351
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Gorrell M. Infection prevention and control self-audit: just a tick box exercise? J Infect Prev 2014; 15:64-68. [PMID: 28989357 DOI: 10.1177/1757177413512388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2013] [Indexed: 11/15/2022] Open
Abstract
The National Health Service (NHS) in England continues to experience ongoing change in order to complete the transition to the new delivery system outlined in Liberating the NHS (Department of Health, 2010a). Treating and caring for patients in a safe environment and protecting them from acquiring avoidable infections remains a high priority and a central quality improvement component within the outcome Indicator set for 2013/14 (NHS Commissioning Board, 2012a). Infection prevention and control practitioners will be required to use a range of innovative quality improvement strategies to facilitate engagement with clinicians and meet the challenges that lie ahead for the NHS. The purpose of this paper is to report on the implementation of an infection prevention and control self-audit (IPCSA) project within general practice. The aim of the project was to empower practice staff to become actively involved with an infection prevention and control (IPC) audit in order to support the development of an IPC quality improvement culture within general practice teams. The paper outlines the methodology used to implement self-audit. The findings suggest that IPCSA can be used as an effective alternative to an IPC nurse-led infection prevention and control audit.
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Affiliation(s)
- Michelle Gorrell
- NHS Coventry & Rugby CCG, Christchurch House, Greyfriars Lane Coventry, UK
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352
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Dilworth S, Higgins I, Parker V, Kelly B, Turner J. Patient and health professional's perceived barriers to the delivery of psychosocial care to adults with cancer: a systematic review. Psychooncology 2014; 23:601-12. [PMID: 24519814 DOI: 10.1002/pon.3474] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 11/29/2013] [Accepted: 12/10/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To explore the barriers experienced and perceived by health professionals and patients in the delivery of psychosocial care to adults with cancer. METHODS Systematic searches were undertaken using the PsychInfo, Medline and CINAHL electronic databases, up to October 2013. Research reporting health professional or patient experiences and perceptions of barriers to psychosocial care are included in the review. The systematic review includes studies that have non-experimental, exploratory and observational designs, as is appropriate to answer the review question. Included studies were critically appraised. The results of individual quantitative studies were aggregated. Qualitative content analysis was used to analyse the qualitative results. RESULTS Twenty-five papers met the pre-specified inclusion criteria for the final review. The most commonly perceived barrier for patients relates to receiving adequate support from elsewhere and a lack of perceived need for psychosocial care. Health professionals report barriers at an organisational level most frequently followed by cultural and then individual clinician-related barriers. CONCLUSIONS Barriers exist on a variety of levels. People with cancer need clear appropriate information and communication about psychosocial services, including information about the role of psychosocial care in addition to existing supports. Interventions that target the complex interplay of individual, organisational and cultural factors need to be developed. Strategies that improve health professional communication skills, identify clear referral pathways, improve acceptability of interventions and clearly identify the need for services could address many of the barriers identified in this review.
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Affiliation(s)
- Sophie Dilworth
- School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
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353
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Teike Lüthi F, Jobin C, Currat T, Cantin B. Le travail de collaboration des équipes mobiles de soins palliatifs : première phase de validation d’un modèle. MEDECINE PALLIATIVE 2014. [DOI: 10.1016/j.medpal.2013.03.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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354
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Yu CH, Stacey D, Sale J, Hall S, Kaplan DM, Ivers N, Rezmovitz J, Leung FH, Shah BR, Straus SE. Designing and evaluating an interprofessional shared decision-making and goal-setting decision aid for patients with diabetes in clinical care--systematic decision aid development and study protocol. Implement Sci 2014; 9:16. [PMID: 24450385 PMCID: PMC3937124 DOI: 10.1186/1748-5908-9-16] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 01/15/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Care of patients with diabetes often occurs in the context of other chronic illness. Competing disease priorities and competing patient-physician priorities present challenges in the provision of care for the complex patient. Guideline implementation interventions to date do not acknowledge these intricacies of clinical practice. As a result, patients and providers are left overwhelmed and paralyzed by the sheer volume of recommendations and tasks. An individualized approach to the patient with diabetes and multiple comorbid conditions using shared decision-making (SDM) and goal setting has been advocated as a patient-centred approach that may facilitate prioritization of treatment options. Furthermore, incorporating interprofessional integration into practice may overcome barriers to implementation. However, these strategies have not been taken up extensively in clinical practice. OBJECTIVES To systematically develop and test an interprofessional SDM and goal-setting toolkit for patients with diabetes and other chronic diseases, following the Knowledge to Action framework. METHODS 1. Feasibility study: Individual interviews with primary care physicians, nurses, dietitians, pharmacists, and patients with diabetes will be conducted, exploring their experiences with shared decision-making and priority-setting, including facilitators and barriers, the relevance of a decision aid and toolkit for priority-setting, and how best to integrate it into practice.2. Toolkit development: Based on this data, an evidence-based multi-component SDM toolkit will be developed. The toolkit will be reviewed by content experts (primary care, endocrinology, geriatricians, nurses, dietitians, pharmacists, patients) for accuracy and comprehensiveness.3. Heuristic evaluation: A human factors engineer will review the toolkit and identify, list and categorize usability issues by severity.4. Usability testing: This will be done using cognitive task analysis.5. Iterative refinement: Throughout the development process, the toolkit will be refined through several iterative cycles of feedback and redesign. DISCUSSION Interprofessional shared decision-making regarding priority-setting with the use of a decision aid toolkit may help prioritize care of individuals with multiple comorbid conditions. Adhering to principles of user-centered design, we will develop and refine a toolkit to assess the feasibility of this approach.
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Affiliation(s)
- Catherine H Yu
- Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Dhalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Dawn Stacey
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Joanna Sale
- Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Susan Hall
- Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
| | - David M Kaplan
- North York Family Health Team, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Noah Ivers
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
- Family Practice Health Centre, Women’s College Hospital, Toronto, Canada
- Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Canada
| | - Jeremy Rezmovitz
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Fok-Han Leung
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Baiju R Shah
- Department of Medicine, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sharon E Straus
- Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Mobility Program Clinical Research Unit, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
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355
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Mohler J, D'Huyvetter K, O'Neill L, Clemens C, Waer A, Began V, Wendel C, Fain M. Development of an Enhanced Interprofessional Chief Resident Immersion Training (IP-CRIT) Program. GERONTOLOGY & GERIATRICS EDUCATION 2014; 35:354-368. [PMID: 24191853 DOI: 10.1080/02701960.2013.858331] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Using interprofessional faculty, the authors reviewed and enhanced the nationally renowned Chief Resident Immersion Training (CRIT) in the Care of Older Adults Program to include Triple Aim objectives and interprofessional competency-based content and developed the Interprofessional CRIT. Evaluations were positive and sustained. The authors educated chief residents about value-based care, linking them to key interprofessional staff to build team-based care. The authors addressed quality improvement issues identified by the Institute of Medicine and our health network. Chief residents are now better prepared to train medical students and residents using a team-based, patient-centered approach, and a culture of continual quality improvement toward improved care of older patients.
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Affiliation(s)
- Jane Mohler
- a Arizona Center on Aging , University of Arizona , Tucson , Arizona , USA
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356
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Dilworth S, Higgins I, Parker V, Kelly B, Turner J. Finding a way forward: a literature review on the current debates around clinical supervision. Contemp Nurse 2014; 45:22-32. [PMID: 24099223 DOI: 10.5172/conu.2013.45.1.22] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Nursing research increasingly calls for clinical supervision to support nurses and improve nursing practice. Despite this, clinical supervision is not well established in healthcare organisations. This paper employs a critical interpretive approach to review the clinical supervision literature. The review discusses the current debates and challenges exploring possible ways of moving beyond the current criticisms and limitations in the literature. The review concludes that despite some confusion about the quantifiable outcomes, clinical supervision presents a professionally enriching activity that provides a forum for sharing of knowledge and generation of shared understandings of health care. Through this shared experience it is possible that innovative and creative approaches to health care will be born.
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Affiliation(s)
- Sophie Dilworth
- School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, Australia
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357
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François P, Boussat B, Fourny M, Seigneurin A. Qualité des services rendus par un Centre hospitalier universitaire : le point de vue de médecins généralistes. SANTE PUBLIQUE 2014. [DOI: 10.3917/spub.138.0189] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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358
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Cooper R, Frank G, Shogren C. Considerations in Dealing with Ethical Conflict Encountered in Healthcare Reform: Perceptions of Nurse Leaders. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojn.2014.410074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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359
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Hartgerink JM, Cramm JM, van Wijngaarden JDH, Bakker TJEM, Mackenbach JP, Nieboer AP. A framework for understanding outcomes of integrated care programs for the hospitalised elderly. Int J Integr Care 2013; 13:e047. [PMID: 24363635 PMCID: PMC3860580 DOI: 10.5334/ijic.1063] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 08/27/2013] [Accepted: 09/04/2013] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Integrated care has emerged as a new strategy to enhance the quality of care for hospitalised elderly. Current models do not provide insight into the mechanisms underlying integrated care delivery. Therefore, we developed a framework to identify the underlying mechanisms of integrated care delivery. We should understand how they operate and interact, so that integrated care programmes can enhance the quality of care and eventually patient outcomes. THEORY AND METHODS Interprofessional collaboration among professionals is considered to be critical in integrated care delivery due to many interdependent work requirements. A review of integrated care components brings to light a distinction between the cognitive and behavioural components of interprofessional collaboration. RESULTS Effective integrated care programmes combine the interacting components of care delivery. These components affect professionals' cognitions and behaviour, which in turn affect quality of care. Insight is gained into how these components alter the way care is delivered through mechanisms such as combining individual knowledge and actively seeking new information. CONCLUSION We expect that insight into the cognitive and behavioural mechanisms will contribute to the understanding of integrated care programmes. The framework can be used to identify the underlying mechanisms of integrated care responsible for producing favourable outcomes, allowing comparisons across programmes.
