Patient-oriented quality assurance. Information and cooperation of the health services as a condition for integrated care

The increasing care needs of the elderly and chronically ill have a growing impact on health care services. With complex needs to meet, the patient's quality of life depends on multiple factors, of which the continuity of care plays an important role. Information on the past and present health state and on self care resources are prerequisites for adequate rehabilitation efforts that are patient-oriented and of high quality. Institutionally induced "cascade episodes of incompetence" (Ulmer & Saller, 1994) have to be avoided. To make sure that interventions promote or stabilize the quality of life, the participation of the client is crucial in all stages of the process of care planning and coordination. Integrated care requires the exchange of information and close coordination on the concept of care between all participants in the care process. Yet, collaborative care is often seriously jeopardized by lack of knowledge about the concepts, scope of action and requests of the involved health professionals and services. At the Agnes Karll Institute of Nursing Research an action research project aiming at cooperative quality assurance was carried out. It became obvious that there is a large amount of intersectoral knowledge necessarily needed by all professionals and services to ensure seamless professional care. But often they have no access to the information needed. Therefore a client's accompanying booklet was developed to pass on basic information. It is kept by the client and shall be used and filled out by them, their relatives and the different health professionals and health care services involved.     

Premorbid brain size as a determinant of reserve capacity against intellectual decline in Alzheimer''s disease

With funding from the Administration on Aging, the National Resource Center: Diversity and Long-Term Care surveyed state administrators of programs serving elders in 24 states in 1994. This survey sought to document what written guidelines and training case managers receive in promoting client autonomy in care planning. In discussions with respondents and review of written materials provided by the states, surveyors explored whether clients received written information about services, the structure for seeking client input into care planning, and the structure for soliciting client feedback once the care plan was in place. Of the states included in this survey, few have developed and implemented guidelines or provide case managers training to promote client autonomy in the care-planning process. After reviewing the survey findings, the authors make two policy recommendations for states to consider in this area.     

Localization of extracellular matrix molecules, integrins and their regulators, TGF betas, is correlated with axon pathfinding in the spinal cord of normal and Danforth''s short tail mice

We present a local Dissemination of EPIC, a project which has been devised to support health and social primary care by an information system. One key point of the EPIC project was a standardization effort at European level, providing a standardized basis for the management system based on client needs for planning and manpower control. Whilst EPIC has been designed as a general community information system, the main EPIC applications focus is on the care of the elderly. Savona is a middle size Italian town with a high percentage of elderly people and has already had an experience of integration of health and social care within an Italian project. It has therefore been regarded as a suitable site for the dissemination of EPIC. The EPIC application solved some of the information problems which emerged during the validation of the previous Italian project, such as the definition of the requirements; the collection, processing and retrieval of the clinical/social data; the definition of responsibilities and relations of the operators.     

Advance directives, AIDS, and mental health: TJ preventive law for the HIV-positive client.

Unfortunately, the possibility of future incapacity to engage in health care decision making remains one of the many potential legal problems faced by HIV-positive clients. Consequently, proactive legal planning, including the use of advance directives, is widely recognized as an important element in avoiding legal crisis for HIV-positive persons. The author suggests that, in light of the emotional and psychological difficulties that an HIV-positive client may face, considerations of psychological well-being ought to be explicitly recognized as one priority among many in legal planning. By integrating principles of therapeutic jurisprudence and preventive law, a lawyer can both protect an HIV-positive client's legal rights by planning for legal contingencies and enhance the client's psychological well-being by making emotional concerns one priority in that planning process. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Sexual health for people with learning disabilities

This article is based on work into the sexual health needs of people with learning disabilities, carried out by a working group of the RCN Family Planning Forum. Literature searches were conducted, and local initiatives, specialist services and information sources for training and education for clients and staff were identified. The authors' aim in this article is to increase awareness among those involved in the care of people with learning disabilities and those providing family planning and sexual health services, so that these services are appropriate, accessible and sensitive to the needs of this vulnerable client group.     

The future of medication information practice: a consensus

OBJECTIVE: To analyze the current practice of drug information and develop a strategic plan for a "valued" specialty of medication information practice. DATA SOURCES: The Consortium for the Advancement of Medication Information, Policy, and Research (CAMIPR) met in June 1994 to initiate a strategic plan for a future of medication information practice. A multidimensional situation analysis and strategic planning process was conducted and the results are discussed. RECOMMENDATIONS: Trends in health care (e.g., healthcare reform, managed care) will impact the future of medication information practice, and the medication information specialist must evolve with society's values. Medication information practice must transform and attention will likely focus on medication policy research/ development and information systems. However, new skills, resources, and relationships must be developed to facilitate this evolution. In addition, interest in the practice of drug information has declined. Strategies are presented to enhance the "value" and "image" of future medication information practice.     

