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Zhao Y, Quadros W, Nagraj S, Wong G, English M, Leckcivilize A. Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review. BMC Med 2024; 22:286. [PMID: 38978070 PMCID: PMC11232288 DOI: 10.1186/s12916-024-03509-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Advanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams. METHODS We conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level). RESULTS We identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations' decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs' backgrounds and characteristics, clinical team members' perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained. CONCLUSIONS We summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.
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Affiliation(s)
- Yingxi Zhao
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK.
| | | | - Shobhana Nagraj
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
- Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Mike English
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
- KEMRI-Wellcome Trust Research Programme, Nairobi, Kenya
| | - Attakrit Leckcivilize
- Nuffield Department of Medicine Centre for Global Health Research, University of Oxford, S Parks Rd, Oxford, OX1 3SY, UK
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Enckell A, Laine MK, Roitto HM, Raina M, Kauppila T. Changes in location and number of nurse consultations as the supply of general practitioners decreases in primary health care: six-year register-based follow-up cohort study in the city of Vantaa, Finland. Scand J Prim Health Care 2024:1-7. [PMID: 38976004 DOI: 10.1080/02813432.2024.2375548] [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: 03/29/2024] [Accepted: 06/27/2024] [Indexed: 07/09/2024] Open
Abstract
OBJECTIVE To investigate whether the location and the number of nurse consultations have changed in response to the continuously decreasing number of GP consultations in the fourth-largest city in Finland. It has been suggested that nurse consultations are replacing GP consultations. DESIGN A retrospective register-based follow-up cohort study. SETTING Public primary health care in the City of Vantaa, Finland. SUBJECTS All documented face-to-face office-hour consultations with practical and registered nurses, and consultations with practical and registered nurse in the emergency department of Vantaa primary health care between 1 January 2009 and 31 December, 2014. MAIN OUTCOME MEASURES Change in the number of consultations with practical and registered nurses between 2009 and 2014 in primary health care both during office-hours and in the emergency department. RESULTS Over the follow-up period, the monthly median number of practical nurse consultations in the emergency department per 1000 inhabitants increased from 1.6 (interquartile range [IQR] 1.3-1.7) to 10.5 (10.3-12.2) (p < 0.001) and registered nurse consultations from a median of 3.6 (3.0-4.0) to 14.5 (13.0-16.6) (p < 0.001). However, there was no significant change in the median monthly number of office-hour consultations with practical or registered nurses. CONCLUSIONS It appears that in primary health care, medical consultations have shifted from GPs to nurses with lower education levels, and from care during office-hours to emergency care.
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Affiliation(s)
- Aina Enckell
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Western Uusimaa Wellbeing Services County, Finland
| | - Merja K Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | - Hanna-Maria Roitto
- Clinics of Internal Medicine and rehabilitation, Department of Geriatrics, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marko Raina
- Wellbeing Services County of Vantaa and Kerava, Vantaa, Finland
- Apotti Ltd
| | - Timo Kauppila
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Kilpatrick K, Savard I, Audet LA, Costanzo G, Khan M, Atallah R, Jabbour M, Zhou W, Wheeler K, Ladd E, Gray DC, Henderson C, Spies LA, McGrath H, Rogers M. A global perspective of advanced practice nursing research: A review of systematic reviews. PLoS One 2024; 19:e0305008. [PMID: 38954675 PMCID: PMC11218965 DOI: 10.1371/journal.pone.0305008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/21/2024] [Indexed: 07/04/2024] Open
Abstract
INTRODUCTION The World Health Organization (WHO) called for the expansion of all nursing roles, including advanced practice nurses (APNs), nurse practitioners (NPs) and clinical nurse specialists (CNSs). A clearer understanding of the impact of these roles will inform global priorities for advanced practice nursing education, research, and policy. OBJECTIVE To identify gaps in advanced practice nursing research globally. MATERIALS AND METHODS A review of systematic reviews was conducted. We searched CINAHL, Embase, Global Health, Healthstar, PubMed, Medline, Cochrane Library, DARE, Joanna Briggs Institute EBP, and Web of Science from January 2011 onwards, with no restrictions on jurisdiction or language. Grey literature and hand searches of reference lists were undertaken. Review quality was assessed using the Critical Appraisal Skills Program (CASP). Study selection, data extraction and CASP assessments were done independently by two reviewers. We extracted study characteristics, country and outcome data. Data were summarized using narrative synthesis. RESULTS We screened 5840 articles and retained 117 systematic reviews, representing 38 countries. Most CASP criteria were met. However, study selection by two reviewers was done inconsistently and language and geographical restrictions were applied. We found highly consistent evidence that APN, NP and CNS care was equal or superior to the comparator (e.g., physicians) for 29 indicator categories across a wide range of clinical settings, patient populations and acuity levels. Mixed findings were noted for quality of life, consultations, costs, emergency room visits, and health care service delivery where some studies favoured the control groups. No indicator consistently favoured the control group. There is emerging research related to Artificial Intelligence (AI). CONCLUSION There is a large body of advanced practice nursing research globally, but several WHO regions are underrepresented. Identified research gaps include AI, interprofessional team functioning, workload, and patients and families as partners in healthcare. PROSPERO REGISTRATION NUMBER CRD42021278532.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Montréal, Québec, Canada
| | - Isabelle Savard
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Li-Anne Audet
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Gina Costanzo
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Mariam Khan
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Renée Atallah
