Do health care providers use online patient ratings to improve the quality of care?

Background: Physician-rating websites have become a popular tool to create more transparency about the quality of health care providers. So far, it remains unknown whether online-based rating websites have the potential to contribute to a better standard of care. Objective: Our goal was to examine which health care providers use online rating websites and for what purposes, and whether health care providers use online patient ratings to improve patient care. Methods: We conducted an online-based cross-sectional study by surveying 2360 physicians and other health care providers (September 2015). In addition to descriptive statistics, we performed multilevel logistic regression models to ascertain the effects of providers' demographics as well as report card-related variables on the likelihood that providers implement measures to improve patient care. Results: Overall, more than half of the responding providers surveyed (54.66%, 1290/2360) used online ratings to derive measures to improve patient care (implemented measures: mean 3.06, SD 2.29). Ophthalmologists (68%, 40/59) and gynecologists (65.4%, 123/188) were most likely to implement any measures. The most widely implemented quality measures were related to communication with patients (28.77%, 679/2360), the appointment scheduling process (23.60%, 557/2360), and office workflow (21.23%, 501/2360). Scaled-survey results had a greater impact on deriving measures than narrative comments. Multilevel logistic regression models revealed medical specialty, the frequency of report card use, and the appraisal of the trustworthiness of scaled-survey ratings to be significantly associated predictors for implementing measures to improve patient care because of online ratings. Conclusions: Our results suggest that online ratings displayed on physician-rating websites have an impact on patient care. Despite the limitations of our study and unintended consequences of physician-rating websites, they still may have the potential to improve patient care.

When a Change in Level of Care Results in a Transfer Between Programs

This project was chosen to investigate the criteria, process, procedures and policies in place for transferring patients of the Charleston Dorchester Mental Health Center between programs due to a change in their level of care in efforts to make the process more consistent and prevent or reduce gaps in care for patients.

Methodology of Care Humanitude in Promoting Self-care in Dependent People: An Integrative Review

Abstract. The aging of the population has led to an increase in the prevalence of chronic degenerative diseases and dependence. We need to implement humanized health care that will improve the quality of life and well-being of these people and help maintain their autonomy and self-care. Objective: To identify the implications of the caring in Humanitude in promoting self-care in the dependent person. Methods: Integrative review of the literature of the period between 2007 and 2015, using the databases Medline, EBSCO and Google Scholar. In using the PI[C]OD methodology and criteria for inclusion and exclusion, we obtained 54 items where 7 were selected for analysis. Results: There are several health benefits in the promotion of self-care, by ap-plying the Humanitude caring philosophy, mainly regarding the relationship be-tween the nurse and the patient. Conclusions: It is essential to develop further studies focused on the implications of caring in Humanitude in self-care in the dependent person.

L’expression de l’identité d’aidant dont le proche est atteint de la maladie d’Alzheimer.