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Affiliation(s)
- Jacqueline M Hartgerink
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jane M Cramm
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jeroen D H van Wijngaarden
- Department of Health Service and Management of Organizations, Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | | | - Johan P Mackenbach
- Department of Public Health, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Anna P Nieboer
- Department of Social Medical Sciences, Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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360
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Kayser JW, Cossette S, Alderson M. Autonomy-supportive intervention: an evolutionary concept analysis. J Adv Nurs 2013; 70:1254-66. [DOI: 10.1111/jan.12292] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2013] [Indexed: 12/01/2022]
Affiliation(s)
- John W. Kayser
- Faculty of Nursing; University of Montreal; Quebec Canada
| | | | - Marie Alderson
- Faculty of Nursing; University of Montreal; Quebec Canada
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361
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White DE, Jackson K, Besner J, Norris JM. The examination of nursing work through a role accountability framework. J Nurs Manag 2013; 23:604-12. [PMID: 24279365 DOI: 10.1111/jonm.12186] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2013] [Indexed: 11/29/2022]
Abstract
AIM To use work analysis data to describe the amount of time registered nurses (RNs) and health care aides (HCA) spent on key clinical role accountabilities and other work activities. BACKGROUND Health care providers are not effectively utilized. To improve their efficiency and effectiveness, it is necessary to understand how nursing providers enact their role accountabilities. METHOD Using palm pilot Function Analysis technology, observers recorded the activities of 35 registered nurse and 17 health care aides shifts on a second-by-second basis over 5 days. Work activities were classified using the Nursing Role Effectiveness Model, which conceptualizes nursing practice in terms of clinical role accountabilities. RESULT The registered nurses spent a considerable amount of time on bio-medical assessment/surveillance, relatively little time was spent on patient and family psycho-social-cultural-spiritual assessment/surveillance and support. CONCLUSION Unlike other work sampling studies, this research project examined nursing work within a role accountability framework; an important first step in the call for the measurement of the impact of nursing care. IMPLICATIONS FOR NURSING MANAGEMENT Changes to how registered nurses and health care aides enact their role will require a clear vision by unit managers and their staff of their role accountabilities, and the gap between ideal and actual practice.
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Affiliation(s)
- Deborah E White
- Workforce Research and Evaluation, Alberta Health Services, Calgary, Alberta, Canada
| | - Karen Jackson
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Jeanne Besner
- Health Systems and Workforce Research Unit, Calgary Health Region, Calgary, Alberta, Canada
| | - Jill M Norris
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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362
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Döpp CME, Graff MJL, Rikkert MGMO, van der Sanden MWGN, Vernooij-Dassen MJFJ. Determinants for the effectiveness of implementing an occupational therapy intervention in routine dementia care. Implement Sci 2013; 8:131. [PMID: 24195975 PMCID: PMC4226207 DOI: 10.1186/1748-5908-8-131] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 10/28/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND A multifaceted implementation (MFI) strategy was used to implement an evidence-based occupational therapy program for people with dementia (COTiD program). This strategy was successful in increasing the number of referrals, but not in improving occupational therapists' (OTs) adherence. Therefore, a process evaluation was conducted to identify factors that influenced the effectiveness of the MFI strategy. METHODS A mixed-method approach of qualitative and quantitative research was used to evaluate the implementation process. The MFI strategy as planned and as executed were reported and evaluated based on the framework of Hulscher et al. (2003; 2006). Data on OTs attitudes and expected barriers were collected at baseline from 94 OTs using a 19-item questionnaire. Data on the experiences were collected after finishing the implementation using focus groups with OTs and telephone interviews with physicians and managers. For quantitative data, frequencies and correlations were calculated and qualitative data were analyzed using inductive content analysis. RESULTS The implementation strategy as executed had a stronger focus than planned on increasing OTs promotional skills due to an initial lack of referrals. This resulted in less attention for increasing OTs' skills in using the COTiD program as initially intended. At baseline, OTs had a positive attitude toward the program, however, 75% did not feel experienced enough and only 14.3% felt competent in using the program. Focus groups and interviews revealed various determinants that influenced implementation. Most managers were positive about the program. However, the degree of operational support of managers for OTs regarding the implementation was not always adequate. Managers stated that a well-defined place for occupational therapy within the dementia care network was lacking although this was perceived necessary for successful implementation. Several physicians perceived psychosocial interventions not to be in their area of expertise or not their responsibility. All professionals perceived inter-professional collaboration to be a facilitator for effective implementation, and general practitioners were perceived as key partners in this collaboration. However, collaboration was not always optimal. OTs indicated that increasing the referral rate was most effective when promoting OT via other disciplines within a physician's network. CONCLUSION Our data suggests that a first step in successful implementation should be to make sure that individual and organizational barriers are resolved. In addition, implementation should be network-based and encourage inter-professional collaboration. Initial promotion of COTiD should focus on physicians that have a positive attitude toward non-pharmacological interventions.
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Affiliation(s)
- Carola ME Döpp
- Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, Netherlands
- Radboud University Medical Center, Radboud Alzheimer Centre, Nijmegen, Netherlands
| | - Maud JL Graff
- Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, Netherlands
- Radboud University Medical Center, Radboud Alzheimer Centre, Nijmegen, Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marcel GM Olde Rikkert
- Radboud University Medical Center, Radboud Alzheimer Centre, Nijmegen, Netherlands
- Department of Geriatrics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Maria WG Nijhuis van der Sanden
- Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, Netherlands
- Department of Rehabilitation, Radboud University Medical Center, Nijmegen, Netherlands
| | - Myrra JFJ Vernooij-Dassen
- Radboud University Medical Center, Scientific Institute for Quality of Healthcare (IQ healthcare), Nijmegen, Netherlands
- Radboud University Medical Center, Radboud Alzheimer Centre, Nijmegen, Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
- Kalorama Foundation, Beek-Ubbergen, Netherlands
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363
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McDaniel SH, Morse DS, Reis S, Edwardsen EA, Gurnsey MG, Taupin A, Griggs JJ, Shields CG. Physicians criticizing physicians to patients. J Gen Intern Med 2013; 28:1405-9. [PMID: 23715689 PMCID: PMC3797330 DOI: 10.1007/s11606-013-2499-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 02/25/2013] [Accepted: 05/07/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Teamwork is critical to providing excellent healthcare, and effective communication is essential for teamwork. Physicians often discuss patient referrals from other physicians, including referrals from outside their primary institution. Sharing conflicting information or negative judgments of other physicians to patients may be unprofessional. Poor teamwork within healthcare systems has been associated with patient mortality and lower staff well-being. OBJECTIVE This analysis explored how physicians talk to patients with advanced cancer about care rendered by other physicians. DESIGN Standardized patients (SPs) portraying advanced lung cancer attended covertly recorded visits with consenting oncologists and family physicians. PARTICIPANTS Twenty community-based oncologists and 19 family physicians had encounters with SPs. APPROACH Physician comments about care by other physicians were extracted from transcriptions and analyzed qualitatively. These comments were categorized as Supportive or Critical. We also examined whether there were differences between physicians who provide supportive comments and those who provided critical comments. KEY RESULTS Fourteen of the 34 encounters (41 %) included in this analysis contained a total of 42 comments about the patient's previous care. Twelve of 42 comments (29 %) were coded as Supportive, twenty-eight (67 %) as Critical, and two (4 %) as Neutral. Supportive comments attributed positive qualities to another physician or their care. Critical comments included one specialty criticizing another and general lack of trust in physicians. CONCLUSION This study described comments by physicians criticizing other physicians to patients. This behavior may affect patient satisfaction and quality of care. Healthcare system policies and training should discourage this behavior.
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Affiliation(s)
- Susan H McDaniel
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA,
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364
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Tyack Z, Frakes KA, Cornwell P, Kuys SS, Barnett AG, McPhail SM. The health outcomes and costs of people attending an interdisciplinary chronic disease service in regional Australia: protocol for a longitudinal cohort investigation. BMC Health Serv Res 2013; 13:410. [PMID: 24119303 PMCID: PMC3852613 DOI: 10.1186/1472-6963-13-410] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 10/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rates of chronic disease are escalating around the world. To date health service evaluations have focused on interventions for single chronic diseases. However, evaluations of the effectiveness of new intervention strategies that target single chronic diseases as well as multimorbidity are required, particularly in areas outside major metropolitan centres where access to services, such as specialist care, is difficult and where the retention and recruitment of health professionals affects service provision. METHODS This study is a longitudinal investigation with a baseline and three follow-up assessments comparing the health and health costs of people with chronic disease before and after intervention at a chronic disease clinic, in regional Australia. The clinic is led by students under the supervision of health professionals. The study will provide preliminary evidence regarding the effectiveness of the intervention, and evaluate the influence of a range of factors on the health outcomes and costs of the patients attending the clinic. Patients will be evaluated at baseline (intake to the service), and at 3-, 6-, and 12-months after intake to the service. Health will be measured using the SF-36 and health costs will be measured using government and medical record sources. The intervention involves students and health professionals from multiple professions working together to treat patients with programs that include education and exercise therapy programs for back pain, and Healthy Lifestyle programs; as well as individual consultations involving single professions. DISCUSSION Understanding the effect of a range of factors on the health state and health costs of people attending an interdisciplinary clinic will inform health service provision for this clinical group and will determine which factors need to be controlled for in future observational studies. Preliminary evidence regarding changes in health and health costs associated with the intervention will be a platform for future clinical trials of intervention effectiveness. The results will be of interest to teams investigating new chronic disease programs particularly for people with multimorbidity, and in areas outside major metropolitan centres. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry: ACTRN12611000724976.
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Affiliation(s)
- Zephanie Tyack
- Institute of Health and Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Victoria Park Road, Kelvin Grove, QLD 4059, Australia.
