typical protocol for office blood pressure measurement is recommended, although it is also useful to attempt to reduce the common issue of patient anxiety. Improving interactions and communication between a patient and their healthcare provider can decrease a patient’s anxiety, which can also decrease a patient’s likelihood of developing white coat hypertension. Training healthcare providers to improve communication by actively listening to the patient and by including the patient in the decision-making process has been shown to effectively decrease patient anxiety, along with improving treatment adherence. Likewise, training patients to ask questions and express concerns can also increase communication between the patient and the physician. Improving patient and healthcare provider interaction through effective communication, empathy, and trust can reduce anxiety and lessen the negative effects associated with white coat hypertension. As illustrated by the idea of common factors theory, any interventions to improve communication skills are grounded in the com- mon ideas of empathy, collaboration, and the therapeutic alliance. 73 Thus, efforts to improve provider–patient com-
participants of initiative or not, in other words – be part of natural audience. Despite active or passive participation in culture strengthens feeling of belonging to community, stimulates positive experience and feelings , any kind of relation between person and culture has a health benefits, despite of participating or attending culture. Cultural engaged social initiatives addressing health and QoL are found throughout the world: in Great Britain prescription of culture (2004) later (2010) recalled “Social Prescription” linked patients to participate in particular social actions (membership in social networks, volunteering clubs, etc.) ; in Sweden, Region Skane in 2009–2011 culture was prescribed as supplemented method to long term sick leave patient„s rehabilitation ; particular Lithuanian case “Cultural prescription” (2013) brought from Turku, Finland, where it was implemented in 2011 while Turku was European Capital of Culture and aimed to uncover the comprehensive role of culture for individuals and communities – well-being providing a valuable perspective. As it was already presented, Lithuanian case Cultural prescription was not linked to art therapy, but it aimed to improve health and QoL through participation in cultural events of those who suffered chronic diseases. A solid number of cultural prescriptions were prescribed (3420 units), which evidence healthcarepractitioner‟s determination to this social project.
O ne area of pediatric care that strongly pre- sents an opportunity for anticipatory guid- ance and clinical intervention is that of toilet training. Because most toilet training problems pre- senting to the healthcarepractitioner reflect inap- propriate training efforts and parental pressure, pro- viders can, by consulting with parents, elucidate and address misconceptions parents have about the toilet training process, help parents to develop appropriate expectations about toilet training, and provide infor- mation, guidance, and support to parents for man- aging this potentially frustrating process. And al- though there already exists a plethora of information on child development in toilet training that parents can access and refer to, parents often solicit the sup- port of healthcare providers at this particular stage in their child’s development.
Confidential information in the NPDB is only available to authorized queriers such as hospitals, healthcare entities with formal peer review, medical and state licensing boards, and to practitioners requesting performing a self query as mandated by law. HRSA is required by 42 U.S.C. § 11137(b) to maintain the public disclosure file in a form that prohibits use of the data alone or in combination with other accessible information from another dataset in a manner to prevent identification of any healthcare entity, physician, other healthcarepractitioner, or patient. HRSA committed to disclosing information to the public over ten years ago by posting the Public Use Data File (PUF) through the Data Bank with de-identified information. The PUF contains records from the NPDB and also records that were added as a result of Section 1921. Therefore records which are contained in both the NPDB and HIPDB are included but not records only contained in the HIPDB. There is no public use file with the information contained only in the HIPDB. The PUF contains information from the NPDB which is intended to be used for statistical reporting and analysis. Researchers, journalists, and others may use the
Prescription is medication information from a prescriber to a Pharmacist about Medicine. The prescriber is not only a doctor but can also be a paramedical worker, such as a medical assistant, a midwife or a nurse. Each and every country has different standards to write a prescription, and its own rules and regulations to define Prescription drugs and over the counter drugs 1 . To write a prescription every country has its own rules and regulations. It must be clear to the dispenser that what should be given. Patient can easily understand if will make in local language for few prescriptions. No one is insisting prescription must be a model but handwriting must be clear and legible 2 . A written prescription for a medicinal drug issued by a healthcarepractitioner licensed by law to prescribe such drug must be legibly printed or typed so as to be capable of being understood by the pharmacist filling the prescription; must contain the name of the prescribing practitioner, the name and strength of the drug prescribed, the quantity of the drug prescribed, and the directions for use of the drug; must be dated; and must be signed by the prescribing practitioner on the day when issued 3 . Medication errors leads seven thousand deaths have been reported annually. Distractions like prescribing errors account for a large portion of errors in healthcare. Prescription errors are often caused by illegibility and misunderstood translations of symbols or abbreviations. Scientific abbreviations may cause errors in drug and dosage information and medication directions and routes of administration. This can be prevented by competing demands from prescribing moment 4 .
