No abstract available.
Continuity of Patient Care*

Objective: Our goal is to identify an operational roadmap of core elements in the set-up of the Philippines General Hospital Child Protection Unit (PGH-CPU) established in 1997, and Child Protection Network (CPN) established in 2002. This roadmap will guide future improvement needs for PGH-CPU and CPN and could help accelerate the set-up of future child protection units or networks. Methods: Using the 5 pillars of the Care Continuum for Child Maltreatment for categorization of deliverables — multidisciplinary intervention, training, governance, research/publication, and prevention — we identified operational deliverables (excluding patient numbers and outcomes) of the PGH-CPU and CPN. These were qualitatively analyzed to identify trends across the past 20-years and along 5 pillars of the Care Continuum. Results: Identification and qualitative analyses of documented deliverables reveal pillar-specific and time-dependent trends across 5-year periods. This trend analysis identified the core elements central to the set-up of a CPU and reveal an operational roadmap in the set-up of CPUs in resource-constrained settings. Conclusions Case study review and qualitative analyses identify core elements that comprise a roadmap for need based prioritization in the set-up of CPUs/CPNs towards a comprehensive care continuum for child maltreatment. The 20-year experience in a developing nation context validates the roadmap
Continuity of Patient Care

In April 2020, the Department of Rehabilitation Medicine (DRM) of the University of the Philippines - Philippine General Hospital (UP-PGH) transitioned to a telerehabilitation program called ITAWAG, an acronym for Introducing Telerehab As a Way to Access General rehabilitation medicine services. This was in response to the designation of UP-PGH as a COVID-19 referral center and the abrupt closure of all its in-patient and out-patient rehabilitation services. Eleven previous in-patients and out-patients with musculoskeletal and neurologic impairments continued their rehabilitation programs remotely, either through a phone call or video call. Their clinical outcomes and the implementation of the ITAWAG program were monitored to determine the effectiveness of an offsite continuing care program. Using the Clinical Global Impressions-Severity (CGI-S) scale, eight patients had a reduction in the severity of their illness, while the remaining three clients had no change. Feedback surveys showed that most clients and caregivers (68%) and health providers (77%) were satisfied with the program's implementation and its outcome. A frequent complaint was the poor phone reception and internet connection. As threats of a COVID-19 outbreak continue, telerehabilitation gives patients a safe, affordable, and convenient alternative for follow-up and continuity of care in medical rehabilitation. Integrating the ITAWAG program into the initial facility-based rehabilitation management can enhance its value in optimizing functional gains and resolving its shortcomings.
Telerehabilitation ; COVID-19 ; Continuity of Patient Care

Cancer patients suffer very diverse physical, psychological symptoms and functional impairments throughout cancer care continuum. These problems often go undetected and untreated, and may result in reduced health-related quality of life and disability. Cancer rehabilitation is a varied and challenging field of increasing public health importance. A growing evidence base suggests that impairment-driven rehabilitative interventions succeed in preserving and restoring the functional status of patients with cancer. There are many clinical and political barriers existed to limit expanding of this field. This article is intended to provide all cancer care physician with an overview of the issues relevant to the medical rehabilitation of patients with cancer.
Continuity of Patient Care ; Humans ; Public Health ; Quality of Life ; Rehabilitation*

Continuity of Patient Care ; Humans ; Models, Nursing ; Practice Patterns, Nurses' ; Singapore

PURPOSE: The purpose of this study was to identify level of recognition of the importance, satisfaction and contribution of APNs' role by physicians, nurses, and advanced practice nurses. METHOD: Perceived importance and satisfaction were measured with a 23-item questionnaire on APN role with 5 subcategories. APNs' contribution was investigated using a 13-item outcome questionnaire developed by the researchers. Between August 15 and October 31, 2009, the researchers collected data from 68 physicians, 265 nurses, and 23 APNs all working in a single tertiary hospital. Data were analyzed using descriptive statistics, Kruskal-Wallis Test with Bonferroni's Correction and scatter plot. RESULT: The importance (3.24~3.39, 4 point scale), satisfaction (3.02~3.13, 4 point scale), and contribution of APNs' role (3.39~4.12, 5 point scale) were well recognized by the health care professionals. All the three health care professional groups rated APNs' contribution high in medical service management, continuity of care, patient accessibility, improvement in patient satisfaction, and patient and family education. 'Importance-Satisfaction Analysis' showed that patient data management by APNs needed greater effort. CONCLUSIONS: The findings show that the importance, satisfaction, contribution of APNs' role are recognized, and indicate a need for further development of APNs' role through efforts to overcome the gaps identified through this research.
Continuity of Patient Care ; Delivery of Health Care ; Humans ; Patient Satisfaction ; Surveys and Questionnaires ; Tertiary Care Centers

BACKGROUND: Continuity is very important in primary care, and in most studies continuous care has been reported to have a good effect on the result of care. So we studied the factors influencing the continuity of patient care by physician in charge, especially in case of out-patient department in a university hospital. METHODS: We posed questionnaires to 55 persons who had visited continually to Paik Hospital in Pusan for at least 6 months. We classified them into three groups according to the degree of continuity using 'Modified Continuity Index', and compared the lower group (18 patients) with the higher group(18 patients). RESULTS: The incame of the higher continuity group was significantly less than that of the lower continuity group(P=0.042). But there were no significant differences between the two groups according to sex, age, the type of family, marital status, job and the level of education. The higher continuity group agreed more significantly than the lower continuity group with the question whether it is important to be treated continually from physician in charge(P=0.005). About the reasons for visiting to other doctors instead of the physician in charge, most of them in both group replied that they could not keep appointment. And there were no significant differences in the care pattern of disease between the groups. CONCLUSIONS: To improve the continuity of patient care by physician in charge, it is necessary to instruct the importance of continuous care to the patients and to motivate them through various methods.
Busan ; Continuity of Patient Care* ; Education ; Family Practice* ; Humans ; Marital Status ; Outpatients ; Primary Health Care ; Surveys and Questionnaires

INTRODUCTIONThe aim of the present study was to investigate the challenges faced by physicians during shift handovers in a university hospital that has a high handover sender/recipient ratio.

METHODSA multifaceted approach was adopted, comprising recording and analysis of handover information, rating of handover quality, and shadowing of handover recipients. Data was collected at the general medical ward of a university hospital in Singapore for a period of three months. Handover information transfer (i.e. senders' and recipients' verbal communication, and recipients' handwritten notes) and handover environmental factors were analysed. The relationship between 'to-do' tasks, and information transfer, handover quality and handover duration, were examined using analysis of variance.

RESULTSVerbal handovers for 152 patients were observed; handwritten notes on 102 (67.1%) patients and handover quality ratings for the handovers of 98 (64.5%) patients were collected. Although there was good task prioritisation (information transfer: p < 0.005, handover duration: p < 0.01), incomplete information transfer and poor implementation of nonmodifiable identifiers were observed. The high sender/recipient ratio of the hospital made face-to-face and/or bedside handover difficult to implement. Although the current handover method (i.e. use of telephone communication), allowed interactive communication, it resulted in systemic information loss due to the lack of written information. The handover environment was chaotic in the high sender/recipient ratio setting, and the physicians had no designated handover time or location.

CONCLUSIONHandovers in high sender/recipient ratio settings are challenging. Efforts should be made to improve the handover processes in such situations, so that patient care is not compromised.

Adult ; Communication ; Continuity of Patient Care ; Data Collection ; Female ; Hospitals, University ; Humans ; Male ; Patient Handoff ; Patient Safety ; Physicians ; Singapore ; Young Adult

OBJECTIVE: We have developed a prototype Personal Health Record (PHR) system that can replace traditional paper-based personal health diary with structured clinical details for healthcare. Because numerous disparate electronic versions of medical record systems are found unable to share medical information among hospitals, pharmacies and clinicians, the proposed PHR system can be used to facilitate patient care. METHODS: The PHR system has been implemented on a flash memory (USB drive) that is found to be compact, light weight, cost-effective and sufficient enough to handle a large amount of clinical data. International communication standard HL7 has recommended Continuity of Care Document (CCD) that can provide complete and accurate summary of an individual health and medical history. Care documents stored in USB can also support alerts, reminders, self-management, and stakeholder communication in a standardized manner. RESULTS: The proposed PHR system consists of modules that help collect distributed patient information from multiple sources to generate individual care document (CCD) as personal health record. The preliminary experiment has demonstrated an acceptable performance. That is, the PHR is found to integrate and share various clinical data such as medications, procedures, patient demographics from admission system, test results from LIS, DICOM images from PACS, bio.signals from patient monitors. Especially, the PHR system was tested by connecting to standardized monitoring device (Mediana device) to collect ECG data. The PHR system had received 3410 HL7 messages for 1 hour, then generate CCD document.
Continuity of Patient Care ; Delivery of Health Care ; Demography ; Electrocardiography ; Electronics ; Electrons ; Health Records, Personal ; Humans ; Light ; Medical Records ; Memory ; Patient Care ; Pharmacies ; Self Care

Anti-Asthmatic Agents ; therapeutic use ; Asthma ; prevention & control ; Continuity of Patient Care ; Humans ; Medication Adherence ; Self Care ; Singapore