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Hemle Jerntorp S, Carlson E, Axelsson M, Aho AC, Jakobsson J. Patients' experiences of involvement at a clinical training ward: a qualitative interview study. J Interprof Care 2024:1-9. [PMID: 39266451 DOI: 10.1080/13561820.2024.2395971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 05/07/2024] [Accepted: 08/19/2024] [Indexed: 09/14/2024]
Abstract
Interprofessional education aims to foster healthcare students' ability to collaborate in interprofessional teams with the patients at the center of care as active participants. However, little is known about how patients experience this collaboration. Therefore, this study aimed to explore patients' experiences of being involved in the interprofessional team of healthcare students at a clinical training ward in Sweden. A descriptive design with a qualitative approach was used. Data were collected through semi-structured individual interviews with 22 patients. Braun and Clarke's reflexive thematic analysis was used. The main finding was that patients were only included as passive participants. Although most patients wanted to be involved, they were hindered due to their health condition or excluded from care planning and decision-making. The patients needed family members' support to be involved. However, this need was not recognised by the interprofessional team of healthcare students. Patient involvement must be highlighted as an important component of interprofessional education initiatives. Further research is needed to explore family members' perspectives on involvement in interprofessional training ward settings.
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Affiliation(s)
| | | | - Malin Axelsson
- Department of Care Science, Malmö University, Malmö, Sweden
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Muller-Schoof IJM, Snoeren M, Verbiest MEA, Luijkx KG. Evaluation of an interprofessional educational program in nursing home practice: a mixed methods multiple-case study. J Interprof Care 2024:1-11. [PMID: 39258413 DOI: 10.1080/13561820.2024.2395966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 03/22/2024] [Accepted: 08/19/2024] [Indexed: 09/12/2024]
Abstract
Research has shown that interprofessional collaboration (IPC) and education (IPE) may potentially lead to better care for residents in nursing homes, but their implementation is challenging. This study evaluates the implementation of a co-designed IPE program and investigates what and how healthcare students learn and what factors influence their learning. A mixed-methods approach was used to evaluate three cases, with student participation in the IPE (n = 72). The study comprised pre- and posttests, focus groups, and interviews (n = 54). The results indicate that students developed their interprofessional skills and person-centered practice, as confirmed by both the students and educators in the interviews. Additionally, the findings suggest that others also learned from the program. The study emphasizes the influence of workplace learning culture, resources, organizational infrastructure for IPC, and educators' embeddedness in the care organization on learning outcomes. The findings suggest that IPE is stimulated and accelerated by existing IPC and can stimulate or accelerate existing IPC. As the enabling factors are interrelated, addressing them simultaneously on all organizational levels may result in the faster development of an IPE-ready organization.
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Affiliation(s)
- Irene J M Muller-Schoof
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Miranda Snoeren
- School of People and Health Studies, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Marjolein E A Verbiest
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - Katrien G Luijkx
- Tranzo Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
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Julien-Marsollier F, Pardessus P, Brouns K, Happiette A, Dahmani S, Ilharreborde B. Benefits of a spine team for the surgical management of paediatric scoliosis. Orthop Traumatol Surg Res 2024:103976. [PMID: 39182838 DOI: 10.1016/j.otsr.2024.103976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 02/14/2024] [Accepted: 03/12/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND For many years, blood-saving techniques and the enhanced recovery after surgery approach have been used to optimise the quality of care and shorten hospital stays. The creation of dedicated spine teams combining surgeons and anaesthesiologists specialised in spine surgery has been proven beneficial in adults. The objective of this study was to determine whether involving a spine team in the management of paediatric patients with scoliosis treated by posterior spinal fusion was associated with shorter hospital stays. HYPOTHESIS The hospital stay would be shorter in patients managed by a spine team. MATERIALS AND METHODS This single-centre, non-randomised, comparative study was initiated after approval by the local ethics committee. One group of patients was managed by a spine team composed of an anaesthesiologist and a surgeon with over 10 years of experience and the control group by an anaesthesiologist and a surgeon with less than 5 years of experience. The primary outcome was hospital stay length (median [interquartile range]). RESULTS The study included 157 paediatric patients who underwent spinal fusion in 2021 for adolescent idiopathic scoliosis (AIS, n = 106) or secondary scoliosis (n = 51). The spinal team was involved for 48 (45%) AIS procedures and 38 (74.5%) secondary-scoliosis procedures. Both operative time and anaesthesia time were significantly shorter in the spinal-team group, by 10% and 15% (p < 0.001 for both comparisons), respectively, for SIA and by 20% (p = 0.002) and 25% (p < 0.001), respectively, for secondary scoliosis. The spinal-team group had a shorter median hospital stay, the difference being significant for AIS (in days, 5 [4-7] versus 7.1 [5-10], p = 0.03) and nearly significant for secondary scoliosis (6.9 [5-10] versus 9 [6-23], p = 0.07). Fewer patients required blood transfusion in the spine-team group than in the control group (AIS: 0% versus 8.8%, p = 0.05; and secondary scoliosis, 28% versus 58%, p<0.01). CONCLUSION Involvement of a spine team optimises the peri-operative management of patients with AIS, thus shortening the hospital stay. Further work is needed to assess the potential associations of spine team involvement with complication rates. LEVEL OF EVIDENCE III; non-randomised comparative study.
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Affiliation(s)
- Florence Julien-Marsollier
- Université de Paris-Cité, Paris, France; Département d'Anesthésie, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France; FHU I2D2, Robert Debré Hospital, 48 Boulevard Sérurier, 75019 Paris, France.
| | - Pierre Pardessus
- Université de Paris-Cité, Paris, France; Département d'Anesthésie, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France
| | - Kelly Brouns
- Université de Paris-Cité, Paris, France; Département d'Anesthésie, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France
| | - Adèle Happiette
- Université de Paris-Cité, Paris, France; FHU I2D2, Robert Debré Hospital, 48 Boulevard Sérurier, 75019 Paris, France; Département de Chirurgie Orthopédique Pédiatrique, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France
| | - Souhayl Dahmani
- Université de Paris-Cité, Paris, France; Département d'Anesthésie, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France; FHU I2D2, Robert Debré Hospital, 48 Boulevard Sérurier, 75019 Paris, France
| | - Brice Ilharreborde
- Université de Paris-Cité, Paris, France; FHU I2D2, Robert Debré Hospital, 48 Boulevard Sérurier, 75019 Paris, France; Département de Chirurgie Orthopédique Pédiatrique, Hôpital Robert Debré, 48 Boulevard Sérurier, 75019 Paris, France
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Sharkas AR, Ali Sherazi B, Sayyed SA, Kinny F, Steichert M, Schwender H, Laeer S. Development and Evaluation of Interprofessional High-Fidelity Simulation Course on Medication Therapy Consultation for German Pharmacy and Medical Students-A Randomized Controlled Study. PHARMACY 2024; 12:128. [PMID: 39195857 PMCID: PMC11359710 DOI: 10.3390/pharmacy12040128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Revised: 08/08/2024] [Accepted: 08/19/2024] [Indexed: 08/29/2024] Open
Abstract
Recently, there has been a remarkable move towards interprofessional collaboration in response to the COVID-19 pandemic and the care of comorbidities. In Germany, there has been a gradual increase in interprofessional learning in medical and pharmacy education, aiming to enhance patient care. To adapt the pharmacy curriculum for collaborative practice between pharmacy and medical students, we developed an immersive interprofessional collaboration course for pharmacy students using adult and pediatric high-fidelity simulators (HFS) to assess and train medication consultation skills. In a randomized controlled trial, we investigated whether interprofessional training between pharmacy and medical students results in differences in pharmacy students' performance of medication therapy consultation compared to the case of mono-professional training of pharmacy students only. Before and after inter/mono-professional training, each pharmacy student performed an objective structured clinical examination (OSCE) and completed a self-assessment questionnaire. Additionally, an attitude survey towards interprofessional learning was completed by pharmacy and medical students at the end of the training. As expected, interprofessional as well as mono-professional training showed a statistically significant increase in medication consultation skills. Of importance, the performance in the interprofessional training group was significantly better than in the mono-professional group, particularly in drug therapy counselling and consultation behaviors. There was a significant difference between the intervention and control groups in self-assessment scores, and all study participants had positive attitudes toward interprofessional collaboration and training. Therefore, interprofessional training using HFS has been shown to appropriately train pharmacy students for collaborative practice and consultation skills.
