Integrated care for MS patients

Purpose. The problem of complex healthcare to MS patients, together with the rising prevalence of MS and escalating costs, has caused healthcare policy makers to consider innovative approaches to controlling costs and improving the quality of care. An integrated care approach may provide a means for better coordination and delivery of care. The aim is to review recent integrated care initiatives and their significance for MS patients.

Method. A literature search was conducted to trace relevant literature on integrated care for MS patients published between 1995 and 2003.

Results. Although integrated care appears to offer potential for eliminating fragmentation and discontinuity in healthcare for MS patients, there are few published studies which have evaluated its implementation with MS patients.

Conclusions. Even though the potential advantages of integrated care are well known, the applicability of this approach for MS patients has still to be demonstrated.     

Integrated care models in Swiss primary care: An embedded multiple case study

Rationale, Aimsand Objectives

Healthcare systems are confronted with a rising number of patients with chronic conditions and complex care needs, requiring the development of new models of coordinated, patient-centred care. In this study, we aimed to describe and compare a range of new models of care recently implemented in primary care in Switzerland, as well as to gain insight into the type of coordination or integration implemented, the strengths and weaknesses of each model and the challenges they face.

Method

We used an embedded multiple case study design to describe in-depth a series of current Swiss initiatives that specifically aim to improve care coordination in primary care. For each model, documents were collected, a questionnaire was administered and semistructured interviews with key actors were conducted. A within-case analysis followed by a cross-case analysis were performed. Based on the Rainbow Model of Integrated Care framework, similarities and differences between the models were highlighted.

Results

Eight integrated care initiatives were included in the analysis, representing three types of models: independent multiprofessional GP practices, multiprofessional GP practices/health centres that are part of larger groups and regional integrated delivery systems. Recognized effective activities and tools to improve care coordination, such as multidisciplinary teams, case manager involvement, use of electronic medical records, patient education and use of care plans, were implemented by at least six of the eight initiatives studied. The main obstacles to the implementation of integrated care models were the inadequate Swiss reimbursement policies and payment mechanisms and the desire of some healthcare professionals to protect their territory in a context where new roles are emerging.

Conclusion

The integrated care models implemented in Switzerland are promising; nevertheless, financial and legal reforms must be introduced to promote integrated care in practice.     

痛风病人的中西医结合护理

综述了痛风病人的中西医结合护理,介绍了痛风病人的中药外治的护理,服用中药的护理,饮食护理,情志调护,起居运动护理。     

Primary Care and Mental Health: Overview of Integrated Care Models

Primary care nurse practitioners are in a visible and critical position to screen, diagnose, and treat common mental health conditions. Integrated care models occur on a continuum from simple communication between providers to fully integrated interprofessional teams. Regardless of integration model available to the primary care nurse practitioner, mental health disorders should be appropriately identified and treated using evidence-based approaches. This clinical feature introduces the primary care nurse practitioner to various integrated care models and provides a brief overview regarding screening, diagnostic, and intervention recommendations, as well as potential future directions for education, training, and research.     

Towards Improving Medical Care for People with Intellectual Disability Living in the Community: Possibilities of Integrated Care

Background Ongoing deinstitutionalization has resulted in several problems in medical care delivery to people with intellectual disability, such as an increased workload for general practitioners (GPs) and a lack of active co‐ordination and co‐operation between healthcare professionals. A major consequence is the incidence of untreated yet treatable medical conditions. An integrated care approach may provide a means for better co‐ordination and delivery of care. The aim is to review recent integrated care initiatives and their significance for people with intellectual disability. Method A literature search was conducted to trace relevant literature on integrated care for people with intellectual disability published between 1995 and 2003. Results Although integrated care appears to offer potential for eliminating fragmentation and discontinuity in medical care for people with intellectual disability and for reducing GP workload, there are few published studies which have evaluated its implementation with people with intellectual disability. Conclusions Even though the potential advantages of integrated care are well known, the applicability of this approach for people with intellectual disability has still to be demonstrated.     

多发性硬化的MRS表现特征评价

目的：着重研究多发性硬化的MRs波谱特征及其诊断价值。材料和方法：经临床和MRI确诊的MS24例,男性13例,女性11例,年龄范围10-59岁,平均34．5岁。24例除行SET1WI、TSET2WI、FLAIR扫描外,还作了1H—MRS检查。MRS检测分析NAA、Cho、Cr、M14种代谢物的谱线下积分面积,并计算其与Cr的比值,着重探讨其在病灶、病灶周围、正常组织内的变化。结果：NAA在病灶、病灶附近、正常脑组织间均有显著性差异。Cho、Cr、Mi以及Cho／Cr和Mi／Cr无显著性差异。正常脑组织与病灶、病灶附近的NAA／Cr有显著性差异（P〈0.05）,后两者间无显著性差异（P〉0．05）。结论：MS的MRS检测表明,在病灶中央、病灶附近、正常脑组织间NAA和NAA／Cr均有显著性差异,故在常规MRI检查基础上,MRS检测对MS还可提供更多生化代谢状态的有用信息。     

Integrated palliative care within a general hospital

 The goal of the project was to integrate essential elements of palliative care into the regular duties of an internal ward located in a general hospital serving a rural area. To achieve this goal, the medical and nursing staff was moderately expanded, which was made possible by a grant from the Deutsche Krebshilfe, and training and supervision were instituted. Patients with malignant diseases in advanced and terminal phases were enrolled in the project and evaluated using a specifically designed documentation system. On average, 8.5 (18%) of the 46 beds on the ward were occupied by patients being cared for as part of the project at any one time. Effective relief of pain, nausea and respiratory distress were documented. For those dying in the hospital, a single room and the presence of family members were possible in the majority of cases. A high impact on the team became apparent through an anonymous questionnaire given during supervision. The project shows that it is possible to integrate palliative care into the work of a regular internal medical ward, with positive consequences for the patients and the team. Published online: 9 September 1999     

