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  1. Article ; Online: "We need to bring them out from the shadows:" A qualitative study of safety net physician leaders' perspectives on caregivers.

    Semere, Wagahta / Cemballi, Anupama G / Schillinger, Dean / Casillas, Alejandra / Lemberg, Miya / Lyles, Courtney R

    Patient education and counseling

    2021  Volume 105, Issue 6, Page(s) 1663–1670

    Abstract: Objective: To explore physician leaders' perspectives on processes and priorities for engaging with caregivers in their clinical practices as well as within their safety net health systems.: Methods: We conducted in-depth semi-structured interviews ... ...

    Abstract Objective: To explore physician leaders' perspectives on processes and priorities for engaging with caregivers in their clinical practices as well as within their safety net health systems.
    Methods: We conducted in-depth semi-structured interviews with primary care physicians in care management leadership at three California safety net health systems. Interviews explored physicians' experiences managing medically and socially complex patients with caregivers. Using thematic analysis, two qualitative researchers independently analyzed interview transcripts and established consensus with the broader research team through iterative input to derive major themes.
    Results: Fifteen physicians completed interviews. Nine participants were women, 8 were White and 10 reported Spanish language proficiency. Participant interviews generated six major themes: challenges uncovering caregiver identities, recognizing variation in caregivers' roles, adapting visit communication strategies to include caregivers, engaging caregivers in patient care, and caring for the caregiver.
    Conclusions: Engaging caregivers is challenging given the limited recognition of caregiver involvement in patient care by health systems. Adapting visit communication to include caregivers requires bridging language and literacy barriers.
    Practice implications: Developing mechanisms to enable the consistent identification of patients' caregivers, facilitate ongoing communication with caregivers, and extend support for them could improve outcomes for vulnerable patients and their families.
    MeSH term(s) Caregivers ; Communication ; Female ; Humans ; Male ; Patient Care ; Physicians ; Qualitative Research
    Language English
    Publishing date 2021-10-23
    Publishing country Ireland
    Document type Journal Article ; Research Support, U.S. Gov't, P.H.S. ; Research Support, N.I.H., Extramural
    ZDB-ID 605590-4
    ISSN 1873-5134 ; 0738-3991
    ISSN (online) 1873-5134
    ISSN 0738-3991
    DOI 10.1016/j.pec.2021.10.019
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Zs.A 1465: Show issues Location:
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  2. Article ; Online: Applying a socioecological framework to chronic disease management: implications for social informatics interventions in safety-net healthcare settings.

    Nguyen, Kim Hanh / Cemballi, Anupama G / Fields, Jessica D / Brown, William / Pantell, Matthew S / Lyles, Courtney Rees

    JAMIA open

    2022  Volume 5, Issue 1, Page(s) ooac014

    Abstract: Objective: Vulnerable populations face numerous barriers in managing chronic disease(s). As healthcare systems work toward integrating social risk factors into electronic health records and healthcare delivery, we need better understanding of the ... ...

    Abstract Objective: Vulnerable populations face numerous barriers in managing chronic disease(s). As healthcare systems work toward integrating social risk factors into electronic health records and healthcare delivery, we need better understanding of the interrelated nature of social needs within patients' everyday lives to inform effective informatics interventions to advance health equity.
    Materials and methods: We conducted in-depth interviews, participant-led neighborhood tours, and clinic visit observations involving 10 patients with diabetes in underserved San Francisco neighborhoods and 10 community leaders serving those neighborhoods. We coded health barriers and facilitators using a socioecological framework. We also linked these qualitative data with early persona development, focusing on patients' experiences in these communities and within the healthcare system, as a starting place for our future informatics design.
    Results: We identified social risk and protective factors across almost every socioecological domain and level-from physical disability to household context to neighborhood environment. We then detailed the complex interplay across domains and levels within two critical aspects of patients' lives: housing and food. Finally, from these data we generated 3 personas that capture the intersectional nature of these determinants.
    Conclusion: Drawing from different disciplines, our study provides a socioecological approach to understanding health promotion for patients with chronic disease in a safety-net healthcare system, using multiple methodologies. Future digital health research should center the lived experiences of marginalized patients to effectively design and implement informatics solutions for this audience.
    Language English
    Publishing date 2022-03-25
    Publishing country United States
    Document type Journal Article
    ISSN 2574-2531
    ISSN (online) 2574-2531
    DOI 10.1093/jamiaopen/ooac014
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Using Electronic Health Record Portals to Improve Patient Engagement: Research Priorities and Best Practices.

    Lyles, Courtney R / Nelson, Eugene C / Frampton, Susan / Dykes, Patricia C / Cemballi, Anupama G / Sarkar, Urmimala

    Annals of internal medicine

    2020  Volume 172, Issue 11 Suppl, Page(s) S123–S129

    Abstract: Ninety percent of health care systems now offer patient portals to access electronic health records (EHRs) in the United States, but only 15% to 30% of patients use these platforms. Using PubMed, the authors identified 53 studies published from September ...