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Affiliation(s)
- Ahmed Reda Sharkas
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (B.A.S.); (S.A.S.); (M.S.); (S.L.)
| | - Bushra Ali Sherazi
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (B.A.S.); (S.A.S.); (M.S.); (S.L.)
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore 54000, Pakistan
| | - Shahzad Ahmad Sayyed
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (B.A.S.); (S.A.S.); (M.S.); (S.L.)
| | - Florian Kinny
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (B.A.S.); (S.A.S.); (M.S.); (S.L.)
| | - Melina Steichert
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (B.A.S.); (S.A.S.); (M.S.); (S.L.)
| | - Holger Schwender
- Mathematical Institute, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany
| | - Stephanie Laeer
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University Duesseldorf, Universitaetsstrasse 1, 40225 Duesseldorf, Germany; (B.A.S.); (S.A.S.); (M.S.); (S.L.)
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Hooley RL, Payne S, Begovic D, Correa-Morales JE, Harding A, Hasselaar J, Preston N. Collaboration, coordination and communication as facilitators of transitions for patients with advanced cancer: a scoping review linked to the Pal-Cycles project. BMC Palliat Care 2024; 23:204. [PMID: 39112983 PMCID: PMC11304839 DOI: 10.1186/s12904-024-01510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 07/10/2024] [Indexed: 08/11/2024] Open
Abstract
BACKGROUND Person-centred care is becoming increasingly recognised as an important element of palliative care. The current review syntheses evidence in relation to transitions in advanced cancer patients with palliative care needs. The review focuses on specific elements which will inform the Pal-Cycles programme, for patients with advanced cancer transitioning from hospital care to community care. Elements of transitional models for cancer patients may include, identification of palliative care needs, compassionate communication with the patient and family members, collaborative effort to establish a multi-dimensional treatment plan, review and evaluation of the treatment plan and identification of the end of life phase. METHODS A scoping review of four databases (MEDLINE, EMBASE, CINAHL, PsycINFO) was conducted to identify peer-reviewed studies published from January 2013 to October, 2022. A further hand-search of references to locate additional relevant studies was also undertaken. Inclusion criteria involved cancer patients transitions of care with a minimum of two of components from those listed above. Studies were excluded if they were literature reviews, if transition of care was related to cancer survivors, involved non-cancer patients, had paediatric population, if the transition implied a change of therapy and or a lack of physical transit to a non-hospital place of care. This review was guided by Arksey and O'Malley's framework and narrative synthesis was used. RESULTS Out of 5695 records found, 14 records were selected. Transition models identified: increases in palliative care consultations, hospice referrals, reduction in readmission rates and the ability to provide end of life care at home. Transition models highlight emotional and spiritual support for patients and families. No uniform model of transition was apparent, this depends on the healthcare system where it is implemented. CONCLUSIONS The findings highlight the importance of collaboration, coordination and communication as central mechanisms for transitional model for patients with advanced cancer. This may require careful planning and will need to be tailored to the contexts of each healthcare system.
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Affiliation(s)
- Rachel Louise Hooley
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK.
| | - Sheila Payne
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Dunja Begovic
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Andrew Harding
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Jeroen Hasselaar
- Department of Primary Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
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Austin EJ, Chen J, Soyer E, Idrisov B, Briggs ES, Ferro L, Saxon AJ, Fortney JC, Curran GM, Moghimi Y, Blanchard BE, Williams EC, Ratzliff AD, Ruiz MS, Koch U. Optimizing Patient Engagement in Treatment for Opioid Use Disorder: Primary Care Team Perspectives on Influencing Factors. J Gen Intern Med 2024:10.1007/s11606-024-08963-9. [PMID: 39073482 DOI: 10.1007/s11606-024-08963-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 07/18/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND Opioid use disorder (OUD) care engagement rates in primary care (PC) settings are often low. Little is known about PC team experiences when delivering OUD treatment and potential factors that influence their capacity to engage patients in treatment. Exploring PC team experiences may inform needed supports that can optimize OUD care delivery and improve outcomes for patients with OUD. OBJECTIVE We explored multidisciplinary PC team perspectives on barriers and facilitators to engaging patients in OUD treatment. DESIGN Qualitative study using in-depth interviews. PARTICIPANTS Primary care clinical teams. APPROACH We conducted semi-structured interviews (n = 35) with PC team members involved in OUD care delivery, recruited using a combination of criterion and maximal variation sampling. Data collection and analysis were informed by existing theoretical literature about patient engagement, specifically that patient engagement is influenced by factors across individual (patient, provider), interpersonal (patient-provider), and health system domains. Interviews were professionally transcribed and doubled-coded using a coding schema based on the interview guide while allowing for emergent codes. Coding was iteratively reviewed using a constant comparison approach to identify themes and verified with participants and the full study team. KEY RESULTS Analysis identified five themes that impact PC team ability to engage patients effectively, including limited patient contact (e.g., phone, text) in between visits, varying levels of provider confidence to navigate OUD treatment discussions, structural factors (e.g., schedules, productivity goals) that limited provider time, the role of team-based approaches in lessening discouragement and feelings of burnout, and lack of shared organizational vision for reducing harms from OUD. CONCLUSIONS While the capacity of PC teams to engage patients in OUD care is influenced across multiple levels, some of the most promising opportunities may involve addressing system-level factors that limit PC team time and collaboration and promoting organizational alignment on goals for OUD treatment.
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Affiliation(s)
- Elizabeth J Austin
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, USA.
