1,721,050 research outputs found
Barriers and Facilitators towards an Integrated Chronic Care Model as experienced by primary care health providers.
No full textBackground: The highly increased prevalence of chronic conditions challenges the actual health care systems. The Flemish governments has adopted the Chronic Care Model as the mainframe for health policy changes. However until now, there was no major practice change in the way how health care is provided in primary care. Most providers continue to work in the classic way on their own with few multidisciplinary contacts, presence of silos between primary and secondary care, lack of planned population management, little use of existing guidelines... Therefore, the Flemish government ordered Domus Medica, the Flemish General Practice professional organisation, to develop an action research project. The aim of the project was 1. To promote and spread the chronic care model amongst Flemish health care workers; 2. To evaluate both barriers and facilitators towards its implementation.
Method: Domus Medica organised a large survey in 16 Flemish regions. Therefore it put up 1 national and 16 regional steering committees. Each regional steering had to involve as many health care workers in the process as possible. Each committee was free to use its own methods. In total, six different methods were used: electronic survey, survey on paper, face to face interviews, workshops, seminars and ‘world cafes’. Most regions used a ‘mixed method’ approach. Each region had to write down the results into a report. The collected reports were analysed. Barriers and facilitators were listed for each region and then brought together. This ‘long’ list was analysed by an expert who used the ‘Implementation model’ (Grol, Wensing) to filter the most relevant items. These results were fed back for validation towards the involved stakeholders: respondents had to mark their agreement on a Likert scale from 1 (strongly disagree) to 4 (strongly agree). Only those items that obtained a score of 3 or 4 by more than 70% of all respondents were selected. This lead to a ‘short list’ summed up according to the pillars of the Chronic Care Model. Finally the results were thoroughly discussed leading to a report with recommendations.
Results: 598 people responded to the written surveys and interviews and 943 people participated to the workshops, seminars and world cafes. There was some overlap but in total, more than 1300 different persons participated including about 400 General Practitioners and nurses and 200 physiotherapists and pharmacists. 166 people participated in the validation process. The ‘long list’ contained 349 barriers and 167 facilitators and the short ‘short list’ 63 barriers and 39 facilitators. The report for the Flemish Minister of health contained 17 core recommendations. Main barriers remain the concept of patient empowerment and health promotion, multidisciplinary teamwork, integration and continuity between hospital and primary care and between health care and social welfare. Evidence Based Medicine is inadequately acquired, especially by non-physicians. ICT is experienced as thé necessary tool for integration and communication. However in practice it is a source of major concern because systems are often unstable, necessary knowledge to use the systems and to resolve technical problems are lacking and ICT investment is both expensive and time consuming. Two major structural barriers that hamper all evolution towards integrated chronic care were put forward: the payment system that enables a comfortable revenue by fee for service and unfitted organisational structures in primary care, both at micro level (too small business units) as at meso-level (a patchwork of different organisations with overlapping competences). Finally, health care providers would like to be more involved in government initiatives and campaigns. Major facilitators put forward were the existing and well developed health services as well as the recent initiatives to promote chronic care and spread ICT. As such, the existing structures and initiatives must be considered as the basement of future change. The professional commitment of the providers towards their patients and the open mind towards the upcoming change were also put forward as essential facilitators. Finally, providers experience the patients’ tendencies to more empowerment and independence as a positive evolution.
Discussion: The strength of this project is the involvement of a large number of Flemish primary care providers into a movement for better chronic care. It also listed essential barriers towards its implementation as well as key facilitators. Its major weakness is its scope, only based on the experience of primary health care providers without involvement of neither social workers, nor secondary care and expert opinion. However, the project enabled a landmark report for the Ministry of Health with key recommendations to successful future nation-wide implementation of chronic care.sponsorship: Domus Medica - Flemish Governmentstatus: Publishe
Exploring the Support and Involvement of Family Caregivers for Reablement Programs: A Qualitative Study
No full textBACKGROUND: Reablement is a person-centered, holistic approach promoting older adults' participation through social, leisure, and physical activities. Family caregivers are seldom involved in reablement services despite their wish to be an active member of the care team and expressing a need for more support and recognition. The voice of family caregivers is often forgotten when evaluating services such as reablement. Little is known how family caregivers can be involved and supported more effectively in reablement services, therefore the aim of our research is to investigate the perceived support and involvement of family caregivers. METHODS: As part of the TRANS-SENIOR project, we studied perceived support and involvement of family caregivers during and after geriatric rehabilitation, a setting in which principles of reablement, like goal setting and training of daily activities, are applied. In total, fourteen semi-structured interviews were conducted with family caregivers of people admitted to a geriatric rehabilitation facility. Thematic analysis was used. RESULTS: Results reflected four themes: (1) support for family caregivers, (2) involvement in care, (3) trusting care professionals, and (4) asking for and accepting support. Family caregivers' experiences with support from care professionals were mainly ambivalent. While caregivers expressing a lack of support and information whilst also indicating that they do not expect to be supported by care professionals. Regarding involvement, caregivers wanted to be involved; ie express their opinion and be involved in decision-making. However, more involvement could also lead to a higher burden. CONCLUSION: There is a discrepancy between the perceived support and involvement of family caregivers, their expressed needs, and their expectations of care professionals. A personalized approach is needed to create room for the family caregiver to be an active participant in the care process while also providing the right amount of support, when preferred by the caregiver
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Full text linkWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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