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Journal of Primary Health Care Jun 2024Introduction Advanced and extended primary health care practice roles have been developed in Aotearoa New Zealand (NZ) for dietetics, nursing, pharmacy, and...
Introduction Advanced and extended primary health care practice roles have been developed in Aotearoa New Zealand (NZ) for dietetics, nursing, pharmacy, and physiotherapy professions. Advanced musculoskeletal physiotherapy roles in primary health care could address escalating health care costs, challenges to workforce sustainability and inefficient primary/secondary care interfaces. Little is known about how stakeholders perceive the recently introduced Advanced Practice Physiotherapist (APP) scope of practice. Aim This study aimed to explore health professionals' perceptions of the APP scope of practice in NZ and how APPs could influence physiotherapy service delivery for people with musculoskeletal conditions in primary health care. Methods Qualitative, face-to-face, semi-structured interviews were conducted with 15 participants including physiotherapists, general practitioners, medical specialists and Accident Compensation Corporation case managers. Inductive interpretive analysis was undertaken. Results Five themes were identified: perceptions of current musculoskeletal management in primary health care; lack of a career pathway; ways in which APPs might facilitate change and what their role would be; characteristics of an APP; and the implementation of the APP role into practice. Discussion Stakeholders were supportive of the APP scope of practice and thought it has the potential to improve patient pathways, health care delivery and health outcomes for those with musculoskeletal conditions. Stakeholders also thought it would fill an important gap in the physiotherapy clinical career pathway. Successful implementation will require assessment of applicants' personal attributes as well as clinical experience and academic qualifications to ensure all stakeholders have confidence to engage with the service, clear communication, active promotion and specific funding.
Topics: Humans; Primary Health Care; New Zealand; Physical Therapists; Qualitative Research; Attitude of Health Personnel; Male; Female; Scope of Practice; Interviews as Topic; Musculoskeletal Diseases; Adult; Professional Role; Middle Aged; Stakeholder Participation
PubMed: 38941257
DOI: 10.1071/HC24029 -
Journal of Primary Health Care Jun 2024Introduction From a coronavirus disease (COVID-19) pandemic perspective, Aotearoa New Zealand (NZ) rural residents formed an at-risk population, and disparities between...
He Aroka Urutā. Rural health provider perspectives of the COVID-19 vaccination rollout in rural Aotearoa New Zealand with a focus on Māori and Pasifika communities: a qualitative study.
Introduction From a coronavirus disease (COVID-19) pandemic perspective, Aotearoa New Zealand (NZ) rural residents formed an at-risk population, and disparities between rural and urban COVID-19 vaccination coverage have been found. Aim To gain insight into factors contributing to the urban-rural COVID-19 vaccination disparity by exploring NZ rural health providers' experiences of the vaccine rollout and pandemic response in rural Māori and Pasifika communities. Methods Rural health providers at four sites participated in individual or focus group semi-structured interviews exploring their views of the COVID-19 vaccine rollout. Thematic analysis was undertaken using a framework-guided rapid analysis method. Results Twenty interviews with 42 participants were conducted. Five themes were identified: Pre COVID-19 rural situation, fragile yet resilient; Centrally imposed structures, policies and solutions - urban-centric and Pakehā focused; Multiple logistical challenges - poor/no consideration of rural context in planning stages resulting in wasted resource and time; Taking ownership - rural providers found geographically tailored, culturally anchored and locally driven solutions; Future directions - sustained investment in rural health services, including funding long-term integrated (rather than 'by activity') health services, would ensure success in future vaccine rollouts and other health initiatives for rural communities. Discussion In providing rural health provider perspectives from rural areas serving Māori and Pasifika communities during the NZ COVID-19 vaccine rollout, the importance of the rural context is highlighted. Findings provide a platform on which to build further research regarding models of rural health care to ensure services are designed for rural NZ contexts and capable of meeting the needs of diverse rural communities.