The impact of managed care on nurses' workplace learning and teaching

This paper examines the impact of managed care on the informal learning process for nurses in a major US-based health organisation. Through the analysis of focus group data we report the nurses' view of the effect recent changes have had on the nurse/patient/care relationship. Managed care, our research indicates, has transformed the learning milieus for nurses with two effects. First, nurses have seen their need for informal learning increase while the time and context for that learning has diminished. Second, the process of teaching patients and families has also been adversely affected even as managed care creates the need for more patient education. We report the analysis of the data collected at group interviews involving nurses working in both hospital and community settings of a leading US-based HMO. All interviews took place during September of 1997 at various sites in California. This study is part of a larger Social Science Research Council of Canada funded investigation into managed care in the US and Canada.     

我国老年保健中社区护理问题分析及展望

分析我国老年人的健康问题、社区护理在老年保健中的作用、老年社区护理现状以及老年社区护理目前存在的问题,展望我国老年社区护理的发展模式.     

Effect of an integrated primary care model on the management of middle-aged and old patients with obstructive lung diseases

OBJECTIVE: To investigate the effect of a primary care model for COPD on process of care and patient outcome. DESIGN: Controlled study with delayed intervention in control group. SETTING: The GP delegates tasks to a COPD support service (CSS) and a practice nurse. The CSS offers logistic support to the practice through a patient register and recall system for annual history-taking and lung function measurement. It also forms the link with the chest physician for diagnostic and therapeutic advice. The practice nurse's most important tasks are education and counselling. SUBJECTS: A total of 44 practices (n =22 for intervention and n =22 for control group) and 260 of their patients > or = 40 years with obstructive lung diseases. RESULTS: Within the intervention group planned visits increased from 16% to 44% and from 19% to 25% in the control condition (difference between groups p =0.014). Annual lung function measurement rose from 17% to 67% in the intervention and from 11% to 18% in the control group (difference between groups p =0.001). Compared with control, more but not statistically significant smokers received periodic advice to quit smoking (p =0.16). At baseline 41% of the intervention group were using their inhalers correctly and this increased to 54% after two years; it decreased in the control group from 47 to 29% (difference between groups p =0.002). The percentage of patients without exacerbation did not change significantly compared with the control condition. The percentage of the intervention group not needing emergency medication rose from 79% to 84% but decreased in the controls from 81 to 76% (difference between groups p =0.08). CONCLUSION: Combining different disciplines in one model has a positive effect on compliance with recommendations for monitoring patients, and improves the care process and some patient outcomes.     

Safety, effectiveness and costs of different models of organising care for critically ill patients: literature review

New ways of working in critical care are emerging in response to increasing demands for care in the context of a limited critical care workforce. This review appraised the comparative safety, effectiveness and costs of new ways of working in critical care. All papers published in peer reviewed journals during 1990-2003 were utilised. A total of 933 potentially relevant papers were identified. Secondary sources including policy papers, and experts within the field were also used to inform this work. Initially 113 papers met the inclusion criteria. However, 58 of these described policy and secular trends in critical care and were therefore used only to provide background information. A total of 55 papers were then critically reviewed to provide academic focus on the subject area. Examples of comparative empirical research on new ways of working were limited, but the review revealed research activity in the areas of: impact of workload; nursing, medical and organisational factors affecting patient outcomes; and methods to support workforce calculations. The findings suggest that research into longer-term patient outcomes is needed together with a proactive and strategic interdisciplinary approach to practice, policy and research.     

Public Health Nurses and the delivery of quality nursing care in the community

Aim. The aim of the study was to explore factors which impact on quality nursing care in the community from the Public Health Nurse's (PHN) perspective. Background. Public Health Nursing has significantly evolved over the past few years with the delivery of quality nursing being a focus point. This study explores factors that impact upon the delivery of quality care in Public Health Nursing in Ireland. The findings provide an opportunity for an additional perspective to be included in the existing international findings and act as a starting point from which further research can be built. Method. A qualitative method using semi‐structured interviews were conducted. Interviews were taped and content analysed. Findings. Four main categories emefrged from the data, namely role change, components of quality nursing care, barriers to quality nursing care and the factors that facilitate the delivery of quality nursing care in the community. PHNs strive for evidence‐based practice; they acknowledged their inability to achieve this and referred to factors that inhibited them from reaching their goal. Conclusion. Enhanced education for PHNs will equip them in the delivery of a quality service and have a positive impact on patient care. Better communication is required between PHNs, line managers and the multidisciplinary team. The delivery of community services need to be reviewed and developed further in accordance with the health strategy policy. Relevance to clinical practice. This study has identified the evolution in clinical practice associated with the changing role and scope of Public Health Nursing. Clinical practice has evolved over time to incorporate societal change, technological advances and the delivery of an evidence‐based service responsive to identified need. This study identified the presence of an increase in the specialist clinical work being undertaken as a result of new technological advances entering the community working environment.     

慢性心功能不全患者实施人文护理的效果评价

目的探讨人文护理在慢性心功能不全患者中的应用效果。方法心功能Ⅳ级患者60例随机分为对照组与实验组各30例,对照组给予常规护理,实验组在此基础上给予人文护理,干预前后进行对比分析。结果实验组患者的焦虑程度、对护理工作的满意度、心功能情况均较对照组改善。结论人文护理可缓解患者的临床症状,提高其对护理工作的满意度,同时提高护理人员的业务素质和文化修养。