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365
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Lacasta Tintorer D, Flayeh Beneyto S, Alzaga Reig X, Mundet Tuduri X, De la Fuente JA, Manresa JM, Torán Monserrat P, Saigí Rubió F. Impact of the implementation of an online network support tool among clinicians of primary health care and specialists: ECOPIH Project. BMC FAMILY PRACTICE 2013; 14:146. [PMID: 24088387 PMCID: PMC3852545 DOI: 10.1186/1471-2296-14-146] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 09/30/2013] [Indexed: 11/10/2022]
Abstract
BACKGROUND There has been created an online communication tool with the objective to improve the communication among different levels of care, between Primary Care clinicians and Specialists. This tool is web 2.0 based technology (ECOPIH project). It allows to review clinical cases and to share knowledge. Our study will evaluate its impact in terms of reduction on the number of referrals to three specialties two years after the use of this tool. METHODS/DESIGN Open, multicenter, controlled, non random intervention study over 24 months. Study population includes 131 Primary Care Physicians assigned to nine health centers. The study will compare the clinicians that use the ECOPIH with the ones that do not use the tool. Also, professionals that start to use the tool during the period time of the study will be included.The number of annual referrals during the first and second year will be analyzed and retrospectively compared with the previous year to the implementation of the tool. Moreover, it will be assessed the level of satisfaction of the professionals with the tool and to what extend the tool responds to their needs. DISCUSSION The implementation of ECOPIH in the field of Primary Health Care can decrease the number of referrals from primary care to specialist care.It is expected that the reduction will be more noticeable in the group of professionals that use more intensively the tool. Furthermore, we believe that it can be also observed with the professionals that read the contributions of the others.We anticipate high degree of customer satisfaction as it is a very helpful resource never used before in our environment.
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Affiliation(s)
- David Lacasta Tintorer
- Centre d’Atenció Primària la Salut. Institut Català de la Salut, Passatge dels Encants s/n, 08914, Badalona, Spain
- Unitat de Suport a la Recerca Metropolitana Nord. IDIAP Jordi Gol, Carrer Major 49-53, 08921, Santa Coloma de Gramenet, Spain
- Universitat Autònoma de Barcelona, Plaça Cívica, 08193, Bellaterra, Cerdanyola del Vallès, Spain
| | - Souhel Flayeh Beneyto
- Centre d’Atenció Primària la Salut. Institut Català de la Salut, Passatge dels Encants s/n, 08914, Badalona, Spain
| | - Xavier Alzaga Reig
- Centre d’Atenció Primària Dr Robert. Institut Català de la Salut, Plaça de la Medicina s/n, 08911, Badalona, Spain
| | - Xavier Mundet Tuduri
- Universitat Autònoma de Barcelona, Plaça Cívica, 08193, Bellaterra, Cerdanyola del Vallès, Spain
- Unitat de Suport a la Recerca Barcelona Ciutat. IDIAP Jordi Gol, Carrer Sardenya 375, 08025, Barcelona, Spain
| | - Josep Anton De la Fuente
- Centre d’Atenció Primària Dr Robert. Institut Català de la Salut, Plaça de la Medicina s/n, 08911, Badalona, Spain
| | - Josep Maria Manresa
- Unitat de Suport a la Recerca Metropolitana Nord. IDIAP Jordi Gol, Carrer Major 49-53, 08921, Santa Coloma de Gramenet, Spain
- Universitat Autònoma de Barcelona, Plaça Cívica, 08193, Bellaterra, Cerdanyola del Vallès, Spain
| | - Pere Torán Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord. IDIAP Jordi Gol, Carrer Major 49-53, 08921, Santa Coloma de Gramenet, Spain
- Departament de Ciències Mèdiques, Universitat de Girona, Carrer Emili Grahit 77, 17071, Girona, Spain
| | - Francesc Saigí Rubió
- Universitat Oberta de Catalunya, Carrer Roc Boronat 117, 08018, Barcelona, Spain
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Walsh C, Siegler EL, Cheston E, O'Donnell H, Collins S, Stein D, Vawdrey DK, Stetson PD. Provider-to-provider electronic communication in the era of meaningful use: a review of the evidence. J Hosp Med 2013; 8:589-97. [PMID: 24101544 PMCID: PMC4030393 DOI: 10.1002/jhm.2082] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 07/23/2013] [Accepted: 07/31/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND Electronic communication between providers occurs daily in clinical practice but has not been well studied. PURPOSE To assess the impact of provider-to-provider electronic communication tools on communication and healthcare outcomes through literature review. DATA SOURCES Ovid MEDLINE, PubMed, Google Scholar, Cumulative Index to Nursing and Allied Health Literature, and Academic Search Premier. STUDY SELECTION Publication in English-language peer-reviewed journals. Studies provided quantitative provider-to-provider communication data, provider satisfaction statistics, or electronic health record (EHR) communication data. DATA EXTRACTION Literature review. DATA SYNTHESIS Two reviewers conducted the title review to determine eligible studies from initial search results. Three reviewers independently reviewed titles, abstracts, and full text (where appropriate) against inclusion and exclusion criteria. LIMITATIONS Small number of eligible studies; few described trial design (20%). Homogeneous provider type (physicians). English-only studies. CONCLUSIONS Of 25 included studies, all focused on physicians; most were observational (68%). Most (60%) described electronic specialist referral tools. Although overall use has been measured, there were no studies of the effectiveness of intra-EHR messaging. Literature describing the effectiveness of provider-to-provider electronic communications is sparse and narrow in scope. Complex care, such as that envisioned for the Patient Centered Medical Home, necessitates further research.
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Affiliation(s)
- Colin Walsh
- Department of Biomedical Informatics, Columbia University
- Department of Medicine, Columbia University
| | - Eugenia L Siegler
- Division of Geriatrics and Gerontology, Weill Cornell Medical College
| | | | - Heather O'Donnell
- Department of Pediatrics, Albert Einstein College of Medicine/Children's Hospital at Montefiore, Wellesley, MA
| | - Sarah Collins
- Partners Healthcare Systems, Wellesley, MA
- Brigham and Women's Hospital, Division of General Internal Medicine and Primary Care, Boston, MA
- Harvard Medical School, Boston, MA
| | - Daniel Stein
- Department of Biomedical Informatics, Columbia University
| | | | - Peter D. Stetson
- Department of Biomedical Informatics, Columbia University
- Department of Medicine, Columbia University
- ColumbiaDoctors, New York
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Schadewaldt V, McInnes E, Hiller JE, Gardner A. Views and experiences of nurse practitioners and medical practitioners with collaborative practice in primary health care - an integrative review. BMC FAMILY PRACTICE 2013; 14:132. [PMID: 24007269 PMCID: PMC3846155 DOI: 10.1186/1471-2296-14-132] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/29/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND This integrative review synthesises research studies that have investigated the perceptions of nurse practitioners and medical practitioners working in primary health care. The aggregation of evidence on barriers and facilitators to working collaboratively and experiences about the processes of collaboration is of value to understand success factors and factors that impede collaborative working relationships. METHODS An integrative review, which used systematic review processes, was undertaken to summarise qualitative and quantitative studies published between 1990 and 2012. Databases searched were the Cochrane Library, the Joanna Briggs Institute Library, PubMed, Medline, CINAHL, Informit and ProQuest. Studies that met the inclusion criteria were assessed for quality. Study findings were extracted relating to a) barriers and facilitators to collaborative working and b) views and experiences about the process of collaboration. The findings were narratively synthesised, supported by tabulation. RESULTS 27 studies conducted in seven different countries met the inclusion criteria. Content analysis identified a number of barriers and facilitators of collaboration between nurse practitioners and medical practitioners. By means of data comparison five themes were developed in relation to perceptions and understanding of collaboration. Nurse practitioners and medical practitioners have differing views on the essentials of collaboration and on supervision and autonomous nurse practitioner practice. Medical practitioners who have a working experience with NPs express more positive attitudes towards collaboration. Both professional groups report concerns and negative experiences with collaborative practice but also value certain advantages of collaboration. CONCLUSIONS The review shows that working in collaboration is a slow progression. Exposure to working together helps to overcome professional hurdles, dispel concerns and provide clarity around roles and the meaning of collaboration of NPs and MPs. Guidelines on liability and better funding strategies are necessary to facilitate collaborative practice whether barriers lie in individual behaviours or in broader policies.
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Affiliation(s)
- Verena Schadewaldt
- Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Elizabeth McInnes
- Nursing Research Institute, Australian Catholic University and St Vincents and Mater Health, St Vincent’s Hospital, Sydney, Australia
| | - Janet E Hiller
- Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Anne Gardner
- Faculty of Health Sciences, Australian Catholic University, Canberra, Australia
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The role of the keyworker in breaking down professional culture barriers to providing high-quality palliative care: a literature review. JOURNAL OF RADIOTHERAPY IN PRACTICE 2013. [DOI: 10.1017/s1460396913000447] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractBackgroundPalliative cancer care is by definition multi-professional in nature. An interdisciplinary approach to disease management emphasising continuity of care results in increased quality of life for patients and families. Complex disease management demands the provision of a full spectrum of high-quality care; requiring both specialist and generalist services. Appointed keyworkers are knowledgeable about patient preferences enabling effective coordination of care and promotes collaborative team-working. The need for diversity in the provision of palliative care is recommended but can challenge effective interdisciplinary collaboration by creating tension and limiting the interdisciplinary team (IDT) from reaching its full potential resulting in adverse outcomes.PurposeThe purpose of this paper is to review the literature available regarding how IDTs and keyworkers influence high-quality palliative care; evaluate how professional culture barriers can influence team collaboration; discuss the keyworker role in minimising these barriers and clinical implications.MethodologyA review of the English literature from 2003 to 2013 was performed using the databases PubMed (NML), OVID Medline and Google Scholar.Results and conclusionKeyworkers can help overcome professional culture barriers that result from ineffective team communication. Facilitating improved communication regarding professional roles fosters mutual understanding among team members. The dissemination of relevant and timely information minimises fragmentation, prompting team decision-making and promotes continuity of high-quality palliative care.
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369
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Chan EA, Lam W, Lam Yeung SKS. Interprofessional competence: a qualitative exploration of social work and nursing students' experience. J Nurs Educ 2013; 52:509-15. [PMID: 23957720 DOI: 10.3928/01484834-20130823-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 04/17/2013] [Indexed: 11/20/2022]
Abstract
Being a professional in today's health care system carries with it an expectation of becoming interprofessional. This study was designed to explore the perceived development of the participants' interprofessional competence through interprofessional seminars and collaborative community practice. Data were collected from social work and nursing undergraduates through two interprofessional seminar discussions, followed by focus group interviews after the completion of 2 weeks of practice experience. Study findings included: (a) role clarification and enhancement, (b) evolving role emphasis, (c) understanding the importance of and various communications in teamwork, and (d) being more responsive to the meaning of teamwork and the understanding of collaborative interdependence. Through interprofessional collaborative practice, students developed an insight into teamwork, where they witnessed the merits of collaboration and gained an understanding of each other's lack of holistic approach. In addition, not only the particular practice settings but also the role variations involved revealed various dimensions of interprofessional learning.
