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Improving Outcomes through Integration of Health and Care

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Epidemiology & Public Health".

Deadline for manuscript submissions: closed (5 December 2021) | Viewed by 14700

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Special Issue Editors

Prof. Paul Batchelor

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Guest Editor

School of Medicine, University of Central Lancashire, Preston, UK
Interests: health improvement; inequalities; qrganisational theory; health determinants; population health and integration
Special Issues, Collections and Topics in MDPI journals

Prof. James Kingsland

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Guest Editor

School of Medicine, University of Central Lancashire, Preston, UK
Interests: health improvement; inequalities; qrganisational theory; health determinants; population health and integration

Special Issue Information

Dear Colleagues,

While theories of how collaboration could achieve better health outcomes abound, care systems around the world continue to search for definitive answers to what this means for delivery arrangements and condition management. Not least, although the term ‘integration’ is frequently used, its definition remains loose and the underpinning evidence base weak.

We are therefore seeking contributions to be featured in a Special Issue on the understanding of integration and how the science and where the existing evidence base has been used to inform the development of care arrangements, how improvements could be made. This includes arguments for the design, their management, addressing cross sector collaboration and condition specific developments.

This Special Issue is open to any subject area related to the structural and process components of integration and how they can contribute to improved care outcomes. In particular, we are looking for the arguments to support the design of care arrangements which are transferrable across systems and not least how developments should be evaluated. We also welcome contributions featuring condition specific examples of where care integration has seen a reduction in inequalities.

Prof. Paul Batchelor
Prof. James Kingsland
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Health improvement
Inequalities
Organisational theory
Wider determinants of health
Population health integration

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Published Papers (5 papers)

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Research

16 pages, 580 KiB

Open AccessArticle

Spirituality in a Doctor’s Practice: What Are the Issues?

by Ángela del Carmen López-Tarrida, Rocío de Diego-Cordero and Joaquin Salvador Lima-Rodríguez

J. Clin. Med. 2021, 10(23), 5612; https://doi.org/10.3390/jcm10235612 - 29 Nov 2021

Cited by 13 | Viewed by 4193

Abstract

Introduction: It is becoming increasingly important to address the spiritual dimension in the integral care of the people in order to adequately assist them in the processes of their illness and healing. Considering the spiritual dimension has an ethical basis because it attends to the values and spiritual needs of the person in clinical decision-making, as well as helping them cope with their illness. Doctors, although sensitive to this fact, approach spiritual care in clinical practice with little rigour due to certain facts, factors, and boundaries that are assessed in this review. Objective: To find out how doctors approach the spiritual dimension, describing its characteristics, the factors that influence it, and the limitations they encounter. Methodology: We conducted a review of the scientific literature to date in the PubMed, Scopus, and CINAHL databases of randomised and non-randomised controlled trials, observational studies, and qualitative studies written in Spanish, English, and Portuguese on the spiritual approach adopted by doctors in clinical practice. This review consisted of several phases: (i) the exclusion of duplicate records; (ii) the reading of titles and abstracts; (iii) the assessment of full articles and their methodological quality using the guidelines of the international Equator Network. Results: A total of 1414 publications were identified in the search, 373 of which were excluded for being off-topic or repeated in databases. Of the remaining 1041, 962 were excluded because they did not meet the inclusion criteria. After initial screening, 79 articles were selected, from which 17 were collected after reading the full text. A total of 8 studies were eligible for inclusion. There were three qualitative studies and five cross-sectional observational studies with sufficient methodological quality. The results showed the perspectives and principal characteristics identified by doctors in their approach to the spiritual dimension, with lack of training, a lack of time, and fear in addressing this dimension in the clinic the main findings. Conclusions: Although more and more scientific research is demonstrating the benefits of spiritual care in clinical practice and physicians are aware of it, efforts are needed to achieve true holistic care in which specific training in spiritual care plays a key role. Full article

(This article belongs to the Special Issue Improving Outcomes through Integration of Health and Care )

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10 pages, 249 KiB

Open AccessArticle

Evidence-Based Practices and Use among Employees and Students at an Austrian Medical University

by Daniela Haluza, David Jungwirth and Susanne Gahbauer

J. Clin. Med. 2021, 10(19), 4438; https://doi.org/10.3390/jcm10194438 - 27 Sep 2021

Viewed by 2390

Abstract

Developed in the pre-internet era in the early 1980s, empirical medical practice, i.e., evidence-based practice (EBP) has become crucial in critical thinking and statistical reasoning at the point-of-care. As little evidence is available so far on how EBP is perceived in the Austrian academic context, we conducted a cross-sectional online survey among a nonrandom purposive sample of employees and students at the Medical University Vienna, Austria (total n = 1247, 59.8% females). The German questionnaire assessed both EBP capability beliefs and EBP use, with the respective indices both yielding good internal consistency. We conducted subgroup comparisons between employees (n = 638) and students (n = 609). In line with Bandura’s self-efficacy theory, we found a correlation between EBP capability beliefs and EBP use, with higher scores reported in the employee group. The results indicated that the participants did not strictly follow the sequential EBP steps as grounded in the item-response theory. Since its emergence, EBP has struggled to overcome the dominating traditional way of conducting medicine, which is also known as eminence-based medicine, where ad hoc decisions are based upon expert opinions, and nowadays frequently supplemented by quick online searches. Medical staff and supervisors of medical students should be aware of the existing overlaps and synergies of these potentially equivalent factors in clinical care. There is a need for intensifying the public and scientific debate on how to deal with the divergence between EBP theory and EBP practice. Full article

(This article belongs to the Special Issue Improving Outcomes through Integration of Health and Care )