Topics: Humans; New Zealand; COVID-19 Vaccines; COVID-19; Qualitative Research; Native Hawaiian or Other Pacific Islander; Rural Health Services; Rural Population; SARS-CoV-2; Female; Health Personnel; Interviews as Topic; Male; Focus Groups; Healthcare Disparities; Attitude of Health Personnel; Pandemics; Adult; Maori People
PubMed: 38941251
DOI: 10.1071/HC23171 -
Journal of Primary Health Care Jun 2024Introduction The University of Otago School of Pharmacy Clinic (the Clinic) is a campus-based non-dispensing clinic that offers consultation-based medicines optimisation...
Introduction The University of Otago School of Pharmacy Clinic (the Clinic) is a campus-based non-dispensing clinic that offers consultation-based medicines optimisation services to patients. Aim This project aims to understand the experiences and opinions of healthcareproviders who have referred patients to the School of Pharmacy Clinic, specifically: their motivation for referring patients; how the Clinic impacts providers, patients and the wider health system; provider satisfaction; and opportunities for further collaboration. Methods Semi-structured interviews were used to collect data from 15 participants who represented five health professions. An inductive reflexive thematic analysis approach was used to analyse the dataset from which codes and themes were developed. Normalisation Process Theory (NPT) was used to structure the interview guide and as a framework to present themes. Results Seven themes were developed; 'Perceptions of Pharmacists' (Coherence), 'Motivators for Engagement' and 'Barriers to Engagement' (Cognitive Participation), 'Utility of Pharmacist Feedback' and 'Opportunities' (Collective Action) and 'Referrers' Experiences' and 'Patient-centred Care' (Reflexive Action). Discussion Healthcare providers described predominantly positive experiences. Medically complex cases and patients requiring medicines education were most likely to be referred for consultation. Engaging with the Clinic presented valuable opportunities for interprofessional collaborative practice and continuing professional education. Referrers would like more regular contact with Clinic pharmacists to encourage interprofessional collaborative relationships. Patients were thought to benefit from their pharmacist's clinical expertise, time, patient-centred approach and subsequent medication and health optimisation. Integration of Clinic pharmacists into specialist outpatient clinics at Dunedin Hospital may broaden the scope and improve efficiency of their services.
Topics: Humans; Qualitative Research; Referral and Consultation; Pharmacists; Attitude of Health Personnel; Female; Male; Motivation; Patient-Centered Care; Interviews as Topic; Health Personnel; Interprofessional Relations; Ambulatory Care Facilities; Adult
PubMed: 38941248
DOI: 10.1071/HC24022 -
Journal of Primary Health Care Jun 2024Introduction Around 5% of the people in Aotearoa New Zealand (NZ) are not enrolled with a general practice. Aim This study aimed to explore the utilisation of general...
Introduction Around 5% of the people in Aotearoa New Zealand (NZ) are not enrolled with a general practice. Aim This study aimed to explore the utilisation of general practice by enrolment status and subsequent use of an emergency department. Methods We compared a cohort of respondents from New Zealand Health Surveys (2013/14-2018/19) on self-reported general practice utilisation and their substitutes, according to their enrolment status (enrolled and not enrolled). They were then followed up to examine their subsequent use of an emergency department. Time to an emergency department presentation was modelled with proportional hazards regression models with enrolment status as the explanatory variable. Confounding variables used were sex, age group, prioritised ethnicity, the New Zealand Deprivation Index and self-rated health. Results Those not enrolled were more likely to be young, male, Asian, more socioeconomically deprived and with better health status than those enrolled. Generally, those not enrolledutilised general practice services less. Those not enrolled who had used an emergency department were more likely to have used it as a substitute for general practice (40% vs 26%). Modelling showed that those not enrolled took longer to access an emergency department. Adjusting for confounding variables did not change that interpretation. Discussion Those not enrolled were younger and healthier and may have a perception that enrolment isn't necessary. As a group, they were more likely to be socioeconomically deprived and to use an emergency department, which is free at a public hospital in NZ, as a substitute for primary care which suggests that cost may influence their choices.
