Search results

This paper aims to explore the perceptions of facilitators and barriers to their using electronic medical records (EMRs) for these functions and contributes baseline data about the use of EMRs for chronic disease management. The sub‐study reported here is a baseline process evaluation of EMRs and their current use, preliminary to a larger, pragmatic, randomized controlled trial. Its purpose is to understand how EMRs are currently being used by primary care physicians to facilitate chronic disease prevention and screening in their practices.

This is a qualitative case study where the lead physician at each of eight primary care clinics (four in Alberta, four in Ontario) participated in semi‐structured interviews. Data were analyzed using thematic content analysis.

Although EMRs are being used in a limited fashion for chronic disease prevention and screening, clinicians identified few current benefits. Participants noted some instances in which paper charts were preferred and that the lack of human and financial resources is inhibiting the use of chronic disease applications already incorporated in EMRs.

To understand fully how EMRs can best be used in the logistical management of chronic disease prevention and screening requires research efforts towards improvement of the data structures they contain.

Data extraction needs to be easier so that screening of patients, at risk or living with chronic disease, can be facilitated.

Evaluation of the benefits, for the content of care and care relationships, conferred by this new method of communicating, needs to be complemented by a parallel exploration of the risks.

The paper illustrates that with the tremendous investments in EMRs it is important to learn how changes in their design could facilitate improvements in patient care in this important area.

Migrant and seasonal farmworkers (MSFWs) have many health challenges due to the nature of their work, low wages, living conditions, mobility, and lack of health insurance. The purpose of this paper is to assess the availability of health services, barriers to accessing health care, and the prevalence of chronic conditions among MSFWs in Indiana.

A site-based convenience sample of MSFWs aged 14 years and older completed a cross-sectional survey. A total of 97 participants who currently or previously identified as farmworkers completed the questionnaire.

Almost one-third of the respondents reported no access to a health care provider. Of those, 43 percent reported that cost prevented them from seeking care. Of those who reported chronic conditions ( n=22), over 50 percent did not have access to a health care provider. These findings highlight the need to further investigate the magnitude of the problem and begin exploring ways to improve affordable health care access among MSFWs in Northeastern Indiana.

The results from this study highlight the need for the development and implementation of community health education programs that target MSFWs in Indiana. The findings, although not generalized, offer important insights into health care challenges and barriers to access in Indiana. The authors recommend that assistance programs should be implemented for providing affordable health care services for Hispanic MSFWs.

Objective. To evaluate a health and fitness programme conducted within a New South Wales, Australia correctional facility for male inmates with a chronic illness. Design. A randomised control trial. Sample. Twenty male inmate participants with a chronic illness, two risk factors for developing a chronic illness or who were over the age of 40 years. Measurements. Pre and post programme health assessments that included resting blood pressure and heart rate, weight, body mass index, waist girth, peak flow measures, peripheral saturation of oxygen, blood glucose levels and 6 minute walk test. Intervention. A 12‐week structured exercise programme focusing on cardio respiratory endurance, strength and flexibility training. Results. Statistically significant improvements in resting heart rate and endurance were found. Conclusions. The health and fitness programme positively impacts on the health of inmates with a chronic illness. A further study with a larger sample size would be productive.

Purpose – This chapter argues that health care is best conceptualized as a complex adaptive system. Sustainable health care depends on harnessing the complexity of the system by building aligned purpose, flexible pathways to connect people, knowledge and resources, and the capacity for self-organization.

Design/methodology/approach – The case study of the Southern California Region of Kaiser Permanente is based on three years of interviews and archival data collection examining the system's transformational change that began in 2004 and has been aimed at building a sustainable health care system with the guiding principles of value and prevention. The case focuses primarily on the medical care delivery system designed by the Southern California Permanente Medical Group, the capabilities that have been built into the system to continually improve the quality of care and the outcomes of the system, and the results that have been achieved.

Findings – During the period from 2004 to 2011, the region improved significantly in slowing cost acceleration by significantly improving medical care. The implementation of an electronic medical records system and its integration with other clinical information technology systems have enabled: (1) truly integrated, well defined, and easily navigated care delivery systems that are based on evidence; (2) upstream focus on prevention, disease control, patient education, and population health; and (3) management accountability and organizational improvement systems based on transparency of data and feedback. Physician leadership and partnering with the region's administrative and hospital leadership have been critical change enablers.

Originality/value – Embracing the complexity of the system has led to the crafting of pathways and linkages that enable patients to move through the system to flexibly and efficiently connect to the knowledge and resources required to optimize their health. This requires continual self-organization based on well-defined roles and connections. Previous health care improvement approaches have stressed initiatives and organizational changes that may further fragment the health care system.

We are currently experiencing, in western societies, a new reality in health systems, the emergence of an epidemic of chronic diseases, which test and raise new challenges to the health systems. This exponential increase in chronic diseases has not been accompanied by updated training of health professionals in this area. The chronic illness implies a bilateral relationship, of commitment and compromise for life, in which the involvement of the sick person must be the rule. The scope of therapeutic education (TE) is making the person autonomous and helping them to maintain or improve their quality of life. To treat patients with chronic disease, health professionals need to adapt their knowledge to their new role in the therapeutic relationship. As for the methodology, a participative observational methodology will be carried out with the training of health professionals who work in this area. It is a descriptive work based on studies and works published by the main schools working in this area, with emphasis on the School of Geneve. The purpose is to identify the problem of chronic diseases, the challenges that patients and health professionals face and how to build educational projects, exploring the use of educational tools, including digital technology.

Building a culture of safety in transportation is not dissimilar from building a culture of safety in health. Public health is widely known for protecting the public from diseases through milk pasteurization and chlorination of drinking water, and from injuries by implementing environmental and occupational safeguards and fostering behavioral change. Lifestyle and environmental changes that have contributed to the reductions in smoking and heart disease can also help change driving, walking and cycling behaviors, and environments. Stimulating a culture of safety on the road means providing safe and accessible transportation for all. The vision for a culture of traffic safety is to change the public’s attitude about the unacceptable toll from traffic injuries and to implement a systems approach to traffic injury prevention as a means for improving public health and public safety. Framing the motor vehicle injury problem in this way provides an opportunity for partnerships between highway safety and public health to improve the culture of safety.

To assist in achieving cost effective health care allocations in a collective choice setting, the purpose of this paper is to illustrate the use of a tool not common in the public budgeting literature but is common in the health economics literature.

Through a meta-analysis of the health care spending literature that computed the value of quality-adjusted life years, the authors provide an alternative approach for budgeters and policymakers.

The authors provide an alternative approach for budgeters and policymakers for weighing the benefits of alternative health care spending allocations.

The authors introduce an alternative approach for weighing the benefits of alternative health care spending allocations. As a tool for budgeting professionals, cost per QALY allows for the opportunity to raise cost-effectiveness of public health expenditures as a tool for governments to allocate resources based on outcomes, rather than inputs.

The purpose of this paper is to conduct a statewide assessment of worksite health promotion (WHP) programs to identify the number of comprehensive programs and the health needs of worksites in Kentucky.

A random sample of 1,200 worksites in Kentucky was selected to receive the Centers for Disease Control and Prevention (CDC) Worksite Health ScoreCard to collect cross-sectional information on their health promotion practices.

Few worksites in Kentucky have WHP programs and even fewer have comprehensive programs. More businesses rely on health insurance to treat chronic diseases than WHP programs to reduce chronic diseases. Small companies were less likely than larger companies to have WHP programs and less likely to have intentions of starting a program.

The response rate of 37 percent was a potential threat to external validity. Respondents had to recall activities conducted during the past 12 months, which could have led to recall bias. Response bias was a potential, as many of the respondents were human resources personnel who may not be as familiar with WHP programs in their worksites. Lastly, four sections of the survey had yet to be validated.

WHP programs, if accessible and comprehensive, have the potential to improve the working population’s health status.

Very little information on the availability and effectiveness of health promotion programs at worksites is available. A statewide assessment on WHP programs has never been conducted in Kentucky.

The COVID-19 pandemic has demonstrated the urgency of better chronic disease management and the importance of making it an integral part of the recovery agenda in Europe. This paper aims to explore the shift towards digital and integrated care systems in Europe.

In this viewpoint paper the Expert Group for Integrated Care and Digital Health Europe (EGIDE) group argues that an orchestrated shift towards integrated care holds the solution to the chronic disease pandemic.

The development of integrated care cannot happen without shifting towards a digitalised healthcare system via large-scale initiatives like the European Health Data Space (EHDS) and the involvement of all stakeholders.

The EGIDE group has identified some foundational principles, which can guide the way to realise the full potential of the EHDS for integrated care and can support the involved stakeholders’ thinking.