Bmc Fam Pract
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Randomized Controlled Trial Multicenter Study
Patient-experienced effect of an active implementation of a disease management programme for COPD - a randomised trial.
People living with chronic disease currently account for the majority of the total healthcare costs. The Central Denmark Region implemented a disease management programme (DMP) for chronic obstructive pulmonary disease (COPD) in 2008. This presented an opportunity to examine the effect of an evidence-based, planned and proactive implementation of a DMP compared to the usual implementation strategy. ⋯ Reinforcing the role of general practice as coordinator for care-and self-management-support with an active implementation of a DMP for COPD made patients score higher on the PACIC instrument, which indicates a better experience of the received healthcare.
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Multicenter Study Clinical Trial
Impact of the implementation of an online network support tool among clinicians of primary health care and specialists: ECOPIH Project.
There has been created an online communication tool with the objective to improve the communication among different levels of care, between Primary Care clinicians and Specialists. This tool is web 2.0 based technology (ECOPIH project). It allows to review clinical cases and to share knowledge. Our study will evaluate its impact in terms of reduction on the number of referrals to three specialties two years after the use of this tool. ⋯ The implementation of ECOPIH in the field of Primary Health Care can decrease the number of referrals from primary care to specialist care.It is expected that the reduction will be more noticeable in the group of professionals that use more intensively the tool. Furthermore, we believe that it can be also observed with the professionals that read the contributions of the others.We anticipate high degree of customer satisfaction as it is a very helpful resource never used before in our environment.
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The numbers of learners seeking placements in general practice is rapidly increasing as an ageing workforce impacts on General Practitioner availability. The traditional master apprentice model that involves one-to-one teaching is therefore leading to supervision capacity constraints. Vertically integrated (VI) models may provide a solution. Shared learning, in which multiple levels of learners are taught together in the same session, is one such model. This study explored stakeholders' perceptions of shared learning in general practices in northern NSW, Australia. ⋯ Shared learning models may partly address supervision capacity constraints in general practice, and bring multiple benefits to the teaching environment that are lacking in the one-to-one model. However, the risks need to be managed appropriately, to ensure learning needs are met for all levels of learners. Supervisors also need to consider that one-to-one teaching may be more suitable in some instances. Policy makers, medical educators and GP training providers need to ensure that quality learning outcomes are achieved for all levels of learners. A mixture of one-to-one and shared learning would address the benefits and downsides of each model thereby maximising learners' learning outcomes and experiences.
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Obstacles to the prevention of overweight and obesity in the context of child health care in Sweden.
Overweight and obesity in younger children could better be brought in focus through a deeper understanding of how Child Health Care nurses (CHC-nurses) perceive their work with the problems of overweight at the CHC Centers. The aim of this study was to elucidate the CHC-nurses conceptions of their preventive work with childhood overweight and obesity in Child Health Care. ⋯ Nurses' attention to monitoring overweight in children, and their initiative for prevention, is based on their conceptions of the obstacles that hinder them in their efforts. An increased awareness of the CHC-nurses conceptions of the priorities, their sense of responsibility and prevention practices is warranted. If measures in this direction are not taken there is a growing risk that overweight children will pass through the CHC without any formal recognition of their situation. There is an indication that the present level of the CHC-nurses' preventive work with childhood overweight has room for improvement in several areas. It is suggested that the specialist education of these health care professionals should be supplemented and that organisation of the management of childhood overweight should be also revised at the primary health care level.
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The introduction of efficacious physical activity interventions in primary health care is a complex process. Understanding factors influencing the process can enhance the development of effective introduction strategies. This Delphi study aimed to identify factors most relevant for the adoption, implementation, and continuation of physical activity interventions in primary health care by examining experts' opinions on the importance and changeability of factors previously identified as potentially relevant for the process. ⋯ This study identified general and stage-specific factors relevant for the introduction of physical activity interventions in primary health care. It emphasizes the importance of taking these factors into account when designing introduction strategies, and of giving special attention to the distinct stages of the process. Due to lack of consensus on the changeability of most important factors, the extent to which these factors can be influenced by introduction strategies remains unclear.