Shared Care (shared + care)

Distribution by Scientific Domains

Selected Abstracts

A qualitative investigation of the views and health beliefs of patients with Type 2 diabetes following the introduction of a diabetes shared care service

S. M. Smith
Abstract Aims A qualitative research approach was adopted in order to explore the views and health beliefs of patients with Type 2 diabetes who had experienced a new structured diabetes shared care service. Methods Patients from 15 general practices were randomly selected and invited to attend three focus groups. Two independent researchers adopted the ,Framework' technique to analyse the transcribed data and identify key themes expressed by patients. Results Themes relating to diabetes included frustration, victimization and powerlessness in relation to living with diabetes, controlling blood sugar, medication and economic barriers to care. Differences in emphases between patients and healthcare providers emerged. Patients were generally positive about shared care and largely identified it with the nurses involved. Conclusion This research highlights the importance of an in-depth exploration of patients' views during changes in diabetes care delivery to identify service delivery failures and gaps in patient knowledge such as lack of awareness of the extent of macrovascular risk. [source]

Why do Both Parents Incubate in the Kentish Plover?

ETHOLOGY, Issue 8 2003
András Kosztolányi
Incubation by both parents is a common parental behaviour in many avian species. Biparental incubation is expected if the survival prospects of offspring are greatly raised by shared care, relative to the costs incurred by each parent. We investigated this proposition in the Kentish plover Charadrius alexandrinus, in which both parents incubate the clutch, but one parent (either the male or the female) usually deserts after hatching of the eggs. We carried out a mate-removal and food supplementation experiment to reveal both the role of the sexes and food abundance in maintaining biparental incubation by removing either the male or the female from the nest for a short period of time. In some nests we provided supplementary food for the parent that remained at the nest to reduce the costs of incubation, whereas other nests were left unsupplemented. Although males spent more time on incubation after their mate had been removed, females' incubation did not change. Notwithstanding the increased male incubation, total nest attentiveness was lower at uniparental nests than at biparental controls. However, incubation behaviour was not influenced by food supplementation. We conclude that offspring desertion during incubation is apparently costly in the Kentish plover, and this cost cannot be ameliorated with supplementary food. [source]

Effectiveness of nurse-led cardiac clinics in adult patients with a diagnosis of coronary heart disease

Tamara Page RN BN HyperbaricNursCert GradDipNSc(HighDep) MNSc
Executive summary Background, Coronary heart disease is the major cause of illness and death in Western countries and this is likely to increase as the average age of the population rises. Consumers with established coronary heart disease are at the highest risk of experiencing further coronary events. Lifestyle measures can contribute significantly to a reduction in cardiovascular mortality in established coronary heart disease. Improved management of cardiac risk factors by providing education and referrals as required has been suggested as one way of maintaining quality care in patients with established coronary heart disease. There is a need to ascertain whether or not nurse-led clinics would be an effective adjunct for patients with coronary heart disease to supplement general practitioner advice and care. Objectives, The objective of this review was to present the best available evidence related to nurse-led cardiac clinics. Inclusion criteria, This review considered any randomised controlled trials that evaluated cardiac nurse-led clinics. In the absence of randomised controlled trials, other research designs such as non-randomised controlled trials and before and after studies were considered for inclusion. Participants were adults (18 years and older) with new or existing coronary heart disease. The interventions of interest to the review included education, assessment, consultation, referral and administrative structures. Outcomes measured included adverse event rates, readmissions, admissions, clinical and cost effectiveness, consumer satisfaction and compliance with therapy. Results, Based on the search terms used, 80 papers were initially identified and reviewed for inclusion; full reports of 24 of these papers were retrieved. There were no papers included that addressed cost effectiveness or adverse events; and none addressed the outcome of referrals. A critical appraisal of the 24 remaining papers identified a total of six randomised controlled trials that met the inclusion criteria. Two studies addressed nurse-led clinics for patients diagnosed with angina, one looked at medication administration and the other looked at educational plans. A further four studies compared secondary preventative care with a nurse-led clinic and general practitioner clinic. One specifically compared usual care versus shared care introduced by nurses for patients awaiting coronary artery bypass grafting. Of the remaining three studies, two have been combined in the results section, as they are an interim report and a final report of the same study. Because of inconsistencies in reporting styles and outcome measurements, meta-analysis could not be performed on all outcomes. However, a narrative summary of each study and comparisons of specific outcomes assessed from within each study has been developed. Although not all outcomes obtained statistical significance, nurse-led clinics were at least as effective as general practitioner clinics for most outcomes. Recommendations, The following recommendations are made: ,The use of nurse-led clinics is recommended for patients with coronary heart disease (Level II). ,Utilise nurse-led clinics to increase clinic attendance and follow-up rates (Level II). ,Nurse-led clinics are recommended for patients who require lifestyle changes to decrease their risk of adverse outcomes associated with coronary heart disease (Level II). [source]

Geriatric Oncology and Primary Care: Promoting Partnerships in Practice and Research

