better engagement of Indigenous people. Models of care and support that are more culturally-friendly, where health professionals take account of both Indigenous and Western beliefs about health and the relationship between these, and which engage and include Indigenous people need to be developed. Cultural security, removing system barriers and technical/scientific excellence are all important to ensure Indigenous people utilise healthcare to realise the benefits of modern cancer treatments.

An Examination of the Dutch Health Care Inspectorate's Supervision System for Suicides of Mental Health Care Users

An Examination of the Dutch Health Care Inspectorate's Supervision System for Suicides of Mental Health Care Users

Learning not to take it seriously: junior doctors’ accounts of error

We aimed to investigate experiences of, and responses to, medical error amongst junior doctors and to examine the challenges junior doctors face and the support they receive. We carried out a qualitative study of 38 randomly selected pre-registration house officers (PRHOs) in 10 hospitals. All 38 had graduated in 2000 or 2001 from a single medical school. Errors were common and sometimes serious. In relation to disclosure and learning from error, four main themes emerged: a norm of selective disclosure; the effects of the team; individualised blame and responsibility, and the 'learning moment'. Trainees reported disclosing errors informally, particularly when teams were seen as supportive, but were reluctant to criticize colleagues. Formal reports and disclosure to patients were very rare. Patient care was compromised when juniors did not access senior help, often when working outside their usual team environment. Lack of cooperation between teams and poor continuity of care also contributed to errors. Learning was maximised when errors were formally discussed and constructive feedback offered. However, both blame and the prioritization of reassurance over learning and structured feedback appeared to inhibit reflection on the experience of error. Junior doctors need help to reflect on their experiences and to recognise where they may have made mistakes, particularly in the contexts of shift-work and fragmented teams. Formal reporting systems alone will not facilitate learning from error. Juniors require individual clinical supervision from seniors with appropriate training. Such expertise may benefit the whole team and the training environment.

Re-visioning cultural competence in community health services in Victoria

There are few studies exploring the need to develop and manage culturally competent health services for refugees and migrants from diverse backgrounds. Using data from 50 interviews with service providers from 26 agencies, and focus group discussion with nine different ethnic groups, this paper examines how the Victorian state government funding and service agreements negatively impact on the quest to achieve cultural competence. The study found that service providers have adopted "one approach fits all" models of service delivery. The pressure and competition for resources to address culturally and linguistically diverse communities' needs allows little opportunity for partnership and collaboration between providers, leading to insufficient sharing of information and duplication of services, poor referrals, incomplete assessment of needs, poor compliance with medical treatment, underutilisation of available services and poor continuity of care. This paper outlines a model for cultural consultation and developing needs-led rather than service-led programs.

Men with cancer: is their use of complementary and alternative medicine a response to needs unmet by conventional care?

This qualitative study aims to investigate why men with cancer choose to use complementary and alternative medicine (CAM), and whether CAM is used to fill 'gaps' in conventional cancer care or as an 'alternative' to conventional treatment. Interviews were carried out with 34 CAM users recruited from a National Health Service (NHS) oncology department, an NHS homeopathic hospital and a private cancer charity offering CAM. Participants used therapies to improve quality of life, to actively 'fight' the disease and possibly prolong life, but rarely as an alternative to conventional treatment. Many were initially sceptical about CAM, but took a 'pragmatic' and 'consumerist' approach to getting their needs met. Gaps in conventional care included: lack of empathy and support during and after treatment, poor continuity of care, and lack of advice on self-help, diet and lifestyle. The skills of CAM therapists may enable them to tap into the underlying needs of men in a way that health professionals do not always have the time or the skills to achieve.