Undercover careseekers: simulated clients in the study of health provider behavior in developing countries

The simulated client method (SCM) has been used for over 20 years to study health care provider behavior in a first-hand way while minimizing observation bias. In developing countries, it has proven useful in the study of physicians, drug retailers, and family planning services. In SCM, research assistants with fictitious case scenarios (or with stable conditions or a genuine interest in the services) visit providers and request their assistance. Providers are not aware that these clients are involved in research. Simulated clients later report on the events of their visit and these data are analyzed. This paper reviews 23 developing country studies of physician, drug retail, and family planning services in order to draw conclusions about (1) the advantages and limitations of the methods; (2) considerations for design and implementation of a simulated client study; (3) validity and reliability; and (4) ethical concerns. Examples are also drawn from industrialized countries, related methodologies, and non-health fields to illustrate the issues surrounding SCM. Based on this review, we conclude that the information gathered through the use of simulated clients is unique and valuable for managers, intervention planners and evaluators, social scientist, regulators, and others. Areas that need to be explored in future work with this method include: ways to ensure data validity and reliability; research on additional types of providers and health care needs; and adaptation of the technique for routine use.     

Observations on potential contributions of health planning

The passage of the National Health Planning and Resources Development Act in the United States in 1974 is used to set the context for a new assessment of health planning as a change agent. In reviewing the record of health planning the most striking conclusion is that even its friends have been unable to establish that it has had any quantifiable impact. The authors suggest, however, that comprehensive health planning may have stimulated the belief that changes in medical care organization are crucial to improving the health care system. The authors next consider the role of health planning inferred from three widely espoused "models" of the health care system: professional, central planning, and market. Although market advocates generally deemphasize health planning as contrasted to those supporting a centrally planned system, none of the models is sufficiently developed to indicate specific roles and functions fro health planning. Basing their argument on goals for health care reform generally espoused by students of medical care organization, the authors assert that health planning agenices will be most effective if they are organizationally linked to general-purpose governments, encourage the formation of Health Maintenance Organizations, consciously involve themselves in health system reorganization, and design their policies so they can be effectively evaluated.     

Nurse managed occupational health services: a primary care model in practice

1. Managed care focus on delivering health care which values prevention, early intervention, continuity of care, commitment to quality care, and outcomes, as well as client satisfaction. Occupational health nurses routinely integrate these values into their practice. 2. An on-site model of primary health care delivery, incorporating the fundamentals of occupational health nursing, can bring significant savings to the organization in health related costs. 3. Case management may provide the greatest potential for growth in occupational health nursing. It is a method that can be used together with managed care to maximize quality health care services. 4. Viewing health related costs as an investment as opposed to part of a benefit plan, influences employees to make positive choices. It also impacts the delivery of health care services on a systematic, global level, which affects total health care costs.     

Chemical synthesis of 15 beta-hydroxytestosterone and its derivatives using a (4-methoxyphenyl)methyl protecting group

This article describes the Community Nursing Organization, a federal health care model designed to provide specific ambulatory and outpatient services to medicare beneficiaries via a nurse managed delivery system under capitated financing. A primary nurse provider, working with the elderly client, family, physician, health care service providers, and community organizations, assesses the need for care and arranges for appropriate services. This nurse must also authorize payment of those services covered by the Community Nursing Organization (CNO). A 3-year demonstration project is currently under way. Findings at 1 year indicate that the system may have a positive effect on client health status.     

The case management model of patient care delivery

Case management is a model of care delivery that integrates patient and provider satisfaction and consideration of cost factors and provides a method of managing individuals' holistic health concerns. Using the case management approach, nurses can optimize client self-care, decrease fragmentation of care, provide quality care across a continuum, enhance clients' quality of life, decrease length of hospitalization, increase client and staff satisfaction, and promote cost-effective use of scarce resources. Case management offers nurses an opportunity to demonstrate their roles in multidisciplinary health care teams. Case management is relevant in ambulatory surgery settings and in the perioperative care of complex surgical patients.     

