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The games nurses play: making narratives known to doctors
Published in Russell Gurbutt, Nurses’ Clinical Decision Making, 2018
The nurse–doctor relationship varied from good to poor, with some doctors being regarded as ‘likeable’ because they acknowledged nurses’ views. Some doctors were described positively (‘he seems to listen’), while others were referred to as ‘horrible’, ‘aloof’ and ‘rude’ because they ‘didn’t generally talk to nurses’ or patients. Poor relationships were attributed to the lack of interpersonal skills of doctors, not nurses, and were associated with a perception of how the doctor ‘saw’ the patient. This was principally from a medical case management perspective. Poor relationships were grounded in judgements about how doctors dealt with others, including an ‘inhuman … bedside manner’ that was ‘prescriptive’ towards the patient and ‘dictatorial’, ‘arrogant’, ‘angry’, ‘disapproving’ and ‘moody’ towards nurses. Senior doctors were implicated in influencing junior doctors’ attitudes towards nurses: ‘Some will only take notice when the consultant listens to you on a round, then they start to give you a bit of respect.’
The New York State Response
Published in Barbara I. Willinger, Alan Rice, A History of AIDS Social Work in Hospitals, 2012
Caseloads within the various SNP case management entities will vary. The SNP medical case manager is limited to a caseload of no more than 150 clients. This differs significantly from what is found in commercial managed care programs that often have ratios of one case manager to 10,000 to 14,000 enrollees. Our goal is to make SNP case management a viable pro-active medical case management effort that does not solely target utilization management and high-cost catastrophic cases but provides realistic and effective medical care coordination. Caseloads for psychosocial case management are limited to sixty clients per manager for nonintensive case management and twenty clients per manager for intensive case management.
Vocational Rehabilitation
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Fong Chan, Gloria K. Lee, Kacie Blalock, Denise E. Catalano, Eun-Jeong Lee
Case management interventions at the time of illnesses and injuries would focus on early medical intervention and conflict resolution to avoid an adversarial relationship between the employee and the employer. Early intervention requires the cultivation of easy access to a network of quality providers such as rehabilitation counselors, who understand occupational health and return-to-work issues. Telephonic medical case management would be appropriate for most situations; the resulting compressed timeframe in medical management would reduce the number of cases that become lost-time cases. However, field-based case management may be required for catastrophic injuries or complicated medical cases (e.g., chronic pain). Examples of cases considered to be catastrophic include amputations, traumatic head injury, spinal cord injuries, severe burns, multiple factures, and crushing injuries. Other indicators that a field-based case manager/rehabilitation counselor intervention may be needed include when: The physician reports that the injured worker is unlikely to return to his or her former jobThe physician labels the period of disability as indefiniteThere is prolonged physical therapyThere is prolonged excessive chiropractic treatmentThe physician cannot offer a specific treatment planThe medical diagnosis or prognosis is unclearMedical complications develop in addition to injuryThere are coexisting medical problems (e.g., epilepsy)The employee is unhappy with the treatment program, fails to follow the treatment plan, or seeks a second medical opinionExperimental, alternative, or otherwise unsubstantiated medical procedures are included in the treatment planThere is a psychiatric reaction to the injury or condition (e.g., depression)
Variation in local Ryan White HIV/AIDS program service use and impacts on viral suppression: informing quality improvement efforts
Published in AIDS Care, 2023
Margo M. Wheatley, Aaron D. Peterson, Julian Wolfson, Jonathan Hanft, Darin Rowles, Thomas Blissett, Eva A. Enns
During the five-year period, MCM was the most commonly used service (Table 2). Number of service encounters per year varied widely between services, with food aid and MCM having the highest mean number of encounters. Over time, there were increases in the proportion of clients receiving ADAP, mental & psychosocial services, medical nutrition therapy, and non-medical case management, and decreases in the proportion of clients receiving health education, treatment adherence counseling, and outpatient health services. The change in mean number of encounters was highest for food aid, with 4.12 more encounters on average for each additional year. Levels of service use often varied between race/ethnicity (Figure 1). For example, 51% of African American clients received financial aid compared to 31% of Hispanic clients, yet 61% of Hispanic clients received ADAP support compared to just 22% of African American clients.
Earlier diagnoses and faster treatment of HIV in the District of Columbia: HIV surveillance analysis, 2006–2016
Published in AIDS Care, 2019
Rupali K. Doshi, J. Li, K. Dorsey, A. Allston, M. Kharfen
Once diagnosed with HIV, it is critical for an individual to be linked to medical care and support services and begin antiretroviral therapy (ART) as soon as possible. National treatment guidelines have promoted ART for all people living with HIV since 2012 (Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV, n.d.). Early ART initiation for people diagnosed with HIV improves individual health outcomes by minimizing the effects of untreated HIV (Lundgren et al., 2015), and it reduces the risk of HIV transmission to others (Cohen et al., 2016). Local efforts to improve early initiation of ART, DC Department of Health has spearheaded initiatives to improve linkage to care and access to ART. These include the Red Carpet Entry program (developed in 2009 and launched in 2010), which focused on rapid entry into medical care, and the DC Quality Collaborative (began in 2011), which brought together providers across the city to work together to improve the quality of care. In addition, DC Department of Health has supported the implementation of extensive medical case management services since 2010, and a more recent focus on medication adherence support for youth and young adults under age 30 and racial/ethnic minorities.
Psychological factors related to resilience and vulnerability among youth with HIV in an integrated care setting
Published in AIDS Care, 2018
Tiffany Chenneville, Kemesha Gabbidon, Courtney Lynn, Carina Rodriguez
This study used existing clinical data from an integrated care clinic serving YLWH in the southeastern United States. This particular clinic provides accessible, comprehensive, family-centered, culturally-competent, community-based, coordinated system of care for infants, children, adolescents, and young adults infected with or exposed to HIV. The program is the sole provider of comprehensive HIV care to children and youth in a 12-county geographic area encompassing West Central and Southwest Florida. The location of this program is important given that Florida ranks third in the nation for persons living with HIV/AIDS (Florida Department of Health; FDOE, 2014a), and first for persons living with an AIDS diagnosis (FDOE, 2014b). The program provides a “medical home” with 24-hour on-call services and intensive medical case management services provided by doctors, nurses, nutritionists, pharmacists, psychologists, and social workers. Youth are retained in care by intensive linkage programs and are educated on basic HIV health information, treatment adherence, prevention, sexuality, family planning, and chronic disease self-management.