Patient, carer and staff experience of a hospital-based stroke service

Here, the aim is to study the experiences of patients, carers and staff throughout a hospital stroke care pathway. Focus groups of patients, carers and staff followed a semi-structured format to elucidate experiences. The groups were recorded, transcribed and subjected to thematic analysis. Analyses were verified by researchers and participants. Patients and carers produced four overlapping themes: 'information', 'staff attitudes', 'availability of care/treatment' and 'considering the whole person in context'. The carers' group produced two additional themes: 'accommodation of patients' individual needs' and 'burden of care'. Their experiences were complex and multi-faceted; positive views of the whole service co-existed with negative views of some aspects. The staff groups produced six themes: 'specialist service', 'split service', 'availability of care', 'consistency of care', 'staff morale' and 'wish for change'. Positive views of the specialist service were tempered by problems with physical and professional separation, staff shortages and 'hierarchical practice' that reduced collective decision-making. Some of the patients' and carers' perspectives have not been previously reported in the stroke literature, including a desire for individualized treatment, the consideration of wider, non-physical needs and the carers' sense of burden. In addition, the study revealed how staff, carers and patients viewed each other and the service and demonstrated the concordance of their perceptions. However, staff showed little insight into the users' need for information and negative experiences of care. In contrast with previous research, lack of emotional care, poor continuity of care and lack of staff knowledge and skills were not identified as problems.

Poor Preventive Care Achievement and Program Retention Among Low Birth Weight Infant Medicaid Enrollees

In this study, I examined the relative odds of achievement of preventive care goals during the first year of life and retention of Medicaid coverage at the end of the first year among Medicaid-enrolled low birth weight infants. Association with maternal prenatal health promotion was also considered. I used a retrospective case-control design. Low birth weight and normal birth weight infants in the Florida Medicaid program (1995-1999) matched on demographic factors were compared on their relative odds of achievement of preventive care goals and Medicaid program retention using multivariate logistic regression (n = 7510). A subsample of infants with linked maternal claims was used to measure the association of maternal health promotion during the prenatal period. Low birth weight infants had lower relative odds of achieving preventive care goals during the first year and of retaining Medicaid coverage after the first year compared with infants of normal birth weight. However, when maternal health promotion during the prenatal care period was held constant, birth weight was no longer related to achievement of preventive care goals and program retention. Maternal health promotion was positively associated with achievement of preventive goals and program retention for all infants regardless of birth weight. Some Medicaid-enrolled low birth weight infants are at risk for poor health supervision and poor continuity of care through failure to retain coverage. The disproportionate odds of poor health promotion among mothers of low birth weight infants explain much of this deficit. States may want to prioritize preventive care supervision and program reenrollment for children of mothers with evidence of low health promotion. This recommendation is particularly important for infants of low birth weight.

Perceptions of hospital managers regarding the impact of doctors' community service

Background In South Africa, the distribution of doctors is skewed in favour of the urban areas, but it is not uncommon to find many peri-urban facilities in short supply of doctors. In 1997, the South African government introduced compulsory community service (CS) to address this uneven distribution of doctors in the country. The CS doctors posted to the Letaba-Sekororo hospital complex in Limpopo Province refused to take up their appointments for various reasons, ranging from lack of supervision to poor basic infrastructure. This study is one of the earliest conducted to understand the perceptions of hospital managers on the impact of the national community service on the health service. Methods After ethical approval was obtained from the Research, Ethics and Publications Committee (REPC) of the Medical University of Southern Africa (now University of Limpopo – Medunsa Campus), three focus group interviews were conducted with hospital managers from three purposefully selected hospitals. The interviews were audio-visually taped and supplemented with field notes, transcribed verbatim, with themes identified using the ‘cut and paste' and ‘colour coding' methods. Combined themes were categorised and interpreted within the context of the study and the available literature. Results CS has improved health services delivery, alleviated work pressure, and improved the image of hospital managers. In addition, it has provided a constant supply of manpower, and increased the utilisation of health services by the community. The negative perceptions identified included a lack of experience and skills, poor relationships with the rural health team, lack of support structures for CS doctors, poor continuity of care and budgetary constraints. Conclusions Hospital managers perceive CS to have had a positive impact on the supply of needed manpower, health service delivery and patient care. As this was a qualitative study, further quantitative and community-oriented studies are required to validate the results. Keywords:Perceptions; hospital managers; impact; community service doctors For full text, click here: SA Fam Pract 2005;47(8):55-59

