Showing papers on "Integrated care published in 1994"

Integrated care for asthma: a clinical, social, and economic evaluation

Abstract: Objective : To evaluate integrated care for asthma in clinical, social, and economic terms. Design : Pragmatic randomised trial. Setting : Hospital outpatient clinics and general practices throughout the north east of Scotland. Patients : 712 adults attending hospital outpatient clinics with a diagnosis of asthma confirmed by a chest physician and pulmonary function reversibility of at least 20%. Main outcome measures : Use of bronchodilators and inhaled and oral steroids; number of general practice consultations and hospital admissions for asthma; sleep disturbance and other restrictions on normal activity; pyschological aspects of health including perceived asthma control; patient satisfaction; and financial costs. Results : After one year there were no significant overall differences between those patients receiving integrated asthma care and those receiving conventional outpatient care for any clinical or psycho-social outcome. For pulmonary function, forced expiratory volume was 76% of predicted for integrated care patients and 75% for conventional outpatients (95% confidence interval for difference -3.6% to 5.0%). Patients who had experienced integrated care were more likely to select it as their preferred course of future management (75% (251/ 333) v 62% (207/333) (6% to 20%); they saved pounds sterling 39.52 a year. This was largely because patients in conventional outpatient care consulted their general practioner as many times as those in integrated care, who were not also visiting hospital. Conclusion : Integrated care for moderately severe asthma patients is clinically as effective as conventional outpatient care, cost effective, and an attractive management option for patients, general practioners, and hospital consultants.

An instrumentation system for the remote monitoring of changes in functional health status of the elderly at home

Abstract: There is a rapidly developing interest in the creative use of information, instrumentation and communications technology for the nonconstrained monitoring of physiological and health variables at home. Evidence for this interest are major research programs in Europe, such as the Technology Initiative for Disabled and Elderly People (TIDE), and the European Prototype for Integrated Care (EPIC), initiated under the general umbrella of the Advanced Informatics in Medicine (AIM) program which has as a major theme the application of Telematics Systems in Health Care. Here, the authors discuss the design and implementation of instrumentation modules for monitoring the interaction between the elderly participant and his or her living environment to assess changes in functional health status. The objectives of the first data collection phase are to develop individualised templates of functional health status and to use knowledge based systems to identify changes which may indicate a deterioration of health and a reduced capacity for coping with the demands of day to day living. This is a major interdisciplinary study involving biomedical design engineers, computer scientists (medical AI) and community medicine specialists. Preliminary data are presented on the results of a small pilot project and a major field trial involving over 75 households. >

Integrated care for patients with asthma: views of general practitioners.

Abstract: BACKGROUND. In 1989, a shared or integrated care scheme was developed for hospital outpatients with asthma, using the computerized patient record system of Grampian Health Board, Scotland. Patients with asthma attending hospital clinics were entered into this scheme and were invited to attend their general practitioner instead of an outpatient clinic for review of their asthma. Three-monthly questionnaires covering clinical aspects of asthma were sent to these patients and their general practitioners; the latter then returned them to the specialist. Patients could be recalled to the hospital clinic if either the general practitioner or consultant felt this was necessary and all patients were reviewed after one year by the specialist. The success of integrated care for patients with asthma relies on the cooperation of general practitioners. AIM. The aim of this study was to investigate how this scheme worked in general practice, and general practitioners' perceptions of it, in order to identify factors that enhance or inhibit integrated care for patients with asthma in general practice. METHOD. A qualitative survey was carried out with a random, stratified sample of 38 of the 317 general practitioners in the region. Semi-structured interviews were designed to elicit general practitioners' accounts of their operation of integrated care and their attitudes towards the scheme. RESULTS. General practitioners perceived the scheme to have several advantages: the continuity and quality of care provided was improved; and the transmission of information between general practitioner and specialist was enhanced. Regular general practitioner reviews, instigated by standard letters generated by computer, were favoured as being clearly structured. Concerns were raised about the processing of paperwork, and the possibility that unnecessary reviews might be generated. CONCLUSION. Integrated care for asthma patients is an acceptable management option among general practitioners.

