Visit Planning Research Articles

Psychosocial health coaching for chronically ill in a telehealth context: a pilot study

Psychosocial health coaching for chronically ill in a telehealth context: a pilot study

Partnering With Community-Dwelling Individuals With Diabetes for Health Behavior Change Using Action Plans: An Innovation in Health Professionals Education and Practice.

Health care practitioners support or hinder an individual's attempts to self-manage health behavior. Practitioners must understand an individual's health needs and goals to effectively partner for behavior change. Self-management support (SMS) promote efforts toward positive health behavior change. Practitioners need training to provide effective SMS, beginning with their formal education. The purpose of this educational practice project was to integrate an evidence-based intervention (SMS using action plans) into a nursing curriculum. Three sequential steps included (1) providing foundational SMS education, (2) SMS application with students' personal action plans, and (3) implementing SMS with community-dwelling individuals with diabetes. Students (n = 130) partnered with participants (n = 85), developing short- (n = 240) and long-term (n = 99) action plans during home visits. The average baseline Diabetes Empowerment Scale score measuring participant's perceived psychosocial diabetes management self-efficacy was 4.3 (1-5 scale, SD = 0.51, n = 83). Most common short-term actions related to physical activity (n = 100, 42%) and healthy eating (n = 61, 25%). Average participant confidence level was 7.7 (SD = 1.9, 0-10 scale). Short-term goal evaluation (n = 209) revealed 66% (n = 137) were met more than 50% of the time. Both participants (99%) and students (99%) expressed satisfaction with home visit and action plan experiences. This teaching-learning experience is replicable and applicable to any professional health care student.

Automatic weather stations for basic and applied glaciological research

Since the early 1980s, the Geological Survey of Denmark and Greenland (GEUS) glaciology group has developed automatic weather stations (AWSs) and operated them on the Greenland ice sheet and on local glaciers to support glaciological research and monitoring projects (e.g. Olesen & Braithwaite 1989; Ahlstrøm et al. 2008). GEUS has also operated AWSs in connection with consultancy services in relation to mining and hydropower pre-feasibility studies (Colgan et al. 2015). Over the years, the design of the AWS has evolved, partly due to technological advances and partly due to lessons learned in the field. At the same time, we have kept the initial goal in focus: long-term, year-round accurate recording of ice ablation, snow depth and the physical parameters that determine the energy budget of glacierised surfaces. GEUS has an extensive record operating AWSs in the harsh Arctic environment of the diverse ablation areas of the Greenland ice sheet, glaciers and ice caps (Fig. 1). The current GEUS-type AWS (Fig. 2) records meteorological, surface and sub-surface variables, including accumulation and ablation, as well as for example ice velocity. A large part of the data is transmitted by satellite near real-time to support ongoing applications, field activities and the planning of maintenance visits. The data have been essential for assessing the impact of climate change on land ice. The data are also crucial for calibration and validation of satellite-based observations and climate models (van As et al. 2014).

Pharmacist Chart Reviews Cannot Replace Direct Care in the Management of Renal Transplant Recipients.

OBJECTIVE: The aim of this study was to determine if a pharmacist executed comprehensive chart review may serve as a sufficient substitution for direct participation during clinic visits beyond the immediate post-transplant period. METHODS: This was a prospective 3 month study of kidney transplant recipients that had a scheduled visit within 3 years of transplant. Within 1 week prior to the visit, a clinical pharmacist completed a comprehensive review of the medical record and placed a note in the chart focusing on identifying all medication-related issues and providing recommendations for management. Providers were notified about the review and, following the visit, were asked to complete a survey about the utility of the note. After the appointment, the visit plan was compared with the pharmacist's note to determine whether the provider accepted the recommendations. An independent blinded transplant surgeon graded the recommendations by severity. Accepted recommendations were identified as novel if the evidence supporting it had been available to the provider but was not previously acted upon. RESULTS: During the study, pharmacists provided 1,401 recommendations from 170 chart reviews. Providers followed 397 (28%) of the recommendations; 232 (34%) of the recommendations pertaining to pharmacologic therapy were accepted, while 410 (29%) were graded as having at least a significant severity (Table 1). Providers completed the usefulness survey after 44 visits and 75% indicated that the pharmacist note impacted their interventions. Greater than 80% of the accepted recommendations were considered novel. CONCLUSIONS: This study demonstrates that a pharmacist chart review was not routinely utilized by providers during follow-up visits and suggests that this method of pharmacist involvement in transplant recipient care may not be effective or efficient. Future analyses should directly compare this form of intervention with direct patient-provider interactions.Table: No Caption available.