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370
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Blomberg K, James I, Kihlgren A. Meanings over time of working as a nurse in elderly care. Open Nurs J 2013; 7:107-13. [PMID: 24044032 PMCID: PMC3772566 DOI: 10.2174/1874434620130726005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 07/08/2013] [Accepted: 07/22/2013] [Indexed: 12/03/2022] Open
Abstract
Background: Although registered nurses (RNs) play a central role in the care of older persons, their work in elderly care has historically been described as “low status” in nursing. This is especially problematic due to the global issue of RN turnover, but there is still little evidence of how to change this trend. Better understanding is needed of the reasons why RNs work in elderly care, as well as knowledge of whether these reasons have changed over time. Aim: The aim was to explore the meaning of working in elderly care, over time, from the perspective of RNs. Method: We interviewed thirteen RNs working in nursing homes, six of them in 2000 and the remaining seven in 2012, and analysed the resulting data using Interpretive Description. Results:
The results show similarities and differences over time in the RNs’ reasoning about the meaning of their work with older persons, from a focus on obstacles to a view of opportunities. Conclusion:
An RN’s intention to continue working in elderly care might be based on their beliefs; their view of older people, and their experiences of being able to influence the care. Managing this knowledge could be an essential factor in reversing the historical trend of RN work in elderly care being seen as low status, and the increasing turnover in such nurses. Our results could stimulate reflection on daily care and beliefs about caring for older persons.
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Affiliation(s)
- Karin Blomberg
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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371
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Minamizono S, Hasegawa H, Hasunuma N, Kaneko Y, Motohashi Y, Inoue Y. Physician's Perceptions of Interprofessional Collaboration in Clinical Training Hospitals in Northeastern Japan. J Clin Med Res 2013; 5:350-5. [PMID: 23976907 PMCID: PMC3748659 DOI: 10.4021/jocmr1474w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2013] [Indexed: 11/25/2022] Open
Abstract
Background Effective and efficient interprofessional collaboration (IPC) is needed between departments in a healthcare setting. Although Japanese physicians are expected to provide leadership in IPC, it has been suggested that their perception of IPC is more negative than among other healthcare professionals. The purpose of this study was to clarify Japanese physician’s perceptions of IPC and what factors influenced their views. Methods This cross-sectional study surveyed 732 medical doctors at a university hospital and six foundation hospitals in a prefecture located in Tohoku district, northeastern Japan. Those hospitals were approved for delivery of postgraduate clinical training. Physician’s perceptions of IPC were investigated for three items, namely providing patient-centered care, preventing medical accidents, and improving the quality of medical care. A total of 409 doctors who were engaged in clinical practice, responded adequately to the survey. Factors associated with negative perceptions towards IPC among physicians were analyzed using a logistic regression model. Results The proportion of negative perceptions of IPC for providing patient-centered care, preventing medical accidents, and improving the quality of medical care were 41.1%, 34.0% and 33.7%, respectively. Negative perceptions of IPC for providing patient-centered care were associated with older age (50 + years; odds ratio (OR): 2.73; 95% confidence interval (CI): 1.11 - 6.68) and a lower frequency of interprofessional meetings (no meetings; OR: 2.95; 95%CI: 1.43 - 6.08). Negative perceptions of IPC for preventing medical accidents were associated with a lower frequency of interprofessional meetings (no meetings, OR: 3.23; 95%CI: 1.58 - 6.62). Negative perceptions of IPC for improving the quality of medical care were associated with middle age (40 - 49 years, OR: 2.93; 95%CI: 1.20 - 7.12) and a lower frequency of interprofessional meetings (no meetings; OR: 2.75; 95%CI: 1.34 - 5.66). Conclusions Physician’s negative perceptions of IPC in our study were associated with age and a lower frequency of interprofessional meetings. Our findings suggest that effective regular interprofessional meetings serve to share information about patients, and to allow physicians to understand each other better, which should have a positive impact on the quality of patient-centered care.
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Affiliation(s)
- Sachiko Minamizono
- Department of Health Care Policy, Akita University Graduate School of Medicine, 1-1-1 Hondo, Akita, Japan ; Department of Community Medicine and Primary Care Development, Akita University School of Medicine, 1-1-1 Hondo, Akita, Japan
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372
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Chinn CH, Levine J, Matos S, Findley S, Edelstein BL. An interprofessional collaborative approach in the development of a caries risk assessment mobile tablet application: My Smile Buddy. J Health Care Poor Underserved 2013; 24:1010-20. [PMID: 23974376 PMCID: PMC4523798 DOI: 10.1353/hpu.2013.0114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Given the rising trend in early childhood caries (ECC) and the wide disparities that exist in pediatric oral health, risk assessment for ECC has become increasingly important. The purpose of this paper is to describe lessons learned from an Interprofessional Collaboration (IPC) approach in the planning, development, and pilot testing of an electronic interactive ECC risk assessment application--My Smile Buddy (MSB). METHODS Five focus groups were conducted during the assessment and development phases of MSB. Community Health Workers (CHW) then facilitated MSB with 35 mothers from the local community. RESULTS MSB was well accepted by mothers and scored well in usability and usefulness by CHWs. Lessons learned during MSB development included recognizing CHW understanding of local community attitudes regarding oral health and access to dental care and that power-sharing is required in order to create an intervention that is both engaging and accepted by the community.
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Affiliation(s)
- Courtney H. Chinn
- Assistant Professor at Columbia University College of Dental Medicine (CU-CDM)
| | - June Levine
- registered dietician and serves as a project manager at CU-CDM
| | - Sergio Matos
- Director for CHW Development at Columbia University Mailman School of Public Health (CU-MSPH) and Executive Director at Community Health Worker Network of New York City
| | - Sally Findley
- Professor in Population and Family Health at CU-MSPH
| | - Burton L. Edelstein
- Professor and Chair of the Section of Social and Behavioral Sciences at CU-CDM
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373
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Peduzzi M, Norman IJ, Germani ACCG, Silva JAMD, Souza GCD. Educação interprofissional: formação de profissionais de saúde para o trabalho em equipe com foco nos usuários. Rev Esc Enferm USP 2013; 47:977-83. [DOI: 10.1590/s0080-623420130000400029] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Accepted: 12/16/2012] [Indexed: 11/22/2022] Open
Abstract
São analisados os constructos teóricos da educação interprofissional com base em duas revisões de literatura, considerado o contexto da formação dos profissionais de saúde no Brasil. Identificam-se três tipos de formação: uniprofissional, multiprofissional e interprofissional, com predomínio da primeira, que ocorre entre estudantes de uma mesma profissão de forma isolada; a segunda, entre estudantes de duas ou mais profissões de forma paralela, sem haver interação, e na terceira há aprendizagem compartilhada, com interação entre estudantes e/ou profissionais de diferentes áreas. Destaca-se a distinção entre interprofissionalidade e interdisciplinaridade, referidas, respectivamente, como a integração das práticas profissionais e das disciplinas ou áreas de conhecimento. Mediante a análise apresentada, conclui-se que no contexto brasileiro, a educação interprofissional, base para o trabalho em equipe colaborativo, ainda está restrita a iniciativas recentes, que merecem estudo.
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374
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Learning to walk before we run: what can medical education learn from the human body about integrated care. Int J Integr Care 2013; 13:e018. [PMID: 23882167 PMCID: PMC3718269 DOI: 10.5334/ijic.1128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 03/23/2013] [Indexed: 11/20/2022] Open
Abstract
True integration requires a shift in all levels of medical and allied health education; one that emphasizes team learning, practicing, and evaluating from the beginning of each students' educational experience whether that is as physician, nurse, psychologist, or any other health profession. Integration of healthcare services will not occur until medical education focuses, like the human body, on each system working inter-dependently and cohesively to maintain balance through continual change and adaptation. The human body develops and maintains homeostasis by a process of communication: true integrated care relies on learned interprofessionality and ensures shared responsibility and practice.
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375
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Döpp CME, Graff MJL, Teerenstra S, Nijhuis-van der Sanden MWG, Olde Rikkert MGM, Vernooij-Dassen MJFJ. Effectiveness of a multifaceted implementation strategy on physicians' referral behavior to an evidence-based psychosocial intervention in dementia: a cluster randomized controlled trial. BMC FAMILY PRACTICE 2013; 14:70. [PMID: 23718565 PMCID: PMC3671244 DOI: 10.1186/1471-2296-14-70] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 04/16/2013] [Indexed: 01/24/2023]
Abstract
BACKGROUND To evaluate the effectiveness of a multifaceted implementation strategy on physicians' referral rate to and knowledge on the community occupational therapy in dementia program (COTiD program). METHODS A cluster randomized controlled trial with 28 experimental and 17 control clusters was conducted. Cluster included a minimum of one physician, one manager, and two occupational therapists. In the control group physicians and managers received no interventions and occupational therapists received a postgraduate course. In the experimental group physicians and managers had access to a website, received newsletters, and were approached by telephone. In addition, physicians were offered one outreach visit. In the experimental group occupational therapists received the postgraduate course, training days, outreach visits, regional meetings, and access to a reporting system. Main outcome measure was the number of COTiD referrals received by each cluster which was assessed at 6 and 12 months after the start of the intervention. Referrals were included from both participating physicians (enrolled in the study and received either the control or experimental intervention) and non-participating physicians (not enrolled but of whom referrals were received by participating occupational therapists). Mixed model analyses were used to analyze the data. All analyses were based on the principle of intention-to-treat. RESULTS At 12 months experimental clusters received significantly more referrals with an average of 5,24 referrals (SD 5,75) to the COTiD program compared to 2,07 referrals in the control group (SD 5,14). The effect size at 12 months was 0.58. Although no difference in referral rate was found for the physicians participating in the study, the number of referrals from non-participating physicians (t -2,55 / 43 / 0,02) differed significantly at 12 months. CONCLUSION Passive dissemination strategies are less likely to result in changes in professional behavior. The amount of physicians exposed to active strategies was limited. In spite of this we found a significant difference in the number of referrals which was accounted for by more referrals of non-participating physicians in the experimental clusters. We hypothesize that the increase in referrals was caused by an increase in occupational therapists' efforts to promote their services within their network. TRIAL REGISTRATION NCT01117285.