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C., USA.
| | - Jessica Chen
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, USA
| | - Elena Soyer
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, USA
| | - Bulat Idrisov
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, USA
| | - Elsa S Briggs
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, USA
| | - Lori Ferro
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Andrew J Saxon
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound, Seattle, WA, USA
| | - John C Fortney
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Center of Excellence in Substance Addiction Treatment and Education, VA Puget Sound, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Geoffrey M Curran
- Departments of Pharmacy Practice and Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
- Central Arkansas Veterans Health Care System, Little Rock, USA
| | - Yavar Moghimi
- Department of Psychiatry and Behavioral Sciences, School of Medicine and Health Sciences, The George Washington University, Washington, D.C., USA
| | - Brittany E Blanchard
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Emily C Williams
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, USA
- Center of Innovation for Veteran-Centered and Value-Driven Care, Health Services Research & Development, VA Puget Sound, Seattle, WA, USA
| | - Anna D Ratzliff
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
- Advancing Integrated Mental Health Solutions (AIMS) Center, University of Washington, Seattle, WA, USA
| | - Monica S Ruiz
- Department of Prevention and Community Health, Milken Institute School of Public Health, The George Washington University, Washington, D.C., USA
| | - Ulrich Koch
- Department of Clinical Research and Leadership, School of Medicine and Health Sciences, The George Washington University, Washington, D.C., USA
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Butler JI, Fox MT. 'Our Voices Aren't Being Heard': A qualitative descriptive study of nurses' perceptions of interprofessional collaboration in care supporting older people's functioning during a hospital stay. Scand J Caring Sci 2024; 38:398-408. [PMID: 38323707 DOI: 10.1111/scs.13243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/10/2024] [Accepted: 01/26/2024] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Older people admitted to hospital are highly susceptible to functional decline and related complications. Care supporting their functioning is complex and requires healthcare professionals working in concert, with nurses playing a central role. Yet, little is known about nurses' perceptions of interprofessional collaboration (IPC) in care supporting functioning in acutely admitted older people. To fill this knowledge gap, we elucidate the perspectives of nurses in Ontario, Canada, on IPC in care supporting older people's functioning during a hospital stay. METHODS We employed a qualitative methodology in conjunction with a qualitative descriptive design. Thirteen focus groups were held with a purposeful, criterion-based sample of 57 acute care nurses practising in a range of acute care settings (e.g. Emergency, General Medicine, General Surgery, Intensive Care, Coronary Care). Data were thematically analysed. RESULTS We identified two overarching themes: (1) IPC is improving, but nurses are excluded from decision-making and (2) nurse advocacy causes friction with other professionals. The first theme captures nurses' perception that IPC in older people's care is improving, but nurses are marginalised in interprofessional decision-making. As a result, nurses perceive that their knowledge is devalued, and their contributions to care supporting older people's functioning are undermined. The second theme underlines a tension between interprofessional team practices and patient- and family-centred care, while also demonstrating nurses' increasing willingness to act as patient and family advocates. CONCLUSIONS Findings can be used to enhance IPC in care supporting the functioning of acutely hospitalised older people. To improve IPC, clinical and administrative leaders should cultivate more egalitarian team relationships that encourage nurses to contribute to decision-making and advocate on behalf of older patients and their families.
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Affiliation(s)
- Jeffrey I Butler
- Faculty of Health, School of Nursing, York University, Toronto, Ontario, Canada
- York University Centre for Aging Research and Education, Toronto, Ontario, Canada
| | - Mary T Fox
- Faculty of Health, School of Nursing, York University, Toronto, Ontario, Canada
- York University Centre for Aging Research and Education, Toronto, Ontario, Canada
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Morgan DG, Kosteniuk J, Bayly M. Perceptions and outcomes of an embedded Alzheimer Society First Link Coordinator in rural primary health care memory clinics. BMC Health Serv Res 2024; 24:607. [PMID: 38724975 PMCID: PMC11080231 DOI: 10.1186/s12913-024-11066-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Primary health care has a central role in dementia detection, diagnosis, and management, especially in low-resource rural areas. Care navigation is a strategy to improve integration and access to care, but little is known about how navigators can collaborate with rural primary care teams to support dementia care. In Saskatchewan, Canada, the RaDAR (Rural Dementia Action Research) team partnered with rural primary health care teams to implement interprofessional memory clinics that included an Alzheimer Society First Link Coordinator (FLC) in a navigator role. Study objectives were to examine FLC and clinic team member perspectives of the impact of FLC involvement, and analysis of Alzheimer Society data comparing outcomes associated with three types of navigator-client contacts. METHODS This study used a mixed-method design. Individual semi-structured interviews were conducted with FLC (n = 3) and clinic team members (n = 6) involved in five clinics. Data were analyzed using thematic inductive analysis. A longitudinal retrospective analysis was conducted with previously collected Alzheimer Society First Link database records. Memory clinic clients were compared to self- and direct-referred clients in the geographic area of the clinics on time to first contact, duration, and number of contacts. RESULTS Three key themes were identified in both FLC and team interviews: perceived benefits to patients and families of FLC involvement, benefits to memory clinic team members, and impact of rural location. Whereas other team members assessed the patient, only FLC focused on caregivers, providing emotional and psychological support, connection to services, and symptom management. Face-to-face contact helped FLC establish a relationship with caregivers that facilitated future contacts. Team members were relieved knowing caregiver needs were addressed and learned about dementia subtypes and available services they could recommend to non-clinic clients with dementia. Although challenges of rural location included fewer available services and travel challenges in winter, the FLC role was even more important because it may be the only support available. CONCLUSIONS FLC and team members identified perceived benefits of an embedded FLC for patients, caregivers, and themselves, many of which were linked to the FLC being in person.
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Affiliation(s)
- Debra G Morgan
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, 104 Clinic Place, Box 23, Saskatoon, SK, S7N 5E5, Canada.
| | - Julie Kosteniuk
- Canadian Centre for Rural and Agricultural Health, University of Saskatchewan, 104 Clinic Place, Box 23, Saskatoon, SK, S7N 5E5, Canada
| | - Melanie Bayly
- Research Ethics Office, Human Ethics, University of Saskatchewan, 2nd Floor, Thorvaldson Building, 110 Science Place, Saskatoon, SK, S7N 5C9, Canada
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Ohta R, Nitta T, Shimizu A, Sano C. Role of family medicine physicians in providing nutrition support to older patients admitted to orthopedics departments: a grounded theory approach. BMC PRIMARY CARE 2024; 25:121. [PMID: 38641569 PMCID: PMC11027398 DOI: 10.1186/s12875-024-02379-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Care of older adults requires comprehensive management and control of systemic diseases, which can be effectively managed by family physicians. Complicated medical conditions in older patients admitted to orthopedic departments (orthopedic patients) necessitate interprofessional collaboration. Nutrition is one of the essential components of management involved in improving the systemic condition of older patients. Nutrition support teams play an important role in nutrition management and can be supported by family physicians. However, the role of family physicians in nutrition support teams is not well documented. This study aimed to investigate the role of family physicians in supporting nutrition management in orthopedic patients. METHODS This qualitative study was conducted between January and June 2023 using constructivist grounded theory methodology. Eight family medicine physicians, three orthopedic surgeons, two nurses, two pharmacists, four rehabilitation therapists, four nutritionists, and one laboratory technician working in Japanese rural hospitals participated in the research. Data collection was performed through ethnography and semi-structured interviews. The analysis was performed iteratively during the study. RESULTS Using a grounded theory approach, four theories were developed regarding family physicians' role in providing nutrition support to orthopedic patients: hierarchical and relational limitation, delay of onset and detection of the need for geriatric care in orthopedic patients, providing effective family medicine in hospitals, and comprehensive management through the nutrition support team. CONCLUSIONS The inclusion of family physicians in nutrition support teams can help with early detection of the rapid deterioration of orthopedic patients' conditions, and comprehensive management can be provided by nutrition support teams. In rural primary care settings, family physicians play a vital role in providing geriatric care in community hospitals in collaboration with specialists. Family medicine in hospitals should be investigated in other settings for better geriatric care and to drive mutual learning among healthcare professionals.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan, Shimane, 699-1221, Japan.