Topics: Humans; New Zealand; Emergency Service, Hospital; Male; Female; Middle Aged; Adult; General Practice; Young Adult; Adolescent; Aged; Cohort Studies; Patient Acceptance of Health Care; Socioeconomic Factors; Sex Factors; Age Factors; Health Status
PubMed: 38941245
DOI: 10.1071/HC24023 -
Revista de La Facultad de Ciencias... Jun 2024Introducción: La fiebre es común en la niñez y existe un alto nivel de preocupación por parte de los cuidadores para manejarla, a esto se le denomina "fiebrefobia".... (Observational Study)
Observational Study
Introducción: La fiebre es común en la niñez y existe un alto nivel de preocupación por parte de los cuidadores para manejarla, a esto se le denomina "fiebrefobia". El objetivo fue evaluar la presencia de fiebrefobia y factores asociados en la población de estudio. Materiales y método: estudio observacional, transversal, con recolección prospectiva y analítico durante el 2021 a 2022, a través de una encuesta ad hoc auto administrada a los padres y/o cuidadores de pacientes menores de 6 años que consultaron a la emergencia del Hospital de Niños Dr. Roberto del Río en Santiago de Chile. Se analizó la asociación entre las variables sociodemográficas, conocimientos, actitudes y temores frente al niño febril mediante Chi cuadrado, Fisher además de análisis de regresión logística univariante. Resultados: Se realizaron 381 encuestas. El 98% presentó algún grado de fiebrefobia. El 40,6% definió fiebre bajo los 38°C. El 56 % de los cuidadores utilizaba medidas físicas. La principal secuela temida por los tutores fueron las convulsiones (82 %) y un 42,7% refirió que podía ser letal. La mayoría (92%) utilizó fuentes de información no confiables y dos tercios (66%) nunca recibieron información sobre el tema por parte del personal de salud. La regresión logística evidenció que el hecho de ser progenitor, el nivel de escolaridad básica o media y un umbral térmico menor a 38°C fueron las variables mayormente asociadas a la fiebrefobia. Conclusiones. La fiebrefobia es un fenómeno vigente en nuestra población y la entrega de información adecuada y oportuna pudiese prevenirlo.
Topics: Humans; Cross-Sectional Studies; Male; Female; Fever; Prospective Studies; Child, Preschool; Health Knowledge, Attitudes, Practice; Caregivers; Socioeconomic Factors; Infant; Parents; Adult; Phobic Disorders; Surveys and Questionnaires; Chile; Child
PubMed: 38941223
DOI: 10.31053/1853.0605.v81.n2.42845 -
JMIR Research Protocols Jun 2024Despite the potential to significantly reduce complications, many patients do not consistently receive diabetes preventive care. Our research team recently applied... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Despite the potential to significantly reduce complications, many patients do not consistently receive diabetes preventive care. Our research team recently applied user-centered design sprint methodology to develop a patient portal intervention empowering patients to address selected diabetes care gaps (eg, no diabetes eye examination in last 12 months).
OBJECTIVE
This study aims to evaluate the effect of our novel diabetes care gap intervention on completion of selected evidence-based diabetes preventive care services and secondary outcomes.
METHODS
We are conducting a pragmatic randomized controlled trial of the effect of the intervention on diabetes care gaps. Adult patients with diabetes mellitus (DM) are recruited from primary care clinics affiliated with Vanderbilt University Medical Center. Participants are eligible if they have type 1 or 2 DM, can read in English, are aged 18-75 years, have a current patient portal account, and have reliable access to a mobile device with internet access. We exclude patients with medical conditions that prevent them from using a mobile device, severe difficulty seeing, pregnant women or women who plan to become pregnant during the study period, and patients on dialysis. Participants will be randomly assigned to the intervention or usual care. The primary outcome measure will be the number of diabetes care gaps among 4 DM preventive care services (diabetes eye examination, pneumococcal vaccination, hemoglobin A, and urine microalbumin) at 12 months after randomization. Secondary outcomes will include diabetes self-efficacy, confidence managing diabetes in general, understanding of diabetes preventive care, diabetes distress, patient portal satisfaction, and patient-initiated orders at baseline, 3 months, 6 months, and 12 months after randomization. An ordinal logistic regression model will be used to quantify the effect of the intervention on the number of diabetes care gaps at the 12-month follow-up. For dichotomous secondary outcomes, a logistic regression model will be used with random effects for the clinic and provider variables as needed. For continuous secondary outcomes, a regression model will be used.