their partners had significantly higher rates of contact with all sectors of the healthcare system than did age- and sex- matched control subjects. This covers contact with general practice, outpatient clinics, and in-hospital services, as well as medication use, and publicly supported payment for medication. Total expenses for stroke patients were more than four times those for the controls. Patients had lower employment rates but received welfare payments signifi- cantly more often than controls. Employed patients had lower incomes than employed control subjects. However, the cost estimates are lower, as some previous studies have found. This is probably because 1) we compared patients with a control group who may have diseases other than stroke, 2) the study did not include the cost of home nurs- ing and nursing homes, and 3) in the aging population under consideration, a higher proportion of patients than controls are on a pension, which reduces the indirect costs.
Comprehensive data on the signs and symptoms children present to GPs are sparse; yet, to recognize children with rare conditions such as brain tumors, GPs ﬁrst need to know what is normal for, and what to expect from, a child of any given age. To help provide this in- formation, we are currently compiling a large data set from children’s pri- mary healthcare records. A strength of our data is that they come from a unique time period in the United King- dom when symptom details are most complete, having been written by hand at the time of consultation. Key to iden- tifying the 1 child among many who merits prompt referral to a pediatri- cian for investigation is recognition of
Background: Patient experience is a key quality outcome for modern health services, but most existing survey methods are long and setting-specific. We identified the need for a short generic questionnaire for tracking patient experience. Methods: We describe the development and validation of the howRwe questionnaire. This has two items relating to clinical care (treat you kindly; listen and explain) and two items relating to the organisation of care (see you promptly; well organised) as perceived by patients. Each item has four responses (excellent, good, fair and poor). The questionnaire was trialled in 828 patients in an orthopaedic pre-operative assessment clinic (PAC).
The nurse practitioner service model is one of the most important developments in nursing in recent times, provid- ing opportunity for significant reform in healthcare . The International Council of Nurses define nurse practitioners as registered nurses who possess expert knowledge, com- plex decision-making skills and clinical competence  with legislated extensions for expanded practice including diagnosis, prescribing and referral. There is an abundance of literature that evidences the success of emergency nurse practitioner service both in Australia and internationally. Three systematic reviews have synthesised the evidence re- garding the effectiveness of the emergency nurse practi- tioner service [9 – 11] finding a positive impact on patient satisfaction, waiting times and quality of care. However, the validity of these findings is open to a degree of criticism. The comparator against which the service was evaluated was almost invariably a medical practitioner, with a reliance on comparisons with junior doctors who do not share the
A sample size calculator software package (Sample Size Calculator V2.0, Health Services Research Unit, University of Aberdeen)  was used to estimate the sample size needed to assess the primary outcome. Validation of the MRS GRACE tool by two clinical phar- macists using de-identified medication charts for 50 resi- dents who were administered medications at least twice per day showed that the number of administration times could be reduced for 23 (46%) residents. As not all rec- ommendations may be implemented by the residential services manager, clinical nurse consultant or GP, we an- ticipate that the number of administration times could be reduced for 25% of SIMPLER participants receiving the intervention. Allowing for a reduction in administra- tion times for 5% of residents in the comparison group, and assuming 80% power, 5% significance and an intracluster correlation coefficient of 0.1 [34, 35], 22 resi- dents would be required from each facility (i.e. 176 resi- dents). Allowing for a 10% attrition of participants over 4 months, as residents estimated to have less than 3 months to live are not eligible to participate, the SIMPLER study will need to recruit a minimum of 194 residents.