Improving treatment of depression in primary health care: a case study of obstacles to perform a clinical trial designed to implement practice guidelines.

The aim of this study is to investigate factors contributing to the failure of a randomized clinical trial designed to implement and test clinical practice guidelines for the treatment of depression in primary health care (PHC). Although the occurrence of depression is increasing globally, many patients with depression do not receive optimal treatment. Clinical practice guidelines for the treatment of depression, which aim to establish evidence-based clinical practice in health care, are often underused and in need of operationalization in and adaptation to clinical praxis. This study explores a failed clinical trial designed to implement and test treatment of depression in PHC in Sweden. Qualitative case study methodology was used. Semi-structured interviews were conducted with eight participants from the clinical trial researcher group and 11 health care professionals at five PHC units. Additionally, archival data (ie, documents, email correspondence, reports on the clinical trial) from the years 2007-2010 were analysed. The study identified barriers to the implementation of the clinical trial in the project characteristics, the medical professionals, the patients, and the social network, as well as in the organizational, economic and political context. The project increased staff workload and created tension as the PHC culture and the research activities clashed (eg, because of the systematic use of questionnaires and changes in scheduling and planning of patient visits). Furthermore, there was a perception that the PHC units' management did not sufficiently support the project and that the project lacked basic incentives for reaching a sustainable resolution. Despite efforts by the project managers to enhance and support implementation of the innovation, they were unable to overcome these barriers. The study illustrates the complexity and barriers of performing clinical trials in the PHC.

Prospective assessment of urinary, gastrointestinal and sexual symptoms before, during and after image-guided volumetric modulated arc therapy for prostate cancer

Objective. The aim of this study was to prospectively assess the development of 24 urinary, gastrointestinal and sexual symptoms in patients with prostate cancer (PCa) during and after image-guided volumetric modulated arc therapy (IG-VMAT). Material and methods. A total of 87 patients with PCa participated in this study. The patients were asked to complete a modified version of the Prostate Cancer Symptom Scale (PCSS) questionnaire before radiotherapy (RT) (baseline), at the start of RT, at the end of RT and 1 year after RT. Changes in symptoms at the start of RT, at the end of RT and 1 year after RT compared to baseline were analysed by a mixed model analysis of repeated measurements with the following covariates: age, comorbidity, smoking and androgen deprivation therapy (ADT). Results. All urinary problems except for haematuria increased significantly at the end of RT compared to baseline. One year after RT, there was no longer any difference compared to baseline for any of the urinary symptoms. All gastrointestinal symptoms except for nausea increased significantly at the end of RT. One year after RT, patients also reported slightly higher degrees of stool frequency, bowel leakage, planning of toilet visits, flatulence, mucus, gastrointestinal bleeding and impact of gastrointestinal bother on daily activities compared to baseline. All sexual symptoms increased significantly at all times compared to baseline. The use of ADT was associated with worse sexual symptoms. Conclusions. IG-VMAT is a safe treatment for PCa, with few and mild changes in urinary and gastrointestinal symptoms 1 year after RT compared to baseline. Sexual symptoms deteriorated both during and after RT. The use of ADT was associated with worse sexual symptoms.

A visita domiciliar de enfermeiros e agentes comunitários de saúde da Estratégia Saúde da Família

The objective of this article was to describe the practice of nurses and community health agents within the context of the Family Health Strategy home visits. This is a descriptive study with a qualitative approach. Data collection was performed between January and March of 2010, through semi-structured interviews with eight nurses and seven community health agents from two family health units in the city of Rio de Janeiro. Data were submitted to content analysis. Low interaction was observed between nurses and community health agents in the home visits. Work overload and violence are the main hindrances identified for performing home visits. It was found that the home visit planning was unsystematic. Permanent education should be intensified with the purpose to discuss, following a problem-posing approach, the roles and attributions of each team member in the home visit, as well as the systematization of this activity. Descriptors: Family Health; Nursing; Community Health Workers; Home Visit.