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376
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Abstract
BACKGROUND This descriptive correlational and comparative study explored health-care faculty (HCF) attitudes toward interprofessional education (IPE) and interprofessional health-care teams, HCF perceptions of subjective norms, the influence of subjective norms on HCF intent to engage in IPE, and HCF intent to engage in IPE. In addition, differences among seven disciplines of HCF were explored. METHODS Nursing, medicine, pharmacy, physical therapy, occupational therapy, physician assistants, and social work faculty were identified. Stratified random sampling was used to ensure that the population surveyed was representative of the target population. The total sample for this study included 439 HCF from the seven identified health-care professions in the US. Data collection included measures of attitudes toward IPE and attitudes toward interprofessional health-care teams. Subjective norms were measured using two 7-point rating scales. Intent to engage in IPE was measured using a 10-point rating scale. RESULTS There were no significant differences among HCF groups regarding attitudes toward IPE or interprofessional health-care teams. Administrative faculty reported greater intent to engage in IPE than teaching faculty. HCF who were currently in or had previously engaged in IPE reported greater intent to engage in or continue to engage, and had higher attitude and subjective norm scores than faculty without IPE experience. The combination of perceived pressure from school administrators and attitudes toward IPE was the best predictor of intent to engage in IPE. CONCLUSION IPE has the potential to influence patient quality of care and lead to better working relationships between health-care providers. HCF are more likely to engage in IPE when they believe their school's administrators think they should engage in IPE and when they have positive attitudes toward IPE.
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Affiliation(s)
- Maria Olenick
- College of Nursing and Health Science, Florida International University, Miami, FL, USA
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377
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Boshoff K, Stewart H. Key principles for confronting the challenges of collaboration in educational settings. Aust Occup Ther J 2013; 60:144-7. [PMID: 23551008 DOI: 10.1111/1440-1630.12003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Kobie Boshoff
- Department of Occupational Therapy Program, Division of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
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378
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Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev 2013; 2013:CD002213. [PMID: 23543515 PMCID: PMC6513239 DOI: 10.1002/14651858.cd002213.pub3] [Citation(s) in RCA: 474] [Impact Index Per Article: 43.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The delivery of effective, high-quality patient care is a complex activity. It demands health and social care professionals collaborate in an effective manner. Research continues to suggest that collaboration between these professionals can be problematic. Interprofessional education (IPE) offers a possible way to improve interprofessional collaboration and patient care. OBJECTIVES To assess the effectiveness of IPE interventions compared to separate, profession-specific education interventions; and to assess the effectiveness of IPE interventions compared to no education intervention. SEARCH METHODS For this update we searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE and CINAHL, for the years 2006 to 2011. We also handsearched the Journal of Interprofessional Care (2006 to 2011), reference lists of all included studies, the proceedings of leading IPE conferences, and websites of IPE organisations. SELECTION CRITERIA Randomised controlled trials (RCTs), controlled before and after (CBA) studies and interrupted time series (ITS) studies of IPE interventions that reported objectively measured or self reported (validated instrument) patient/client or healthcare process outcomes. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed the eligibility of potentially relevant studies. For included studies, at least two review authors extracted data and assessed study quality. A meta-analysis of study outcomes was not possible due to heterogeneity in study designs and outcome measures. Consequently, the results are presented in a narrative format. MAIN RESULTS This update located nine new studies, which were added to the six studies from our last update in 2008. This review now includes 15 studies (eight RCTs, five CBA and two ITS studies). All of these studies measured the effectiveness of IPE interventions compared to no educational intervention. Seven studies indicated that IPE produced positive outcomes in the following areas: diabetes care, emergency department culture and patient satisfaction; collaborative team behaviour and reduction of clinical error rates for emergency department teams; collaborative team behaviour in operating rooms; management of care delivered in cases of domestic violence; and mental health practitioner competencies related to the delivery of patient care. In addition, four of the studies reported mixed outcomes (positive and neutral) and four studies reported that the IPE interventions had no impact on either professional practice or patient care. AUTHORS' CONCLUSIONS This updated review reports on 15 studies that met the inclusion criteria (nine studies from this update and six studies from the 2008 update). Although these studies reported some positive outcomes, due to the small number of studies and the heterogeneity of interventions and outcome measures, it is not possible to draw generalisable inferences about the key elements of IPE and its effectiveness. To improve the quality of evidence relating to IPE and patient outcomes or healthcare process outcomes, the following three gaps will need to be filled: first, studies that assess the effectiveness of IPE interventions compared to separate, profession-specific interventions; second, RCT, CBA or ITS studies with qualitative strands examining processes relating to the IPE and practice changes; third, cost-benefit analyses.
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Affiliation(s)
- Scott Reeves
- Center of Innovation in Inteprofessional Education, University of California, San Francisco, San Francisco, California, USA.
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379
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Elissen A, Nolte E, Knai C, Brunn M, Chevreul K, Conklin A, Durand-Zaleski I, Erler A, Flamm M, Frølich A, Fullerton B, Jacobsen R, Saz-Parkinson Z, Sarria-Santamera A, Sönnichsen A, Vrijhoef H. Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches. BMC Health Serv Res 2013; 13:117. [PMID: 23530744 PMCID: PMC3621080 DOI: 10.1186/1472-6963-13-117] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Accepted: 03/20/2013] [Indexed: 11/26/2022] Open
Abstract
Background Self-management support is a key component of effective chronic care management, yet in practice appears to be the least implemented and most challenging. This study explores whether and how self-management support is integrated into chronic care approaches in 13 European countries. In addition, it investigates the level of and barriers to implementation of support strategies in health care practice. Methods We conducted a review among the 13 participating countries, based on a common data template informed by the Chronic Care Model. Key informants presented a sample of representative chronic care approaches and related self-management support strategies. The cross-country review was complemented by a Dutch case study of health professionals’ views on the implementation of self-management support in practice. Results Self-management support for chronically ill patients remains relatively underdeveloped in Europe. Similarities between countries exist mostly in involved providers (nurses) and settings (primary care). Differences prevail in mode and format of support, and materials used. Support activities focus primarily on patients’ medical and behavioral management, and less on emotional management. According to Dutch providers, self-management support is not (yet) an integral part of daily practice; implementation is hampered by barriers related to, among others, funding, IT and medical culture. Conclusions Although collaborative care for chronic conditions is becoming more important in European health systems, adequate self-management support for patients with chronic disease is far from accomplished in most countries. There is a need for better understanding of how we can encourage both patients and health care providers to engage in productive interactions in daily chronic care practice, which can improve health and social outcomes.
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Affiliation(s)
- Arianne Elissen
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Duboisdomein 30, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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Vachon B, Désorcy B, Camirand M, Rodrigue J, Quesnel L, Guimond C, Labelle M, Fournier J, Grimshaw J. Engaging primary care practitioners in quality improvement: making explicit the program theory of an interprofessional education intervention. BMC Health Serv Res 2013; 13:106. [PMID: 23514278 PMCID: PMC3623830 DOI: 10.1186/1472-6963-13-106] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 03/11/2013] [Indexed: 11/13/2022] Open
Abstract
Background The scientific literature continues to advocate interprofessional collaboration (IPC) as a key component of primary care. It is recommended that primary care groups be created and configured to meet the healthcare needs of the patient population, as defined by patient demographics and other data analyses related to the health of the population being served. It is further recommended that the improvement of primary care services be supported by the delivery of feedback and performance measurements. This paper describes the theory underlying an interprofessional educational intervention developed in Quebec’s Montérégie region (Canada) for the purpose of improving chronic disease management in primary care. The objectives of this study were to explain explicitly the theory underlying this intervention, to describe its components in detail and to assess the intervention’s feasibility and acceptability. Method A program impact theory-driven evaluation approach was used. Multiple sources of information were examined to make explicit the theory underlying the education intervention: 1) a literature review and a review of documents describing the program’s development; 2) regular attendance at the project’s committee meetings; 3) direct observation of the workshops; 4) interviews of workshop participants; and 5) focus groups with workshop facilitators. Qualitative data collected were analysed using thematic analysis. Results The theoretical basis of the interprofessional education intervention was found to be work motivation theory and reflective learning. Five themes describing the workshop objectives emerged from the qualitative analysis of the interviews conducted with the workshop participants. These five themes were the importance of: 1) adopting a regional perspective, 2) reflecting, 3) recognizing gaps between practice and guidelines, 4) collaborating, and 5) identifying possible practice improvements. The team experienced few challenges implementing the intervention. However, the workshop’s acceptability was found to be very good. Conclusion Our observation of the workshop sessions and the interviews conducted with the participants confirmed that the objectives of the education intervention indeed targeted the improvement of interprofessional collaboration and quality of care. However, it is clear that a three-hour workshop alone cannot lead to major changes in practice. Long-term interventions are needed to support this complex change process.
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Affiliation(s)
- Brigitte Vachon
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, 7077 Park Avenue, Montreal, Quebec H3N 1X7, Canada.
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381
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Trivedi D, Goodman C, Gage H, Baron N, Scheibl F, Iliffe S, Manthorpe J, Bunn F, Drennan V. The effectiveness of inter-professional working for older people living in the community: a systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:113-28. [PMID: 22891915 DOI: 10.1111/j.1365-2524.2012.01067.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Health and social care policy in the UK advocates inter-professional working (IPW) to support older people with complex and multiple needs. Whilst there is a growing understanding of what supports IPW, there is a lack of evidence linking IPW to explicit outcomes for older people living in the community. This review aimed to identify the models of IPW that provide the strongest evidence base for practice with community dwelling older people. We searched electronic databases from 1 January 1990-31 March 2008. In December 2010 we updated the findings from relevant systematic reviews identified since 2008. We selected papers describing interventions that involved IPW for community dwelling older people and randomised controlled trials (RCT) reporting user-relevant outcomes. Included studies were classified by IPW models (Case Management, Collaboration and Integrated Team) and assessed for risk of bias. We conducted a narrative synthesis of the evidence according to the type of care (interventions delivering acute, chronic, palliative and preventive care) identified within each model of IPW. We retrieved 3211 records and included 37 RCTs which were mapped onto the IPW models: Overall, there is weak evidence of effectiveness and cost-effectiveness for IPW, although well-integrated and shared care models improved processes of care and have the potential to reduce hospital or nursing/care home use. Study quality varied considerably and high quality evaluations as well as observational studies are needed to identify the key components of effective IPW in relation to user-defined outcomes. Differences in local contexts raise questions about the applicability of the findings and their implications for practice. We need more information on the outcomes of the process of IPW and evaluations of the effectiveness of different configurations of health and social care professionals for the care of community dwelling older people.
