Understanding Of Healthcare Providers Research Articles

Healthcare providers’ perspectives on use of the national guideline for family planning services in Amhara Region, Ethiopia: a qualitative study

ObjectiveTo explore healthcare providers’ views on barriers to and facilitators of use of the national family planning (FP) guideline for FP services in Amhara Region, Ethiopia.DesignQualitative study.SettingNine health facilities including...

Connect with your patients, not the screen

This article examined the usability claims that Electronic Health Records (EHRs) make to healthcare providers. Usability claims appear as statements that persuade users to adopt the interface based on usability or user experience. These claims may show what healthcare providers are presumed to require from online health technologies. Usability claims in this study included intuitive interfaces, adaptability of documentation and records, and supplementing patient communication. Analyzing usability claims then becomes a way of understanding healthcare providers, their patients, and the technologies both use for health communication

The Role of Inhalation Delivery Devices in COPD: Perspectives of Patients and Health Care Providers.

Background: Inhaled medications form the foundation of pharmacologic treatment for chronic obstructive pulmonary disease (COPD).The Delivery Makes a Difference (DMaD) project was conducted to better understand health care provider (HCP) and patient perspectives about the role of inhalation delivery devices in COPD, and to examine the nature of educational efforts between HCPs and patients on proper device technique. Methods: Data were derived from 2 original quantitative, web-based, descriptive, cross-sectional surveys distributed to HCPs who manage COPD (n=513) and patients with COPD (n=499) in the United States. Descriptive statistics were used to assess data across important demographic variables. Inferential statistics were used to assess differences in attitudinal, descriptive, and behavioral measures that were cross-tabulated with demographic data. Results: When prescribing medication for newly diagnosed patients with stable or unstable COPD, only 37% of HCPs considered type of device to be highly important, with only 45% of HCPs assessing device technique in every newly diagnosed patient. Patients with COPD were also relatively unconcerned with proper device technique (64% never concerned), regardless of their COPD severity. Although patients did not identify education as a significant impediment to proper device use, they reported inconsistent educational experiences. Conclusions: We found that HCPs and patients prioritize medication over device when selecting treatments, showing limited concerns about proper device use. These results highlight the need to coordinate professional education with patient-directed educational efforts to further promote proper device selection and use in COPD management.

Understanding health care provider barriers to hospital affiliated medical fitness center facility referral: a questionnaire survey and semi structured interviews

BackgroundThe purpose of this study is to understand health care provider barriers to referring patients to Medical Fitness Center Facilities within an affiliated teaching hospital system using referral of diabetic services as an example. The aims of this study include: (1) to assess health care providers’ awareness and use of facilities, (2) to determine barriers to referring patients to facilities, (3) identify current and needed resources and/or changes to increase referral to facilities.MethodsA 20-item electronic survey and requests for semi-structured interviews were administered to hospital system directors and managers (n = 51). Directors and managers instructed physicians and staff to complete the survey and interviews as applicable. Perceived barriers, knowledge, utilization, and referral of patients to Medical Fitness Center Facilities were collected and examined. Descriptive statistics were generated regarding practice characteristics, provider characteristics, and referral.ResultsOf the health care providers surveyed and interviewed (n = 25) 40% indicated verbally suggesting use of facilities, 24% provided a flyer about the facilities. No respondents indicated that they directly referred patients to the facilities. However, 16% referred patients to other locations for physical activity - including their own department’s management and prevention services. 20% do not refer to Medical Fitness Center Facilities or any other lifestyle programs/locations. Lack of time (92%) and lack of standard guidelines and operating procedures (88%) are barriers to referral. All respondents indicated a strong ability to refer patients to Medical Fitness Center Facilities if given education about referral programs available as well as standard clinical guidelines and protocol for delivery.ConclusionThe results of this study indicate that, although few healthcare providers are currently referring patients to Medical Fitness Center Facilities, health care providers with an affiliated Medical Fitness Center Facility not only want clinical standard guidelines, protocol, and training to refer patients to Medical Fitness Center Facilities, but believe they have the ability to increase referral if given these tools. The Medical Fitness Association has a unique opportunity to bridge health care providers to Medical Fitness Center Facilities by developing clinical practice guidelines in cooperation with the American Diabetes Association.