A162: Pre‐visit Planning and Quality Improvement in Juvenile Idiopathic Arthritis

Background/Purpose:Pre visit planning (PVP) is a tool used in the management of chronic illnesses. Healthcare providers are given the necessary information prior to the visit, to provide efficient and effective care at the visit. PVP addresses key aspects of the individual patient's needs, provides data for decision making and ensures standard of care with the intent of improving clinical outcomes.PVP has improved diabetic care to achieve clinical targets that reduce cardiovascular events and improved care of pediatric inflammatory bowel disease.In pediatric rheumatology, PVP is becoming important in quality improvement (QI) initiatives. We describe PVP for children with juvenile idiopathic arthritis (JIA) and characterize outcomes at a single site within the Pediatric Rheumatology Care and Outcomes Improvement Network (PR‐COIN).Methods:Nationwide Children's Hospital rheumatology clinic has 4600 annual visits, with JIA being the most common diagnosis. PVP is a platform to unify and implement QI priorities: compliance with uveitis screening guidelines, lab monitoring, optimum pharmacotherapy, and disease activity assessment (PGA) scores.PVP started in February 2013 after buy‐in from all providers and staff. The team includes one administrative staff (who prepares PVP forms and obtains eye visit records), three nurses, three nurse practitioners, 4 physicians who review the PVP forms, and one QI administrative champion. A one‐page PVP form was developed, containing the most important information for a patient visit. The team completes PVP forms two weeks prior to the visit which are made available to the providers on the day of the visit.The PVP form uses a checklist format documenting whether a letter was received from the ophthalmologist about the latest eye exam result, most recent labs to determine medication toxicity, a list of current medications, recommendations on optimum medication doses and a PGA score. The team meets twice a month to evaluate process improvement. Data is entered into the PR‐COIN registry and monthly reports are generated for individual sites.Results:In November 2013, 190 or 36 % of eligible patients were enrolled in PR‐COIN compared to 17% in October 2012. Compliance with the uveitis screening, measured by the number of patients with completed uveitis screens per recommended guidelines, remained stable at 70% from November 2012 to September 2013. Lab monitoring, measured by the number of patients on non‐biologic DMARDS who had toxicity labs performed within the prior three months, remained stable from 100% in Nov 2012 to 100% in Sept 2013. The number of patients with clinically inactive disease on medication increased from 19.6 % in November 2012 to 27.8 % in September 2013, representing a trend in improvement but not yet reaching statistical significance.Conclusion:PVP within PR‐COIN allows us to provide effective patient care, implement ongoing QI goals and link process to measureable outcomes. On a broader scale we can strive for 100% compliance with uveitis screening, as we do with lab monitoring. On an individual level, we can target patients who are not in remission on medications and improve their outcomes.

Virtual visits in home health care for older adults.

Background. This review identifies the content of virtual visits in community nursing services to older adults and explores the manner in which service users and the nurses use virtual visits. Design. An integrative literature review. Method. Data collection comprised a literature search in three databases: Cinahl, Medline, and PubMed. In addition, a manual search of reference lists and expert consultation were performed. A total of 12 articles met the inclusion criteria. The articles were reviewed in terms of study characteristics, service content and utilization, and patient and health care provider experience. Results. Our review shows that in most studies the service is delivered on a daily basis and in combination with in-person visits. The findings suggest that older home-dwelling patients can benefit from virtual visits in terms of enhanced social inclusion and medication compliance. Service users and their nurses found virtual visits satisfactory and suitable for care delivery in home care to the elderly. Evidence for cost-saving benefits of virtual visits was not found. Conclusions. The findings can inform the planning of virtual visits in home health care as a complementary service to in-person visits, in order to meet the increasingly complex needs of older adults living at home.