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Mira Jabbour
- Centre Intégré Universitaire de Santé et de Services sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Montréal, Québec, Canada
| | - Wentao Zhou
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore; National University Health System, Singapore, Singapore
- Singapore National Neuroscience Institute, Singapore, Singapore
| | - Kathy Wheeler
- College of Nursing, University of Kentucky, Lexington, Kentucky, United States of America
| | - Elissa Ladd
- MGH Institute of Health Professions, School of Nursing, Boston, Massachusetts, United States of America
| | - Deborah C. Gray
- School of Nursing, Old Dominion University, Virginia Beach, Virginia, United States of America
| | - Colette Henderson
- School of Health Sciences, University of Dundee, Dundee, Scotland, United States of America
| | - Lori A. Spies
- Louise Herrington School of Nursing, Baylor University, Dallas, Texas, United States of America
| | - Heather McGrath
- St James Public Health Services, Montego Bay, St James, Jamaica
| | - Melanie Rogers
- Department of Nursing and Midwifery, University of Huddersfield, Queensgate, Huddersfield, United Kingdom
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Lee HY, Cooper JE, Kruk ME. Regional determinants of quality of care for sick children: A multilevel analysis in four countries. J Glob Health 2024; 14:04053. [PMID: 38483441 PMCID: PMC10939116 DOI: 10.7189/jogh.14.04053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024] Open
Abstract
Background The limited impact of increased access to care on improvements in health outcomes during the Millennium Development Goal era has been attributed, in part, to inadequate quality of care. We identified regional factors associated with health service quality for sick child care in low-income countries and examined whether provider factors interact with regional factors to affect the quality of care. Methods We conducted cross-sectional random intercept four-level linear regression using the most recent Service Provision Assessment and Demographic Health Survey data from four countries (467 from the Democratic Republic of Congo 2018, 2425 from Afghanistan 2018, 2072 from Nepal 2015, and 813 from Senegal 2017). The outcome variable was the service quality score for sick child care, which was measured as the percentage of clinically recommended tasks completed in the integrated management of childhood illness (ranging from 0 to 100). Regional factors were selected based on the High-Quality Health System Framework. Results The service quality score was found to be positively associated with the proportion of large facilities (β = 8.61; P = 0.004) and the proportion of providers ranked in the top fifth for service quality score (β = 30.15; P < 0.001) in the region. We identified significant cross-level interactions between provider qualifications (β = -16.6; P < 0.001) or job descriptions (β = 12.01; P = 0.002) and the proportion of providers in the top fifth for service quality scores within the region. As the proportion of top-performing providers in a region increased, the increase in the service quality score was more pronounced among providers who were nonmedical doctors or did not have job descriptions than among their counterparts. Conclusions Our findings indicate that the quality of care for sick children in a region improves with a greater proportion of high-performing providers or larger facilities. Providers who are not medical doctors, or those who have specific job descriptions, tend to benefit more from the presence of these top-performing providers.
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Affiliation(s)
- Hwa-Young Lee
- Graduate School of Public Health and Healthcare Management, The Catholic University of Korea, Seoul, Republic of Korea
- Catholic Institute for Public Health and Healthcare Management, The Catholic University of Korea, Seoul, Republic of Korea
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Jan E Cooper
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Glarcher M, Vaismoradi M. A systematic integrative review of specialized nurses' role to establish a culture of patient safety: A modelling perspective. J Adv Nurs 2024. [PMID: 38366739 DOI: 10.1111/jan.16105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
AIMS To understand specialized nurses' role in the culture of patient safety and their ability to promote and enforce it within healthcare. DESIGN A systematic integrative review using the approach of Whittemore and Knafl. METHODS Systematic literature search for qualitative, quantitative and mixed-methods studies, followed by data evaluation, quality assessment, analysis and research synthesis with a narrative perspective. Findings were contextualized within a 'framework for understanding the development of patient safety culture'. DATA SOURCES Searches were conducted in PubMed [including MEDLINE], Scopus, CINAHL, Web of Science and EMBASE from Jan 2013 until Sep 2023. RESULTS Sixteen studies published in English from six different countries were selected and used for research synthesis. Diverse enabling factors and enacting behaviours influencing specialized nurses' roles to promote patient safety culture were identified, mainly focusing on nurses' workload, professional experiences and organizational commitment. Patient safety outcomes focused on medication management, infection prevention, surveillance process in critical care, oversight on quality and safety of nurses' practice, patient care management, continuity of care, adherence to the treatment plan and implementation of a specialized therapeutic procedure. CONCLUSION Specialized nurses can make a significant contribution to promote patient safety culture and support organizational initiatives to prevent adverse events. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Stronger participation and leadership of specialized nurses in initiatives to improve patient safety culture requires appropriate investments and support by policy makers and managers in terms of resources and training. IMPACT There is a gap in existing literature on the contribution that specialized nurses can make in promoting patient safety culture. Review results highlight the importance of interprofessional collaboration and teamwork by involving specialized nurses. They inform healthcare policy makers about recognizing their roles and competencies in patient safety culture. Preferred reporting items for systematic reviews and meta-analysis. No patient or public contribution.
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Affiliation(s)
- Manela Glarcher
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, New South Wales, Australia
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Santos AMD, Magno L, Anjos EFD, Porto JP, Barroso RRF, Araújo MDPN, Guimarães BEDB, