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Braut H, Storm M, Mikkelsen A. A Qualitative Study on Distributed Leadership in Integrated Care: Exploring the Experiences of Elderly Multimorbid Patients with GP Collaboration. J Multidiscip Healthc 2023; 16:3167-3177. [PMID: 37915976 PMCID: PMC10615873 DOI: 10.2147/jmdh.s412283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 09/11/2023] [Indexed: 11/03/2023] Open
Abstract
Objective This study explores how the collaboration between elderly multimorbid patients and general practitioners contributes to the patient's experience of integrated care in the municipality. The research also investigates whether the municipality's integrative mechanisms creating integrated care can be understood as distributed leadership. Method In this qualitative study, we conducted a thematic analysis of semi-structured interviews with twenty elderly multimorbid patients living at home and their general practitioners. Results Analysis of patients' and general practitioners' experience of healthcare service characterized by collective efforts identified four themes: 1) an impression of collective processes as difficult for patients to access and influence; 2) that the fluidity and location of leadership is dependent on the individual patient and his or her health condition; 3) that collective implementation of healthcare services is separated in time, geography and between organizations; and 4) that patients experience individual healthcare workers as specialized and unable to support the medical and holistic goals of the collective. The Direction, Alignment, and Commitment or DAC framework, is used to investigate the capabilities of the collective. Conclusion To promote distributed leadership and create a patient experience of integrated care in the municipality, healthcare organizations must develop collective processes that enhance patient participation to a greater extent. General practitioners and other healthcare personnel should be encouraged to play a more central role in solving elderly multimorbid patients' healthcare needs in the municipality.
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Affiliation(s)
- Harald Braut
- University of Stavanger Business School, University of Stavanger, Stavanger, Norway
| | - Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Aslaug Mikkelsen
- University of Stavanger Business School, University of Stavanger, Stavanger, Norway
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Heuser C, Schellenberger B, Ernstmann N, Diekmann A, Krüger E, Schreiber L, Scholl I, Ansmann L. Shared-Decision-Making Experiences in Breast Cancer Care with and without Patient Participation in Multidisciplinary Tumor Conferences: A Mixed-Methods-Study. J Multidiscip Healthc 2023; 16:397-409. [PMID: 36816614 PMCID: PMC9930677 DOI: 10.2147/jmdh.s397300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/17/2023] [Indexed: 02/12/2023] Open
Abstract
Purpose This study aimed (1) to analyze patients' perceived shared decision-making (SDM) experiences over 4 weeks between patients participating or not in multidisciplinary tumor conferences (MTCs) and (2) to analyze the association of patients' active participation in and organizational variables of MTCs with patients' perceived SDM experience directly after MTC. Patients and Methods From the N=317 patients, this observational study included patient surveys, observations, and audio transcripts from MTCs with (N=82) and without (N=145) patient participation in six breast and gynecologic cancer centers. We performed t tests for within- and between-group comparisons and linear regression with "patients' perceived SDM experiences in MTC" as the dependent variable. Results Patients' perceived SDM experiences increased at 4 weeks after MTC (p<0.001) with lower perceived SDM experiences for participating versus nonparticipating patients (p<0.001). Linear regression showed that the organizational variable "round table seating arrangement" was significantly associated with higher perceived SDM experiences compared with a theater or U-shape arrangement (beta=-0.38, p=0.043; beta=-0.69, p=0.010) directly after MTC. Conclusion Results provide first insights into patients' perceived SDM experiences in MTCs. SDM in MTCs is associated with organizational variables of MTCs. A round table seating arrangement in MTCs with patient participation seems important for patients' perceived SDM experiences. The relatively low perceived SDM experiences of participating patients directly after MTC indicates room for improvement, eg concerning patient-centered communication.
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Affiliation(s)
- Christian Heuser
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany,Chair for Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany,Correspondence: Christian Heuser, Chair for Health Services Research, Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany, Tel +49-221-478-97133, Email
| | - Barbara Schellenberger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany,Chair for Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany
| | - Nicole Ernstmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany,Chair for Health Services Research, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, 50933, Germany
| | - Annika Diekmann
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany
| | - Emily Krüger
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany
| | - Leonie Schreiber
- Center for Health Communication and Health Services Research (CHSR), Department for Psychosomatic Medicine and Psychotherapy, Center for Integrated Oncology (CIO Bonn), University Hospital Bonn, Bonn, 53127, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, 20246, Germany
| | - Lena Ansmann
- Division for Organizational Health Services Research, School of Medicine and Health Sciences, Carl von Ossietzky University Oldenburg, Oldenburg, 26129, Germany
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Abstract
Background Over the last decade, the Short-Term Assessment of Risk and Treatability (START) has provided a strong evidence base to predict a range of problem behaviors. The implementation of START and adaptation of the services to the use of START have so far been sparsely described in the literature. The purpose of this study was to describe the continuation and the interdisciplinarity of risk assessments through the two phases. Methods Over a period of 10 years, the forensic mental health services at Brøset has implemented START in two phases: initially with implementing the instrument (2005–2009) and secondarily by customizing the instrument to everyday treatment and planning (since 2009). This implementation was based on data from 887 START assessments for 181 patients over a decade (2005–2015). Results The results showed that the number of START assessments has been stable throughout the past 10 years and the interval between the ratings has decreased significantly (p<0.05). The involvement by diversity of professionals has increased significantly over the two implementation phases. Conclusion This study also addressed the continuity and organization of the implementation process and presented an overview of how START has been widespread in the service through treatment. The results showed an increased multidisciplinary participation and a continuing rate of assessments as the implementation progressed from assessment to a combined assessment–treatment phase.