Mobile application to provide personalized sightseeing tours

Tourist recommendation systems have been growing over the last few years, mainly because of the use of mobile devices to obtain user context. This work discusses some of the most relevant systems on the field and presents PSiS Mobile, which is a mobile recommendation and planning application designed to support a tourist during his vacations. It provides recommendations about points of interest to visit based on tourist preferences and on user and sight context. Also, it suggests a visit planning which can be dynamically adapted based on current user and sight context. This tool works also like a journey dairy since it records the tourist moves and tasks to help him remember how the trip was like. To conclude, some field experiences will be presented.

Classification of Family Risk in a Family Health Center

To identify and classify the degree of family risk in a Family Health Center by means of a multidimensional evaluation instrument. A cross-sectional study, with a quantitative and descriptive design, which evaluated 927 families registered in the center, which covers five micro-areas. The Coelho and Savassi Scale was applied, this consisting of 13 sentinels of evaluation of the social risk, using secondary data available in the File A of the families' medical records, in the last trimester of 2011. The data was analyzed using the SPSS (Statistical Package for the Social Sciences) for Windows software, version 18.0. Among the families studied, 68.5% were classified as not being at risk. It was ascertained that the smallest proportion of at-risk families (8.2%) was found in micro-area 1, and that micro-area 4 had the highest proportion (55.9%). The most-prevalent risk situations were poor conditions of basic sanitation, systemic arterial hypertension, diabetes mellitus and drug addiction. This study's results make it possible to create support for the planning of home visits, to implement health surveillance actions, and for health professionals to better understand the vulnerabilities of the families attended.

Predicting hemoglobin levels in whole blood donors using transition models and mixed effects models

BackgroundTo optimize the planning of blood donations but also to continue motivating the volunteers it is important to streamline the practical organization of the timing of donations. While donors are asked to return for donation after a suitable period, still a relevant proportion of blood donors is deferred from donation each year due to a too low hemoglobin level. Rejection of donation may demotivate the candidate donor and implies an inefficient planning of the donation process. Hence, it is important to predict the future hemoglobin level to improve the planning of donors’ visits to the blood bank.MethodsThe development of the hemoglobin prediction rule is based on longitudinal (panel) data from blood donations collected by Sanquin (the only blood product collecting and supplying organization in the Netherlands). We explored and contrasted two popular statistical models, i.e. the transition (autoregressive) model and the mixed effects model as plausible models to account for the dependence among subsequent hemoglobin levels within a donor.ResultsThe predictors of the future hemoglobin level are age, season, hemoglobin levels at the previous visits, and a binary variable indicating whether a donation was made at the previous visit. Based on cross-validation, the areas under the receiver operating characteristic curve (AUCs) for male donors are 0.83 and 0.81 for the transition model and the mixed effects model, respectively; for female donors we obtained AUC values of 0.73 and 0.72 for the transition model and the mixed effects model, respectively.ConclusionWe showed that the transition models and the mixed effects models provide a much better prediction compared to a multiple linear regression model. In general, the transition model provides a somewhat better prediction than the mixed effects model, especially at high visit numbers. In addition, the transition model offers a better trade-off between sensitivity and specificity when varying the cut-off values for eligibility in predicted values. Hence transition models make the prediction of hemoglobin level more precise and may lead to less deferral from donation in the future.

Report on CTSA Consortium Use of the Community Engagement Consulting Service

The CTSA Community Engagement Consultative Service (CECS) is a national partnership designed to improve community engaged research (CEnR) through expert consultation. This report assesses the feasibility of CECS and presents findings from 2008 to 2009. A coordinating center and five regional coordinating sites managed the service. CTSAs identified a primary previsit CE best practice for consultants to address and completed self-assessments, postvisit evaluations, and action plans. Feasibility was assessed as the percent of CTSAs participating and completing evaluations. Frequencies were calculated for evaluation responses. Of the 38 CTSAs, 36 (95%) completed a self-assessment. Of these 36 sites, 83%, 53%, and 44% completed a consultant visit, evaluation, and action plan, respectively, and 56% of the consultants completed an evaluation. The most common best practice identified previsit was improvement in CEnR (addressing outcomes that matter); however, relationship building with communities was most commonly addressed during consulting visits. Although 90% of the consultants were very confident sites could develop an action plan, only 35% were very confident in the CTSAs' abilities to implement one. Academic medical centers interested in collaborating with communities and translating research to improve health need to further develop their capacity for CE and CEnR within their institutions.