Mycobacterium ulcerans infection in a child from Angola: diagnosis by direct detection and culture

The purpose of this study is to listen to and interpret the experiences of independent older women in the community regarding their medication use. Their experiences were examined regarding medication information, sources of information, types of medication used, relationships with health care professionals and social support systems. The techniques used for data collection included guided qualitative semistructured interviews based on the principle of empowerment and notions of ideal and nonhierarchical communication. The emergent themes show that for these older women general practitioners were important in their medication experiences. Whilst trusted as carers in the acute care setting, registered nurses did not play a role in the medication experiences of these older women. Registered nurses are perceived as 'traditional carers' associated with medical and acute care settings. Although medication issues emerged that ideally required attention, the older women in this study generally perceived themselves to be capable of actively managing their health and medication use.     

Evaluation of problem solving and communication skills of persons with schizophrenia

This study examined gender differences in 162 female and 65 male patients with cancer referred to home care. Data were collected before hospital discharge using the Multidimensional Functional Assessment Questionnaire, the Karnofsky Performance Status, and the Quality of Life-Cancer Scale. Controlling for age and stage of disease, the results showed that men reported significantly more cancer-related impairments, more limitations in activity of daily living, and poorer social resources than women. No gender differences were found in quality of life, perceived emotional health, perceived physical health, performance status, and comorbidity. Significant predictors of self-care activities were: for women perceived physical health, Karnofsky Performance Status, and stage of disease (58% variance explained); for men Karnofsky Performance Status and medication taken (67% variance explained). Gender differences should be considered in discharge planning to provide appropriate home care services for male and female patients with cancer.     

High-tech homecare infusion therapies

Dramatic changes in health care delivery have created an increased reliance on ambulatory care. Adults and children increasingly are receiving infusions of intravascular medication or fluid in the home for a wide array of conditions. Several therapies have been adapted to the home, including chemotherapy, BRMs, TPN, blood components, anti-infectives, analgesics, inotropic agents, and investigational drugs. High-technology therapy in the home mandates safe and reliable vascular access to maximize positive outcomes, independence, and self-care; minimize costs and disruption of daily activities and work schedules; and enhance client and family adjustments and satisfaction. Currently, the four main VADs for vascular access are central venous catheters (CVCs), peripherally inserted central catheters (PICCs, implantable infusion ports, and external or implantable ambulatory infusion pumps.     

The impact of power in therapeutic relationships

Power is an important factor in how health care is delivered. Neither health care professionals nor clients fully appreciate the power that they exercise, nor how they influence others. Understanding how power works, however, is vital to establishing a helping relationship. In a traditionally rigid health care system, professionals who try to empower clients can create conflicts among colleagues. A possible solution is an explicit contract with a client, setting out the responsibilities of those involved.     

A needle type therapeutic system incorporating laser light and lumin for immunotherapy of cancer growing in deep organs

The dynamic interactions of the client, service provided, and payer are complex relationships in today's health care environment. An advanced practice nurse's abilities to care physically and psychosocially for clients and their families are essential within the case management framework. With a holistic view of clients' health status, the nurse case manager develops and carries out advanced practice functions that help achieve the best outcome for the client through effective interactions with clients, payers, and providers. Those functions, illustrated by the Star Case Management Model, include interpretation, advocacy, and surveillance.     

The health of traveller-Gypsies

Travellers are not a healthy group. They experience widespread prejudice and discrimination from the settled population. In the sphere of health care, they have poor access to services. This article reviews the prevalent health care needs of this group from the perspective of client factors and service factors.     

HLA-Cw genotyping of serologically and non-serologically defined alleles using sequence-specific primers (PCR-SSP) in a Shanghai Han population]

The medical care system is not very effective in modifying health behavior of individuals, in particular, ensuring patient compliance with medication regimens, healthy diets, regular physical activity, and regular health screening, and in the avoidance of substance abuse. Telephone-Linked Care (TLC) is a telecommunications technology that enables computer-controlled telephone counseling with patients in their homes. It has been applied to the task of improving a number of different health behaviors. Randomized controlled studies suggest that use of the system for as little as 3 months is associated with improvement in adherence to medication regimens, dietary change in hypercholesterolemia, and increased physical activity among sedentary individuals. Future work involves applying the technology to other important health behaviors, optimally using health behavior theory in the system design, targeting use of TLC to the most appropriate patient groups, incorporating new computer and telecommunications technology into the system, and interfacing TLC into the health care delivery system.     

Serious mental health problems: policy changes

Recent developments in services and strategies for helping people with serious mental health problems represent a watershed in mental health provision. This has implications not only for specialist mental health nursing, but also-- as increasing numbers of people with serious mental health problems live in the community-- for nurses working in all areas of health care, who will have to play a role in meeting their needs. This article describes current developments in policy and practice, and seeks to explain the basic principles of working with people in this client group.