Nous ne pouvons, désormais, ignorer l’implication des aidants familiaux au sein du dispositif des soins de santé. Lors de l’apparition d’une maladie chronique, telle une démence de type Alzheimer, certains aidants prennent considérablement part dans les soins, au risque de sacrifier leur propre santé physique et mentale. Cette population est maintenant considérée vulnérable sur les plans physiques, psychologiques et sociaux, et requiert un soutien adapté à ses besoins. Par ailleurs, la gestion de la prise en charge, ainsi que les stratégies employées par les aidants, sont loin d’être homogènes et varient d’un aidant à un autre. Objectif : Afin d’améliorer le soutien destiné aux aidants, ce mémoire vise à illustrer l’importance de considérer les types de soutien adoptés et à analyser le sens donné par l’aidant dans le soutien envers un proche atteint de démence de type Alzheimer. Sujets : Six aidants familiaux soutenant un proche (conjoint(e) ou parent) atteint de démence de type Alzheimer ont été rencontrés à plusieurs reprises, à un intervalle d’une année et demi, et ce jusqu’au décès du proche. Méthode : L’approche qualitative longitudinale a permis l’analyse des 16 entretiens afin de mieux cerner les types de soutien employés par les aidants à partir des typologies d’aidants élaborées par Clément, Gagnon, & Rolland (2005) et Pennec (2002) et l’identité d’amour de compassion détaillée par Underwood (2009). Les identités décrites par ces auteurs s’avèrent être des idéaltypes inexistants tels quels dans la réalité. Résultats : À l’exception d’un sujet, tous les aidants ont adopté des traits et des stratégies de gestion de prise en charge se rapportant à plus d’une identité d’aidant. Dans le cas de l’aidante à qui nous n’avons pas pu apposer une identité, peu d’information au niveau de ses stratégies dans la gestion de la prise en charge a été partagée. Ceci serait probablement dû au fait que l’aidante est très peu organisée dans le soutien et qu’elle prend peu d’initiatives, étant elle-même atteinte de démence de type Alzheimer. Conclusion : Afin de mieux adapter les services et le soutien destinés aux aidants familiaux, il importe de mieux comprendre les stratégies de soutien des aidants et leur évolution.

Desenlace intrahospitalario temprano del trauma ocupacional agudo, atendido “Entre Semana/Fin de Semana”, en una institución hospitalaria de III nivel, Bogotá, 2007 -2010

Resumen Objetivo. El desenlace temprano del trauma ocupacional agudo (TOA) puede estar condicionado al desarrollo industrial local en relación con el momento de la semana donde se presente el evento, por lo que evaluamos las diferencias en los desenlaces clínicos tempranos de trabajadores que presentaron TOA en diferentes momentos de la semana. Metodología. Se realizó un estudio descriptivo retrospectivo utilizando una base de datos administrativa de trabajadores atendidos por TOA, entre enero/2007-diciembre/2010, en una institución hospitalaria de III nivel de Bogotá. Se comparó la distribución del TOA entre semana (ES) y en fin de semana (FdS) según variables sociodemográficas/clínicas y la mediana de estancia hospitalaria (EH), el riesgo de muerte o de un trauma específico. Resultados. Se incluyeron 65169 trabajadores, la mayoría hombres (78,4%), adultos jóvenes (83,7%), edad mediana 31 años, con razón de ingreso ES:FdS 3:1, predominantemente durante el día (81,3%). La EH mediana (horas) en FdS (0,48) fue mayor que ES (0,43) (p: 0,000) en general y al evaluar por las sub-categorías de sexo, grupo de edad, momento de ingreso, área de manejo y estado al alta. Se presentaron 35 muertes, con mayor riesgo (OR;IC95%) en el grupo 45-64 años (3,47;1,71-6,76), en los ingresados en la noche (3,27;1,64-6,40) o durante el FdS (4,57;1,25-18,4). Durante el FdS se identificó mayor riesgo de TOA con compromiso de Cabeza/Cuello, traumas múltiples y de causadas por vehículos en movimiento. Durante el FdS disminuyó la frecuencia de trabajadores atendidos por Ortopedia/Oftalmología/Cirugía General (p: < 0,05). Conclusión. Evidenciamos que los trabajadores ingresados por TOA durante el FdS presentaron mayor EH y riesgo de muerte; además se identificó una redistribución en el Servicio de atención en el FdS, con una baja frecuencia de atenciones prestadas por médicos especialistas.