Un sistema di certificazione risk-based per i controlli in agricoltura biologica: un'applicazione tramite Bayesian networks

The existing method of certification in the organic agriculture system, which requires periodic inspection of all operators, is inefficient due to the high cost of these controls. A risk-based decision support system, which could assist the inspection body during the planning of the annual inspection visits, is advocated as being more cost-effective and efficient. The risk-based decision support system is constructed as a Bayesian network; the models incorporate the factors that influence risk of irregularity and analyse their effects by determining probability of noncompliance. Empirical findings, using a sample of Italian data regarding inspection of organic farms, support the idea that the current risk categories used by control bodies in Italy are reasonable, but could be recursively updated by using a Bayesian network model and incremental inspection evidence.

E-heritage and e-museums: technological resources for tourism planning

Internet use for travel planning has increased steadily in recent years, becoming the usual source of travel planning. However, the limited research that has been conducted on the use of websites for museums and heritage presentation sites shows a considerable gap between growing demands and the supply of resources. Websites seem to be a very important tool in the management of audiences, by increasing the capacity to disseminate information, increasing the ability to reach new potential audiences, improving public programmes for entertainment and learning, and improving communication campaigns. In addition, the use of websites for visit planning would allow heritage centres to manage the |visitor|s agenda|. This work seeks to examine the effects of the interaction between heritage sites and new technologies, and the implications of this interaction for cultural diffusion, from a shared approach that integrates heritage, tourism, and web-based communities.

Reducción de la hospitalización mediante un algoritmo de manejo del dengue en Colombia

Assess the impact of a dengue management algorithm on the hospitalization rate of patients with suspected disease in a primary care health facility in an endemic area of Colombia. A quasi-experimental study was conducted at the local hospital in Piedecuesta, Santander, Colombia, based on comparison of two periods (18 weeks each), before and after use of the algorithm. This included recommendations for clinical diagnosis of dengue and the planning of follow-up visits and hemograms, as well as criteria for hospitalization and the discontinuation of follow-up. Hospitalization rates in the two periods were compared using the Poisson analysis. The population analyzed consisted of patients seen in the facility for acute febrile syndrome. For adjustment purposes, the number of dengue cases (IgM positive) identified in the municipality was included. Information was obtained on 964 patients in the first period and 1350 patients in the second. There were 44 and 13 hospitalizations during the respective periods. Use of the algorithm was associated with a significant reduction in the hospitalization rate (ratio: 0.21; 95% confidence interval; 0.11-0.39). This association did not change when adjusted for the number of dengue cases identified in the city. There were no significant differences in the rate of follow-up visits (P = 0.85) and hemograms (P = 0.24) in the two periods. There were no case fatalities. The results suggest that health care resources for dengue management can be optimized with the use of the algorithm.

Continuity of care: when do patients visit community healthcare providers after leaving hospital?

Enhanced communication and transfer of information between healthcare providers and healthcare settings can reduce medication and healthcare errors post-hospital discharge. The timeframes within which patients access community healthcare providers post-hospital discharge are not well studied. This study aimed to determine length of time from hospital discharge until a general practice, pharmacy or specialist visit, or care planning service. We conducted a retrospective analysis of Department of Veterans' Affairs health claims data. All 109 860 veterans hospitalized in 2006 were included. Main outcome measures were time from first hospital discharge to first claim for a general practice, pharmacy, specialist visit and/or care planning service. Within 30 days of hospital discharge 71% of subjects visited a general practitioner (GP), 86% had medicines dispensed from a community pharmacy and 44% saw a specialist. Median time to first pharmacy visit was 6 days (interquartile range 2-14) and 12 days for a GP visit (interquartile range 4-31). Less than 2% of the cohort received a discharge plan, case conference or medication review in the month after discharge. With 25% of patients having a claim for a GP service within 4 days of discharge, discharge summaries need to reach community-based health professionals within this time. Most patients visited their community pharmacy within 2 weeks of hospital discharge and before they saw their GP. Pharmacists are not routinely advised of hospitalization or provided with discharge summaries. More active engagement of this professional group in the continuum of care might improve care after hospital discharge.