Understanding Healthcare Provider Behaviour to Reduce Low-Value Practice: A Conceptual Framework

The reduction of low-value healthcare practices is necessary to ensure patient safety and satisfaction, reduce costs and develop a sustainable healthcare system. The field of de-adoption research is emerging, and little scholarship to date has explored the conceptual and operational challenges inherent in reducing or eliminating a practice which has been deemed ineffective, inappropriate or harmful. In this paper I present a conceptual framework and argue that a deeper understanding of the factors that affect behaviour change and the unique factors that impact de-adoption are needed to advance this field and support the healthcare system through this fundamental practice change. I propose that current models and frameworks used to understand behaviour are inadequate for this task and present an integrated de-adoption conceptual framework which incorporates comprehensive measures from the Theory of Planned Behavior, the COM-B Framework and behavioural economics concepts. The infrastructure developed in this framework provides clear guidance on the critical factors which influence healthcare provider behaviour, and deepens our understanding of modifiable factors which can facilitate healthcare provider behaviour change to reduce or eliminate low- value practices.

Postpartum Hypertension: Etiology, Diagnosis, and Management.

Postpartum hypertension complicates approximately 2% of pregnancies and, similar to antepartum severe hypertension, can have devastating consequences including maternal death. This review aims to increase the knowledge and skills of women's health care providers in understanding, diagnosing, and managing hypertension in the postpartum period. Hypertension complicating pregnancy, including postpartum, is defined as systolic blood pressure 140 mm Hg or greater and/or diastolic blood pressure 90 mm Hg or greater on 2 or more occasions at least 4 hours apart. Severe hypertension is defined as systolic blood pressure 160 mm Hg or greater and/or diastolic blood pressure 110 mm Hg or greater on 2 or more occasions repeated at a short interval (minutes). Workup for secondary causes of hypertension should be pursued, especially in patients with severe or resistant hypertension, hypokalemia, abnormal creatinine, or a strong family history of renal disease. Because severe hypertension is known to cause maternal stroke, women with severe hypertension sustained over 15 minutes during pregnancy or in the postpartum period should be treated with fast-acting antihypertension medication. Labetalol, hydralazine, and nifedipine are all effective for acute management, although nifedipine may work the fastest. For persistent postpartum hypertension, a long-acting antihypertensive agent should be started. Labetalol and nifedipine are also both effective, but labetalol may achieve control at a lower dose with fewer adverse effects. Providers must be aware of the risks associated with postpartum hypertension and educate women about the symptoms of postpartum preeclampsia. Severe acute hypertension should be treated in a timely fashion to avoid morbidity and mortality. Women with persistent postpartum hypertension should be administered a long-acting antihypertensive agent. Obstetricians and gynecologists, family physicians. After completing this activity, the learner should be better able to assist patients and providers in identifying postpartum hypertension; provide a framework for the evaluation of new-onset postpartum hypertension; and provide instructions for the management of acute severe and persistent postpartum hypertension.

Merging video coaching and an anthropologic approach to understand health care provider behavior toward hand hygiene protocols.

We used videorecordings of routine care to analyze health care providers' deviance from protocols and organized follow-up interviews that were conducted by an anthropologist and a nurse. After consent, health care workers were recorded during routine care by an automatic video remote control. Each participant was invited to watch her or his recorded behaviors on 2 different videos showing routine practices and her or his deviance from protocols, and to comment on them. After this step an in-depth interview based on preestablished guidelines was organized and explanations regarding the observed deviance was discussed. This design was intended to reveal the HCWs' subjectivity; that is, how they perceive hand hygiene issues in their daily routine, what concrete difficulties they face, and how they try to resolve them. We selected 43 of 250 videorecordings created during the study, which allowed us to study 15 out of 20 health care professionals. Twenty out of 43 videos showed 1 or more breaches in the hand hygiene protocol. The breaches were frequently linked to glove abuse. Deviance from protocols was explained by the health care workers as the result of an adaptive behavior; that is, facing work constraints that were disconnected from infection control protocols. Professional practices and protocols should be revisited to create simple messages that are adapted to the mandatory needs in a real life clinic environment.