O cuidador familiar do idoso com alzheimer: percepções e sentimentos

The Brazilian Constitution maintains that care for elderly people is a responsibility shared by the state, the family and the society. The politics for the elderly corroborate this understanding and treats home as a privileged place for elderly care taking. This determines the participation of the familiar as a caregiver, but highlights the lack of strategic assistance for the needs of the relative caregiver who feels helplessly and unattended in their responsibility for elderly homecare. In recent years , despite the recently pursuit for health and life quality, there is an increasing incidence of elderly patients with dementia diseases that lead to disability, the most common among then is the Alzheimer´s disease. This disease affects seriously and irreversibly cognition, memory and independence of the elderly, making it dependent on others to perform basic activities of daily life, for all his life. The present study aims to evaluate the perceptions and feelings of family caregivers of elders with Alzheimer on the role of caregiver. This is a qualitative study conducted with family caregivers of seniors with Alzheimer´s, caregivers linked to the group of the Specialized Care Center of the Elderly´s Health, located in Natal / RN. Through semi-structured interview research sought to investigate the perceptions of family caregivers on the role of caregiver, the feelings and the changes in the caregiver´s life since they assumed this role. The data were organized into categories and units of semantic analysis and analyzed using thematic content analysis by Bardin. The reports originated three categories: the perception of the role of caregiver, feelings related to the caregving and consequences of the caregiver role. Perceptions of caregivers of elderly from the requirement of dedication to the care generates losses in personal and professional life for the familiar who assumes this responsibility. The lack of family and social support, aggravates the burden of care for the dependent elderly. Public health politics for the elderly recognize the importance and needs of family caregivers, but not enough to provide support and meet the needs and assist them in supporting their limitations. The research results show the urgent need to take measures to assist the caregivers of seniors with Alzheimer, recognizing them as an action of promotion quality of life and health of the elderly and protection the health of the caregiver

Caracterização da demanda do pronto socorro do Hospital das Clínicas da Faculdade de Medicina de Botucatu - UNESP

The demand for health services can be understood as an application needs the user has. The inability to use the outpatient services and limited supply of these make it possible for users to browse sites that focus attention on a greater possibility of entry doors, in which first-aid centers and hospital emergency match this profile, distorting the flow of patients in the network through an inverse demand of the movement hierarchy. Added to this, the burden of care in these services results in overcrowding and poor quality of care. Evaluate the demand of the visits occurred in the Emergency Room of the Hospital of the Medical School of Botucatu / UNESP (PS - HC - FMB / UNESP) during June-July 2010. A transversal, descriptive and retrospective. For data collection sheet was used in the proposed Service unit and the data it was filled out the form with the necessary items for the search. Made an exploratory analysis and frequency distributions for categorical variables of the form. Females predominated (56%) and aged 61 years or older with 30%. 96.5% were owned by DRS VI, and 62.5% of Botucatu. The attendance by the physician on duty and corresponded to 57.7% among the 23 medical specialties, Gastric (7.0%), Cardiology (4.5%), Medical (4.4%), urology (4.2%) and Pulmonology (4.1%) were the ones that stood out. The medical procedures performed that stood out were X-ray (46.4%) and electrocardiogram (ECG) (42.3%) and in most specialty care occurred, only the daily consultation with the patient. It was possible to characterize, so the demand for PS - HC - FMB / UNESP for the period June- July 2010, The predominance of the elderly shows that come along with aging diseases and addictions, causing a greater need for health services. Moreover, this study showed that the high number of visits is related to both the daily demands that the tertiary hospital has the same transformation... (Complete abstract click electronic access below)

Teaching medical students about dementia: a brief review

Underdeveloped nations have the largest absolute number of the world's elderly population. Approximately 10.7% of the Brazilian population comprises aged individuals. Aging populations are associated with a higher incidence of chronic degenerative diseases such as dementia. Demented individuals place a high burden of care on healthcare systems and family members. General practitioners should be able to diagnose the most common elderly diseases such as dementia since they act as gatekeepers to specialized care. In Brazil, many medical students work as general practitioners upon graduating. The present study shows some scenarios of medical schools worldwide, including Brazilian, regarding teaching on dementia.

