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At least 127 records · Page 7Linked to original sources
PubMed2005

Improving care for patients with dysphagia.

BACKGROUND: Early diagnosis and effective management of dysphagia reduce the incidence of pneumonia and improve quality of care and outcome. Dysphagic stroke patients rarely perceive that they have a swallowing problem, and thus carers have to take responsibility for following the safe swallow recommendations made by the Speech and Language Therapist (SLT). Published work and observations in our own Trust indicated that patients with dysphagia may be fed in a manner which places them at significant risk of aspiration, despite SLT advice for safe swallowing. OBJECTIVE: To determine compliance with swallowing recommendations in patients with dysphagia and to investigate the effectiveness of changes in practice in improving compliance. DESIGN: Sequential observational study before and after targeted intervention. SETTING: An acute general and teaching hospital in an inner city area. SUBJECTS: All patients with dysphagia on the caseload of the speech and language therapy department at the time of the study. METHODS: Observations were made on compliance with the recommendations of SLTs regarding consistency of fluids, dietary modifications, amount to be given at a single meal/drink, swallowing strategies, general safe swallow recommendations and whether supervision was required. A dysphagia link nurse programme was established, together with modification of an in-house training scheme, use of pre-thickened drinks and modification of swallowing advice sheets. The same observations were repeated after this intervention. RESULTS: Thirty-one patients were observed before and 54 after the intervention. There was improvement in compliance with the recommendations on consistency of fluids (48-64%, P<0.05), amount given (35-69%, P<0.05), adherence to safe swallow guidelines (51-90%, P<0.01) and use of supervision (35-67%, P<0.01). There were no significant differences in compliance with dietary modifications or swallowing strategies. Improvement in compliance was demonstrated in medical and geriatric wards and the stroke unit, but not in the surgical wards. Compliance with 'nil by mouth' instructions was 100% throughout. CONCLUSIONS: Relatively simple and low-cost measures, including an educational programme tailored to the needs of individual disciplines, proved effective in improving the compliance with advice on swallowing in patients with dysphagia. It is suggested that this approach may produce widespread benefit to patients across the NHS.

Aged↗
PubMed2004

Effect of education and guidelines for treatment of uncomplicated dental pain on patient and provider behavior.

STUDY OBJECTIVE: Patients with uncomplicated odontalgia use a significant proportion of emergency department (ED) resources. Some odontalgia patients are unaware that routine dental care is unavailable in most EDs. Using extensive input from regional dentists and oral surgeons, and after reviewing the dental literature, guidelines for the ED management of uncomplicated odontalgia were written for physician and patient use. The guidelines, which emphasize appropriate community dental clinic referrals and the use of nonsteroidal anti-inflammatory drugs, were developed to reflect community standard of care. We hypothesize that patient education and treatment guidelines will decrease the number of ED visits, return visits, and narcotic prescriptions written for odontalgia. METHODS: This retrospective, observational study used primary International Classification of Diseases, Ninth Revision codes to identify visits for odontalgia during the year before and the year after guideline implementation in a tertiary care teaching hospital with 161,181 ED visits during the 2-year period of our study. RESULTS: There were 5,930 visits for odontalgia during the study. The proportion (95% confidence interval [CI]) of visits with odontalgia decreased after guideline implementation from 4.3% (95% CI 4.2% to 4.5%) to 3.1% (95% CI 3.0% to 3.2%). The proportion of patients with return visits decreased from 19.8% (95% CI 18.1% to 21.6%) to 9.2% (95% CI 7.9% to 10.8%). The proportion of patients filling narcotic prescriptions for odontalgia decreased from 29.6% (95% CI 28.1% to 31.2%) to 9.5% (95% CI 8.5% to 10.8%). CONCLUSION: Implementing odontalgia guidelines and providing patients with written information about alternative treatments and a list of dental clinics can reduce the burden of uncomplicated odontalgia on EDs that do not provide routine dental care.

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PubMed2002

Strategies to improve Adult Treatment Panel III guideline adherence and patient compliance.

The National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III report outlines the management of hypercholesterolemia through guidelines. These guidelines call for more aggressive diagnosis and treatment of hypercholesterolemia, which will substantially increase the number of individuals in the United States considered to be at risk for heart disease and will expand the number who will receive dietary and drug treatment. The new features of ATP III add complexity to the guidelines, which will impact adherence as well as add challenges to the management of hypercholesterolemia. Following key recommendations and incorporating essential elements of adherence can improve implementation of the NCEP ATP III guidelines. The use of global risk scoring aids, including the Palm Pilot cholesterol risk calculators, can improve guideline adherence and provide education and motivation to patients to maintain compliance.

Adult↗
PubMed2000

Surveys go full-service.

In response to health care organizations' increasing diversity of services, the Joint Commission has developed an integrated survey process.

Data Collection↗
PubMed2005

Patient perceptions and provider documentation of diabetes care in rural areas.

Measures of effective diabetes management usually include laboratory results and the provider's point of view, omitting the patient perspective. To address this oversight, a descriptive study was conducted to examine congruence between rural patient self-reported and provider-documented information on American Diabetes Association recommended guidelines. Provider medical record information and patient questionnaires were matched for 149 patients with a diagnosis of type 2 diabetes being treated at rural healthcare facilities. Chi-squared testing showed a significant difference (P < 0.05) between patient and provider information in answers to questions on blood pressure and cholesterol testing, eye examination, influenza and pneumovax rates, and diabetic and nutrition education. Patients' perception of diabetes and blood pressure control did not always match documented values. To achieve diabetes control, providers must implement clinical practice guidelines and patients must take an active role in their disease management. Both must communicate effectively. This does not seem to be the case in rural areas.

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