Knowledge and Attitudes Regarding Antibiotic Use Among Adult Consumers, Adult Hispanic Consumers, and Health Care Providers--United States, 2012-2013.

Appropriate antibiotic use, in particular avoidance of antibiotics for upper respiratory infections likely to be caused by viruses, is a key component of efforts to slow the increase in antibiotic-resistant infections. Studies suggest that Hispanic consumers might differ from non-Hispanic consumers in their knowledge and attitudes regarding antibiotic use (4). To better understand health care provider and consumer knowledge and attitudes that influence antibiotic use, CDC analyzed national internet survey data collected from participants living in the United States during 2012-2013. The participants represented three groups: 1) the total population of adult consumers (all ethnicities); 2) adult Hispanic consumers; and 3) health care providers. Hispanic consumers were more likely than all consumers to believe that if they have a cold, antibiotics would help them to get better more quickly (48% versus 25%), and more likely to obtain antibiotics not prescribed by a clinician, such as antibiotics left over from a previous illness (25% versus 9%), obtained from a neighborhood grocery store (23% versus 5%), or obtained from a friend or family member (17% versus 6%). Most providers surveyed (54%) reported that they believed their patients expect antibiotics during visits for a cough or cold, whereas 26% of all consumers reported this expectation. To maximize knowledge about appropriate antibiotic use among outpatients in the United States, public health initiatives should target Hispanic as well as general audiences.

Intimate partner violence, partner notification, and expedited partner therapy: a qualitative study.

Over one-third of women experience intimate partner violence (IPV) in their lifetime. IPV increases the risk of infection and re-infection with sexually transmitted infections (STIs). The extent to which health care providers consider IPV when recommending partner notification and expedited partner therapy is unknown. The objective of this qualitative study was to understand health care providers' views on IPV and STIs when recommending partner treatment to patients with chlamydia. Using a purposive sampling strategy to include health care providers who treat young women at risk for chlamydia, 23 semi-structured, in-depth interviews were conducted. While some health care providers expressed concern for their patients' safety and believed assessing for IPV was needed before provision of expedited partner therapy, nearly a third had not considered the links between IPV and STIs. Strategies used by health care providers to assess for IPV did not include inquiry about specific behaviours related to IPV, STI risk, and sexual coercion. Many health care providers understand the risk for IPV in the setting of STI treatment, yet a significant portion of those interviewed failed to recognise the link between IPV and STIs. Provider education is necessary to increase knowledge and implement more effective inquiry and counselling about IPV to more safely recommend expedited partner therapy.

Being discharged from hospice alive: the lived experience of patients and families.

Approximately 259,000 patients were discharged alive from U.S. hospices in 2010. There is a paucity of research describing the experiences of these individuals and their family members. The study objective was to explore the experiences of adults discharged from a hospice program due to decertification related to ineligibility or extended prognosis, from the perspective of the individual and his or her adult family members. Research questions were, How do participants perceive and describe (1) the experience of being discharged alive from hospice, and (2) their quality of life after a live hospice discharge? A transcendental phenomenological design guided this study. Purposive, snowball sampling was used to recruit 12 volunteers, aged 35-92 years, who had experienced live hospice discharge due to decertification. Data collection included open-ended interviews and journals. Findings included two primary themes: suffering "AS…" and the paradox of hospice discharge. These primary themes were supported by 12 subthemes: abandonment, unanswered questions, loss of security, loneliness, uncertainty, anger and frustration, physical decline, bearing exhaustive witness, having and needing support, mixed feelings, not dying fast enough, and hospice equals life. Understanding this experience may enhance understanding and aid health care providers to anticipate the unique needs of the hospice population.

The Rapidly Emerging Role for Whole Exome Sequencing in Clinical Genetics

Sequencing of the exome, the protein-coding region of the human genome, has quickly grown into a new approach for clinical diagnosis of disease. Enabled by next-generation sequencing technologies, clinical exomes accompanied by clinical interpretation of the genome variants are used today to guide health care providers in understanding and diagnosing their patient’s disease. Continuing improvement in both sequencing technology and exome approaches, as well as interpretation of the variation identified, will be required to fully realize the power of this new science. This review provides a glimpse into the value and complexities we all face in this quest.

Understanding Surgical Preference and Practice in Hemodialysis Vascular Access Creation

Understanding healthcare providers' preferences, values, and beliefs around AVF eligibility is important to explain variability in practice. We conducted a survey of international surgeons, using hypothetical patient scenarios, to assess resources used, variables, perceived barriers, and absolute contraindications to access creation. A total of 134 surgeons completed the survey. Venous duplex ultrasound mapping (VDUM) was offered to all patients by 90% of US, 68% Canadian, and 63% European respondents. VDUM altered clinical decision less than 25% of the time for 33% American, 48% Canadian, and 85% European surgeons. Increased comorbidities and previous failed access were deterrents to AVF creation as was vessel size. Second choice access was the AV graft in the US and Europe and the catheter in Canada. Absolute contraindications to AVF creation included patient life expectancy <1 year, left ventricular ejection fraction (LVEF) <15%, and a history of dementia, while 42% surgeons reported no absolute contraindications. Perceived barriers included patient preferences, long wait times for surgery, and late referral to a Nephrologist. Significant variability exists in the surgical preoperative assessment of patients, and the eligibility criteria used for fistula creation. Understanding surgeons' preferences can aid in establishing standardization for VA access eligibility, including surgical assessment.

The management of menstrual suppression and uterine bleeding: A survey of current practices in the pediatric blood and marrow transplant consortium

Current guidelines recommend the use of combined hormonal contraceptive pills for menstrual suppression in pediatric blood and marrow transplant (BMT) recipients but recent research reveals that provider practice varies. This study was designed to describe the current practice for managing menstrual issues, that is, menstrual suppression and uterine bleeding, in pediatric BMT patients and to better understand health care providers' practices in the use of gonadotropin-releasing hormone agonists (GnRHa). A cross sectional survey consisting of 53 questions was distributed via email to principal investigators in the Pediatric Blood and Marrow Transplant Consortium (PBMTC). Responses were collected using www.surveymonkey.com. Menstrual suppression and uterine bleeding in pediatric BMT patients are primarily managed by pediatric oncologists (97%). The most frequently reported hormonal method used for induction of therapeutic amenorrhea was GnRHa (41%). The top three reasons for choosing a method were greater likelihood of amenorrhea, concerns about side effects, and possible gonadal protection. Continuous combined hormonal contraceptive pills were the most commonly used method for the management of clinically significant uterine bleeding regardless of primary method used for menstrual suppression. Despite the 2002 PBMTC guidelines, wide variation in menstrual suppression management practices still exists. Our data show that use of GnRHa is more common than previously reported. Additional research is needed to develop evidence-based practice guidelines in pediatric BMT patients.

Overview of the Guidelines and Evidence for the Pharmacologic Management of Type 2 Diabetes Mellitus

The number of novel treatment options for type 2 diabetes mellitus, including those with distinctive mechanisms of action, has risen sharply this decade, and health care providers must be aware of the drugs' safety and efficacy in order to provide patients with the best care possible. Guidelines for type 2 diabetes provide recommendations for initiating and continuing treatment that will enable patients to achieve glycemic control and maintain it over time. Several recently completed, large clinical trials have provided information pertaining to potential benefits and risks of achieving specific treatment goals, and medical professionals should consider applying the insights from these trials when optimizing care for their patients. The pharmacist plays an essential role in helping patients achieve and maintain tight glycemic control by assisting other health care providers in understanding and utilizing the guidelines as part of individualized treatment regimens.