National survey of the prevalence, incidence, primary care burden, and treatment of heart failure in Scotland

Objective: To examine the epidemiology, primary care burden, and treatment of heart failure in Scotland, UK. Design: Cross sectional data from primary care practices participating in the Scottish continuous morbidity recording scheme between 1 April 1999 and 31 March 2000. Setting: 53 primary care practices ( 307 741 patients). Subjects: 2186 adult patients with heart failure. Results: The prevalence of heart failure in Scotland was 7.1 in 1000, increasing with age to 90.1 in 1000 among patients greater than or equal to 85 years. The incidence of heart failure was 2.0 in 1000, increasing with age to 22.4 in 1000 among patients greater than or equal to 85 years. For older patients, consultation rates for heart failure equalled or exceeded those for angina and hypertension. Respiratory tract infection was the most common comorbidity leading to consultation. Among men, 23% were prescribed a beta blocker, 11% spironolactone, and 46% an angiotensin converting enzyme inhibitor. The corresponding figures for women were 20% (p = 0.29 versus men), 7% (p = 0.02), and 34% (p < 0.001). Among patients, 75 years 26% were prescribed a β blocker, 11% spironolactone, and 50% an angiotensin converting enzyme inhibitor. The corresponding figures for patients &GE; 75 years were 19% (p = 0.04 versus patients < 75), 7% (p = 0.04), and 33% (p < 0.001). Conclusions: Heart failure is a common condition, especially with advancing age. In the elderly, the community burden of heart failure is at least as great as that of angina or hypertension. The high rate of concomitant respiratory tract infection emphasises the need for strategies to immunise patients with heart failure against influenza and pneumococcal infection. Drugs proven to improve survival in heart failure are used less frequently for elderly patients and women.

The role of economic evaluation in mental health care

Objective: A consequence of the integration of psychiatry into acute and public health medicine is that psychiatrists are being asked to evaluate their services. There is pressure on mental health-care systems because it is recognized that funds should be directed where they can provide the best health outcomes, and also because there are resource constraints which limit our capacity to meet all demands for health care. This pressure can be responded to by evaluation which demonstrates the effectiveness and efficiency of psychiatric treatment. This paper seeks to remind psychiatrists of the fundamental principles of economic evaluation in the hope that these will enable psychiatrists to understand the methods used in evaluation and to work comfortably with evaluators. Method: The paper reviews the basic principles behind economic evaluation, illustrating these with reference to case studies. It describes: (i) the cost of the burden of illness and treatment, and how these costs are measured; (ii) the measurement of treatment outcomes, both as changes in health status and as resources saved; and (iii) the various types of economic evaluation, including cost-minimization, cost-effectiveness, cost-utility and cost-benefit analysis. Results: The advice in the paper provides psychiatrists with the necessary background to work closely with evaluators. A checklist of the critical questions to be addressed is provided as a guide for those undertaking economic evaluations. Conclusions: If psychiatrists are willing to learn the basic principles of economic evaluation and to apply these, they can respond to the challenges of evaluation.

LATERAL FLOW ASSAY FOR CRYPTOCOCCAL ANTIGEN: AN IMPORTANT ADVANCE TO IMPROVE THE CONTINUUM OF HIV CARE AND REDUCE CRYPTOCOCCAL MENINGITIS-RELATED MORTALITY

SUMMARYAIDS-related cryptococcal meningitis continues to cause a substantial burden of death in low and middle income countries. The diagnostic use for detection of cryptococcal capsular polysaccharide antigen (CrAg) in serum and cerebrospinal fluid by latex agglutination test (CrAg-latex) or enzyme-linked immunoassay (EIA) has been available for over decades. Better diagnostics in asymptomatic and symptomatic phases of cryptococcosis are key components to reduce mortality. Recently, the cryptococcal antigen lateral flow assay (CrAg LFA) was included in the armamentarium for diagnosis. Unlike the other tests, the CrAg LFA is a dipstick immunochromatographic assay, in a format similar to the home pregnancy test, and requires little or no lab infrastructure. This test meets all of the World Health Organization ASSURED criteria (Affordable, Sensitive, Specific, User friendly, Rapid/robust, Equipment-free, and Delivered). CrAg LFA in serum, plasma, whole blood, or cerebrospinal fluid is useful for the diagnosis of disease caused by Cryptococcusspecies. The CrAg LFA has better analytical sensitivity for C. gattii than CrAg-latex or EIA. Prevention of cryptococcal disease is new application of CrAg LFA via screening of blood for subclinical infection in asymptomatic HIV-infected persons with CD4 counts < 100 cells/mL who are not receiving effective antiretroviral therapy. CrAg screening of leftover plasma specimens after CD4 testing can identify persons with asymptomatic infection who urgently require pre-emptive fluconazole, who will otherwise progress to symptomatic infection and/or die.

Prevalence of Risk for Obstructive Sleep Apnea Syndrome and Association With Risk Factors in Primary Care

Abstract Background: Obstructive sleep apnea syndrome (OSAS) is a chronic, progressive disease with high morbidity and mortality. It is underdiagnosed, especially among women. Objective: To study the prevalence of high risk for OSAS globally and for the Berlin Questionnaire (BQ) categories, and to evaluate the reliability of the BQ use in the population studied. Methods: Observational, cross-sectional study with individuals from the Niterói Family Doctor Program, randomly selected, aged between 45 and 99 years. The visits occurred between August/2011 and December/2012. Variables associated with each BQ category and with high risk for OSAS (global) were included in logistic regression models (p < 0.05). Results: Of the total (616), 403 individuals (65.4%) reported snoring. The prevalence of high risk for OSA was 42.4%, being 49.7% for category I, 10.2% for category II and 77.6% for category III. Conclusion: BQ showed an acceptable reliability after excluding the questions Has anyone noticed that you stop breathing during your sleep? and Have you ever dozed off or fallen asleep while driving?. This should be tested in further studies with samples mostly comprised of women and low educational level individuals. Given the burden of OSAS-related diseases and risks, studies should be conducted to validate new tools and to adapt BQ to better screen OSAS.

Perinatal care at the limit of viability between 22 and 26 completed weeks of gestation in Switzerland.

Perinatal care of pregnant women at high risk for preterm delivery and of preterm infants born at the limit of viability (22-26 completed weeks of gestation) requires a multidisciplinary approach by an experienced perinatal team. Limited precision in the determination of both gestational age and foetal weight, as well as biological variability may significantly affect the course of action chosen in individual cases. The decisions that must be taken with the pregnant women and on behalf of the preterm infant in this context are complex and have far-reaching consequences. When counselling pregnant women and their partners, neonatologists and obstetricians should provide them with comprehensive information in a sensitive and supportive way to build a basis of trust. The decisions are developed in a continuing dialogue between all parties involved (physicians, midwives, nursing staff and parents) with the principal aim to find solutions that are in the infant's and pregnant woman's best interest. Knowledge of current gestational age-specific mortality and morbidity rates and how they are modified by prenatally known prognostic factors (estimated foetal weight, sex, exposure or nonexposure to antenatal corticosteroids, single or multiple births) as well as the application of accepted ethical principles form the basis for responsible decision-making. Communication between all parties involved plays a central role. The members of the interdisciplinary working group suggest that the care of preterm infants with a gestational age between 22 0/7 and 23 6/7 weeks should generally be limited to palliative care. Obstetric interventions for foetal indications such as Caesarean section delivery are usually not indicated. In selected cases, for example, after 23 weeks of pregnancy have been completed and several of the above mentioned prenatally known prognostic factors are favourable or well informed parents insist on the initiation of life-sustaining therapies, active obstetric interventions for foetal indications and provisional intensive care of the neonate may be reasonable. In preterm infants with a gestational age between 24 0/7 and 24 6/7 weeks, it can be difficult to determine whether the burden of obstetric interventions and neonatal intensive care is justified given the limited chances of success of such a therapy. In such cases, the individual constellation of prenatally known factors which impact on prognosis can be helpful in the decision making process with the parents. In preterm infants with a gestational age between 25 0/7 and 25 6/7 weeks, foetal surveillance, obstetric interventions for foetal indications and neonatal intensive care measures are generally indicated. However, if several prenatally known prognostic factors are unfavourable and the parents agree, primary non-intervention and neonatal palliative care can be considered. All pregnant women with threatening preterm delivery or premature rupture of membranes at the limit of viability must be transferred to a perinatal centre with a level III neonatal intensive care unit no later than 23 0/7 weeks of gestation, unless emergency delivery is indicated. An experienced neonatology team should be involved in all deliveries that take place after 23 0/7 weeks of gestation to help to decide together with the parents if the initiation of intensive care measures appears to be appropriate or if preference should be given to palliative care (i.e., primary non-intervention). In doubtful situations, it can be reasonable to initiate intensive care and to admit the preterm infant to a neonatal intensive care unit (i.e., provisional intensive care). The infant's clinical evolution and additional discussions with the parents will help to clarify whether the life-sustaining therapies should be continued or withdrawn. Life support is continued as long as there is reasonable hope for survival and the infant's burden of intensive care is acceptable. If, on the other hand, the health care team and the parents have to recognise that in the light of a very poor prognosis the burden of the currently used therapies has become disproportionate, intensive care measures are no longer justified and other aspects of care (e.g., relief of pain and suffering) are the new priorities (i.e., redirection of care). If a decision is made to withhold or withdraw life-sustaining therapies, the health care team should focus on comfort care for the dying infant and support for the parents.