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Affiliation(s)
- Daksha Trivedi
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
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382
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Muller-Juge V, Cullati S, Blondon KS, Hudelson P, Maître F, Vu NV, Savoldelli GL, Nendaz MR. Interprofessional collaboration on an internal medicine ward: role perceptions and expectations among nurses and residents. PLoS One 2013; 8:e57570. [PMID: 23469027 PMCID: PMC3585159 DOI: 10.1371/journal.pone.0057570] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 01/23/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Effective interprofessional collaboration requires that team members share common perceptions and expectations of each other's roles. OBJECTIVE Describe and compare residents' and nurses' perceptions and expectations of their own and each other's professional roles in the context of an Internal Medicine ward. METHODS A convenience sample of 14 residents and 14 nurses volunteers from the General Internal Medicine Division at the University Hospitals of Geneva, Switzerland, were interviewed to explore their perceptions and expectations of residents' and nurses' professional roles, for their own and the other profession. Interviews were analysed using thematic content analysis. The same respondents also filled a questionnaire asking their own intended actions and the expected actions from the other professional in response to 11 clinical scenarios. RESULTS Three main themes emerged from the interviews: patient management, clinical reasoning and decision-making processes, and roles in the team. Nurses and residents shared general perceptions about patient management. However, there was a lack of shared perceptions and expectations regarding nurses' autonomy in patient management, nurses' participation in the decision-making process, professional interdependence, and residents' implication in teamwork. Results from the clinical scenarios showed that nurses' intended actions differed from residents' expectations mainly regarding autonomy in patient management. Correlation between residents' expectations and nurses' intended actions was 0.56 (p=0.08), while correlation between nurses' expectations and residents' intended actions was 0.80 (p<0.001). CONCLUSIONS There are discordant perceptions and unmet expectations among nurses and residents about each other's roles, including several aspects related to the decision-making process. Interprofessional education should foster a shared vision of each other's roles and clarify the boundaries of autonomy of each profession.
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Affiliation(s)
- Virginie Muller-Juge
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Stéphane Cullati
- Quality of Care Service, University Hospitals of Geneva, Geneva, Switzerland
- Institute of Demographic and Life Course Studies, Faculty of Economic and Social Sciences, University of Geneva, Geneva, Switzerland
| | - Katherine S. Blondon
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Patricia Hudelson
- Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Fabienne Maître
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Nu V. Vu
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Georges L. Savoldelli
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Anaesthesiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Mathieu R. Nendaz
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of General Internal Medicine, University Hospitals of Geneva, Geneva, Switzerland
- * E-mail:
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383
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Di Giulio P, Arnfield A, English MW, Fitzgerald E, Kelly D, Jankovic M, Gibson F. Collaboration between doctors and nurses in children's cancer care: insights from a European project. Eur J Oncol Nurs 2013; 17:745-9. [PMID: 23462303 DOI: 10.1016/j.ejon.2013.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Revised: 12/23/2012] [Accepted: 01/05/2013] [Indexed: 10/27/2022]
Abstract
PURPOSE It has long been recognised that effective cancer care is not possible without multi-professional team working. Collaboration and multi-professional working however are known to be less than straightforward. This project aimed to use a collaborative approach to explore and facilitate professional groups to work together more effectively in the field of children's cancer care. METHOD Based on an earlier project in Italy, a three-year seminar series was organised involving both a doctor and nurse from 15 paediatric haematology/oncology units across Europe. Participants had to be able to speak English and commit to participate in annual seminars as well as the development and implementation of a local project to enhance doctor-nurse collaboration in their own unit. Appreciative Inquiry was the methodological approach used to address organisational as well as interpersonal change. RESULTS Fifteen doctor-nurse teams were initially selected from a range of different countries, and 10 completed the project. Key outcomes reported include implementation and successful completion of projects, publication of the results achieved, participant satisfaction with improvements in collaboration. Feedback from participants would suggest that change had been implemented and possibly sustained. CONCLUSIONS Active involvement and group support were required for success. More formal relationships needed to be activated with participating centres to guarantee support for those involved in implementing lasting change. A web-based resource to allow other programmes and centres to use the resources developed has been made available. The same approach, we believe, could be used to improve multi-professional working in the care of other childhood illnesses.
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Affiliation(s)
- P Di Giulio
- Turin University, Italy; SUPSI University, Switzerland
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384
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Fragemann K, Meyer N, Graf BM, Wiese CHR. [Interprofessional education in pain management: development strategies for an interprofessional core curriculum for health professionals in German-speaking countries]. Schmerz 2013; 26:369-74, 376-82. [PMID: 22729804 DOI: 10.1007/s00482-012-1158-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The care of patients, suffering from acute, chronic, or malignant pain, requires systematic and interprofessional collaboration between all team members to ensure a holistic approach to pain management. In doing so, the different professions are often in a competitive, tense, or dependent relationship resulting from a lack of precise definitions and concepts regarding their responsibilities in the wide field of pain management. Considering pain management as a whole, we can define numerous interfaces concerning competencies and tasks which may open up some new perspectives on concepts of interprofessional education (IPE). Internationally, there have been many attempts to establish concepts of interprofessional education, and it is considered a great challenge to improve continuing medical education. However, interdisciplinary subjects like pain management may benefit from it. Apart from enhancing specialized knowledge, interprofessional education aims to consider the different roles, skills, and responsibilities as well as interprofessional strategies of decision-making. In Germany, only a few efforts have been made with regard to interprofessional pain education. In the following paper, different challenges, tasks, and roles within the field of pain management are discussed in the sense of potential areas of collaboration in the context of interprofessional education. Against this background, the Regensburg model for interprofessional pain management education is described as one national program to enhance the effectiveness of pain management.
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Affiliation(s)
- K Fragemann
- Bildungszentrum, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
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385
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Lapkin S, Levett-Jones T, Gilligan C. A systematic review of the effectiveness of interprofessional education in health professional programs. NURSE EDUCATION TODAY 2013; 33:90-102. [PMID: 22196075 DOI: 10.1016/j.nedt.2011.11.006] [Citation(s) in RCA: 192] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Revised: 11/03/2011] [Accepted: 11/09/2011] [Indexed: 05/13/2023]
Abstract
OBJECTIVE The objective of this systematic review was to identify the best available evidence for the effectiveness of university-based interprofessional education for health students. BACKGROUND Currently, most health professional education is delivered in a traditional, discipline specific way. This approach is limited in its ability to equip graduates with the necessary knowledge, skills and attitudes for effective interprofessional collaboration and for working as part of a complex health care team. Interprofessional education is widely seen as a way to improve communication between health professionals, ultimately leading to improved patient outcomes. INCLUSION CRITERIA The review included all randomised controlled trials and quasi-experimental studies in which two or more undergraduate or post-graduate health professional groups are engaged in interprofessional education. REVIEW METHODS A three-stage comprehensive search of ten electronic databases as well as grey literature was conducted. Two independent reviewers assessed each paper prior to inclusion using the standardised critical appraisal instruments for evidence of effectiveness developed by the Joanna Briggs Institute. RESULTS Nine published studies consisting of three randomised controlled trials, five controlled before and after studies and one controlled longitudinal study were included in the review. CONCLUSION Student's attitudes and perceptions towards interprofessional collaboration and clinical decision-making can be potentially enhanced through interprofessional education. However, the evidence for using interprofessional education to teach communication skills and clinical skills is inconclusive and requires further investigation. IMPLICATIONS FOR RESEARCH Future randomised controlled studies explicitly focused on interprofessional education with rigorous randomisation procedures, allocation concealment, larger sample sizes, and control groups, would improve the evidence base for interprofessional education.
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Affiliation(s)
- Samuel Lapkin
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, NSW 2308, Australia.
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386
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Harris M, Greaves F, Gunn L, Patterson S, Greenfield G, Car J, Majeed A, Pappas Y. Multidisciplinary group performance-measuring integration intensity in the context of the North West London Integrated Care Pilot. Int J Integr Care 2013; 13:e001. [PMID: 23687473 PMCID: PMC3653286 DOI: 10.5334/ijic.996] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 10/22/2012] [Accepted: 11/19/2012] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Multidisciplinary Group meetings (MDGs) are seen as key facilitators of integration, moving from individual to multi-disciplinary decision-making, and from a focus on individual patients to a focus on patient groups. We have developed a method for coding MDG transcripts to identify whether they are or are not vehicles for delivering the anticipated efficiency improvements across various providers and apply it to a test case in the North West London Integrated Care Pilot. METHODS We defined 'integrating' as the process within the MDG meeting that enables or promotes an improved collaboration, improved understanding, and improved awareness of self and others within the local healthcare economy such that efficiency improvements could be identified and action taken. Utterances within the MDGs are coded according to three distinct domains grounded in concepts from communication, group decision-making, and integrated care literatures-the Valence, the Focus, and the Level. Standardized weighted integrative intensity scores are calculated across ten time deciles in the Case Discussion providing a graphical representation of its integrative intensity. RESULTS Intra- and Inter-rater reliability of the coding scheme was very good as measured by the Prevalence and Bias-adjusted Kappa Score. Standardized Weighted Integrative Intensity graph mirrored closely the verbatim transcript and is a convenient representation of complex communication dynamics. Trend in integrative intensity can be calculated and the characteristics of the MDG can be pragmatically described. CONCLUSION This is a novel and potentially useful method for researchers, managers and practitioners to better understand MDG dynamics and to identify whether participants are integrating. The degree to which participants use MDG meetings to develop an integrated way of working is likely to require management, leadership and shared values.