RESULTS
This study is ongoing. Recruitment was closed in February 2022; a total of 433 patients were randomized. Of those randomized, most (n=288, 66.5%) were non-Hispanic White, 33.5% (n=145) were racial or ethnic minorities, 33.9% (n=147) were aged 65 years or older, and 30.7% (n=133) indicated limited health literacy.
CONCLUSIONS
The study directly tests the hypothesis that a patient portal intervention-alerting patients about selected diabetes care gaps, fostering understanding of their significance, and allowing patients to initiate care-will reduce diabetes care gaps compared with usual care. The insights gained from this study may have broad implications for developing future interventions to address various care gaps, such as gaps in cancer screening, and contribute to the development of effective, scalable, and sustainable approaches to engage patients in chronic disease management and prevention.
TRIAL REGISTRATION
ClinicalTrials.gov NCT04894903; https://classic.clinicaltrials.gov/ct2/show/NCT04894903.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)
DERR1-10.2196/56123.
Topics: Humans; Patient Portals; Adult; Middle Aged; Female; Male; Aged; Adolescent; Diabetes Mellitus; Young Adult; Pragmatic Clinical Trials as Topic
PubMed: 38941148
DOI: 10.2196/56123 -
JAMA Network Open Jun 2024
Topics: Humans; Opioid-Related Disorders; Primary Health Care; Health Knowledge, Attitudes, Practice; Female; Male; Adult; Middle Aged; Analgesics, Opioid; Cross-Sectional Studies; Surveys and Questionnaires
PubMed: 38941101
DOI: 10.1001/jamanetworkopen.2024.19094 -
Global Health Action Dec 2024Although there is increasing awareness of the health risks of air pollution as a global issue, few studies have focused on the methods for assessing individuals'... (Review)
Review
BACKGROUND
Although there is increasing awareness of the health risks of air pollution as a global issue, few studies have focused on the methods for assessing individuals' perceptions of these risks. This scoping review aimed to identify previous research evaluating individuals' perceptions of air pollution and its health effects, and to explore the measurement of perceptions, as a key resource for health behaviour.
METHODS
The review followed the methodological framework proposed by Arksey and O'Malley. PubMed and Web of Science were searched. After initial and full-text screening, we further selected studies with standardised scales that had previously been tested for reliability and validity in assessing awareness and perceptions.
RESULTS
After full-text screening, 95 studies were identified. 'Perception/awareness of air quality' was often measured, as well as 'Perception of health risk.' Only nine studies (9.5%) used validated scaled questionnaires. There was considerable variation in the scales used to measure the multiple dimensions of risk perception for air pollution.
CONCLUSION
Few studies used structured scales to quantify individuals' perceptions, limiting comparisons among studies. Standardised methods for measuring health risk perception are needed.
Topics: Humans; Air Pollution; Health Knowledge, Attitudes, Practice; Risk Assessment; Perception; Surveys and Questionnaires
PubMed: 38940815
DOI: 10.1080/16549716.2024.2370100 -
Alternative Therapies in Health and... Jun 2024To evaluate the effectiveness of Information, Knowledge, Attitude, and Practice (IKAP) nursing in the perioperative care of endometriosis patients treated with...
OBJECTIVE
To evaluate the effectiveness of Information, Knowledge, Attitude, and Practice (IKAP) nursing in the perioperative care of endometriosis patients treated with laparoscopic surgery.