| | - Tachiko Nitta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan, Shimane, 699-1221, Japan
| | - Akiko Shimizu
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan, Shimane, 699-1221, Japan
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo, Shimane, 693-8501, Japan
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Crunenberg R, Charles C, Lallemand A, Buret L, Philippe G, Ethgen O. Interpretative phenomenological analysis of the collaboration among healthcare professionals in the nursing home setting. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2024; 13:100424. [PMID: 38516547 PMCID: PMC10955404 DOI: 10.1016/j.rcsop.2024.100424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 02/12/2024] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
Background The theory of planned behavior (TPB) postulates that behavioral performance is guided by the intention to perform that behavior, influenced by attitudes, subjective norms, and perceived behavioral control. This framework can be applied to studying interprofessional collaboration among healthcare professionals to enhance patient safety and public health within nursing homes. Objectives This study aimed to explore the roles of physicians, pharmacists, and nurses in the interprofessional collaboration process while identifying facilitators and barriers to effective collaboration among healthcare professionals. Methods A qualitative interpretative phenomenological analysis (IPA) was carried out. Individual semi-structured interviews were conducted with 19 healthcare professionals. Qualitative data were then integrated and analyzed through the lens of the TPB. Findings The IPA revealed the ten following themes, considered as both facilitators and barriers to interprofessional collaboration among healthcare professionals in the nursing home setting: communication, roles and responsibilities, willingness and recognition of collaboration's importance, mutual knowledge, trust, confidence, support from decision-makers, protocols, and technology were considered as facilitators while distance was considered as a barrier. Conclusion Enhancing pharmacist-physician collaboration and refining pharmacist-nurse collaboration were essential goals. Intention for collaboration was influenced by attitudes (such as communication and mutual understanding), subjective norms (including support from decision-makers), and perceived behavioral control (such as confidence and adherence to protocols and technology). Addressing these factors could improve collaboration, enhancing residents' quality of life and professionals' sense of achievement.
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Affiliation(s)
- Robin Crunenberg
- Faculty of Medicine, Department of Pharmacy, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium
- Faculty of Medicine, Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium, Liège, Belgium
| | - Camille Charles
- Faculty of Medicine, Department of Pharmacy, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium
| | - Alice Lallemand
- Faculty of Medicine, Department of Pharmacy, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium
| | - Laetitia Buret
- Faculty of Medicine, Department of General Medicine, University of Liège, Liège, Belgium
| | - Geneviève Philippe
- Faculty of Medicine, Department of Pharmacy, Center for Interdisciplinary Research on Medicines (CIRM), University of Liège, Liège, Belgium
| | - Olivier Ethgen
- Faculty of Medicine, Department of Public Health, Epidemiology and Health Economics, University of Liège, Belgium, Liège, Belgium
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11
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Ohta R, Yawata M, Sano C. Effectiveness of Doctor Clerks Supporting Physicians' Work in Japan: A Systematic Review. Cureus 2024; 16:e53407. [PMID: 38435195 PMCID: PMC10908375 DOI: 10.7759/cureus.53407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
The burgeoning administrative workload on physicians in Japan's healthcare system has necessitated innovative approaches to optimize clinical care. Integrating doctor clerks, tasked with administrative and clerical duties, has emerged as a potential solution to alleviate this burden. This systematic review aims to evaluate the effectiveness of doctor clerks in improving physicians' working conditions and patient care quality. A comprehensive literature search was conducted using Ichushi Web and Google Scholar from January 2000 to September 2023. Data were extracted on publication year, study setting, department focus, work scope, and outcomes of doctor clerk implementation. The search identified 3570 studies, with 17 meeting the inclusion criteria. Most studies were performed in general hospitals with 76.5% (13/17). The studies regarding university hospitals were 17.6% (3/17). Only one study was performed in a community hospital with 5.9% (1/17). More than half of doctor clerks worked not explicitly allocated to one department and did their work not specific to one department with 52.9% (9/17). Three studies report that doctor clerks collaborate with orthopedic surgeons. Two studies report that doctor clerks collaborate with emergency medicine physicians. Each study reports that doctor clerks collaborate with respiratory or general medicine. The most frequent is document support, with 94.1% (16/17). The second most frequent working content is consultation support, with 47.1% (8/17). The third most frequently working content is ordering support, with 23.5% (4/17). Call response, secretary work, education support, research support, conference support, and other professional support are included, each with 5.9% (1/17). Regarding clinical outcomes, five studies assessed a reduction in physician paperwork time (29.4%). Four studies assessed the frequency of the contents of doctor clerks' work (23.5%). Four studies assessed the positive perception of physicians (23.5%). Four studies assessed the amount of the reduction in physicians' overtime work (23.5%). Three studies assess the amount of the reduction in hospital costs (17.6%). One study assessed part-time physicians' fatigue reduction (5.9%). Each study assessed the quality of patient care, such as doctor's clerk education for standardization, increase in the number of patients accepted, reduction in medical incidents, decrease in patient waiting time, and primary to tertiary prevention. Introducing doctor clerks in Japan's healthcare system shows promise in enhancing physicians' working conditions and potentially improving patient care. However, conclusive evidence on the impact on patient care quality necessitates further investigation, serving as a foundation for future policy and healthcare system optimization.
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Affiliation(s)
| | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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12
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Ohta R, Sano C. Integrating Clinical and Socio-Environmental Approaches in Managing Rheumatoid Arthritis With Social Determinants of Health: A Case Study of an Elderly Patient in Rural Japan. Cureus 2023; 15:e50915. [PMID: 38249275 PMCID: PMC10799749 DOI: 10.7759/cureus.50915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2023] [Indexed: 01/23/2024] Open
Abstract
Rheumatoid arthritis (RA) poses significant management challenges, especially in elderly patients living in rural areas with limited access to health care. This case report illustrates an integrative approach to managing RA, emphasizing the interplay of clinical, social, and environmental factors. A 72-year-old woman in a rural Japanese setting presented with progressive, widespread joint pain, initially self-managed with over-the-counter medications. Her condition, complicated by socioeconomic constraints and limited access to health care, necessitated a comprehensive management strategy. Clinical examination revealed bilateral joint tenderness, swelling, and high titers of rheumatoid factor and anti-citrullinated protein antibodies, confirming RA. Treatment included methotrexate and prednisolone, complemented by lifestyle modifications. Interdisciplinary collaboration among healthcare professionals, including nutritionists and physiotherapists, facilitated her management. The patient's care was guided by the chronic care model and the ecological model, addressing her clinical needs and socio-environmental context. This holistic approach resulted in improved clinical outcomes and enhanced quality of life. This case highlights the importance of a patient-centered, multidisciplinary approach in managing RA in rural settings. Integrating clinical management with an understanding of social determinants and patient empowerment is crucial for effective treatment. The case underscores the need for adaptable healthcare strategies that are sensitive to the unique challenges faced by elderly patients in rural communities.