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Affiliation(s)
- Matthew Harris
- Department of Primary Care and Public Health, Imperial College London, 3 Floor, Reynolds Building, St. Dunstan's Road, Hammersmith, W6 8RP, UK
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387
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Bilodeau K, Dubois S, Pepin J. Contribution des sciences infirmières au développement des savoirs interprofessionnels. Rech Soins Infirm 2013. [DOI: 10.3917/rsi.113.0043] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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388
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Hayes SM, Murray S, Castriotta RJ, Landrigan CP, Malhotra A. (Mis) perceptions and interactions of sleep specialists and generalists: obstacles to referrals to sleep specialists and the multidisciplinary team management of sleep disorders. J Clin Sleep Med 2012; 8:633-42. [PMID: 23243396 DOI: 10.5664/jcsm.2252] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
STUDY OBJECTIVES This study assessed generalists' perceptions and challenges in providing care to sleep disorders patients and the role of sleep specialists in improving gaps in care. METHODS A mixed-method approach included qualitative (semi-structured interviews, discussion groups) and quantitative (online surveys) data collection techniques regarding care of patients with obstructive sleep apnea (OSA) and shift work disorder (SWD). RESULTS PARTICIPANTS OSA: generalists n = 165, specialists (internists, neurologists, psychiatrists, pulmonologists) n = 12; SWD: generalists n = 216, specialists n = 108. Generalists reported challenges in assessing sleep disorders and diagnosing patients with sleep complaints. Generalists lacked confidence (selected ≤ 3 on a 5-pt Likert scale) in managing polypharmacy and drug interactions (OSA: 54.2%; SWD: 62.6%), addiction (OSA: 61.8%), and continuous positive airway pressure (OSA: 66.5%). Generalists in both studies reported deficits in knowledge of monitoring sleep disorders (OSA: 57.7%; SWD: 78.7%), rather relying on patients' subjective reports; 23% of SWD generalists did not identify SWD as a medical condition. Challenges to generalist-specialist collaboration were reported, with 66% of generalists and 68% of specialists in the SWD study reporting lack of coordination as a barrier. Generalists reported lack of consistency in sleep medicine and a perceived lack of value in consulting with sleep specialists. CONCLUSIONS Knowledge and attitudinal challenges were found in primary care of patients with sleep disorders. Sleep specialists need to clarify and educate practitioners regarding primary care's approach.
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389
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Norton WE, McCannon CJ, Schall MW, Mittman BS. A stakeholder-driven agenda for advancing the science and practice of scale-up and spread in health. Implement Sci 2012; 7:118. [PMID: 23216748 PMCID: PMC3541125 DOI: 10.1186/1748-5908-7-118] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 11/30/2012] [Indexed: 11/17/2022] Open
Abstract
Background Although significant advances have been made in implementation science, comparatively less attention has been paid to broader scale-up and spread of effective health programs at the regional, national, or international level. To address this gap in research, practice and policy attention, representatives from key stakeholder groups launched an initiative to identify gaps and stimulate additional interest and activity in scale-up and spread of effective health programs. We describe the background and motivation for this initiative and the content, process, and outcomes of two main phases comprising the core of the initiative: a state-of-the-art conference to develop recommendations for advancing scale-up and spread and a follow-up activity to operationalize and prioritize the recommendations. The conference was held in Washington, D.C. during July 2010 and attended by 100 representatives from research, practice, policy, public health, healthcare, and international health communities; the follow-up activity was conducted remotely the following year. Discussion Conference attendees identified and prioritized five recommendations (and corresponding sub-recommendations) for advancing scale-up and spread in health: increase awareness, facilitate information exchange, develop new methods, apply new approaches for evaluation, and expand capacity. In the follow-up activity, ‘develop new methods’ was rated as most important recommendation; expanding capacity was rated as least important, although differences were relatively minor. Summary Based on the results of these efforts, we discuss priority activities that are needed to advance research, practice and policy to accelerate the scale-up and spread of effective health programs.
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Affiliation(s)
- Wynne E Norton
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL 35294, USA.
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390
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Buscemi J, Steglitz J, Spring B. The impact of team science collaborations in health care: a synopsis and comment on "Interprofessional collaboration: effects of practice-based interventions on professional practice and healthcare outcomes". Transl Behav Med 2012; 2:378-9. [PMID: 24073139 PMCID: PMC3717942 DOI: 10.1007/s13142-012-0169-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The eighth column on evidence-based behavioral medicine is a synthesis of the study of Zwarenstein et al. (1). which examines the effects of practice-based interventions to improve interprofessional collaboration. Poor interprofessional collaboration may have deleterious effects on quality of care. The purpose of the systematic review was to investigate whether interventions aimed at improving interprofessional collaboration affect patient satisfaction and/or the effectiveness and efficiency of care. Five randomized controlled trials were reviewed, examining studies that differed across setting, interventions, and outcomes. Of the five studies reviewed, three showed improvements in patient care, one found no effect, and one had mixed findings. Findings indicate that interventions aimed at improving interprofessional care may improve outcomes, but interpretation of these findings is limited due to the small sample size and heterogeneity across studies reviewed.
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Affiliation(s)
- Joanna Buscemi
- Department of Preventive Medicine, Northwestern University, 680 N. Lake Shore Dr. Suite 1220, Chicago, IL 60611 USA
| | - Jeremy Steglitz
- Department of Preventive Medicine, Northwestern University, 680 N. Lake Shore Dr. Suite 1220, Chicago, IL 60611 USA
| | - Bonnie Spring
- Department of Preventive Medicine, Northwestern University, 680 N. Lake Shore Dr. Suite 1220, Chicago, IL 60611 USA
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391
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Edvardsson K, Ivarsson A, Garvare R, Eurenius E, Lindkvist M, Mogren I, Small R, Nyström ME. Improving child health promotion practices in multiple sectors - outcomes of the Swedish Salut Programme. BMC Public Health 2012; 12:920. [PMID: 23107349 PMCID: PMC3564907 DOI: 10.1186/1471-2458-12-920] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 10/24/2012] [Indexed: 11/18/2022] Open
Abstract
Background To improve health in the population, public health interventions must be successfully implemented within organisations, requiring behaviour change in health service providers as well as in the target population group. Such behavioural change is seldom easily achieved. The purpose of this study was to examine the outcomes of a child health promotion programme (The Salut Programme) on professionals’ self-reported health promotion practices, and to investigate perceived facilitators and barriers for programme implementation. Methods A before-and-after design was used to measure programme outcomes, and qualitative data on implementation facilitators and barriers were collected on two occasions during the implementation process. The sample included professionals in antenatal care, child health care, dental services and open pre-schools (n=144 pre-implementation) in 13 out of 15 municipalities in a Swedish county. Response rates ranged between 81% and 96% at the four measurement points. Results Self-reported health promotion practices and collaboration were improved in all sectors at follow up. Significant changes included: 1) an increase in the extent to which midwives in antenatal care raised issues related to men’s violence against women, 2) an increase in the extent to which several lifestyle topics were raised with parents/clients in child health care and dental services, 3) an increased use of motivational interviewing (MI) and separate ‘fathers visits’ in child health care 4) improvements in the supply of healthy snacks and beverages in open pre-schools and 5) increased collaboration between sectors. Main facilitators for programme implementation included cross-sectoral collaboration and sector-specific work manuals/questionnaires for use as support in everyday practice. Main barriers included high workload, and shortage of time and staff. Conclusion This multisectoral programme for health promotion, based on sector-specific intervention packages developed and tested by end users, and introduced via interactive multisectoral seminars, shows potential for improving health promotion practices and collaboration across sectors. Consideration of the key facilitators and barriers for programme implementation as highlighted in this study can inform future improvement efforts.
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Affiliation(s)
- Kristina Edvardsson
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, SE 901 87, Umeå, Sweden.
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392
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Fänge AM, Lindberg K, Iwarsson S. Housing adaptations from the perspectives of Swedish occupational therapists. Scand J Occup Ther 2012; 20:228-40. [PMID: 23095046 DOI: 10.3109/11038128.2012.737368] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The aim of this study was to investigate how occupational therapists in Sweden administer housing adaptation cases, how they perceive the housing adaptation process, and which improvements they consider necessary. METHODS A total of 1 679 occupational therapists employed by the county councils or the local authorities (and involved in housing adaptations) participated in a web-based survey. The survey targeted issues related to referral and needs identification, assessment, certification, case progress feedback, and evaluation. RESULTS Less than half of the occupational therapists systematized the assessment prior to intervention and very few conducted any evaluation afterwards. Feedback from workmen or grant managers to the occupational therapists on each case's adaptation progress was often asked for but rarely given. The majority of the participants were satisfied with the housing adaptation process in general, while at the same time they indicated a need for further improvements in the process. Differences between occupational therapists related to employer and year of graduation were found on the majority of the targeted issues. CONCLUSIONS To conclude, to a very large extent housing adaptations seem to be based on non-standardized procedures for assessment, and only a few of them are evaluated systematically.
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393
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Al-Baho A, Serour M, Al-Weqayyn A, AlHilali M, Sadek AAA. Clinical audits in a postgraduate general practice training program: an evaluation of 8 years' experience. PLoS One 2012; 7:e43895. [PMID: 22970146 PMCID: PMC3438188 DOI: 10.1371/journal.pone.0043895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 07/30/2012] [Indexed: 11/23/2022] Open
Abstract
Background Clinical audit can be of valuable assistance to any program which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at evaluating audits' effectiveness, valuable opportunities will be overlooked. Clinical audit projects are required as a part of the formative assessment of trainees in the Family Medicine Residency Program (FMRP) in Kuwait. This study was undertaken to draw a picture of trainees' understanding of the audit project with attention to the knowledge of audit theory and its educational significance and scrutinize the difficulties confronted during the experience. Methodology/Principal Findings The materials included the records of 133 audits carried out by trainees and 165 post course questionnaires carried out between 2004 and 2011. They were reviewed and analyzed. The majority of audit projects were performed on diabetic (44.4%) and hypertensive (38.3%) care. Regarding audits done on diabetic care, they were carried out to assess doctors' awareness about screening for smoking status (8.6%), microalbuminuria (19.3%), hemoglobin A1c (15.5%), retinopathy (10.3%), dyslipidemia (15.8%), peripheral neuropathy (8.8%), and other problems (21.7%). As for audits concerning hypertensive care, they were carried out to assess doctors' awareness about screening for smoking status (38.0%), obesity (26.0%), dyslipidemia (12.0%), microalbuminuria (10.0%) and other problems (14.0%). More than half the participants (68.48%) who attended the audit course stated that they ‘definitely agreed’ about understanding the meaning of clinical audit. Most of them (75.8%) ‘definitely agreed’ about realizing the importance of clinical audit in improving patients' care. About half (49.7%) of them ‘agreed’ that they can distinguish between ‘criteria’ and ‘standards’. Conclusion The eight years of experience were beneficial. Trainees showed a good understanding of the idea behind auditing the services provided. They demonstrated their ability to improve the care given in health centers in which these projects were undertaken.
