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Pediatric Oncology
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Stephen Lowis, Rachel Cox, John Moppett, Helen Rees
The multidisciplinary pediatric oncology team has pioneered ambulatory pediatrics. Minimizing time spent in hospital has been for the psychological benefit of the child and family rather than economic benefit to the health service. In fact, resources needed to provide such a service are enormous. Specialist domiciliary care nurses do far more than just travel to the child’s home or school to take blood samples or administer treatment. Integral to the success of ambulatory care is extensive education of all those involved in caring for the child including parents, teachers, and general practitioners.
Balancing Quality with Costs in Managed Care Settings
Published in A.F. Al-Assaf, Managed Care Quality, 2020
James C. Benneyan, Vivian Valdmanis
In order to assess quality performance, the managed care organization, for example, needs to evaluate ambulatory care patterns for evidence of regular monitoring of severity of illness, patient education regarding compliance with medical treatment, patient knowledge of warning signs of disease, as well as provider education on the benefits of cost-effective care. Note that in this sense, quality of care responsibility rests with both providers and patients.
Cost containment in Finnish health care
Published in Elias Mossialos, Julian Le Grand, Health Care and Cost Containment in the European Union, 2019
Most ambulatory care is provided in health centres, the out-patient departments of specialized hospitals, in private practice or by employers as part of occupational care. Between 1990 and 1994, the total number of visits to outpatient departments of somatic specialties increased by over 10 per cent (Table 16.7) while the number of other visits decreased.22
Tackling antimicrobial resistance across sub-Saharan Africa: current challenges and implications for the future
Published in Expert Opinion on Drug Safety, 2022
Brian Godman, Abiodun Egwuenu, Evelyn Wesangula, Natalie Schellack, Aubrey Chichonyi Kalungia, Celda Tiroyakgosi, Joyce Kgatlwane, Julius C. Mwita, Okwen Patrick, Loveline Lum Niba, Adefolarin A. Amu, Racheal Tomilola Oguntade, Mobolaji Eniola Alabi, Nondumiso B. Q. Ncube, Israel Abebrese Sefah, Joseph Acolatse, Robert Incoom, Anastasia Nkatha Guantai, Margaret Oluka, Sylvia Opanga, Ibrahim Chikowe, Felix Khuluza, Francis K. Chiumia, Collins Edward Jana, Francis Kalemeera, Ester Hango, Joseph Fadare, Olayinka O. Ogunleye, Bernard E. Ebruke, Johanna C. Meyer, Amos Massele, Oliver Ombeva Malande, Dan Kibuule, Otridah Kapona, Trust Zaranyika, Mutsa Bwakura-Dangarembizi, Tapiwanashe Kujinga, Zikria Saleem, Amanj Kurdi, Moyad Shahwan, Ammar Abdulrahman Jairoun, Janney Wale, Adrian J Brink
It was also encouraging to see there is active monitoring of antimicrobial utilization patterns across sectors among the various sub-Saharan African countries. This includes PPS studies in hospitals as well as seeking greater knowledge of resistance patterns through WHO-GLASS and other activities. Both activities are essential to develop and instigate pertinent quality improvement programs as part of ASPs to improve future prescribing and dispensing of antimicrobials. However, ASP activities are variable across sub-Saharan Africa, and their effectiveness is influenced by available resources, personnel, and knowledge within countries [35,85,88]. Among the sub-Saharan African countries assessed, South Africa appears to have made greatest strides with the implementation of activities to curb AMR across sectors including regular monitoring activities with the implementation of their NAP as well as multiple ASP and other activities [65,307–311]. However, there is still room for improvement [94]. We are also seeing greater use of the AWaRe classification of antibiotics, to facilitate the assessment of the quality of antimicrobial prescribing, alongside greater instigation of IPC programs and activities as well ASPs across countries. These activities will continue as progress is made. This includes the development of potential quality indicators in ambulatory care across Africa building on the AWaRe classification and guidelines.
Health care utilization by people with HIV on release from provincial prison in Ontario, Canada in 2010: a retrospective cohort study
Published in AIDS Care, 2019
Sumeet Khanna, Jessica Leah, Kinwah Fung, Tony Antoniou, Fiona Kouyoumdjian
For persons released from provincial prison, we used the Kaplan-Meier method to calculate time to access any ambulatory care for people with and without HIV, and any HIV-specific ambulatory care for people with HIV. We defined ambulatory care as primary or specialty care but not emergency department care. We defined HIV-specific ambulatory care as physician visits for which ICD-9 codes for HIV (042, 043 or 044) were listed in OHIP as the reason for care. We looked at both any ambulatory care and HIV-specific ambulatory care given that physicians are only able to indicate a single diagnostic code in OHIP and may have provided care for HIV as well as another condition at a single visit but written the diagnostic code for the other condition. We also explored time to access any HIV-specific ambulatory care for the general population of people with HIV.
OPAT: proof of concept in a peripheral Belgian hospital after review of the literature
Published in Acta Clinica Belgica, 2018
Annick Smismans, Astrid Vantrappen, Freija Verbiest, Christophe Indevuyst, Bea Van den Poel, Sandrina von Winckelmann, Annelore Peeters, Sara Ombelet, Peter Lybeert, Andre Heremans, Eric Frans, Erwin Ho, Johan Frans
OPAT can be provided using one of the four models that have been shown to be successful: an ambulatory care center, a health care professional attending the patient’s home, self-administration, or delivery in an assisted living facility [46]. The ambulatory care centers function as day hospitals, with readily available medical staff and equipment, but since the patient has to travel, once daily administrations are preferred. In the hospital at home model, the nurse has to travel, however also in this model antibiotics with a long half-life or delivered in continuous infusion are favored, and potential problems with the functioning of utilities, safety, cleanliness and substance abuse, need to be assessed. In the third model the patients self-administer OPAT (S-OPAT). Recent studies confirm the safety of this approach, even for severe infections, if preceded by a thorough patient selection, intensive education and continuous support [1,3,9,37,46,58–61]. It enables the use of antimicrobial agents that require multiple daily dosing. Nowadays, self-administration is even more facilitated by the introduction of non-electric elastomeric infusion pumps that offer simplicity, the elimination of programming errors and the continuous infusion of selected antibiotics (Table 3) [61,62]. Finally, OPAT delivery in assisted living facilities, may avoid prolonged hospitalizations of patients not capable to self-care.