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Affiliation(s)
| | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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Bouton C, Journeaux M, Jourdain M, Angibaud M, Huon JF, Rat C. Interprofessional collaboration in primary care: what effect on patient health? A systematic literature review. BMC PRIMARY CARE 2023; 24:253. [PMID: 38031014 PMCID: PMC10685527 DOI: 10.1186/s12875-023-02189-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND In a period of change in the organization of primary care, Interprofessional Collaboration (IPC) is presented as one of the solutions to health issues. Although the number of inter-professional interventions grounded in primary care increases in all developed countries, evidence on the effects of these collaborations on patient-centred outcomes is patchy. The objective of our study was to assess the effects of IPC grounded in the primary care setting on patient-centred outcomes. METHODS We conducted a systematic literature review using the PubMed, Embase, PsycINFO and CINAHL databases from 01/01/1995 to 01/03/2021, according to the PRISMA guidelines. Studies reporting the effects of IPC in primary care on patient health outcomes were included. The quality of the studies was assessed using the revised Downs and Black checklist. RESULTS Sixty-five articles concerning 61 interventions were analysed. A total of 43 studies were prospective and randomized. Studies were classified into 3 main categories as follows: 1) studies with patients at cardiovascular risk (28 studies)-including diabetes (18 studies) and arterial hypertension (5 studies); 2) studies including elderly and/or polypathological patients (18 studies); and 3) patients with symptoms of mental or physical disorders (15 studies). The number of included patients varied greatly (from 50 to 312,377). The proportion of studies that reported a positive effect of IPC on patient-centred outcomes was as follows: 23 out of the 28 studies including patients at cardiovascular risk, 8 out of the 18 studies of elderly or polypathological patients, and 11 out of the 12 studies of patients with mental or physical disorders. CONCLUSIONS Evidence suggests that IPC is effective in the management of patients at cardiovascular risk. In elderly or polypathological patients and in patients with mental or physical disorders, the number of studies remains very limited, and the results are heterogeneous. Researchers should be encouraged to perform studies based on comparative designs: it would increase evidence on the positive effect and benefits of IPC on patient variables.
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Affiliation(s)
- Céline Bouton
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France.
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France.
| | - Manon Journeaux
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France
| | - Maud Jourdain
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
| | - Morgane Angibaud
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
| | - Jean-François Huon
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
- Faculty of Pharmacy, University of Nantes, Nantes, France
| | - Cédric Rat
- Department of General Practice, Faculty of Medicine, University of Nantes, 1, Rue Gaston Veil, 44035, Nantes, France
- Primary Care Federative Department, Faculty of Medicine, University of Nantes, Nantes, France
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Ohta R, Nishikura N, Sano C. What Do Medical Students Learn about Community Care from Discussions with General Physicians? A Thematic Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1855. [PMID: 37893573 PMCID: PMC10607926 DOI: 10.3390/medicina59101855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: Sustainable healthcare is fundamentally rooted in community medicine education. The COVID-19 pandemic disrupted global advancement in integrating traditional teaching and experiential learning. Additionally, an alarming decline in interest in community care has been observed among senior medical students. Here, we examined the perspectives on community care obtained from conversations with general physicians in rural medical universities. Materials and Methods: Using a constructivist lens, a qualitative methodology was employed to examine the perceptions of second-year medical students from Shimane University Medical School regarding community care, informed by dialogues with general physicians. We conducted a thematic analysis at Shimane University, Japan, an area known for its aging population. In 2023, 116 second-year students participated, none of whom had prior formal training in community care. The study was structured into three phases: (1) Pre-education: Students wrote essays about their initial understanding of community care, its advantages, disadvantages, and potential improvements; (2) Dialogue: Grouped by topic, students engaged in discussions that culminated in a comprehensive session with general physicians; and (3) Reflection: After discussions, students wrote essays reflecting any shift in their views on community care. A thematic analysis of essays from the pre-education and reflection phases provided a comparative perspective on the students' understanding. Results: Five dominant themes emerged from the thematic analysis: (1) Re-evaluating community care: Recognizing diversity and addressing societal challenges; (2) Interdisciplinary collaboration: Promoting shared roles and teamwork; (3) Learning and practice: Emphasizing hands-on experience and self-reflection; (4) Technological influence: The mutual relationship between community care and technological advancements; and (5) Challenges and resolutions: Identifying problems and crafting solutions. Conclusions: This study sheds light on the evolution of medical students' views on community care and underscores the importance of continuous adaptation in medical education programs.
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Affiliation(s)
- Ryuichi Ohta
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Japan;
| | - Nozomi Nishikura
- Community Care, Unnan City Hospital, 96-1 Iida, Daito-cho, Unnan 699-1221, Japan;
| | - Chiaki Sano
- Department of Community Medicine Management, Faculty of Medicine, Shimane University, 89-1 Enya cho, Izumo 693-8501, Japan;
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Vaalburg AM, Wattel EM, Boersma P, Hertogh CMPM, Gobbens RJJ. The Role of Nursing Staff Regarding Goal Setting and Achieving in Geriatric Rehabilitation: A Focus Group Study. Rehabil Nurs 2023; 48:148-159. [PMID: 37669324 PMCID: PMC10487360 DOI: 10.1097/rnj.0000000000000429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
PURPOSE The aim of this study was to explore and clarify the role of nursing staff in geriatric rehabilitation on supporting patients in goal setting and achieving, through reflecting on rehabilitation interventions. DESIGN A descriptive qualitative study was conducted. METHODS We conducted four online focus group interviews with 23 members of the nursing staff working in geriatric rehabilitation. They reflected on six interventions, preclassified into three types: setting goals in the admission phase, increasing patient participation in order to personalize the rehabilitation trajectory, and supporting patients in working on short-term goals. Data were analyzed using thematic content analysis. RESULTS Setting goals in the admission phase is primarily the task of the multidisciplinary team rather than the nursing staff. Interventions to increase patient participation align with the coordinating role of nursing staff in the rehabilitation team. Working on short-term goals is of great value to patients. CLINICAL RELEVANCE TO THE PRACTICE OF REHABILITATION NURSING The connection between the patient's personal goals and professional treatment aimed at functional recovery can be enhanced by strengthening the position of nursing staff working in geriatric rehabilitation. CONCLUSION Members of nursing staff in geriatric rehabilitation see themselves playing a coordinating role in the multidisciplinary team, supporting the patient in goal work. Interventions aimed at advancing patient participation and providing support for short-term goals reinforce this role.
