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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
1

A SCOPING STUDY TO DESCRIBE ‘FOR WHAT’ AND ‘HOW’ PATIENT CONTRACTS ARE BEING USED IN THE SCIENTIFIC LITERATURE FOR THE MANAGEMENT OF CHRONIC MEDICAL CONDITIONS

Gallagher, Erin 11 1900 (has links)
Introduction: Prevalence of chronic conditions continues to rise in North America. Despite the lack of evidence supporting their use, patient contracts are commonly used by medical professionals to manage such conditions. To date, literature reviews on patient contracts has been limited to randomized controlled trials, with specific purposes and limited populations. The purpose of this study is to describe ‘for what’ and ‘how’ medical contracts are being used for the management of chronic medical conditions. Methods: In order to capture and describe the breadth of knowledge around medical contracts in the literature, a scoping review was conducted. This inclusive approach allowed for analytic reinterpretation of research activity, gaps in the literature to be identified and further avenues of inquiry to be opened. Database searches included Medline, EMBASE, AMED, PsycINFO, Cochrane, CINAHL and Nursing & Allied Health. Results: A total of 7,528 articles resulted from the original search. Seventy-six articles were included in the final review. Multiple types of studies were represented with limited follow-up durations. Extensive variety was seen for contract target population, clinical setting and co-interventions. Purposes for initiating contracts included: 1) behavior change and skill development, including goal development and problem solving; 2) altering beliefs and knowledge, including motivation and perceived self-efficacy; 3) improving interpersonal relationships and role clarification; 4) improving the quality and process of chronic care; and 5) altering objective and subjective health indices. In relationship to how contracts are used, their development, application of behavioral theory, inclusion of patient input, training for their use and implementation processes were inconsistently described. Conclusion: More research is required to determine if contracts are capable of accomplishing their intended purposes. Questions remain regarding their rationale, development and implementation. / Thesis / Master of Public Health (MPH) / Rates of chronic medical conditions continue to rise in North America. To manage such conditions, medical professionals commonly use patient contracts, defined as any type of agreement by which one or both parties agree to a set of behaviors related to the care of the patient. The purpose of this study is to describe ‘for what’ and ‘how’ medical contracts are being used for the management of chronic medical conditions. A scoping literature review was undertaken. Extensive variety was seen in the literature for contract target population, clinical setting and co-interventions. Purposes for initiating contracts included: 1) behavior change and skill development; 2) altering beliefs and knowledge; 3) improving interpersonal relationships; 4) improving the quality and process of care; and 5) altering objective and subjective health indices. Contract development and implementation processes were inconsistently described. More research is required to determine if contracts are capable of accomplishing their intended purposes. Questions remain regarding their rationale, development and implementation processes.
2

Fast vårdkontakt inom nära vård -ett förbättringsarbete om personcentrerat arbetssätt samt en studie ur patient och medarbetarperspektiv / Case management in local health -improvement work concerning personcentred manor an a study following up patient and staff perspecitve

Leitzig, Andrea January 2023 (has links)
Svensk patientlag fastställer att patienter med stort vårdbehov ska ha en fast vårdkontakt (FVK). Inom ramen av god och nära vård ska FVK erbjudas till dessa patienter. FVK förutsätter att vårdpersonalen antar ett personcentrerat arbetssätt och upprättar en hälsoplan i samskapande med patienten. I kontrast upplever sjuksköterskorna att de saknar stöd och kunskap om arbetssättet FVK. Detta leder till att patienterna känner sig otrygga, är frekvent vårdsökande och träffar olika vårdpersonal. Syftet var att förbättra trygghet och kontinuitet för patienter listat på en vårdcentral i Dalarna genom att erbjuda FVK till dessa patienter. Det specifika målet var att erbjuda tolv patienter en FVK inklusive hälsoplan inom sex månader samt att förbättra sjuksköterskornas kunskap om arbetssättet FVK. Syfte med studien var att evaluera om patienter ansåg att deras vårdbehov tillgodoses genom arbetssätt FVK och beskriva sjuksköterskorna erfarenhet av arbetssättet. Förbättringsarbetet inkluderade Nolans’ förbättringsverktyg, patientinvolvering och kunskapshöjande insatser för sjuksköterskor. För att undersöka hur arbetssättet FVK upplevs av patienter och sjuksköterskor genomfördes en mixad-metodstudie. En enkät riktat till patienter utformades och tre fokusgruppintervjuer, en dyad och en enskild intervju med sjuksköterskorna genomfördes. Inom sex månader hade tolv patienter en FVK tilldelad varav tio patienter hade en hälsoplan. Patienterna uttryckte att deras vårdbehov tillgodoses genom arbetssätt FVK vilket stämmer överens med sjuksköterskornas uppfattning att deras patienter söker mindre vård. FVK ökar trygghet och kontinuitet för patienter med stort vårdbehov under omständigheter som tillåter sjuksköterskorna att anta personcentrerat arbetssätt. Patienterna upplever att deras vård förbättrats och sjuksköterskorna att arbetssättet FVK ger mer värde. Studien var småskalig och begränsat till en mindre vårdcentral vilket limiterar dess överförbarhet till andra verksamheter och fler studier behövs. / The Swedish Health law obliges healthcare centers to assign case managers for patients in need. Good quality in local health care thus includes providing case managers. The case manager method presupposes that care staff adopts a person-centered manor and creates care in co-production with the patients. In contrast the nurse lacks support and knowledge to provide case management. This results in patients feeling insecure, seeking frequently for health related afflict and meeting various caregivers. To improve safety and continuity for patients in need one healthcare center in the county of Dalarna has decided to provide case management for patients assigned to the center. The specific goals were to assign twelve patients to a case manager, including health care plan within six months, and to increase knowledge for nurses. Aims of the study were to describe patients’ perception whether they consider if their needs are accommodated by the case manager, and nurses’ experiences to work as a case manager. Nolans’ improvement tool was used involving patients in their care as well as training nurses in case management skills. To study the effect of case management on patients and nurses a mixed-method design was conducted. A patient questionnaire was performed and three focus group interviews, one dyad and one individual interview with nurses were conducted. Twelve patients were assigned a case manager after six months. Ten patients had an established care plan. The patients expressed that their need of care was accommodated which is in coherence with the nurses who described that their patients were in less need for care. Case managers improve safety and continuity for patients in need under circumstances that allow nurses to develop person-centred manor. Patients expressed care improved and nurses increased work values. Yet this survey was limited to a small unit and further studies are needed.

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