Environmental factors associated with physician's engagement in communication activities

Market Factors Associated with Comprehensive Behavioral Health Crisis Care Availability: A Resource Dependence Theory Study

Behavioral health crisis care (BHCC) is a care delivery model for individuals experiencing acute distress related to a mental health or substance use disorder. We examined market factors associated with comprehensive BHCC availability using 2022 data on mental health treatment facilities (n = 9385) obtained from the Substance Abuse and Mental Health Services Administration. We aggregated facility-level data by county (n = 3142) and merged with county-level market factors. Logistic regression models were used to examine the adjusted associations between market factors and BHCC availability. We found that 468 (14.9%) counties had at least one mental health treatment facility offering comprehensive BHCC services. Specifically, counties with more mental health providers (Adjusted Odds Ratio = 2.26, Confidence Interval = 1.32-3.86) and metropolitan counties (AOR = 3.26, CI = 1.95-5.43) had higher odds of having a comprehensive BHCC facility. Our findings highlight the importance of developing the mental health workforce to increase BHCC availability and a need to address disparities in rural counties.

Predicting student-teacher self-directed learning using intrinsic and extrinsic factors: a Theory of Planned Behavior adoption

Introduction

This study set out to develop a model that illustrates the causal relationship between factors influencing Thai student-teacher self-directed learning (SDL). To achieve this, the authors analyzed and applied the Theory of Planned Behavior (TPB) to investigate the role of family support, teacher support, friend support, fellow students, and the university in influencing SDL.

Methods

The research used a sample of 468 student-teachers from five academic majors randomly selected from the King Mongkut's Institute of Technology Ladkrabang (KMITL) Bachelor of Industrial Education Program during the 2021 academic year. The authors developed a questionnaire which was evaluated from both a panel of experts and a 30 student-teacher pilot test which found that item reliability was acceptable. LISREL 9.10 was used to analyze the data from the study's structural equation model path analysis.

Results

The results revealed that all the causal variables in the model positively influenced SDL, explaining the variance of influencing factors on SDL (R2) at 51%. SDL comprised five variables, when ranked in order of importance these were fellow students (FSt), teacher support (TS), family support (FS), friend support (FrS), and their university (Uni). The study also highlighted issues concerning each student-teacher's learning time management ability and their perception of the university's ability/willingness to allow each individual to choose their course, thus enhancing their SDL learning ability skills.

Discussion

It was speculated that some university educators even today perceive SDL as an adult education tool which they perceive is not appropriate at the university level. The authors also felt that for younger student-teachers that the COVID-19 medical emergency limited teacher/student/university interaction, thus contributing to student misconceptions about support availability. This study contributes significantly to the literature by investigating how TPB intrinsic and extrinsic factors impact a university student's self-directed learning.

Collaboration Between Physicians from Different Medical Specialties in Hospital Settings: A Systematic Review

Health care today is characterized by an increasing number of patients with comorbidities for whom interphysician collaboration seems very important. We reviewed the literature to understand what factors affect interphysician collaboration, determine how interphysician collaboration is measured, and determine its effects. We systematically searched six major databases. Based on 63 articles, we identified five categories that influence interphysician collaboration: personal factors, professional factors, preconditions and tools, organizational elements, and contextual characteristics. We identified a diverse set of mostly unvalidated tools for measuring interphysician collaboration that focus on information being transferred and understood, frequency of interaction and tone of the relationship, and value judgements about quality or satisfaction. We found that interphysician collaboration increased clinical outcomes as well as patient and staff satisfaction, while error rates and length of stay were reduced. The results should, however, be interpreted with caution, as most of the studies provide a low level of evidence.

The Relationship Between Family Support and e-Learning Engagement in College Students: The Mediating Role of e-Learning Normative Consciousness and Behaviors and Self-Efficacy

Due to the current COVID-19 pandemic, colleges and universities have implemented network teaching. E-learning engagement is the most important concern of educators and parents because this will directly affect student academic performance. Hence, this study focuses on students’ perceived family support and their e-learning engagement and analyzes the effects of e-learning normative consciousness and behaviors and self-efficacy on the relationship between family support and e-learning engagement in college students. Prior to this study, the relationship between these variables was unknown. Four structural equation models revealed the multiple mediating roles of e-learning normative consciousness and behaviors and self-efficacy in the relationship between family support and e-learning engagement. A total of 1,317 college students (mean age=19.51; 52.2% freshman) voluntarily participated in our study. The results showed that e-learning normative consciousness and behaviors and self-efficacy played significant and mediating roles between students’ perceived family support and e-learning engagement. Specifically, these two individual variables fully mediated the relationship between students’ perceived family support and e-learning engagement. The multiple mediation model showed that family members can increase family support of their children by creating a household environment conducive to learning, displaying positive emotions, demonstrating the capability to assist their children, advocating the significance of learning normative consciousness and behaviors, and encouraging dedicated and efficient learning. The findings complement and extend the understanding of factors influencing student e-learning engagement.