Abstract: In the establishment, development, and provision of equal access to the healthcare system, the operation of adequate primary healthcare is essential and has undergone significant transformation in the most developed countries over the past decades. The central and eastern European countries, including Hungary, are struggling with the disadvantages of the traditional model of primary healthcare, based on independent general practitioner and family paediatrician practices: the ability of the system is extremely limited to meet emerging needs and is facing a chronic human resource crisis. In the current study, the functions, legislation, and challenges of the Hungarian primary healthcare system, as well as the basic interrelations of the development of vacant general practitioner and family paediatrician districts were examined, and the government measures for the sake of solving the occurrence of the vacancy and improving access in the lagging areas. (The situation of the other fields of primary healthcare—e.g., dental care, child care officer care, etc.—was not subject of the analysis.). The basic characteristics of the vacant districts (type by supplied age group, bounding region, population size, length of vacancy) were primarily examined by the analysis of categorical and metric variables, with the use of cross-tabulation and nonparametric correlation, while the discovery of soft interrelations was supported by an expert interview conducted with the professionals of the Primary HealthCare Department of the National HealthCare Services Centre. In Hungary, the fundamentals of primary healthcare are made up of the individual practices of general practitioners and paediatricians, and there is a growing concern about the permanent vacancy of the districts, and the fact that the system is less suitable for meeting the needs of the population. The ever-increasing number of vacant general practitioner and family paediatrician districts due to the growing shortage of professionals because of aging and emigration poses the burden of substitution on the physicians in existing practices, that concerns the access of more than a half million people to healthcare, almost 70 percent of which live in settlements with a population less than 5000 inhabitants.
Motivational Interviewing (MI) is an evidence-based approach that strengthens motivation to change health-behaviours by eliciting people’s beliefs about change, collaboratively developing goals, and increasing confidence to achieve change 33,34 . MI techniques typically foster people’s motivations for change by asking them to identify personal reasons, ability, or desires to change; reducing opposition to change by acknowledging barriers and facilitators to making this change; and by reflecting personal strengths and previous examples of engaging in behaviour change. MI has successfully supported individuals to change behaviours across health contexts including in substance addiction, and long-term conditions (LCTs), including psoriasis 33,35-39 . No study has evaluated the effectiveness of MI training tailored to clinicians working with people with psoriasis, or conducted process evaluations to explore factors potentially influencing training efficacy and uptake (e.g. via clinicians’ perspectives on training relevance and utility).
It is important to bear in mind that nurse practitioners and indeed many registered nurses, often work as members of multidisciplinary teams. An important, historical legal case illustrates the significant legal implications of this (Wilshire vs. Essex Area Health Authority All ER 1986 3; All ER 801 HL 1988; 1 All ER 871). This case established that team liability under law is questionable. In this case, a premature baby was placed in a special care baby unit staffed by a team consisting of two consultants, a senior registrar, several junior doctors and a group of nurses. A junior doctor inadvertently cannulated a vein not an artery meant to measure arterial blood gas levels. A more senior registrar missed this error and later repeated the error on the same baby when the cannula needed re-siting. As the catheter was in a vein and not an artery, blood gas levels were not monitored correctly and it was alleged that the baby later suffered an incurable condition of the eye resulting in near blindness. On the point of the standard of care the court held that there was no concept of team negligence in the sense that each individual team member was required to adhere to standards demanded of the unit as a whole.
A measure to diminish the number of ED visits might be cost sharing for emergency care. Several studies in the USA demonstrate a significant reduction in ED use vary- ing from 12% to 23% after the introduction of a copay- ment [26,27]. It is suggested that interventions aimed at ED cost sharing could be effective in reducing ED use . In the Netherlands, members of the Dutch HealthCare Consumer Panel of the Netherlands Institute for Health Services Research (NIVEL) were questioned about their opinion towards copayments when visiting the ED as a SRP . An obligation to pay more than 25 EUR for a presentation at the ED would prevent half of the SRPs from coming to the ED. If a patient had to pay more than 100 EUR, only 15% would still visit the ED. In this study we obtained similar results. We showed that nearly one third of SRPs is not prepared to make extra payments. A payment of more than 25 EUR would cause 60% of SRPs to abandon visiting the ED. Only less than 10% is willing to pay more than 100 EUR, which also depends on the level of education of the SRP.