METHODS
A total of 100 patients with endometriosis who underwent laparoscopic surgery in our hospital from June 2020 to December 2021 were recruited and assigned to receive either routine care (control group) or IKAP care (observation group), with 50 cases in each group. Outcome measures included operative time, time-lapse before postoperative passing gas, length of hospital stay, self-rating anxiety scale (SAS), self-rating depression scale (SDS), Generic Quality of Life Inventory-74 (GQOLI-74) scores, and nursing outcomes.
RESULTS
Before nursing, the SAS, SDS, and GQOLI-74 scores of the two groups were comparable (P > .05). IKAP care resulted in significantly lower SAS and SDS scores, and higher GQOLI-74 scores than routine care (P < .05). IKAP care was associated with significantly shorter operative time, time-lapse before postoperative passing gas, and length of hospital stay compared to routine care (P < .05). Patients receiving IKAP care showed higher compliance, lower incidence of postoperative complications, and higher nursing satisfaction than those with routine care (P > .05).
CONCLUSION
IKAP nursing shortens the length of hospital stay after laparoscopic surgery for endometriosis, mitigates patients' adverse emotions, reduces postoperative complications, and effectively improves patients' medication adherence and quality of life.
PubMed: 38940808
DOI: No ID Found -
Alternative Therapies in Health and... Jun 2024Traumatic brain injury (TBI) can result in lifelong cognitive, emotional, and motor impairments. The emergency department is the first stop for diagnosing and treating...
CONTEXT
Traumatic brain injury (TBI) can result in lifelong cognitive, emotional, and motor impairments. The emergency department is the first stop for diagnosing and treating patients with acute TBI, and the quality of nursing care can greatly influence the prognosis and progression of a patient's condition. Currently, standardized evaluation tools are lacking in the world for assessment of the quality of nursing care.
OBJECTIVE
The study intended to construct a nursing-sensitive indicator system for TBI patients, based on the scientific method of evidence-based nursing and the Delphi method, to provide a quantitative tool for emergency-nursing personnel to manage the quality of care for those patients.
DESIGN
Based on the Joanna Briggs Institute's evidence-based healthcare model, the research team performed a literature search and consulted reference guidelines, conducted two rounds of consultations with experts. sensitive indicators for quality of care, and constructed the sensitive indicator system. The team then conducted a retrospective study.
SETTING
The study took place in the department of emergency surgery at Shanxi Norman Bethune Hospital in Taiyuan, Shanxi, China.
PARTICIPANTS
Participants were 56 patients with TBI who had been admitted to the emergency department between January 2022 and December 2022 and 44 patients with TBI who had been admitted to the emergency department between January 2023 and December 2023.
INTERVENTIONS
The research team assigned: (1) the 56 patients in the first group to the control group, who received routine nursing care and (2) the 44 patients in the second group to the intervention group, who received treatment using the sensitive indicator system for the quality of emergency care for TBI patients as well as routine care.
OUTCOME MEASURES
In the verification study, the research team compared the group's rescue effects and satisfaction with emergency care.
RESULTS
In the first and second rounds of inquiries to experts, the research team distributed 25 questionnaires each time, with 25 valid questionnaires collected both times. The response rate for both rounds of inquiries was 100%. The expert authority coefficients for the first and second rounds of inquiries are 0.844 and 0.878, respectively. The sensitive indicator system's final construction included three primary indicators, seven secondary indicators, and 17 tertiary indicators. The AUC for the sensitive indicators was 0.8355882. The indicator system's use found that the intervention group had a shorter time to diagnosis (P < .001), emergency-department stay (P < .001), and emergency-department-to-surgery time (P < .001) compared to the control group. The intervention group also has a higher success rate for the emergency treatment (P = .014) and a higher nursing satisfaction with nurse-patient communications (P = .003), first-aid operations (P < .001), nursing attitudes (P < .001), and emergency environment (P < .001) compared to the control group.
CONCLUSIONS
The process of constructing quality-sensitive indicators for the nursing care of TBI patients was scientific. The constructed quality-sensitive indicator system for the care of patients with TBI covers key factors that influence the quality of care. It's highly practical and has the ability to transform certain indicators, which can better guide the management of quality of care for TBI.
PubMed: 38940780
DOI: No ID Found