Electronic patient self-assessment and management (SAM): a novel framework for cancer survivorship

BackgroundWe propose a novel framework for management of cancer survivorship: electronic patient Self-Assessment and Management (SAM). SAM is a framework for transfer of information to and from patients in such a way as to increase both the patient's and the health care provider's understanding of the patient's progress, and to help ensure that patient care follows best practice.MethodsPatients who participate in the SAM system are contacted by email at regular intervals and asked to complete validated questionnaires online. Patient responses on these questionnaires are then analyzed in order to provide patients with real-time, online information about their progress and to provide them with tailored and standardized medical advice. Patient-level data from the questionnaires are ported in real time to the patient's health care provider to be uploaded to clinic notes. An initial version of SAM has been developed at Memorial Sloan-Kettering Cancer Center (MSKCC) and the University of California, San Francisco (UCSF) for aiding the clinical management of patients after surgery for prostate cancer.ResultsPilot testing at MSKCC and UCSF suggests that implementation of SAM systems are feasible, with no major problems with compliance (> 70% response rate) or security.ConclusionSAM is a conceptually simple framework for passing information to and from patients in such a way as to increase both the patient's and the health care provider's understanding of the patient's progress, and to help ensure that patient care follows best practice.

Reported rapes at a hospital rape centre: Demographic and clinical profiles

Figures for the period 2008/2009 indicate a 10% rise in the number of reported sexual offences compared with figures for 2007/2008. The increase may be partly attributable to the recent version of the act regulating sexual offences: the Criminal Law (Sexual Offences and Related Matters) Amendment Act, Act 32 of 2007 (Act). In this Act, the definition of rape has been broadened to include the non-consensual vaginal, oral or anal penetration of any person, regardless of gender, with any object. South Africa has one of the highest incidences of rape in the world and the most violent types of rape in the world, with gang rape and severe physical injury to rape victims commonly occurring. Moreover, the consequences of rape potentially include many medical and psychological difficulties, such as unwanted pregnancy, risk of sexually transmitted infections (STIs), genital and physical injury, and psychological disturbance e.g. post-traumatic stress disorder, major depression, increased risk of suicide ideation, and alcohol and drug abuse problems. Rape survivors have specific health needs, ideally met by providing integrated and holistic post-rape services, including the provision of pregnancy testing and prevention, termination of pregnancy, testing and treatment of STIs and injuries, and psychosocial counselling. Rape survivors strongly value the availability of HIV prophylaxis, an understanding health care provider, access to and receiving counselling, and thorough physical examination, emphasising the need for a holistic approach to post-rape care. The Act aims to provide certain services to survivors of sexual assault to minimise or prevent further traumatisation, yet the only medical service conditionally provided to rape survivors is the provision of post-exposure prophylaxis (PEP). We aimed to replicate and build on a previous record review of female rape survivors by providing an overview of the demographic, clinical, and rape characteristics of female and male children and adult rape survivors presenting to a rape centre in the Western Cape. We aimed to provide evidence and support for the ongoing call for the provision of effective and integrated post-rape services for rape survivors.

Patient–physician communication barriers regarding fertility preservation among newly diagnosed cancer patients

With cancer survival rates increasing, new directions have focused on issues of survivorship, with an intense focus on quality of life. One area gaining increased attention is fertility preservation and future parenthood among cancer survivors. Although medical options for fertility preservation exist, most are not well understood by physicians, patients and family members, and are not readily accessible to patients and their health care providers. This paper discusses the current difficulties in communicating information about fertility preservation in the United States. Physician level of knowledge about fertility preservation, attitudes and comfort level with the topics, patient preferences, and financial and practice barriers may serve as obstacles in the communication process. Social, interaction and behavioral research studies are well poised to address the communication barriers and provide possible solutions to problems in understanding fertility preservation, for patients, family members and health care providers alike.

