RESUMEN
Tension blisters from adhesive dressings may lead to pain and delayed surgical wound healing for surgical patients and cause an institutional cost burden. Commercial skin barrier film products may reduce dressing-related postoperative skin blistering in surgical patients. Project investigators at an orthopedic specialty hospital randomized 185 surgical spine patients to receive either a standard wound dressing (ie, control group) or a dressing with the addition of a skin barrier film applied beneath it (eg, treatment group). During the first postoperative dressing change, the participants' skin was assessed for redness, soreness, blistering, or tearing. Approximately 15% of participants in the treatment group and 15% of participants in the control group developed a postoperative skin injury (P = .98). Multivariable analyses did not indicate the skin barrier film provided a protective effect. Additionally, there was no association between patient-specific characteristics and skin blisters among the participants. These results do not support the use of a skin barrier film in surgical spine patients.
Asunto(s)
Vesícula , Cicatrización de Heridas , Vendajes , Humanos , Incidencia , Infección de la Herida QuirúrgicaRESUMEN
BACKGROUND: Shared medical appointments (SMAs) are comprehensive medical visits conducted with groups of patients. We have previously discussed the potential and assessed likely support for SMAs in Australia. In this paper, we report on patient and provider satisfaction, and some subjective outcomes. OBJECTIVE: To measure patients' and providers' attitude and satisfaction with SMAs after attending at least two, and consider the most appropriate form of SMA suited to Australian conditions. METHODS: A total of 24 SMAs were conducted in eight medical centres in New South Wales, South Australia and Queensland. Satisfaction and subjective outcomes from these sessions were tested in a mixed method analysis after more than 200 attendances. RESULTS: Satisfaction with SMAs was high among patients and providers. Almost all of the patients involved said they would continue using SMAs, if these were available. All providers wished to continue being involved as an alternative form of clinical management. DISCUSSION: The results of this pilot study, and our previously reported studies, suggest that SMAs could be a valuable process tool in chronic disease management in Australia.
Asunto(s)
Citas y Horarios , Actitud del Personal de Salud , Medicina General/métodos , Procesos de Grupo , Satisfacción del Paciente , Adulto , Anciano , Australia , Humanos , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Proyectos Piloto , Adulto JovenRESUMEN
BACKGROUND: In some countries, shared medical appointments (SMAs) have been shown to be more effective than single consultations for managing chronic diseases. Our study was designed as the first stage of a Royal Australian College of General Practitioners (RACGP) funded project to assess potential patient and provider support for SMAs if they were to become available in Australia. METHODS: We conducted focus groups with healthcare providers and patients with diabetes in four large regional health centres in NSW. The data were analysed using rigorous qualitative processes. RESULTS: Healthcare provider participants appeared overwhelmingly in favour of SMAs, while patients were divided on the process. Where opposed, patients cited concerns about confidentiality and their satisfaction with the status quo. DISCUSSION: There appears to be a groundswell of interest in SMAs that warrants further investigation in the Australian healthcare system. Issues of reimbursement, homogeneity of groups and training need further consideration.
Asunto(s)
Citas y Horarios , Diabetes Mellitus/terapia , Medicina General/organización & administración , Satisfacción del Paciente , Derivación y Consulta , Adulto , Anciano , Australia , Eficiencia Organizacional , Femenino , Grupos Focales , Medicina General/métodos , Procesos de Grupo , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: The incidence of chronic disease continues largely unabated in modern western societies. While the content (physiology, determinants) of these diseases is well studied, processes of dealing with them at the clinical level have been less well considered. Shared medical appointments (SMAs) or group consultations (also often referred to as group visits) are 'a series of individual office visits sequentially attending to each patient's unique medical needs individually, but in a supportive group setting where all can listen, interact and learn'. OBJECTIVE: To examine the potential acceptability of SMAs for the management of chronic diseases in the Australian context. DISCUSSION: SMAs were developed in the US to improve access to care, utilise peer support, reduce costs and improve patient and provider satisfaction in the management of chronic disease. An SMA is a comprehensive medical visit, not just a group education session, where a significant part of the added value comes from the facilitated peer interaction, particularly around aspects of self-management and empowerment. While more studies are required to compare outcomes with conventional one-on-one consultations, the reported gains in time efficiency, patient numbers managed, and patient as well as provider satisfaction, are sufficient to justify further consideration of a trial of SMAs in Australia.