Support Continuity Of Care Research Articles

Continuity of care for people with multimorbidity: the development of a model for a nurse-led care coordination service

Objective: To collaboratively develop a model of nurse-led care, within a multidisciplinary team and support continuity of care at the primary-secondary interface for people with multimorbidity. Background: Existing models of care are frequently based on a medical model, designed to manage a single disease condition, and thus pose a significant challenge to provide healthcare for people with multimorbidity. Particular design elements for models of care affecting the primary-secondary interface have been previously demonstrated, however, these have not been applied to the development of a nurse-led model of care for people with multimorbidity. Study design and methods: This paper, the first in a series of two, is part of a broader action research study and reports on the development of a model which will subsequently be assessed in terms of feasibility to provide a nurse-led care coordination service for people with multi-morbidity. This paper reports on the first action research cycle and methodology including a literature search, stakeholder engagement forums, validation workshop, team meetings, and professional engagement and validation. Results: Data from two stakeholder forums were sorted into 257 ‘structure, process and outcome’ statements and 86 goal related statements. These were cross referenced with design elements on models of care from the literature and finally aggregated into themes. The aggregated themes were then integrated into a model of care for a nurse–led care coordination service. The model consists of an overarching component, 4 domains and 6 operational areas with underpinning criteria. Conclusion: Through stakeholder consultation, consideration of the strengths of previous models and building blocks, a new nurse-led model of care that provides a pathway for transitional healthcare management at the primary -secondary interface has been developed. Inclusion of governance and culture within the model’s domains enables the approach to be pragmatic and adaptable, contributing to the potential for successful change management and model implementation in the clinical workplace. Further evaluation and refinement of the model is planned and will be reported on, in part 2 of this two-part series. Implications for research, policy, and practice: These findings provide direction for model implementation and further research required regarding nurse-led models of care. The supporting documents, systems, and processes reported, positions the model to support change and guide clinical practitioners and nursing management working at the primary-secondary healthcare interface. The future success of model implementation could provide evidence for health workforce policy and coordinated healthcare management. What is already known about this topic: Particular design elements for models of care affecting the primary-secondary interface have been previously demonstrated. Interventions delivered at the primary-secondary care interface, particularly stepped care and models of shared care are effective for the management of depression. Established model design elements and interventions to improve continuity of care at the primary-secondary interface have not been applied to nurse- led models of care for chronic conditions and still require development within research settings. What this paper adds: A new person-centred nurse-led model of care coordination, with healthcare management activities intended to support and enable development of the person’s agency in their healthcare optimisation. A model with specific domains and criteria with the potential for application to nurse-led services across primary and secondary settings, for a range of patients. Inclusion of governance and culture as domains within the model, to enable the best possibility for change, model implementation and continuity of care between the primary-secondary healthcare interface.

The Initial Reproductive Health Visit: ACOG Committee Opinion Summary, Number 811.

The primary goal of the initial reproductive health visit is to provide preventive health care services, educational information, and guidance, in addition to problem-focused care. The initial reproductive health visit should take place between the ages of 13 and 15 years. The scope of the initial visit will depend on the patient's concerns, medical history, physical and emotional development, and the level of care the patient is receiving from other health care professionals. All adolescents should have the opportunity to discuss health issues with a health care professional one-on-one, because they may feel uncomfortable talking about these issues in the presence of a parent or guardian, sibling, or intimate partner. Addressing confidentiality concerns is imperative because adolescents in need of health care services are more likely to forego care if there are concerns about confidentiality. Laws regarding confidentiality of care to minors vary by state, and health care professionals should be knowledgeable about current laws for their practice. Taking care to establish secure lines of communication can build trust with the patient and guardian, support continuity of care, ensure adherence to legal statutes, and decrease barriers to services. Obstetrician-gynecologists have the opportunity to serve as educators of parents and guardians about reproductive health issues. Preparing the office environment to include adolescent-friendly and age-appropriate reading materials, intake forms, and educational visual aids can make the general office space more inclusive and accessible. Resources should be provided for both the adolescent patient and the parent or guardian, if possible, at the conclusion of the visit. This Committee Opinion has been updated to include gender neutral terminology throughout the document, counseling topics with direct links to helpful resources, screening tools with direct links, addition of gender and sexuality discussion, and inclusion of trauma-informed care.

The Initial Reproductive Health Visit: ACOG Committee Opinion, Number 811.

The primary goal of the initial reproductive health visit is to provide preventive health care services, educational information, and guidance, in addition to problem-focused care. The initial reproductive health visit should take place between the ages of 13 and 15 years. The scope of the initial visit will depend on the patient's concerns, medical history, physical and emotional development, and the level of care the patient is receiving from other health care professionals. All adolescents should have the opportunity to discuss health issues with a health care professional one-on-one, because they may feel uncomfortable talking about these issues in the presence of a parent or guardian, sibling, or intimate partner. Addressing confidentiality concerns is imperative because adolescents in need of health care services are more likely to forego care if there are concerns about confidentiality. Laws regarding confidentiality of care to minors vary by state, and health care professionals should be knowledgeable about current laws for their practice. Taking care to establish secure lines of communication can build trust with the patient and guardian, support continuity of care, ensure adherence to legal statutes, and decrease barriers to services. Obstetrician-gynecologists have the opportunity to serve as educators of parents and guardians about reproductive health issues. Preparing the office environment to include adolescent-friendly and age-appropriate reading materials, intake forms, and educational visual aids can make the general office space more inclusive and accessible. Resources should be provided for both the adolescent patient and the parent or guardian, if possible, at the conclusion of the visit. This Committee Opinion has been updated to include gender neutral terminology throughout the document, counseling topics with direct links to helpful resources, screening tools with direct links, addition of gender and sexuality discussion, and inclusion of trauma-informed care.