Effectiveness of a nurse-led case management home care model in Primary Health Care. A quasi-experimental, controlled, multi-centre study

Background Demand for home care services has increased considerably, along with the growing complexity of cases and variability among resources and providers. Designing services that guarantee co-ordination and integration for providers and levels of care is of paramount importance. The aim of this study is to determine the effectiveness of a new case-management based, home care delivery model which has been implemented in Andalusia (Spain). Methods Quasi-experimental, controlled, non-randomised, multi-centre study on the population receiving home care services comparing the outcomes of the new model, which included nurse-led case management, versus the conventional one. Primary endpoints: functional status, satisfaction and use of healthcare resources. Secondary endpoints: recruitment and caregiver burden, mortality, institutionalisation, quality of life and family function. Analyses were performed at base-line, and at two, six and twelve months. A bivariate analysis was conducted with the Student's t-test, Mann-Whitney's U, and the chi squared test. Kaplan-Meier and log-rank tests were performed to compare survival and institutionalisation. A multivariate analysis was performed to pinpoint factors that impact on improvement of functional ability. Results Base-line differences in functional capacity – significantly lower in the intervention group (RR: 1.52 95%CI: 1.05–2.21; p = 0.0016) – disappeared at six months (RR: 1.31 95%CI: 0.87–1.98; p = 0.178). At six months, caregiver burden showed a slight reduction in the intervention group, whereas it increased notably in the control group (base-line Zarit Test: 57.06 95%CI: 54.77–59.34 vs. 60.50 95%CI: 53.63–67.37; p = 0.264), (Zarit Test at six months: 53.79 95%CI: 49.67–57.92 vs. 66.26 95%CI: 60.66–71.86 p = 0.002). Patients in the intervention group received more physiotherapy (7.92 CI95%: 5.22–10.62 vs. 3.24 95%CI: 1.37–5.310; p = 0.0001) and, on average, required fewer home care visits (9.40 95%CI: 7.89–10.92 vs.11.30 95%CI: 9.10–14.54). No differences were found in terms of frequency of visits to A&E or hospital re-admissions. Furthermore, patients in the control group perceived higher levels of satisfaction (16.88; 95%CI: 16.32–17.43; range: 0–21, vs. 14.65 95%CI: 13.61–15.68; p = 0,001). Conclusion A home care service model that includes nurse-led case management streamlines access to healthcare services and resources, while impacting positively on patients' functional ability and caregiver burden, with increased levels of satisfaction.