Julia Hannum Rose PhD
This supplement is a compilation of original work that was presented at an interdisciplinary conference on "Geriatric Oncology and Primary Care: Promoting Partnerships in Practice and Research" held in Cleveland, Ohio, April 3 to 4, 2008. An audience of 77 clinicians and researchers attended this conference, primarily coming from Ohio and adjacent states. Articles are organized around a conceptual framework to consider primary and shared care roles of primary care physicians (PCPs) and oncologists in the care of older patients with cancer and their families. Articles in Section One focus on evidence-based clinical practice and recommendations. Section Two includes articles on original psychosocial and health services research that inform this topic. Papers in this conference were developed in recognition of the greater prevalence and growing incidence of cancer in older adults; the unique geriatric expertise and practice considerations essential to the prevention and control of cancer in older adults; the important and effective roles that PCPs may play in such care; and the need to develop shared care models that foster collaboration between PCPs and oncologists, from cancer prevention through long-term survivorship and end-of-life care of older adults. Models of shared care between oncologists and PCPs should be tested and compared for optimal care of older patients with cancer and their families. Potential implications of ideally shared care include more-informed patient-centered decision-making, better adherence to treatment, improved match between older patient goals and treatments, and thus better outcomes. [source]

Shared Care in Geriatric Oncology: Primary Care Providers' and Medical/Oncologist's Perspectives

Cynthia Owusu MD
Existing literature lends support to the benefit of shared care in the management of chronic diseases, but there are limited data on the feasibility, cost-effectiveness, or benefits of shared care in oncology. A recent conference organized by the Aging and Cancer Program of the Case Comprehensive Cancer Center sought to explore the perceptions of physicians and other allied health professionals who attended the conference about shared care in the acute management of older patients with cancer using a case history presentation and an anonymous audience response system. Analyses of the audience response indicated that shared responsibility and enhanced information exchange in addition to the current level of communication between providers involved in the acute management of older patients with cancer is desirable. Studies exploring the feasibility and benefits of a shared care model in the management of older patients with cancer are needed. [source]

Survivorship care after breast cancer: Follow-up practices of Australian health professionals and attitudes to a survivorship care plan

Abstract Objective: The increasing number of breast cancer survivors and the complexity of follow-up care make the provision of high-quality survivorship care a challenge. This study explored the follow-up practices of health professionals and their attitudes to alternative models such as shared care and the use of a survivorship care plan. Methods: Specialist oncologists (surgeons, medical and radiation oncologists) breast physicians and breast-care nurses completed an online survey. Results: A total of 217 practitioners completed the survey, which was estimated to include 42.8% of oncologists treating breast cancer in Australia. One-third of responding specialists reported spending more than 25% of their clinical time providing follow-up care. They reported many positive aspects to follow-up consultations and viewed follow-up care as an important part of their clinical role but expressed concern about the sustainability of follow-up care in their practices. The follow-up intervals and recommendations were in line with national guidelines. The specialists were supportive of sharing follow-up care with primary-care physicians, breast physicians and breast-care nurses. Most professionals felt that a survivorship care plan would improve care and said they would use a proforma. Conclusion: The oncologists felt that follow-up care was an important part of their role and they were supportive of the concepts of shared care programs and a survivorship care plan. Input from consumers is required to evaluate the acceptability of these alternative models and to assess ways of implementing these changes to work towards a more comprehensive and sustainable method of delivering survivorship care. [source]

Sharing obstetric care: barriers to integrated systems of care

Objectives: To map the provision of shared obstetric care in Victoria, and investigate the views of care providers about the ways in which current practice could be improved. Method: All Victorian public hospitals with <300 births per annum and a purposive sample of hospitals with <300 births per annum were mailed a questionnaire seeking information about current practice. Interviews with key informants (n = 32) were conducted at four case study sites. Results: The response rate to the hospital survey was 98% (42/43). Fourteen different models of shared care were identified. Two,thirds of hospitals with <300 births per annum (16/28) had three or more different models of shared care. Six hospitals (15%) had written guidelines for all models of shared care offered; 13 (32%) had written guidelines covering some models. Practice varied considerably in relation to: exclusion criteria, recommended schedule of visits and use of patient,held records. There was little consensus about the content of visits and responsibility fa covering particular aspects of care. Few hospitals (6/42) had written information for women about shared care. Care providers expressed divergent views regarding the question of where ultimate responsibility lies for individual patient care and for the overall management of shared care. Conclusions: Current funding arrangements provide strong incentives to expand enrolment in shared obstetric care. Expansion of shared care has occurred without the development of formal, consultative and agreed arrangements between providers, or adequate provision for monitoring, evaluation and review. The variety, complexity and fluidity of models of shared care and lack of agreed procedures contribute to difficulties experienced by both providers and women participating in shared care. Implications: Detailed evidence,based agreed guidelines developed in consultation with hospital and community providers, and provision of improved information to women about what to expect in shared care arrangements are urgently required. [source]