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Affiliation(s)
- Anne Marie Vaalburg
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
| | - Elizabeth M. Wattel
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- University Network of Organizations for Care for the Elderly of VU University Medical Centre, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Petra Boersma
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Ben Sajet Center for Long-Term Care, Amsterdam, the Netherlands
| | - Cees M. P. M. Hertogh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- University Network of Organizations for Care for the Elderly of VU University Medical Centre, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Robbert J. J. Gobbens
- Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, Amsterdam, the Netherlands
- Zonnehuisgroep Amstelland, Amstelveen, the Netherlands
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, the Netherlands
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Vareta DA, Oliveira C, Família C, Ventura F. Perspectives on the Person-Centered Practice of Healthcare Professionals at an Inpatient Hospital Department: A Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5635. [PMID: 37174155 PMCID: PMC10178857 DOI: 10.3390/ijerph20095635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 05/15/2023]
Abstract
The characteristics of health professionals and their understanding of person-centeredness may have important implications for the development of person-centered practice in specific care settings. In this study, we characterized the perceptions of the person-centered practice of a multidisciplinary team of health professionals working in the internal medicine inpatient unit of a Portuguese hospital. Data were collected using a brief sociodemographic and professional questionnaire and the person-centered practice inventory-staff (PCPI-S), and the effect of different sociodemographic and professional variables on each PCPI-S domain was determined using an analysis of variance (ANOVA). The results showed that a person-centered practice was positively perceived in the major constructs of prerequisites (M = 4.12; SD = 0.36), the practice environment (M = 3.50; SD = 0.48), and person-centered process (M = 4.08; SD = 0.62) domains. The highest scored construct was developed interpersonal skills (M = 4.35; SD = 0.47), and the lowest was supportive organization systems (M = 3.08; SD = 0.80). Gender was found to influence the perceptions of knowing self (F(2,75) = 3.67, p = 0.03, partial η2 = 0.089) and the physical environment (F(2,75) = 3.63, p = 0.03, partial η2 = 0.088), as was profession on shared decision-making systems (F(2,75) = 5.38, p < 0.01, partial η2 = 0.125) and commitment to the job (F(2,75) = 5.27, p < 0.01, partial η2 = 0.123), and the educational level on being professionally competent (F(1,75) = 4.99, p = 0.03, partial η2 = 0.062) and having commitment to the job (F(2,75) = 4.49, p = 0.04, partial η2 = 0.056). In addition, the PCPI-S proved to be a reliable instrument for characterizing healthcare professionals' perceptions of the person-centeredness of care in this context. Identifying personal and professional variables that influence these perceptions could provide a starting point for defining strategies to move practice toward person-centeredness and for monitoring changes in healthcare practice.
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Affiliation(s)
- Diana Alves Vareta
- PhD Program, University of Lisbon (UL) and Nursing School of Lisbon (ESEL), 1600-214 Lisboa, Portugal
- Egas Moniz Interdisciplinary Research Centre (CiiEM), Egas Moniz Universitary Institute, Quinta da Granja, 2829-511 Monte de Caparica, Portugal
| | - Célia Oliveira
- Nursing School of Lisbon (ESEL), 1600-096 Lisboa, Portugal
| | - Carlos Família
- Egas Moniz Interdisciplinary Research Centre (CiiEM), Egas Moniz Universitary Institute, Quinta da Granja, 2829-511 Monte de Caparica, Portugal
- Laboratory of Molecular Pathology and Forensic Biochemistry, Egas Moniz Universitary Institute, Quinta da Granja, 2829-511 Monte de Caparica, Portugal
| | - Filipa Ventura
- The Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3000-076 Coimbra, Portugal
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Alpay L, Koster Y, Dallinga J, Siemonsma P, Verhoef J, Kassens E, Flaton P, Baars K, van Kessel F. Technology-based interprofessional collaboration in primary care for home rehabilitation of the older adults: A dutch exploratory study. Health Informatics J 2023; 29:14604582231169299. [PMID: 37083311 DOI: 10.1177/14604582231169299] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Primary healthcare professionals face an increasing number of geriatrics patients, and patient care often involves different disciplines. eHealth offers opportunities to support interprofessional collaboration (IPC). This exploratory study aimed to gain insight in 1) IPC in community-based rehabilitation, 2) facilitators and barriers for technology-based IPC and 3) technological IPC solutions envisioned by the primary healthcare professionals An focus group with six primary healthcare professionals and a design thinking session with four participants were conducted. Data analysis was based upon an IPC model. Results indicate that facilitators and barriers for IPC can be clustered in three categories: human, organization and technology, and provide some requirements to develop suitable IPC technological solutions Primary healthcare professionals recognise the urgency of working collaboratively. Current barriers are understanding each other's professional vocabulary, engaging the older adults, and using technology within the patient's environment. Further research is needed to integrate IPC components in a technological solution.
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Affiliation(s)
- Laurence Alpay
- Medical Technology Research Group, Inholland University of Applied Sciences, Haarlem, Netherlands
| | - Ybranda Koster
- Medical Technology Research Group, Inholland University of Applied Sciences, Haarlem, Netherlands
| | - Joan Dallinga
- Medical Technology Research Group, Inholland University of Applied Sciences, Haarlem, Netherlands
| | - Petra Siemonsma
- Physical Therapy Research Group, Leiden University of Applied Sciences, Leiden, Netherlands
| | - John Verhoef
- Physical Therapy Research Group, Leiden University of Applied Sciences, Leiden, Netherlands
| | - Erzy Kassens
- Arembergelaan Fysiotherapie, Voorburg, Netherlands
| | | | - Koen Baars
- Sport Sciences Research Group, Inholland University of Applied Sciences, Haarlem, Netherlands
| | - Floor van Kessel
- Sport Sciences Educational Program, Inholland University of Applied Sciences, Haarlem, Netherlands
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18
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Soemantri D, Findyartini A, Werdhani RA, Koesnoe S, Dahlia D. Are we ready to collaborate? The interprofessional collaborative competencies of healthcare professionals in the Global South context. Front Med (Lausanne) 2022; 9:904658. [PMID: 36341234 PMCID: PMC9633846 DOI: 10.3389/fmed.2022.904658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/04/2022] [Indexed: 11/25/2022] Open
Abstract
Background Current evidence of interprofessional collaboration suggests the importance of measuring and identifying the current state of the health professions’ interprofessional competencies. Therefore, this study was aimed at measuring the interprofessional competencies of health professionals in the Global South context using the validated CICS29. Materials and methods This was a cross-sectional study involving 300 healthcare professionals of a newly established teaching hospital. Prior to the measurement of interprofessional competencies, the 29-items CICS29, which has been translated into Indonesian language, was revalidated using a confirmatory factor analysis (CFA). The 29 items of CICS29 were grouped into six subscales and each item was measured using a 5-point Likert scale. Data on gender, age, type of profession, and the length of working experience was also collected to identify whether discernible differences between grouping variables exists. Results Prior to measuring the interprofessional competencies, the validity of the instrument was established. Based on the CFA, the same six-factor model was found in the current study. The Indonesian CICS29 was reliable, with Cronbach alpha values of 0.921 for the whole instrument and that of each subscale ranged between 0.656 and 0.726. The mean total score of CICS29 was 128.53 (out of 145), ranged from 123 to 133.40 obtained by pharmacists and dentists respectively. No significant differences of CICS29 scores were found between grouping variables. Conclusion The current study has revealed relatively good interprofessional competencies of healthcare professionals working in a newly established teaching hospital in the Global South healthcare context. Measuring the interprofessional competencies serves as baseline for further intervention to nurture and maintain collaborative practice. In addition, the current study has further proven the cross-cultural validity of CICS29, thus appropriate to be utilized in different setting and context.