Three Images of Interdisciplinary Team Meetings

Abstract: Teams are an essential aspect of health care today, especially in rehabilitation or chronic illness where the course of care is frequently long, complex, and unpredictable. The coordinative function of teams and their interdisciplinary aspects are thought to improve patient care because team members bring their unique professional skills together to address patient problems. This coordination is enacted through the team meeting, which typically results in an integrated care plan. This professional image of team meetings is explicit and addresses the description and provision of care as objective and rational activities. In contrast, the constructed and ritualistic images of health care team meetings are implicit and concern the less objective and rational aspects of planning care. The constructed image pertains to the definitional activity of team members as they try to understand patient troubles and achieve consensus. This process involves the individual clinical reasoning of team members and the collective reasoning of the group. The ritualistic image is that aspect of team meetings in which the team affirms and reaffirms its collective identity. Drawing from field research of geropsychiatric team meetings, this article defines and explicates these images, focusing on the constructed and ritualistic aspects of team meetings and the influence of these images on group function.

Leadership and quality of working life in home health care.

Abstract: Home health care has undergone startling changes in the past decade and, in the process, become a strategically important ingredient of health care delivery. However, the question remains whether home health care organizations can deliver the benefits anticipated for integrated care delivery systems. The answer to this question depends to a great extent on whether home health care organizations build vibrant, visionary leadership capable of transforming organizations and motivating staff to deliver high quality and low cost services. This paper examines a case study of transformational leadership as it relates to the quality of working life for nurses, homemakers, and staff. The findings indicate that leader behavior is strongly associated with homemakers', and to a lesser extent staff members', job satisfaction, job involvement, and propensity to remain with the organization. These job attitudes have been shown to be related to higher job performance. The implications for leadership in home health agenci...

The Multidisciplinary Approach to Occupational Low Back Pain and Disability.

Abstract: Chronic disability generates most of the growing costs of occupational low back injuries. When back problems persist for more than a few months, traditional diagnostic and therapeutic approaches are rarely curative. Beyond the challenges of physical impairment, disabling back pain is commonly complicated by psychosocial issues, including depression, fear of reinjury, family discord, and vocational dissatisfaction. The biopsychosocial complexity of chronic disability often demands integrated care from physicians, physical and occupational therapists, psychologists, and vocational counselors. In the past decade, the care of back-injured workers has shifted emphasis from symptom palliation toward functional restoration. This evolution has been possible, in part, through improved quantification of physical capacities. Repeated objective measurements of function guide rehabilitation and recommendations for return to work and other activities. Published results of function-oriented multidisciplinary care depend on the outcome variables reported and the particular socioeconomic setting.

Costing shared care.

Abstract: Growing interest in shared health care schemes over the last decade has received additional impetus with the introduction of GP fund holding and the internal market in health care provision. Ken Buckingham and colleagues report on the relative costs of such a scheme for asthma in comparison with the costs of conventional outpatient care. Data was collected during a randomised controlled trial of shared or integrated care for patients with chronic asthma, who had been referred to a hospital outpatient clinic.

Introducing Anticipated Recovery Pathways: A Teaching Hospital Experience

Abstract: Integrated Care Plans, or Anticipated Recovery Pathways, embrace quality and efficiency concepts. They allow multi‐disciplinary input on patient care planning. Pathways are now being developed hospital‐wide. Discusses their development and implementation.

A networked patient-based integrated care system as a basis for the achievement of quality in practice.

Abstract: Traditionally, telematics initiatives have mainly been used to link patients with specific conditions to monitoring services located in acute hospitals. However, latest application of telematics to the networking of integrated electronic records for ambulatory or community care has great potential to measure and assure the quality of health care delivery to a large sector of the population in a structured and comprehensive way. This paper categorizes the major quality opportunities of a pioneering initiative now achieving operational status.

A framework for commissioning services for people with learning disabilities

Abstract: The needs of people who have global developmental learning disabilities (mental handicap) are complex and lifelong. Unless social and health service commissioners agree a framework for conceptualizing their need, there is a danger that services could become fragmented. This paper uses the World Health Organization's model of disabilities to put in context these needs. Using this model it is logical for health services to focus on (1) ensuring access to the full range of primary and secondary health services, (2) reducing the occurrence and severity of intellectual and associated impairments and (3) ensuring the provision of assessment and treatment of behaviour disorders and associated mental health problems. Some of these inputs are required before birth and in early childhood, but a number of people will require health services throughout life because of the presence of other disabilities or continuing behaviour and/or mental health problems. At school age, the education authority should provide the lead in ensuring the best physical and social learning environment. All children with learning disabilities will be socially disadvantaged in adulthood unless they are provided with opportunities for social integration, continuing education, skills training, employment and normal living facilities which meet their needs. Although there appears a logical shift in agencies' responsibilities as children with intellectual impairment progress through life, there is considerable diversity within this group and care can only be effectively provided on the basis of a sophisticated assessment of individual need and provision of integrated care.