12 pages, 505 KiB

Open AccessArticle

Ocular Morbidity—A Critical Analysis to Improve Outpatient Services in an Eye Department in a Sub-Saharan Megacity

by Edith Mukwanseke, Janvier Kilangalanga, Flavien Lutete, Adrian Hopkins, Rudolf F. Guthoff and Stefanie Frech

J. Clin. Med. 2021, 10(17), 3791; https://doi.org/10.3390/jcm10173791 - 25 Aug 2021

Cited by 4 | Viewed by 2260

Abstract

The aim of this study was to analyse outpatient services in an ophthalmic clinic of a church-run hospital providing secondary level care in an African megacity, paying special attention to the poorest users of the services. The range of examination was reviewed from 500 patient records of all ages consecutively chosen on random days attending the outpatient department for the first time in order to optimize workflow and to analyse the offered treatment modalities. Mean age was 41.9 ± 21.9 years, and 53.6% of the patients were female. Of the patients, 74.8% presented with visual impairment. The most frequent findings were refractive errors (35.8%), presbyopia (21.2%), allergic conjunctivitis (14.0%), cataract (13.2%) and glaucoma (6.4%). Patient management consisted of optical treatment (49.6%), surgery (11.4%) and medical treatment (39.0%). These results show the importance of the demand in refractive services and the need to train specific service providers. Knowing the frequencies of common conditions enables more appropriate diagnostic and treatment strategies, e.g., the importance of refractive errors, and should lead to improvements in training, staffing, therapeutics and patient outcomes. This approach can be applied to many other outpatient services and should be evaluated in light of the city’s impoverished health outreach and educational situation. Full article

(This article belongs to the Special Issue Improving Outcomes through Integration of Health and Care )

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7 pages, 492 KiB

Open AccessArticle

Multidimensional Prognostic Index and Mortality in Intermediate Care Facilities: A Retrospective Study

by Nicola Veronese, Stefano Vianello, Claudia Danesin, Florina Tudor, Gianfranco Pozzobon and Alberto Pilotto

J. Clin. Med. 2021, 10(12), 2632; https://doi.org/10.3390/jcm10122632 - 15 Jun 2021

Cited by 7 | Viewed by 2508

Abstract

Multidimensional prognostic index (MPI) is a frailty assessment tool used for stratifying prognosis in older hospitalized people, but data regarding older people admitted to intermediate care facilities (ICFs) are missing. The aim of this study is to evaluate whether MPI can predict mortality in older patients admitted to the ICFs. MPI was calculated using different domains explored by a standard comprehensive geriatric assessment and categorized into tertiles (MPI-1 ≤ 0.20, MPI-2 0.20–0.34, MPI-3 > 0.34). A Cox’s regression analysis, taking mortality as the outcome, was used, reporting the results as hazard ratios (HRs) with 95% confidence intervals (CIs). In total, 653 older patients were enrolled (mean age: 82 years, 59.1% females). Patients in MPI-2 (HR = 3.66; 95%CI: 2.45–5.47) and MPI-3 (HR = 6.22; 95%CI: 4.22–9.16) experienced a higher risk of mortality, compared to MPI-1. The accuracy of MPI in predicting mortality was good (area under the curve (AUC) = 0.74, 95%CI: 0.70–0.78). In conclusion, our study showed that prognostic stratification, as assessed by the MPI, was associated with a significantly different risk of mortality in older patients admitted to the ICFs, indicating the necessity of using a CGA-based tool for better managing older people in this setting as well. Full article

(This article belongs to the Special Issue Improving Outcomes through Integration of Health and Care )

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16 pages, 811 KiB

Open AccessArticle

Investigating the Relationship between Stress and Self-Rated Health during the Financial Crisis and Recession in 2008: The Mediating Role of Job Satisfaction and Social Support in Spain

by Raquel Sánchez-Recio, Cristina García-Ael and Gabriela Topa

J. Clin. Med. 2021, 10(7), 1463; https://doi.org/10.3390/jcm10071463 - 2 Apr 2021

Cited by 4 | Viewed by 2433

Abstract

Background: the 2008 financial crisis and subsequent recession had a strong impact on employment and certain health indicators, such as mental health. Many studies carried out with diverse samples attest to the negative influence of stress on health. However, few studies focus on stress and self-rated health among the Spanish workforce, or analyse which variables can act as a buffer against the negative effects of stress on self-perceived health. Aim: to analyse the mediator role of social support and job satisfaction in the relationship between work-related stress and self-rated health among the Spanish working population between 2006 and 2017. Method: repeated cross-sectional study using Spanish Surveys from 2006 to 2017, a total of 32.105 participants (47.4% women) aged 16 years and over (M = 42.3, SD = 10.7) answered a series of questions about work-related stress (PV), self-rated health (CV), job satisfaction, and social support (mediator variables) through the National Health Survey (NHS) prevalences of work-related stress, self-rated health, job satisfaction, and social support were calculated (standardised by age). We performed mediation/moderation analysis with Macro Process for SPSS to analyse the role of social support and job satisfaction in the relationship between self-rated health and work-related stress among the Spanish working population. Results: three mediation analyses were conducted, one for each time point in the study period. The results revealed a significant direct association between stress and job satisfaction. In the 2006 model, both job satisfaction and social support acted as mediators between stress and self-rated health, while in the 2011 and 2017 models, only job satisfaction acted as a mediator. The data reveal that the working population in Spain has a good capacity for resilience, since no drop in health indicators was observed. Conclusion: following the economic recession, employment has partially recovered. However, social and employment policies are required to help the population face the recent situation triggered by the Coronavirus crisis. Full article

(This article belongs to the Special Issue Improving Outcomes through Integration of Health and Care )

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