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Affiliation(s)
- Diantha Soemantri
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- Center for Administration, Health Sciences Cluster, Universitas Indonesia, Depok, Indonesia
- *Correspondence: Diantha Soemantri, ,
| | - Ardi Findyartini
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Retno Asti Werdhani
- Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Sukamto Koesnoe
- Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia—Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Debie Dahlia
- Department of Medical Surgical Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- Universitas Indonesia Hospital, Depok, Indonesia
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Williams VN, McManus BM, Brooks-Russell A, Yost E, Allison MA, Olds DL, Tung GJ. A qualitative study of effective collaboration among nurse home visitors, healthcare providers and community support services in the United States. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1881-1893. [PMID: 34543476 DOI: 10.1111/hsc.13567] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/14/2021] [Accepted: 08/27/2021] [Indexed: 06/13/2023]
Abstract
Collaboration across sectors is needed to improve community health, but little is known about collaborative activities among public health prevention programs. Using the Nurse-Family Partnership® (NFP) home visiting program as context, this qualitative study aimed to describe effective collaboration among nurse home visitors, healthcare providers and community support services to serve families experiencing social and economic adversities. We used grounded theory to characterise collaboration with six purposively sampled NFP sites in the United States through in-depth interviews. We interviewed 73 participants between 2017 and 2019: 50 NFP staff, 18 healthcare providers and 5 other service providers. Interviews were recorded, transcribed, validated and analysed in NVivo 11. Validation steps included inter-coder consistency checks and expert review. Thematic memos were synthesised across sites. Most participants perceived collaboration to be important when serving families with complex needs, but substantial variation existed in the degree to which NFP nurses collaborate with providers dependent on provider type and community context. Factors that contributed to effective collaboration were relational in nature, including leadership commitment and provider champions, shared perceptions of trust, respect and value, and referral partnerships and outreach; organisational in terms of mission congruence between providers; and structural such as policy and system integration that facilitated data sharing and communication channels. These findings provide greater insights into effective cross-sector collaboration and care coordination for families experiencing adversities. Collaboration across sectors to promote health among families experiencing adversities requires intentional efforts by all inter-professional providers and continued commitment among all levels of leadership to coordinate services.
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Affiliation(s)
- Venice Ng Williams
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, Colorado, USA
| | - Beth M McManus
- Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, Colorado, USA
| | - Ashley Brooks-Russell
- Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, Colorado, USA
| | - Elly Yost
- Nurse-Family Partnership National Service Office, Denver, Colorado, USA
| | - Mandy A Allison
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Children's Hospital Colorado, Aurora, Colorado, USA
| | - David L Olds
- Prevention Research Center for Family & Child Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Gregory J Tung
- Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, Colorado, USA
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Jankowska AK, Matjanowska J, Borowczyk M, Libura M. Shared decision-making in Poland: State of the art, challenges and opportunities. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 171:117-121. [PMID: 35525719 DOI: 10.1016/j.zefq.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 06/14/2023]
Abstract
The purpose of the present paper is to review the progress in recognition and implementation of shared decision-making (SDM) practice in the Polish health care system. In Poland, equal access to health care is a constitutional right. The foundations for SDM practice within the Polish health care system are laid in legislation regulating the professions of doctors and dentists, as well as patients' rights, which assert the duty of physicians to provide clear and patient-adjusted information on diagnostic and treatment options, health status and prognosis before obtaining consent. Over recent years, patient organizations have gained voice in the institutional setting. At the same time participatory decision-making at the individual patient level remains uneven, with a considerable variety between health care settings or even physicians. The challenges related to the implementation of SDM practices include low health care funding and staff shortages, which limit both the scope of available choices and consultation time. Fragmentation of care and inadequate standardization constitute additional barriers to the elaboration and sharing of good SDM practices.
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Affiliation(s)
- Aldona K Jankowska
- Laboratory for Social Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
| | - Joanna Matjanowska
- Laboratory for Social Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Martyna Borowczyk
- Department of Medical Simulation, Poznan Univeristy of Medical Sciences, Poznań, Poland
| | - Maria Libura
- Medical Education and Simulation Centre, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
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Poder interprofissional em cuidados intensivos: reflexão filosófica a partir de perspectivas foucaultianas e críticas. ACTA PAUL ENFERM 2022. [DOI: 10.37689/acta-ape/2022ar0245345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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22
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Bossert J, Mahler C, Boltenhagen U, Kaltenbach A, Froehlich D, Szecsenyi J, Wensing M, Joos S, Klafke N. Protocol for the process evaluation of a counselling intervention designed to educate cancer patients on complementary and integrative health care and promote interprofessional collaboration in this area (the CCC-Integrativ study). PLoS One 2022; 17:e0268091. [PMID: 35560173 PMCID: PMC9106164 DOI: 10.1371/journal.pone.0268091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/21/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Conducting a process evaluation is essential to understand how health interventions work in different healthcare settings. Particularly in the case of complex interventions, it is important to find out whether the intervention could be carried out as planned and which factors had a beneficial or hindering effect on its implementation. The aim of this study is to present the detailed protocol of the process evaluation embedded in the controlled implementation study CCC-Integrativ aiming to implement an interprofessional counselling program for cancer patients on complementary and integrative health care (CIH).
Methods
This mixed methods study will draw upon the “Consolidated Framework for Implementation Research” (CFIR) combined with the concept of “intervention fidelity” to evaluate the quality of the interprofessional counselling sessions, to explore the perspective of the directly and indirectly involved healthcare staff, as well as to analyze the perceptions and experiences of the patients. The qualitative evaluation phase consists of analyzing audio-recorded counselling sessions, as well as individual and group interviews with the involved persons. The quantitative evaluation phase applies questionnaires which are distributed before (T0), at the beginning (T1), in the middle (T2) and at the end (T3) of the intervention delivery.
Discussion
This protocol provides an example of how a process evaluation can be conducted parallel to a main study investigating and implementing a complex intervention. The results of this mixed methods research will make it possible to identify strengths and weaknesses of the team-based intervention, and to target more specifically the key factors and structures required to implement healthcare structures to meet patients’ unmet needs in the context of CIH. To our knowledge, this study is the first applying the CFIR framework in the context of interprofessional CIH counselling, and its results are expected to provide comprehensive and multidisciplinary management of cancer patients with complex supportive healthcare needs.