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Affiliation(s)
| | | | | | - Erik Søndenaa
- Department Brøset, St. Olavs Hospital.,Regional Centre for Child and Youth Mental Health and Child Welfare, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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O’Connell E, Pegler J, Lehane E, Livingstone V, McCarthy N, Sahm LJ, Tabirca S, O’Driscoll A, Corrigan M. Near field communications technology and the potential to reduce medication errors through multidisciplinary application. Mhealth 2016; 2:29. [PMID: 28293602 PMCID: PMC5344100 DOI: 10.21037/mhealth.2016.07.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/08/2016] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Patient safety requires optimal management of medications. Electronic systems are encouraged to reduce medication errors. Near field communications (NFC) is an emerging technology that may be used to develop novel medication management systems. METHODS An NFC-based system was designed to facilitate prescribing, administration and review of medications commonly used on surgical wards. Final year medical, nursing, and pharmacy students were recruited to test the electronic system in a cross-over observational setting on a simulated ward. Medication errors were compared against errors recorded using a paper-based system. RESULTS A significant difference in the commission of medication errors was seen when NFC and paper-based medication systems were compared. Paper use resulted in a mean of 4.09 errors per prescribing round while NFC prescribing resulted in a mean of 0.22 errors per simulated prescribing round (P=0.000). Likewise, medication administration errors were reduced from a mean of 2.30 per drug round with a Paper system to a mean of 0.80 errors per round using NFC (P<0.015). A mean satisfaction score of 2.30 was reported by users, (rated on seven-point scale with 1 denoting total satisfaction with system use and 7 denoting total dissatisfaction). CONCLUSIONS An NFC based medication system may be used to effectively reduce medication errors in a simulated ward environment.
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Affiliation(s)
- Emer O’Connell
- Cork Breast Research Centre, Cork University, Hospital, Wilton, Cork, Ireland
| | - Joe Pegler
- Department of Computer Science, University College Cork, Cork, Ireland
| | - Elaine Lehane
- School of Nursing, University College Cork, Cork, Ireland
| | - Vicki Livingstone
- Cork Breast Research Centre, Cork University, Hospital, Wilton, Cork, Ireland
| | - Nora McCarthy
- School of Medicine, University College Cork, Cork, Ireland
| | - Laura J. Sahm
- School of Pharmacy, University College Cork, Cork, Ireland
- Department of Pharmacy, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - Sabin Tabirca
- Department of Computer Science, University College Cork, Cork, Ireland
| | - Aoife O’Driscoll
- Cork Breast Research Centre, Cork University, Hospital, Wilton, Cork, Ireland
| | - Mark Corrigan
- Cork Breast Research Centre, Cork University, Hospital, Wilton, Cork, Ireland
- Royal College of Surgeons Ireland, 121 St Stephen’s Green, Dublin 2, Ireland
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Vincent-Onabajo GO, Mustapha A, Oyeyemi AY. Medical students' awareness of the role of physiotherapists in multidisciplinary healthcare. Physiother Theory Pract 2014; 30:338-44. [PMID: 24397369 DOI: 10.3109/09593985.2013.871765] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Successful implementation of multidisciplinary healthcare approach may among other things depend on students' education and knowledge of the roles of healthcare professions other than their own. This study investigated medical students' awareness of the role of physiotherapists in multidisciplinary healthcare teams. METHODS One hundred and ninety-eight medical students of the University of Maiduguri, Nigeria, participated in this study. Each student completed a self-administered questionnaire that obtained information on demographics, awareness of role of physiotherapists and educational sources of information as well as suggestions about other sources of information about physiotherapy. Chi-square test was used to analyze differences in awareness by gender and year of study. RESULTS Although rates of awareness regarding some physiotherapy roles were high, many of the medical students were unaware that physiotherapists can practice on first-contact basis and autonomously. About 60% of the students also viewed the role of physiotherapists in the health team as one of providing assistance for medical work. Clinical ward round was the most common source of information on physiotherapy although many of the students suggested classroom lecture as a preferred means of obtaining information. Year of study resulted in significantly different level of awareness (p < 0.05) with a higher proportion of final year students exhibiting awareness of physiotherapists' roles. CONCLUSION Clinical ward rounds facilitated the students' awareness of the role of physiotherapists. Interprofessional education involving lectures and clinical ward rounds may assist in building medical students' level of awareness and appreciation of the physiotherapy profession.
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Affiliation(s)
- Grace O Vincent-Onabajo
- Department of Medical Rehabilitation (Physiotherapy), University of Maiduguri , Maiduguri, Borno State , Nigeria
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