Authentic caring: the sensible answer for clients and staff dealing with HIV/AIDS.

Abstract: The Denver Nursing Project in Human Caring is a nurse-managed outpatient center providing integrated care and services for persons living with HIV/AIDS, their family members, and friends. The center is collaboratively sponsored by three Denver hospitals and the University of Colorado School of Nursing. Programs and services of the center are based on Watson's theory of human care nursing. The ongoing challenge to operationalize authentic caring has resulted in growth and satisfaction for both clients and staff. In addition, the center has documented its cost effectiveness for the participating institutions.

A Home Telecare Management System

Abstract: The actual tendency to discharge chronic patients from hospital as well as the increasing request for improving quality of life of elderly and disabled people at home, was the original motivation of the development of the Home Telecare Management System here described. This system allows, at the Home Telecare Service Center, the remote monitoring of biological signals and data, as well as the management of different types of alarm calls generated at home, as part of the services implemented during the course of the EU funded EPIC (European Prototype for Integrated Care) project (AIM A.2007). >

The Integrated Care in Shropshire project: lessons from experience.

Abstract: Support for the idea of teamwork as an abstract ideal is not matched by practice The Integrated Care in Shropshire project formed a partnership between Shropshire Social Services Department, Shropshire District Health Authority and Shropshire Family Health Services Authority together with the Helen Hamlyn Foundation The first strand of the project was the development of procedures for assessment; it had a relatively clear goal and a firm deadline The second strand was the development of better-integrated primary health care teams, but insufficient time and resources limited what could be achieved Collaboration between the agencies has been extended for a further period and local units will be invited to put forward their own schemes The ICIS project illustrates the need for 'pilot projects' to be conceived and managed by their sponsor agencies as sites for organisational learning if they are to be effective

Integrated care for diabetes.

Abstract: EDITOR, — The Diabetes Integrated Care Evaluation Team reports a comparison of integrated care versus conventional care for diabetes.1 In our opinion the results of this study cannot be generalised to all diabetic patients, even if the exclusion criteria are taken into account. The mean glycated haemoglobin concentration when the patients were recruited …

Organization and financing of home care in Europe: an overview.

Abstract: The aim of this study was to provide an overview of the organization and financing of home nursing in the 15 member states in the European Union. Home nursing was defined as the nursing care provided at the patients' home by professional home nursing organizations. Data were gathered by means of three complementary research methods: desk research, postal questionnaire among identified experts and face-to-face interviews with experts. The results showed that there are large differences between the countries in the way home nursing care is financed. There seems to be a relation between the way of funding and the organizational structure. In member states where the organizations receive a fixed budget, based on the number of inhabitants or the demography of the catchment area, home nursing is mainly provided by one type of organization and is freely accessible for the patients. In this situation there is little competition among the organizations, and the catchment areas of the regional organizations do not tend to overlap. On the other hand, in countries where organizations are reimbursed according to a fee-for-service principle and a referral of a doctor is required, home nursing is provided by different types of organizations and also by independent nurses. It seems that fee-for-service reimbursement stimulates competition between providers and a market-oriented home care. In addition, a fee-for-service method of funding also has the consequence that mainly technical nursing procedures and some basic care are reimbursed; this leaves little room for nurses to perform preventive and psychosocial activities or to provide more integrated care. (aut. ref.)

“HIS-Treck -- the next generation”: an introduction to future hospital information systems

Abstract: The shift by health care organizations to integrated care with an outpatient emphasis requires the development of a new generation of multifaceted electronic medical record systems to coordinate these services. This paper introduces the context of present day health care computing to set the stage for Dr. Essin's paper on our proposed paradigm shift from record processing to document processing, using mark up language technologies. We believe that such document oriented systems can be designed to be both distributed and secure with respect to patient and institutional confidentiality.

Integrated care at the bedside: job description consensus.

Abstract: A Nursing Career Pathway Committee developed a differentiated nursing model based upon the Midwest Alliance in Nursing competencies. Two distinct and complementary roles provide direct nursing care: the Registered Nurse in the Associate Role and the Registered Nurse in the Primary Role. Through a differentiated nursing demonstration project, the need for changes in the "charge nurse" role became apparent. Opportunities for growth and participation, regardless of position held, are presented. Agencies without "clinical ladders" will be intrigued with this fresh approach for rewarding nurses who provide direct care.