Patients' preferences for involvement in clinical decision-making within secondary care and the factors that influence their preferences

The research aimed to identify what involvement patients want in clinical decision-making and explore the underlying factors influencing that choice, thus identifying aids and barriers to increasing patients' involvement in decision-making. The study design was inspired by interpretative phenomenology, thus the framework for analysis is intended to aid interpretation and comprehension of the patients' experiences and understanding through identifying similarities and differences in their stories. Data were collected through semi-structured interviews of twenty people who were patients in a secondary care milieu at the time of interview. Results showed that, 20% of patients chose an active role in decision-making and 80% chose a collaborative or a passive role. However what people selected on the autonomy preference index was not always reflected in the interview. Additionally, the findings suggest that the NHS maintains a paternalistic approach. Lack of staff, lack of information and poor continuity of care with nursing staff made patients feel disempowered.

Can Continuity of Care Be Improved? Results From a Randomized Pilot Study

Although continuity of care is an important component of primary care, few mechanisms for improving it have been studied. To determine if automated reminders to providers and patient schedulers can improve continuity of care in a practice. Prospective randomized controlled trial. Four hundred and nine patients in the lowest tertile of continuity of care in a university-affiliated clinic with a computerized information system were randomized to 1 of 4 groups: 1) control (no reminder), 2) provider alert, 3) scheduler alert, or 4) provider and scheduler alert. Continuity of care as measured by a previously described dispersion index that ranges from 0 to 1.Results.-Initial continuity of care was.134 (standard deviation,.07). In a linear regression model, 9 months after implementation of the system, both the provider-prompt group (.027 [.006,.05]) and the provider and scheduler group (.024 [.001,.054]) were associated with increased continuity compared with the control group Prompting providers for patients with poor continuity of care may improve it.

Psychiatric symptoms masking pituitary adenoma in Spanish speaking immigrants

Barriers to clear communication, such as culture, language, and other aspects of self-presentation may have an important impact on the doctor-patient relationship. When not addressed, cultural and linguistic issues can result in unreliable clinical histories, noncompliance with medical treatment, misinterpretation of data, poor continuity of care, less preventive screening, miscommunication, and inadequate analgesia. Lack of access to competent interpreters and failure to take a full history may result in inaccurate assessment of presenting complaints leading to a delay in initiating necessary treatment. In addition, the presence of psychiatric symptoms can interfere with the medical diagnostic process, leading sometimes to premature closure of the differential diagnosis and attributing all presenting complaints to psychiatric illness. When both language barriers and psychotic symptoms present together, the risk of inaccurate diagnosis is multiplied. We report two Spanish-speaking patients with primary central nervous system tumors who had delayed diagnosis and treatment due to triage personnel focusing on presenting psychiatric complaints without attention to co-morbid medical symptoms. In each case, the patients initially presented to non-Spanish-speaking medical providers who did not have access to trained interpreter services. Physician attention to primary psychiatric symptoms led to referral for psychiatric care, delaying treatment for obvious neuro-endocrinologic problems.

The general practice care of people with intellectual disability: barriers and solutions.

A questionnaire exploring general practitioners' (GPs') perceptions of the barriers and solutions to providing health care to people with intellectual disability was sent to 912 randomly selected GPs throughout Australia. A response rate of 58% was obtained. Results indicated that numerous barriers compromise the quality of health care able to be provided to people with intellectual disability. Communication difficulties with patients and other health professionals, and problems in obtaining patient histories stood out as the two most significant barriers. A range of other barriers were identified, including GPs' lack of training and experience, patients' poor compliance with management plans, consultation time constraints, difficulties in problem determination, examination difficulties, poor continuity of care, and GPs' inadequate knowledge of the services and resources available. General practitioners also suggested numerous solutions to these barriers, and emphasized the need for increased opportunities for education and training in intellectual disability. The GPs showed an overwhelming willingness to be involved in further education. Other major solutions included increasing consultation duration or frequency, proactively involving families and carers in patients' ongoing health care, and increasing remuneration.