Journal of evaluation in clinical practice
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More knowledge is needed regarding the complex factors and perceptions that enable the implementation of change in health care. The study aimed to examine the enabling factors and barriers encountered in the implementation of improvements in health care in order to achieve patient-centred care (PCC) and to study if there was a correlation in the extent the improvements were perceived to be implemented and the preconditions that were considered to affect them. ⋯ The PARiHS framework was appropriate to use since the three components of evidence, context, and facilitation present different important preconditions in the implementation process. Evidence was the highest rated contributor since evidence-based practices in health care are necessary. It is vital that the important role of the context and facilitators is acknowledged in the implementation process to enable a successful implementation of change. There is a need to incorporate a clear strategy involving all levels in the organization. Furthermore, leaders play an important role in the implementation by facilitating communication and support and by having trust in facilitators and health care personnel. The results are applicable to other interventions implementing change in health care.
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Compulsory community treatment for people with severe mental illness remains controversial due to conflicting research evidence. Recently, there have been challenges to the conventional view that trial-based evidence should take precedence. ⋯ Second, it develops a critique of trials centred on both how we can have knowledge and what it is we can have knowledge of. Third, it uses this critique to develop a research strategy that capitalizes on the information in large-scale datasets.
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Clinical and research evidence suggests that family functioning is an important variable in shaping psychological well-being, despite being often overlooked in the prevailing approaches to mental health. The aim of the present study is to examine the associations between psychological distress and family functioning in a sample of patients accessing a public mental health service. ⋯ This study confirms that family functioning is significantly associated with psychological distress, also in the absence of clear and conspicuous signs of structural imbalances within family relationships.
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Care transitions between hospitals and skilled nursing facilities (SNFs) are often associated with breakdowns in communication that may place patients at risk for adverse events. Less is known about how to address these issues in the context of busy patient care settings. We used process mapping to examine hospital discharge and SNF admission processes to identify opportunities for improvement. ⋯ Process mapping highlighted specific opportunities for improving communication between care teams. Participants advocated for earlier assessments of patients' functional status and support systems, including reliable at-home services. They also reasoned that improved communication would help patients and providers reach decisions together, coordinate work efforts, and better prepare for hospital discharge and SNF admission. This information can be used to improve patient care transitions between hospitals and SNFs.
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The predominant assumption of doctor professionalism may be prone to unpredicted alterations in the face of "a new age of doctoring." The aim in this study is to explore one dimension in the doctor-patient dyadic relationship: the face-to-face interaction between doctors and patients and whether satisfaction of role expectations affects service outcomes as perceived by the patient-consumer. ⋯ Role expectations play a moderating role between emotions and service outcomes. The medical performance can be perceived good or bad depending on whether the doctor smiles "too much" or not. Results are discussed within the context of role expectation theory and the changing nature of service relationships in the health care sector.