Becoming the best mom that I can: women's experiences of managing depression during pregnancy – a qualitative study

BackgroundThe purpose of this constructivist grounded theory study was to develop a theoretical model that explains women's processes of managing diagnosed depression when pregnant.MethodsWe explored the experiences of 19 women in Ontario who were diagnosed with depression during their pregnancy.ResultsThe model that emerged from the analysis was becoming the best mom that I can. Becoming the best mom that I can explains the complex process of the women's journey as they travel from the depths of despair, where the depression is perceived to threaten their pregnancy and their ability to care for the coming baby, to arrive at knowing the self and being in a better place. In order to reground the self and regain control of their lives, the women had to recognize the problem, overcome shame and embarrassment, identify an understanding healthcare provider, and consider the consequences of the depression and its management. When confronting and confining the threat of depression, the women employed strategies of overcoming barriers, gaining knowledge, and taking control. As a result of counseling, medication, or a combination of both, women felt that they had arrived at a better place.ConclusionFor many women, the idea that depression could occur during pregnancy was antithetical to their vision of the pregnant self. The challenge for a pregnant woman who is diagnosed with depression, is that effective care for her may jeopardize her baby's future health. This provides a dilemma for about-to-be parents and their healthcare providers. Improved awareness of depression during pregnancy on the part of healthcare professionals is needed to improve the women's understanding of this disorder and their ability to recognize and seek help with depression should it occur during the prenatal period. Further qualitative research is needed to determine the specific aspects that need to be addressed in such classes.

Apoio no nascimento: percepções de profissionais e acompanhantes escolhidos pela mulher

To understand health care providers' perception on managing laboring women in the presence of a labor companion of their choice, and the labor companion's perception of this experience. A qualitative study was conducted based on a controlled randomized clinical trial. Sampling was intentional and determined through information saturation. Semi-structured interviews were carried out with 11 health care providers and 16 laboring companions in the obstetric unit of a maternity facility at the hospital complex, in Campinas, Southern Brazil, between October 2004 and March 2005. The thematic analysis of discourse was applied using the following methodological figures: central idea, key expressions and discourse of the collective subject. The most remarkable central ideas of health care providers were: no difference was observed in managing laboring women with a labor companion; positive changes were noted in labor management when a labor companion was present; the companion provided emotional support to laboring women who were more pleased, and felt safer and peaceful; many positive aspects were seen in the behavior and involvement of laboring women with a labor companion; the companion caused no problems and encouraged health providers to engage in a more humane and less routine attitude. The main central ideas of labor companions were: positive feelings, emotions, a sense of satisfaction with the experience; being with the laboring woman was a great opportunity to provide her emotional support; and they felt welcome by health care providers. Health providers considered positive the support provided by a labor companion and had no problems in managing laboring women in the presence of their companions. Labor companions were pleased and happy with this experience. There was no conflicting opinions.

Occupational exposure to sharps and splash: Risk among health care providers in three tertiary care hospitals in South India

Occupational exposure to blood and body fluids places Health care providers at risk of infection with blood borne viruses including HIV. To understand Health Care Providers' (HCP*) perception of risk of occupational exposure to needles, blood and body fluids, to find out the correlates of exposure and to identify groups of HCP at high risk of sustaining maximum number of such exposures. A cross sectional survey was conducted on HCP in three tertiary care hospitals in Kerala, between August 20th and October 30th, 2004 Chi square test, independent-sample T test and one-way ANOVA was used for analysis. Overall, 74.5% (95% CI 71.3 to 78.2) of the respondents were exposed at least once in the last 12 months. Surgeons were exposed most frequently, with a mean of 3.8 injuries per person per year. Injection needles were responsible for 68% of the injuries. Those who underwent the in-service training program on needle safety were less injured (<i> P</i> =0.001). Only 4% of surgeons had undergone needle safety training. Almost half the surgeons, anesthetists and medical students did not know the reporting procedure and only 10% of anesthetists knew about the provision of Post Exposure Prophylaxis (PEP). A considerable proportion of respondents (85%) (95% CI- 81.2 to 88.5) were concerned about acquiring blood borne infections and 90% were immunized against Hepatitis B.<br>Training of Health care providers is absolutely essential for injury reduction and should take into account the varying incidence of exposure across different occupation groups.<br>