International Journal of Care Coordination

In many jurisdictions internationally, distributed networks of clinical care have emerged as a planning principle to meet the needs of rural communities. Such networks rely on productive relationships between small rural sites and larger regional centres as the mechanism for training and backup and as the pathways for transfer when triage to a higher level of care is required. This paper explores the impact of the Rural Surgical Obstetrical Network (RSON) initiative on regional relationships between networked sites in order to provide data on the efficacy of networked models of healthcare. Implementation of networked care may ultimately lead to better patient care.

This qualitative study involved interviews and focus groups over 4 years with 169 rural healthcare workers and hospital administrators at different RSON sites. Data was analysed inductively using thematic analysis.

Findings revealed three primary areas considered in the context of RSON funding: improved relationships (primarily through clinical coaching and the consequent building of reciprocal trust) and increased regional coordination of patient care through more efficient triage pathways and increased involvement of specialists through outreach care in rural communities. Continued lack of engagement with regional specialists was reported by a minority of participants.

RSON provided a supportive infrastructure that benefitted both rural and regional services namely through funding for clinical coaching and quality improvement initiatives which enabled overall improved provider relationships between sites. This strengthened a regional approach to optimal patient care that should be supported on an ongoing basis.

Osteoporosis remains unrecognised and untreated in patients with fragility fractures, which leads to higher mortality rate, increasing social and economic burden related to subsequent fractures. However, the presence of a coordinated and centralised care pathway for fragility fractures is lacking. The purpose of this paper is to explore the perspectives of health professionals regarding the current management for distal radius fragility fractures, how the care pathway can be optimised for patients with distal radius fragility fractures, and where occupational therapists can contribute.

This paper uses a phenomenological qualitative methodology with selective and purposeful sampling, consisting of health professionals from an Australian Health Service (N  =  20). Online surveys (N  =  18) and semi-structured interviews (N  =  16) were conducted. Content analysis was applied, followed by thematic analysis to identify emerging themes.

Eighteen health professionals participated in the presurvey of which 16 were interviewed. The identified themes presented the gaps in the knowledge and awareness of fragility fractures and osteoporosis, as well as a lack of coordination in the system, especially the referral process.

These findings are consistent with previous studies which also highlight the importance of communication, coordination, collaboration, cooperation, responsibility, and a population approach in achieving integrated care. This study contributes to the global call for a centralised and coordinated care pathway for fragility fractures. The study explores personal experiences of health professionals who expressed interest in fragility fractures management. Exploring patients’ perspectives on their journey of fragility fractures management provides opportunity for future research.

Challenges are often observed during care transitions from home to hospital among frail elderly individuals who tend to be treated by different providers. This study evaluated the effectiveness of early care information transfer on the quality of care transitions among home-dwelling elderly patients in Japan who needed acute hospitalization.

A cluster randomized controlled trial with a clinic as a clustering unit was conducted with patients aged 65 years and older who had home-visit care and then needed to be hospitalized for acute care. The main outcomes were the quality of care transition perceived by the patient, measured by a self-administered questionnaire, and patient satisfaction, measured by the Hospital Patient Satisfaction Questionnaire. Multilevel regression analysis was used to adjust for clustering and covariates.

Among 177 patients (78 patients in the intervention group vs. 99 patients in the control group) from 17 clinics (8 vs. 9 clinics) who were admitted to hospitals during the study period, 112 patients with main outcomes were included in the analysis (45 patients vs. 67 patients). Quality of care transition was not statistically significantly different between groups (understanding of home care situations: 58.8 vs. 58.2, p = 0.88; preference on where to be cared for: 58.1 vs. 59.6, p = 0.67; goal for discharge: 71.9 vs. 70.9, p = 0.79; care coordination: 66.3 vs. 63.8, p = 0.56).

Early care referral in care transition did not show effectiveness in the quality of care transition and patient satisfaction. Studies on information-sharing in the care transition from home to hospitals are needed.

Children born with neonatal abstinence syndrome (NAS) have lower rates of preventive care utilization than children born without NAS, a pattern which is only partially explained by differences in social determinants of health (SDH). We sought to determine whether SDH and clinical characteristics were associated with well-child visit (WCV) attendance among children born with NAS in a rural academic health system.

Infants born at a single hospital in 2016–2018 were retrospectively included if they were diagnosed with non-iatrogenic NAS attributable to in utero opioid exposure and established care with an affiliated primary care clinic by 6 months of age. Healthcare utilization was tracked through the first 12 months of life. Independent variables included demographics, prenatal risk factors, insurance coverage, and SDH such as housing problems and food insecurity. Ages and Stages Questionnaire (ASQ) scores were extracted from the latest completed WCV during the first year of life.

We identified 182 patients with NAS, of whom 80 established care with the primary care clinic, with a median of four WCVs (interquartile range: 2, 5) completed by 12 months of age. On unadjusted Poisson regression, none of the demographic, clinical, or SDH characteristics were associated with the number of completed WCVs. Among 44 patients with available ASQ data, the number of WCVs was not associated with ASQ scores at the latest WCV.

Within an academic rural health system, SDH and other infant or family characteristics did not predict WCV attendance among infants with NAS.

Nurses play a crucial part in responding to pandemics. Not only are they often in direct contact with patients but nurses also can inform and educate the general public regarding vaccination. Mapping nurses’ preferences and knowledge on the value of vaccination can contribute to shaping policy, generate support for policy measures and help address vaccination hesitancy.

The present exploratory study was based on an electronic survey distributed amongst nurses working in Europe. Analysis included descriptive statistics to summarize knowledge levels, attitudes and demographics and tests for associations.

Of 103 respondents, most assessed their knowledge about vaccines, the immune system and pathogens on a medium level. Most respondents agreed that the best policy is to leave influenza vaccination voluntary for healthcare workers and vulnerable groups, but to make COVID-19 vaccination mandatory. Country of employment of respondents was associated with their preferred policy of influenza- and COVID-19 vaccination. Most needed by nurses in the current study to increase their involvement in vaccination programs were improved perceptions amongst patients and society at large. To perform better in responding to future pandemics, the most needed type of institutional support was continuous free nursing education.

This study emphasizes a need for more nurse-generated data regarding the value of vaccination. Complexity of vaccine-related decision-making was highlighted by findings that opinions of nurses on (vaccination-) policy differ between influenza- and COVID vaccines and appear to be influenced by the policy environment in their country of employment.

Decision-makers are constantly confronted with the need of balancing limited resources while establishing rationing criteria in health care system. However, there is an emerging trend in involving citizens in rationing debates as mechanism to assuring legitimacy in the decision-making process. This paper aims to explore citizens’ opinions on priority setting in health care access in comparison with the perspectives of managers.

An online questionnaire was used to collect the data. A logistic regression was applied to evaluate factors that shape the prioritisation of groups in access to health care services. The collected data comprehends 400 individuals, aged 18 years old and over living in continental Portugal.

The study results reveal that managers and the general public, in the context of limited resources, both agree with the need to prioritise some groups over others in access to health care services. The priority groups would include the elderly, children, and people with chronic conditions. The most outstanding finding is that managers prefer children as their first priority group against the general public who has considered as top priority the elder ones.

This study identified which stakeholders are prone to be included in decision-making processes for effective priority-setting models in the health care systems and evaluated their preferences.