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      Cost Savings through Clinical Care Pathways in Austria, Poland, and the Slovak Republic

      Clinical Social Work and Health Intervention
      Journal of Clinical Social Work and Health Intervention

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          Facilitators and barriers to implementing clinical care pathways

          Background The promotion of care pathways in the recent Governmental health policy reports of Lord Darzi is likely to increase efforts to promote the use of care pathways in the NHS. Evidence on the process of pathway implementation, however, is sparse and variations in how organisations go about the implementation process are likely to be large. This paper summarises what is known about factors which help or hinder clinicians in adopting and putting care pathways into practice, and which consequently promote or hinder the implementation of scientific evidence in clinical practice. Discussion Care pathways can provide patients with clear expectations of their care, provide a means of measuring patient's progress, promote teamwork on a multi-disciplinary team, facilitate the use of guidelines, and may act as a basis for a payment system. In order to achieve adequate implementation, however, facilitators and barriers must be considered, planned for, and incorporated directly into the pathway with full engagement among clinical and management staff. Barriers and/or facilitators may be present at each stage of development, implementation and evaluation; and, barriers at any stage can impede successful implementation. Important considerations to be made are ensuring the inclusion of all types of staff, plans for evaluating and incorporating continuous improvements, allowing for organisational adaptations and promoting the use of multifaceted interventions. Summary Although there is a dearth of information regarding the successful implementation of care pathways, evidence is available which may be applied when implementing a care pathway. Multifaceted interventions which incorporate all staff and facilitate organisational adaptations must be seriously considered and incorporated alongside care pathways in a continuous manner. In order to better understand the mechanism upon which care pathways are effective, however, more research specifically addressing conditions under which providers become engaged in using care pathways is needed.
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            Costs of chronic obstructive pulmonary disease in relation to compliance with guidelines: a study in the primary care setting.

            The aim of this study was to analyse the economic impact of nonadherence to the Global Initiative for Obstructive Lung Disease (GOLD) guidelines in patients with chronic obstructive pulmonary disease (COPD).
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              Exacerbations of Chronic Obstructive Pulmonary Disease and Implementation of Guidelines Gold 2011 in Practice

              Background: Chronic obstructive pulmonary disease (COPD) is a disease that is characterized by a persistent blockage of airflow from the lungs. It is an under-diagnosed, life-threatening disease which is not fully reversible. COPD is not only global health problem, the disease is also serious economic problem. Objective: The aim of this study was to evaluate the effects of implementation of new guidelines Global Initiative for Chronic Obstructive Lung Disease (GOLD) for diagnosis and treatment of chronic obstructive pulmonary disease (COPD). Design: Consecutive, observational, retrospective, mono-centric study. Methods: Into the study were included all patients admitted with COPD exacerbations to Department of Pneumology and Phtiseology, Jessenius Faculty of Medicine in Martin and University Hospital, separately in year 2008 and year 2013, who have satisfied the inclusion criteria. Those years were chosen specifically from the reason of biennial application of diagnosis and treatment, according to recommended guidelines GOLD 2006 and GOLD 2011, in practice. The study was focused on the basic anthropometric parameters, data of medical history, complications of underlying disease, comorbidities, laboratory parameters, treatment strategy of patients after release from hospital and mortality within one year were evaluated. Results: Patients in group 2013, when were applied guidelines GOLD 2011 had a higher average oxygen saturation and higher pO 2 at all stages of the disease, significantly in GOLD D. They had higher values of FEV1 and FVC significantly in GOLD B. There was decrease of overuse of inhalation corticosteroids in group GOLD B from 53.34% to 28.57%. There was a downturn in use of theophylline, significantly in GOLD C. The average number of exacerbations leading to hospitalizations was lower in group 2013 in all stages of the disease. One-year mortality of patients in group 2013 was lower. Conclusions: The implementation and application of guidelines GOLD 2011 in practice is a challenging and complex process, which is in region of University hospital Martin gradually and successfully implemented. The achievement the objectives of the GOLD 2011 not only contributes to the efficiency of prevention and timely diagnosis, but mainly on setting of adequate treatment, improves survival and quality of life of patients with COPD.
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                Author and article information

                Journal
                10.22359/cswhi_8_2_08

                Psychology,Social & Behavioral Sciences
                Psychology, Social & Behavioral Sciences

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