    Abstract Ninety percent of health care systems now offer patient portals to access electronic health records (EHRs) in the United States, but only 15% to 30% of patients use these platforms. Using PubMed, the authors identified 53 studies published from September 2013 to June 2019 that informed best practices and priorities for future research on patient engagement with EHR data through patient portals, These studies mostly involved outpatient settings and fell into 3 major categories: interventions to increase use of patient portals, usability testing of portal interfaces, and documentation of patient and clinician barriers to portal use. Interventions that used one-on-one patient training were associated with the highest portal use. Patients with limited health or digital literacy faced challenges to portal use. Clinicians reported a lack of workflows to support patient use of portals in routine practice. These studies suggest that achieving higher rates of patient engagement through EHR portals will require paying more attention to the needs of diverse patients and systematically measuring usability as well as scope of content. Future work should incorporate implementation science approaches and directly address the key role of clinicians and staff in promoting portal use.
    MeSH term(s) Electronic Health Records/statistics & numerical data ; Health Literacy/statistics & numerical data ; Humans ; Patient Participation/statistics & numerical data ; Patient Portals/statistics & numerical data ; Qualitative Research
    Language English
    Publishing date 2020-05-28
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S. ; Systematic Review
    ZDB-ID 336-0
    ISSN 1539-3704 ; 0003-4819
    ISSN (online) 1539-3704
    ISSN 0003-4819
    DOI 10.7326/M19-0876
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Assessing Alignment of Patient and Clinician Perspectives on Community Health Resources for Chronic Disease Management.

    Potharaju, Kameswari A / Fields, Jessica D / Cemballi, Anupama G / Pantell, Matthew S / Desai, Riya / Akom, Antwi / Shah, Aekta / Cruz, Tessa / Nguyen, Kim H / Lyles, Courtney R

    Healthcare (Basel, Switzerland)

    2022  Volume 10, Issue 10

    Abstract: Addressing social determinants of health (SDoH) is associated with improved clinical outcomes for patients with chronic diseases in safety-net settings. This qualitative study supplemented by descriptive quantitative analysis investigates the degree of ... ...

    Abstract Addressing social determinants of health (SDoH) is associated with improved clinical outcomes for patients with chronic diseases in safety-net settings. This qualitative study supplemented by descriptive quantitative analysis investigates the degree of alignment between patient and clinicians’ perceptions of SDoH resources and referrals in clinics within the public healthcare delivery system in San Francisco. We conducted a qualitative analysis of in-depth interviews, patient-led neighborhood tours, and in-person clinic visit observations with 10 patients and 7 primary care clinicians. Using a convergent parallel mixed methodology, we also completed a descriptive quantitative analysis comparing the categories of neighborhood health resources mentioned by patients or community leaders to the resources integrated into the electronic health record. We found that patients held a wealth of knowledge about neighborhood resources relevant to SDoH that were highly localized and specific to their communities. In addition, multiple stakeholders were involved in conducting SDoH screenings and referrals, including clinicians, system navigators such as case workers, and community-based organizations. Yet, the information flow between these stakeholders and patients lacked systematization, and the prioritization of social needs by patients and clinicians was misaligned, as represented by qualitative themes as well as quantitative differences in resource category distribution analysis (p < 0.001). Our results shed light upon opportunities for strengthening social care delivery in safety-net healthcare settings by improving patient engagement, clinic workflow, EHR engagement, and resource dissemination.
    Language English
    Publishing date 2022-10-12
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2721009-1
    ISSN 2227-9032
    ISSN 2227-9032
    DOI 10.3390/healthcare10102006
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: The Role of Community-Based Organizations in Improving Chronic Care for Safety-Net Populations.

    Nguyen, Kim Hanh / Fields, Jessica D / Cemballi, Anupama G / Desai, Riya / Gopalan, Anjali / Cruz, Tessa / Shah, Aekta / Akom, Antwi / Brown, William / Sarkar, Urmimala / Lyles, Courtney Rees

    Journal of the American Board of Family Medicine : JABFM

    2021  Volume 34, Issue 4, Page(s) 698–708

    Abstract: Introduction: Social determinants of health (SDoH) influence health outcomes and contribute to disparities in chronic disease in vulnerable populations. To inform health system strategies to address SDoH, we conducted a multi-stakeholder qualitative ... ...

    Abstract Introduction: Social determinants of health (SDoH) influence health outcomes and contribute to disparities in chronic disease in vulnerable populations. To inform health system strategies to address SDoH, we conducted a multi-stakeholder qualitative study to capture the multi-level influences on health for those living in socio-economically deprived contexts.
    Methods: Varied qualitative inquiry methods - in-depth interviews, participant-led neighborhood tours, and clinic visit observations - involving a total of 23 participants (10 patients with chronic illnesses in San Francisco neighborhoods with high chronic disease rates, 10 community leaders serving the same neighborhoods, and 3 providers from San Francisco's public health care delivery system). Qualitative analyses were guided by the Chronic Care Model (CCM).
    Results: Several key themes emerged from this study. First, we enumerated a large array, neighborhood resources such as food pantries, parks/green spaces, and financial assistance services that interact with patients' self-management. Health service providers leveraged these resources to address patients' social needs but suggested a clear need for expanding this work. Second, analyses uncovered multiple essential mechanisms by which community-based organizations (CBOs) provided and navigated among many neighborhood health resources, including social support and culturally aligned knowledge. Finally, many examples of how structural issues such as institutional racism, transportation, and housing inequities are intertwined with health and social service delivery were elucidated.
    Conclusion: The results contribute new evidence toward the community domain of the CCM. Health care systems must intentionally partner with CBOs to address SDoH and improve community resources for chronic care management, and directly address structural issues to make progress.
    MeSH term(s) Ambulatory Care ; Humans ; Long-Term Care ; Residence Characteristics ; Social Determinants of Health ; Social Support
    Language English
    Publishing date 2021-07-23
    Publishing country United States
    Document type Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, P.H.S.
    ZDB-ID 2239939-2
    ISSN 1558-7118 ; 1557-2625
    ISSN (online) 1558-7118
    ISSN 1557-2625
    DOI 10.3122/jabfm.2021.04.200591
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    Zs.A 2626: Show issues Location:
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    ab Jg. 2022: Lesesaal (EG)

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