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Affiliation(s)
- Jasmin Bossert
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
- * E-mail:
| | - Cornelia Mahler
- Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Ursula Boltenhagen
- Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Anna Kaltenbach
- Department of Nursing Science, University Hospital Tuebingen, Tuebingen, Germany
| | - Daniela Froehlich
- Institute for General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, University Hospital Tuebingen, Tuebingen, Germany
| | - Nadja Klafke
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Melo LC, Lima FR, Bracarense CF, Ferreira JFMF, Ruiz MT, Parreira BDM, Goulart BF. Inter-professional relationships in the Family Health Strategy: perception of health management. Rev Bras Enferm 2022; 75:e20210636. [DOI: 10.1590/0034-7167-2021-0636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 10/28/2021] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objectives: to analyze the teamwork in the Family Health Strategy from the perspective of professionals from the Primary Care Department and the municipal manager/secretary of health of a Municipal Health Secretariat. Methods: an exploratory/qualitative study. All professionals of the Department and municipal manager/municipal health secretary/interior of Minas Gerais participated. Data collection was through semi-structured interviews/May to November/2019. Data analysis: Content analysis/thematic mode and work process theoretical referential. Results: three categories emerged: Inter-professional relations permeated by non-material instruments of work; Professional training, experience, and profile influence teamwork; and Proposals for the realization of teamwork in the Family Health Strategy. Results revealed assumptions for teamwork in the referred Strategy, facilitators/difficulties/strategies for its realization, according to the professionals. Final Considerations: collaboration/communication/proactivity to facilitate teamwork. Need for approximation between municipal management and Family Health Strategy to achieve teamwork.
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Goto R, Haruta J, Ozone S. Verification of a Sense of Community Scale for Hospitals in Japan. J Prim Care Community Health 2022; 13:21501319221107317. [PMID: 35726750 PMCID: PMC9218502 DOI: 10.1177/21501319221107317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/26/2022] [Accepted: 05/27/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION/OBJECTIVES We aimed to verify whether a sense of community scale developed for hospital wards can be applied to hospitals. METHODS A cross-sectional study was conducted using a self-administered questionnaire between July and October 2018 in 3 hospitals in Japan. The subjects were staff members working in these hospitals who provide direct medical or administrative services to patients and their families. The questionnaire inquired about the participants' basic attributes and workplace satisfaction, and included the sense of community scale and the Japanese version of the Assessment of Interprofessional Team Collaboration Scale-II. We evaluated the scale's structural validity, internal consistency, and hypothesis testing for construct validity. RESULTS Of 826 eligible staff members, 539 were included in the analysis. Mean age was 40.4 years and 77.4% were female. Exploratory factor analysis showed that 24 of the 28 items in the sense of community scale could be categorized under 3 factors. Confirmatory factor analysis demonstrated a goodness of fit index of 0.794, adjusted goodness of fit index of 0.752, comparative fit index of 0.885 and root mean square error of approximation of 0.092. Cronbach's α for score in the sense of community scale was high (.96). Participants who reported high workplace satisfaction had significantly higher scores in the sense of community scale than those who indicated low workplace satisfaction (P < .001). CONCLUSIONS We verified the reliability and validity of the Japanese version of the sense of community scale, which was originally developed for hospital wards, for the community in hospitals. With further verification, we hope the scale will be useful for evaluating the sense of community in hospitals.
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Affiliation(s)
- Ryohei Goto
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Junji Haruta
- Medical Education Center, School of Medicine, Keio University, Shinanomachi, Shinjuku ku, Tokyo, Japan
| | - Sachiko Ozone
- Department of Primary Care and Medical Education, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
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Williams VN, Brooks-Russell A, McManus BM, Yost E, Olds DL, Tung GJ. National survey of nurse home visitor collaboration with health care and social services. Public Health Nurs 2021; 38:825-836. [PMID: 33749013 DOI: 10.1111/phn.12897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/24/2021] [Accepted: 03/07/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the degree to which nurses in a national public health home visiting program collaborate with interprofessional providers to serve families experiencing adversity. DESIGN A descriptive, cross-sectional survey measured collaborative practices between nurse home visitors, health care, and social service providers. A census of 263 nursing supervisors completed a web-based survey. MEASUREMENTS The survey included the validated 7-item Relational Coordination Scale, adapted items from the Interagency Collaboration Activities Scale on shared resources, and items related to collaboration attitudes and beliefs. Data were analyzed with descriptive statistics. RESULTS Relational coordination scores, which are relative measures, ranged from 1 to 5; highest with supplemental nutrition for Women, Infants & Children (M = 3.77) and early intervention (M = 3.44); and lowest with housing (M = 2.55). The greatest sharing of resources was with supplemental nutrition (sum = 12.95) and mental health providers (sum = 11.81), and least with housing (sum = 7.26); with a range of 1-30 where higher scores indicated greater resource-sharing. CONCLUSION Home visiting nurses collaborate with interprofessional providers with variation in the degree of collaboration between agencies and by provider type within an agency. Collaboration was a function of two interrelated domains: interpersonal relationships supported by organizational and contextual factors at the systems-level.
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Affiliation(s)
- Venice Ng Williams
- Prevention Research Center for Family & Child Health, University of Colorado School of Medicine, Aurora, CO, USA.,Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, CO, USA
| | - Ashley Brooks-Russell
- Department of Community & Behavioral Health, Colorado School of Public Health, Aurora, CO, USA
| | - Beth M McManus
- Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, CO, USA
| | - Elly Yost
- Nurse-Family Partnership National Service Office, Denver, CO, USA
| | - David L Olds
- Prevention Research Center for Family & Child Health, University of Colorado School of Medicine, Aurora, CO, USA
| | - Gregory J Tung
- Department of Health Systems, Management & Policy, Colorado School of Public Health, Aurora, CO, USA
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Monavvari AA, Brady L, Harper L, Mehrfar P. Shifting traditional healthcare paradoxes-The case for true system transformation. Healthc Manage Forum 2020; 33:259-264. [PMID: 32666836 DOI: 10.1177/0840470420935474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although national spending on healthcare has progressed on an upward trend over several decades, issues regarding performance remain. Challenges such as access to specialist care and maternal and infant mortality rates contributed to Canada's recent ranking of ninth among 11 Organisation for Economic Co-operation and Development countries for overall health system performance. Although disruptive transformation is required to resolve our chronic performance issues, effective change cannot be realized without addressing the foundational elements of patient-centred care, interprofessional care, and system integration. Inspired by examples of innovative disruption in other jurisdictions and industries, these three concepts are outlined as the core ingredients for healthcare transformation and describe how they currently function in a paradoxical manner-as self-contradictory statements which in reality are not executed to their true meaning. This article illustrates how improvements in health system performance are hinged to the need to rectify and fuse these three mutually inclusive and inseparable concepts.
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Affiliation(s)
- Alan A Monavvari
- University of Toronto, Toronto, Ontario, Canada.,Family Medicine, 8613North York General Hospital, Toronto, Ontario, Canada.,Primary Care Working Group, North York Toronto Health Partners OHT, Toronto, Ontario, Canada
| | - Lori Brady
- Strategic Projects and Accountability, 60444Markham Stouffville Hospital, Markham, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Lisa Harper
- Medical Administration, Planning and Transformation, 60444Markham Stouffville Hospital, Markham, Ontario, Canada
| | - Parisa Mehrfar
- Planning and Integration, 60444Markham Stouffville Hospital, Markham, Ontario, Canada.,Eastern York Region North Durham Ontario Health Team, Markham, Ontario, Canada
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