The project started with collecting information and data to portray long-term care in Europe (WP 1). After establishing a framework for individual country reports, including data templates, information was collected and typologies of LTC systems were created. The collected data will form the basis of estimates of actual and future long term care needs in selected countries (WP 2). WP 3 builds on the estimates of needs to characterise the response: the provision and determinants of formal and informal care across European long-term care systems. Special emphasis is put on identifying the impact of regulation on the choice of care and the supply of caregivers. WP 6 integrates the results of WPs 1, 2 and 3 using econometric micro and macro-modelling, translating the projected needs derived from WP2 into projected use by using the behavioral models developed in WP3, taking into account the availability and regulation of formal and informal care and the potential use of technological developments.
counseling, information on development, food, hygiene, adequate sleep, accident prevention, behavioral problems, drug safety. The study (Oliveira, 2015), when comparing the presence and extent of FHS attributes to the health of the child between FHS and UBS showed that FHS presents the attribute of integrality with a higher score, the UBS, it was pointed out that only some services are available in both units, such as vaccination and family planning.With this study, we can reflect the fragility in the management of common health conditions, in reach of preventable diseases, which the quality of life of the population can be put at risk, due to failures in the actions directed to the real health needs.It should be emphasized that integrality requires that services be adequately available and provided when necessary, through prevention, promotion and / or health recovery interventions, and those that seek to achieve recognition of the needs of the population. Research Findings (Silva, 2015), conducted at FHS in Minas Gerais, which aimed to evaluate the attributes of PHC, demonstrated that the available services and services provided were evaluated by adult users, caregivers and / or family members of children and professionals, to compare the difference in these three groups, the score issued by users pointed out that counseling is not contemplated.The available services received low score by the three groups, and the services provided received high scores by professionals and low scores by users. Scientific evidences, point out that integrality does not present itself in a resolutive way in view of the availability of child healthcare, point to the fragmentation of care, where attention models are limited, because there is still a lack of qualification in the work process and qualified
Antimicrobial resistance is complex [7,18], dynamic  and continuous , meaning that no single solution will manage the problem effectively. Multifaceted interventions aimed at multiple stakeholders (GP, patients and the wider community) have been shown to be successful in reducing inappropriate prescribing [2,21-23] and can bring about social change by addressing local barriers to change . Patients may have preconceived expectations of the con- sultation , determined by their prior experience within the practice and the treatment of a recurring condition in some cases . However, a review of patient-orientated interventions to improve antimicrobial prescribing con- cluded that change is better achieved by encouraging health professionals rather than by educating patients about the negative aspects of antimicrobials . The GP’s decision to prescribe antimicrobials should be a balance between the treatment of the individual in the short term and its harm- ful impact on society in the long term [19,26]. General practitioners prescribe antimicrobials to treat (bacterial) in- fection, to guard against the risk of a missed diagnosis , or because they believe the patient expects this outcome from the consultation ; therefore, to obtain a behav- ioural change, many factors need to be addressed .
There is a good body of research regarding accessibility, quality, efficiency, safety, continuity, and affordability of care provided by NP providers, as well as satisfaction with NP care (Austin, 2016; DeCapua, 2016; Horrocks, Anderson, & Salisbury, 2002; Hubbs, 1999; Newhouse et al., 2011; Rejtar, Ranstrom, & Allcox, 2017). In a systematic review of patient care outcomes after treatment by a NP, it was concluded that NPs provide effective and high-quality care to patients (Newhouse at al., 2011). In all cases, collaboration between a NP and physician provided equal or better care than given by a physician alone (Newhouse et al., 2011). In another study from 2002, it was shown that patients were more satisfied with their care provided by a NP than a doctor (Horrocks et al., 2002). NPs were able to have longer consultations and therefore made more investigations about patient health status than doctors did (Horrocks et al., 2002). They also scored higher on patient satisfaction by offering more advice on self-care and health management (Horrocks et al., 2002). NPs have higher satisfaction in many scenarios and improve patient care in various situations (DeCapua, 2016). At a large tertiary care children’s hospital, the implementation of a 24/7 NP coverage model of care led to a reduction in intensive care unit (ICU) transfers from surgical units and an overall greater satisfaction by nurses and attending surgeons (Rejtar et al., 2017).