Improving Care at Correctional Facilities: Listening, Learning and Creating Change from a Patient Care Quality Office.

Correctional Health Services (CHS) became part of the Provincial Health Services Authority in British Columbia (BC) in October, 2017. There are 2,700 clients in BC in 10 facilities, and approximately 60% of these clients have mental health issues and/or substance use issues. To address healthcare quality complaints and queries for this unique setting, in keeping with provincial legislation, nursing role of the patient care quality specialist was created in 2018. Challenges, particularly related to direct communication limitations due to the security of incarcerated persons, have led to adapted processes, tools and approaches. Numerous collaborations have been established within and external to the CHS in BC, including the Federal Correctional Services and Accreditation Canada, which have resulted in new relationships to better understand client issues, develop policies and support continuity of care between the community and the correctional facility.

Getting a balance between generalisation and specialisation in mental health services: a defence of general services.

Mental health services in the UK National Health Service have evolved to include primary-care generalist, secondary-care generalist and secondary-care specialist services. We argue that there continues to be an important role for the secondary-care generalists as they minimise interfaces, can live with diagnostic uncertainty and support continuity of care. The lack of commissioning and clinical boundaries in secondary-care generalist services can undermine their feasibility, leading to difficulties recruiting and retaining staff. There is a risk of a polo-mint service, where the specialist services on the edge are well resourced, but the secondary-care generalist services taking the greatest burden struggle to recruit and retain clinicians. We need to establish equity in resources and expectations between generalist and specialist mental health services.Declaration of interestNone.

Supporting continuity of care between prison and the community for women in prison: a medical record review.

Objectives The aim of the present study was to examine health information transfer and continuity of care arrangements between prison and community health care providers (HCPs) for women in prison. Methods Medical records of women released from New South Wales prisons in 2013-14 were reviewed. Variables included health status, health care in prison and documented continuity of care arrangements, including information transfer between prison and community. Associations were measured by adjusted odds ratios (AORs) using a logistic regression model. Text from the records was collected as qualitative data and analysed to provide explanatory detail. Results In all, 212 medical records were systematically sampled and reviewed. On prison entry, information was requested from community HCPs in 53% of cases, mainly from general practitioners (GPs, 39%), and was more likely to have occurred for those on medication (AOR 7.08; 95% confidence interval (CI) 3.71, 13.50) or with schizophrenia or other psychotic disorders (AOR 4.20; 95% CI 1.46, 12.11). At release, continuity of care arrangements and health information transfer to GPs were usually linked to formal pre-release healthcare linkage programs. Outside these programs, only 20% of records had evidence of such continuity of care at release, with the odds higher for those on medication (AOR 8.28; 95% CI 1.85, 37.04) and lower for women with problematic substance misuse (AOR 0.32; 95% CI 0.14, 0.72). Few requests for information were received after individuals had been released from custody (5/212; two from GPs). Conclusion Increased health information transfer to community HCPs is needed to improve continuity of care between prison and community. What is known about the topic? Many women in prison have high health needs. Health and well being are at further risk at the time of transition between prison and community. What does this paper add? This study provides evidence that outside formal programs, which are currently available only for a minority of women, continuity of care arrangements and transfer of health information do not usually occur when women leave prison. Pragmatic choices about continuity of care at the interface between prison and community may have been made, particularly focusing on medication continuity. Barriers to continuity of care and ways forward are suggested. What are the implications for practitioners? Siloing of health care delivered within prison health services through lack of continuity of care at release is wasteful, both in terms of healthcare costs and lost opportunities to achieve health outcomes in a vulnerable population with high health needs. There is need for an increased focus on continuity of care between prison and community health services, HCP support and training and expansion of pre-release planning and healthcare linkage programs to assist larger numbers of women in prison.

Current Telerehabilitation Research With Older Adults at Home: An Integrative Review.

Increased demand for in-home rehabilitation services for older adults may be met through telerehabilitation information and communication technologies. The current article reports the results of an integrative literature review summarizing current in-home telerehabilitation research with older adults. Nine studies from 2006-2015 are included. Six studies employed a remote therapist using real-time video. Three studies used text- or web-based messaging and electronic surveys. Six studies relied on dial-up Internet service and the remaining three studies used broad-band Internet connections. Future research should address (a) in-home and wearable sensing technologies to monitor health and (b) mobile devices, such as tablet computers, to collect patient self-reports. Interoperable platforms are needed to integrate disparate devices and support continuity of care across post-acute care settings. [Journal of Gerontological Nursing, 42(10), 15-20.].

Supporting continuity of care: referral to the NMS after discharge from hospital

Supporting continuity of care: referral to the NMS after discharge from hospital