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Affiliation(s)
- Abeer Al-Baho
- Department of Health Promotion, Ministry of Health, Kuwait City, Al-Kuwait, Kuwait
| | - Maleka Serour
- Family Medicine Residency Program, Kuwait Institute for Medical Specialization, Kuwait City, Al-Kuwait, Kuwait
- * E-mail:
| | - Adnan Al-Weqayyn
- Family Medicine Residency Program, Kuwait Institute for Medical Specialization, Kuwait City, Al-Kuwait, Kuwait
| | - Mohammed AlHilali
- Internal Medicine Department, Ain Shams University Hospitals, Cairo, Al-Qahirah, Egypt
| | - Ali A. A. Sadek
- Department of Public Health, Faculty of Medicine Alexandria University, Alexandria, Al-Eskandariyya, Egypt
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394
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Sullivan KR, Rollins MD. Innovations in anaesthesia medical student clerkships. Best Pract Res Clin Anaesthesiol 2012; 26:23-32. [PMID: 22559954 DOI: 10.1016/j.bpa.2012.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 03/06/2012] [Indexed: 11/18/2022]
Abstract
Undergraduate medical education is currently being reformed to adapt to our evolving systems of health care. Medical student curricula are focussing less on mastery of knowledge and clinical skills and more on achieving multiple competencies that will provide students with a solid foundation to practice in complex health-care environments. Anaesthesiologists are uniquely positioned to teach towards a number of competencies. In order to do so, innovations in the traditional apprentice-style clerkships need to be considered. Anaesthesiology rotations should be made part of the core curriculum in order to meet evolving student educational needs and better position anaesthesia educators to assist future curriculum reform. Innovative approaches applicable to anaesthesia clerkships include the use of integration techniques, continuity of patient care and educator preceptorship, as well as multidisciplinary and interprofessional teaching. Continued inquiry into teaching effectiveness and curricular innovation is critical in order to meet the educational needs of future medical students.
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Affiliation(s)
- Kristina R Sullivan
- Department of Anesthesia and Perioperative Care, Division of Critical Care Medicine, University of California San Francisco, 94143-0624, USA.
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395
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Bunkenborg G, Samuelson K, Akeson J, Poulsen I. Impact of professionalism in nursing on in-hospital bedside monitoring practice. J Adv Nurs 2012; 69:1466-77. [PMID: 22924865 DOI: 10.1111/jan.12003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2012] [Indexed: 11/29/2022]
Abstract
AIM This article reports a study exploring nursing practice of monitoring in-hospital patients including intra- and interprofessional communication and collaboration. BACKGROUND Sub-optimal care in general in-hospital wards may lead to admission for intensive care, cardiac arrest, or sudden death. Reasons may include infrequent measurements of vital parameters, insufficient knowledge of their predictive values, and/or sub-optimal use of Medical Emergency Teams. This study was designed to improve understanding of nursing practice and to identify changes required to support nursing staff in improving standards of clinical monitoring practice and patient safety in general in-hospital wards. DESIGN The study was designed as a qualitative descriptive clinical study, based on method triangulation including structured individual observations and semi-structured individual interviews. METHODS In the spring of 2009, structured observations and semi-structured interviews of 13 nurses were carried out at a university hospital in Copenhagen, Denmark. The observational notes and interview transcriptions were analysed using content analysis. RESULTS One theme (Professionalism influences nursing monitoring practice) and two sub-themes (Knowledge and skills and Involvement in clinical practice through reflections) were identified. Three categories (Decision-making, Sharing of knowledge, and Intra- and interprofessional interaction) were found to be associated with the theme, the sub-themes, and with each other. CONCLUSION Clinical monitoring practice varies considerably between nurses with different individual levels of professionalism. Future initiatives to improve patient safety by further developing professionalism among nurses need to embrace individual and organizational attributes to strengthen their practice of in-hospital patient monitoring and management.
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Affiliation(s)
- Gitte Bunkenborg
- Department of Anaesthesiology, Copenhagen University Hospital, Hvidovre, Denmark.
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396
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Pettersen G, Rosenvinge JH, Thune-Larsen KB, Wynn R. Clinical confidence following an interprofessional educational program on eating disorders for health care professionals: a qualitative analysis. J Multidiscip Healthc 2012; 5:201-5. [PMID: 22936849 PMCID: PMC3426273 DOI: 10.2147/jmdh.s33089] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
There are an increasing number of educational programs to improve clinical competence and skills to treat mental disorders. For complex disorders there is also a focus on improving the quality of interprofessional work. This paper reports on interprofessional outputs of an educational program on eating disorders. A total of 207 professionals who completed the program were requested to describe up to 12 possible scenarios depicted as realistic prospects for their future work within this field. Analyzing the scenarios resulted in three categories of describing the participants’ preferences: (1) interprofessional interventions and treatment; (2) the further development of competence; and (3) organization of the health care system. The findings showed that the participants were considering working across new lines in their current workplaces or crossing borders to new frontiers in the execution of competence. Our findings may be summarized into the concept of “clinical confidence.” This concept has so far been understood as some kind of personal trait, disposition, or attitude. The present findings add nuances to this concept in terms of state-dependent encouragement, engagement, and a potential to act and to cross professional borders in order to better treat complex mental disorders.
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Affiliation(s)
- Gunn Pettersen
- Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
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397
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King TL, Laros RK, Parer JT. Interprofessional collaborative practice in obstetrics and midwifery. Obstet Gynecol Clin North Am 2012; 39:411-22. [PMID: 22963700 DOI: 10.1016/j.ogc.2012.05.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
As the health care system transforms to accommodate an increased need for primary care services and more patients, new models of health care delivery are needed that can provide quality health care services efficiently. An integrated collaborative practice of certified nurse-midwives, obstetrician-gynecologists, and perinatologists is best suited to meet the rapidly changing needs of the maternity health care delivery system. This article reviews the literature on interprofessional collaborative practice and describes the structure, function, and essential elements of successful collaboration in health care.
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Affiliation(s)
- Tekoa L King
- Journal of Midwifery & Women's Health, Oakland, CA 94602, USA.
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398
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Roth CP, Ganz DA, Nickles L, Martin D, Beckman R, Wenger NS. Nurse care manager contribution to quality of care in a dual-eligible special needs plan. J Gerontol Nurs 2012; 38:44-54. [PMID: 22833891 DOI: 10.3928/00989134-20120606-10] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We evaluated the quality of care provided to older patients with complex needs in a dual-eligible, community-based Medicare Special Needs Plan that used a nurse care manager model. Care provided by physicians was substantially supplemented by nurse care managers, as measured by Assessing Care of Vulnerable Elders quality indicators. We describe selected nurse care manager activities for six geriatric conditions (falls, dementia, depression, nutrition, urinary incontinence, and end-of-life care) during provision of patient care coordination and management for patients in the highest decile of clinical complexity. We identify areas of high nurse performance (i.e., falls screening, functional assessment, behavioral interventions for dementia problems, advance care planning) and areas of potential missed opportunities (i.e., follow up for new memory problems, targeted dementia counseling, nutrition, and behavioral approaches to urinary incontinence). Increasing the collaborative interaction between nurses providing care in this model and physicians has the potential to enhance nurses' contributions to primary care for vulnerable older adults.
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399
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Denis JL, Forest PG. Real reform begins within: an organizational approach to health care reform. JOURNAL OF HEALTH POLITICS, POLICY AND LAW 2012; 37:633-645. [PMID: 22466053 DOI: 10.1215/03616878-1597457] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Health care systems are under pressure to control their increasing costs, to better adapt to evolving demands, to improve the quality and safety of care, and ultimately to ameliorate the health of their populations. This article looks at a battery of organizational options aimed at transforming health care systems and argues that more attention must be paid to reforming the delivery mechanisms that are so crucial for health care systems' overall performance. To support improvement, policies can rely on organizational assets in two ways. First, reforms can promote the creation of new organizational forms; second, they can employ organizational levers (e.g., capacity development, team-based organizations, evidence-informed practices) to achieve specific policy goals. In both cases organizational assets are mobilized with a view to creating complete health care organizations -- that is to say, organizations that have the capacity to function as high-performing systems. The challenges confronting the development of more complete health care organizations are significant. Real health care system reforms may likewise require implementing ecologies of complex innovation at the clinical, organizational, and policy levels. Policies play a determining role in shaping these new spaces for action so that day-to-day practices may change.
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400
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Djukic M, Fulmer T, Adams JG, Lee S, Triola MM. NYU3T: teaching, technology, teamwork: a model for interprofessional education scalability and sustainability. Nurs Clin North Am 2012; 47:333-46. [PMID: 22920424 DOI: 10.1016/j.cnur.2012.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Interprofessional education is a critical precursor to effective teamwork and the collaboration of health care professionals in clinical settings. Numerous barriers have been identified that preclude scalable and sustainable interprofessional education (IPE) efforts. This article describes NYU3T: Teaching, Technology, Teamwork, a model that uses novel technologies such as Web-based learning, virtual patients, and high-fidelity simulation to overcome some of the common barriers and drive implementation of evidence-based teamwork curricula. It outlines the program's curricular components, implementation strategy, evaluation methods, and lessons learned from the first year of delivery and describes implications for future large-scale IPE initiatives.
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Affiliation(s)
- Maja Djukic
- College of Nursing, New York University, 726 Broadway, 10th Floor, New York, NY 10003, USA.
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