Browsing by Author "Woodhouse, Linda"
Now showing 1 - 2 of 2
Results Per Page
Sort Options
- ItemOpen AccessA categorisation of problems and solutions to improve patient referrals from primary to specialty care(2018-12-20) Greenwood-Lee, James; Jewett, Lauren; Woodhouse, Linda; Marshall, Deborah AAbstract Background Improving access to specialty care has been identified as a critical issue in the delivery of health services, especially given an increasing burden of chronic disease. Identifying and addressing problems that impact access to specialty care for patients referred to speciality care for non-emergent procedures and how these deficiencies can be managed via health system delivery interventions is important to improve care for patients with chronic conditions. However, the primary-specialty care interface is complex and may be impacted by a variety of potential health services delivery deficiencies; with an equal range of interventions developed to correct them. Consequently, the literature is also diverse and difficult to navigate. We present a narrative review to identify existing literature, and provide a conceptual map that categorizes problems at the primary-specialty care interface with linkages to corresponding interventions aimed at ensuring that patient transitions across the primary-specialty care interface are necessary, appropriate, timely and well communicated. Methods We searched MEDLINE and EMBASE databases from January 1, 2005 until Dec 31, 2014, grey literature and reference lists to identify articles that report on interventions implemented to improve the primary-specialty care interface. Selected articles were categorized to describe: 1) the intervention context, including the deficiency addressed, and the objective of the intervention 2) intervention activities, and 3) intervention outcomes. Results We identified 106 articles, producing four categories of health services delivery deficiencies based in: 1) clinical decision making; 2) information management; 3) the system level management of patient flows between primary and secondary care; and 4) quality-of-care monitoring. Interventions were divided into seven categories and fourteen sub-categories based on the deficiencies addressed and the intervention strategies used. Potential synergies and trade-offs among interventions are discussed. Little evidence exists regarding the synergistic and antagonistic interactions of alternative intervention strategies. Conclusion The categorization acts as an aid in identifying why the primary-specialty care interface may be failing and which interventions may produce improvements. Overlap and interconnectedness between interventions creates potential synergies and conflicts among co-implemented interventions.
- ItemOpen AccessThe Association Between Serum COMP Expression and Intra-articular Knee Injury Sustained 3-10 Years Previously in Youth Sport.(2016) Laudon, Jordan; Emery, Carolyn; Krawetz, Roman; Whittaker, Jackie; Hart, David; Woodhouse, LindaPurpose: This research investigates the relationship between knee injury and cartilage oligomeric matrix protein (COMP), a known indicator of joint deterioration in osteoarthritis (OA). Methods: 170 participants were recruited aged 16-26 years (85 with a sport-related intra-articular knee injury 3-10 years ago and 85 age, sex, and sport-matched controls). Serum samples were collected to evaluate COMP levels before and after physical activity. Results: Male participants averaged 15% greater (219.5 ng/ml, 95% CI 11.0–428.0, p = 0.04 serum COMP levels than uninjured controls. Female participants showed no significant elevation (9.8 ng/ml, 95% CI -208.4-227.9, p = 0.93). There were no differences between injured and uninjured participants in change in COMP pre to post exercise. Conclusions: This research demonstrated differences in baseline COMP values between participants based on history of knee injury in males only. Future research into specific knee injuries may yield insights in COMP’s value identifying risk of OA.