Patient management and care after primary percutaneous coronary intervention: reinforcing a continuum of care after primary percutaneous coronary intervention

Primary percutaneous coronary interventions (PPCIs) improve outcomes in patients with ST-elevation myocardial infarction and facilitate the hospitalization course. In most cases, the patient can be discharged within 3 to 5 days after the PPCI, provided that careful triage is applied. Bleeding--often associated with excessive antithrombotic drug dosing--is a major concern. Transfusion has been documented to be a strong and independent predictor of mortality; for this reason, recent guidelines recommend that bleeding be managed using a conservative strategy that limits transfusions and the discontinuation of antithrombotic drugs to major bleeding events and only when local hemostatic interventions are not effective. Primary percutaneous coronary intervention is often performed without previous assessment of renal function, and the amount of contrast medium should be kept to a minimum, because contrast-induced nephropathy occurs frequently and is associated with higher early and late mortality. The risk of major arrhythmias should also be addressed correctly. The prognostic implication of ventricular arrhythmias is extremely dependent on the timing of presentation: midterm mortality is much higher among subjects experiencing a new arrhythmic event after PPCI compared with patients with existing arrhythmias at PPCI or those without arrhythmias. The Zwolle risk score is useful for identifying subjects who may be safely discharged early. Secondary prevention starts at the end of PPCI. Hospital discharge and the planning of follow-up visits are critical for therapeutic recommendations. After an ST-elevation myocardial infarction, patients are at increased risk of recurrences, even when the PPCI is timely; a rehabilitation program and all measures that increase adherence to medications should be implemented, starting at discharge.

IDPC Briefing Paper - The Need for Increased Transparency: The Country Correspondence of the International Narcotics Control Board

The International Narcotics Control Board (INCB) remains one of the least transparent and most secretive of UN bodies. It meets in secret, and while agendas can now be found on the INCB’s website, no minutes of its meetings are published, nor are the analyses by which it arrives at its positions on policy issues. Although retrospective reports are available on-line, the Board’s country visits are conducted behind a veil of secrecy. There is no advance publicity, criteria for country selection or opportunities for public forums while Board members are in-country. The governments visited undoubtedly value the chance to discuss their drug policies in confidence. Yet the secrecy surrounding the planning of such visits and the lack of mechanisms for input from health professionals or non-governmental experts surely impedes the effectiveness of the Board’s visits. Such secrecy insulates the INCB from healthy dialogue about its focus and priorities. The Board’s culture of secrecy insulates it from much needed oversight in general; a point well illustrated by current practice surrounding INCB-country correspondence - the main focus of this IDPC briefing paper.

Reaching every district (RED) approach to strengthen routine immunization services: evaluation in the African region, 2005

This evaluation was undertaken in 2005, in the African region, to better understand the reaching every district (RED) implementation process that provides a framework for strengthening immunization services at the district level. In June 2005, a convenience sample of five countries was selected to evaluate the implementation of RED. Evaluation teams consisting of key partners conducted site visits to the national, district and health facility levels using standardized qualitative questionnaires. RED was implemented in a similar manner in all five countries, i.e. starting with training and micro-planning. All RED components were implemented to some degree in the countries. Common implementation factors included development of plans, expanding outreach services (defined as services provided in sites outside fixed immunization sites), planning of supervisory visits and efforts to link with communities and utilize community volunteers. Monitoring tools such as wall charts and maps were observed and reportedly used. Evaluation of the RED implementation process provided evidence of improvement in delivery of routine immunization services. The RED framework should continue to be used to strengthen the immunization delivery system to meet continuing new demands, such as the introduction of new vaccines and integrated delivery of other child survival interventions.