The influence of gratitude on learning engagement among adolescents: The multiple mediating effects of teachers' emotional support and students' basic psychological needs

INTRODUCTION

Gratitude, a positive response to receiving a benefit, may aid adolescents' development by fostering a general sense of connectedness to others as well as a motivation to use one's strengths to broadly contribute to others. Previous studies have emphasized that gratitude is a powerful factor for learning engagement; however, the underlying mechanism that mediates this relationship remains unclear. To fill this gap, the current study aimed to explore the multiple mediating effects of students' perceived emotional support from their teachers (hereafter "teachers' emotional support") and students' basic psychological needs (hereafter "basic psychological needs") on the association between gratitude and learning engagement among Chinese adolescents.

METHODS

A total of 688 Chinese junior middle school students (336 boys and 352 girls; mean age = 13.1, SD = 1.2) completed the Gratitude Questionnaire, Teachers' Emotional Support Questionnaire, Basic Need Satisfaction Scale, and Learning Engagement Scale.

RESULTS

Path analysis showed that gratitude positively predicted learning engagement; the mediating roles of teachers' emotional support and basic psychological needs in the association between gratitude and learning engagement were significant. There were three mediating paths: gratitude affected learning engagement through the mediating role of teachers' emotional support; basic psychological needs; and the serial mediating role of teachers' emotional support and basic psychological needs.

CONCLUSIONS

These findings suggest that schools should pay more attention to improving teachers' emotional support to adolescents and meeting students' basic psychological needs, which would enhance the positive impact of gratitude on learning engagement.

Physician engagement: a concept analysis

The term "physician engagement" is used quite frequently, yet it remains poorly defined and measured. The aim of this study is to clarify the term "physician engagement." This study used an eight step-method for conducting concept analyses created by Walker and Avant. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched on February 14, 2019. No limitations were put on the searches with regard to year or language. Results identify that the term "physician engagement" is regular participation of physicians in (1) deciding how their work is done, (2) making suggestions for improvement, (3) goal setting, (4) planning, and (5) monitoring of their performance in activities targeted at the micro (patient), meso (organization), and/or macro (health system) levels. The antecedents of "physician engagement" include accountability, communication, incentives, interpersonal relations, and opportunity. The results include improved outcomes such as data quality, efficiency, innovation, job satisfaction, patient satisfaction, and performance. Defining physician engagement enables physicians and health care administrators to better appreciate and more accurately measure engagement and understand how to better engage physicians.

The relationship between the external environment and physician e-mail communication: The mediating role of health information technology availability

BACKGROUND

Physician e-mail communication, with patients and other providers, is one of the cornerstones of effective care coordination but varies significantly across physicians. A physician's external environment may contribute to such variations by enabling or constraining a physician's ability to adopt innovations such as health information technology (HIT) that can be used to support e-mail communication.

PURPOSE

The aim of the study was to examine whether the relationship of the external environment and physician e-mail communication with patients and other providers is mediated by the practice's HIT availability.

METHODOLOGY

The data were obtained from the Health Tracking Physician Survey (2008) and the Area Resource File (2008). Cross-sectional multivariable subgroup path analysis was used to investigate the mediating role of HIT availability across 2,850 U.S. physicians.

FINDINGS

Solo physicians' perceptions about malpractice were associated with 0.97 lower odds (p < .05) of e-mail communication with patients and other providers, as compared to group and hospital practices, even when mediated by HIT availability. Subgroup analyses indicated that different types of practices are responsive to the different dimensions of the external environment. Specifically, solo practitioners were more responsive to the availability of resources in their environment, with per capita income associated with lower likelihood of physician e-mail communication (OR = 0.99, p < .01). In contrast, physicians working in the group practices were more responsive to the complexity of their environment, with a physician's perception of practicing in environments with higher malpractice risks associated with greater information technology availability, which in turn was associated with a greater likelihood of communicating via e-mail with patients (OR = 1.02, p < .05) and other physicians (OR = 1.03, p < .001).

PRACTICAL APPLICATIONS

The association between physician e-mail communication and the external environment is mediated by the practice's HIT availability. Efforts to improve physician e-mail communication and HIT adoption may need to reflect the varied perceptions of different types of practices.

Why hospitals adopt patient engagement functionalities at different speeds? A moderated trend analysis

OBJECTIVE

To investigate acute care hospitals' adoption speed of patient engagement health information technology (HIT) functionalities from 2008 to 2013 and how this speed is contingent on environmental factors and hospital characteristics.

METHODS

Data on non-government acute care hospitals located in the United States was obtained from merging three databases: the American Hospital Association's (AHA) annual survey information technology supplement, AHA annual survey, and the Area Health Resource File (AHRF). The variables obtained from these datasets were the amount of annually adopted patient engagement HIT functionalities and environmental and organizational characteristics. Environmental factors included were uncertainty, munificence, and complexity. Hospital characteristics included size, system membership, ownership, and teaching status.

RESULTS

A regression analysis of 4176 hospital-year observations revealed a positive trend in the adoption of HIT functionalities for patient engagement (β= 1.109, p < 0.05). Moreover, the study showed that large, system-affiliated, not-for-profit, teaching hospitals adopt patient engagement HIT functionalities at a faster speed than their counterparts. Environmental munificence and uncertainty were also associated with an accelerating speed of adoption. Environmental complexity however did not show a significant impact on the speed of adoption.

DISCUSSION

From 2008 to 2013, there was a significant acceleration in the speed of adopting patient engagement HIT functionalities. Further efforts should be made to ensure proper adoption and consistent use by patients in order to reap the benefits of these IT investments.

CONCLUSION

Hospitals adopted at least one HIT functionality for patient engagement per year. The adoption speed varied across hospitals, depending on both environmental and organizational factors.

The Impact of Environmental Design on Teamwork and Communication in Healthcare Facilities: A Systematic Literature Review

The purpose of this systematic review is to investigate the current knowledge about the impact of healthcare facility design on teamwork and communication by exploring the relevant literature. Teamwork and communication are behavioral factors that are impacted by physical design. However, the effects of environmental factors on teamwork and communication have not been investigated extensively in healthcare design literature. There are no published systematic reviews on the current topic. Searches were conducted in PubMed and Google Scholar databases in addition to targeted design journals including Health Environmental Research & Design, Environment and Behavior, Environmental Psychology, and Applied Ergonomics. Inclusion criteria were (a) full-text English language articles related to teamwork and communication and (b) involving any healthcare built environment and space design published in peer-reviewed journals between 1984 and 2017. Studies were extracted using defined inclusion and exclusion criteria. In the first phase, 26 of the 195 articles most relevant to teamwork and 19 studies of the 147 were identified and reviewed to understand the impact of communication in healthcare facilities. The literature regarding the impact of built environment on teamwork and communication were reviewed and explored in detail. Eighteen studies were selected and succinctly summarized as the final product of this review. Environmental design, which involves nurses, support staff, and physicians, is one of the critical factors that promotes the efficiency of teamwork and collaborative communication. Layout design, visibility, and accessibility levels are the most cited aspects of design which can affect the level of communication and teamwork in healthcare facilities.

Exploring the components of physician volunteer engagement: a qualitative investigation of a national Canadian simulation-based training programme

OBJECTIVES

Conceptual clarity on physician volunteer engagement is lacking in the medical literature. The aim of this study was to present a conceptual framework to describe the elements which influence physician volunteer engagement and to explore volunteer engagement within a national educational programme.

SETTING

The context for this study was the Acute Critical Events Simulation (ACES) programme in Canada, which has successfully evolved into a national educational programme, driven by physician volunteers. From 2010 to 2014, the programme recruited 73 volunteer healthcare professionals who contributed to the creation of educational materials and/or served as instructors.

METHOD

A conceptual framework was constructed based on an extensive literature review and expert consultation. Secondary qualitative analysis was undertaken on 15 semistructured interviews conducted from 2012 to 2013 with programme directors and healthcare professionals across Canada. An additional 15 interviews were conducted in 2015 with physician volunteers to achieve thematic saturation. Data were analysed iteratively and inductive coding techniques applied.

RESULTS

From the physician volunteer data, 11 themes emerged. The most prominent themes included volunteer recruitment, retention, exchange, recognition, educator network and quasi-volunteerism. Captured within these interrelated themes were the framework elements, including the synergistic effects of emotional, cognitive and reciprocal engagement. Behavioural engagement was driven by these factors along with a cue to action, which led to contributions to the ACES programme.

CONCLUSION

This investigation provides a preliminary framework and supportive evidence towards understanding the complex construct of physician volunteer engagement. The need for this research is particularly important in present day, where growing fiscal constraints create challenges for medical education to do more with less.

Brazilian Specialists' Perspectives on the Patient Referral Process

Since 1988, healthcare has been considered a citizen’s right in Brazil. The Sistema Único de Saúde (SUS), has undergone development and expansion to ensure universal health coverage for the Brazilian public, the world’s fifth largest population. The coordination of effective communications between primary care physicians, specialists and patients is a significant challenge, particularly the referral process. Our study objective was to understand the facilitators and barriers associated with referral process communications between primary care physicians and regional university hospital specialists in the State of Sao Paulo. This paper reports specialists’ perspectives of the referral process. This was a phenomenological study that employed a qualitative research method with three components (description, reduction and comprehension). We conducted focus groups with 54 hospital residents from different specialties (surgery, medicine, obstetrics/gynecology, pediatrics) from July to October 2014. The main results showed lack of an adequate referral-return referral process resulting in treatment delays and inappropriate use of emergency services. Communications were impeded by lack of integrated, computerized booking and standardized referral-return referral processes; underlying lack of trust in primary care physicians; and patients’ inappropriate use of healthcare services. Although computerized systems will facilitate communications between primary and specialty care, other strategies are needed to promote collaboration between services, and ensure appropriate utilization of them.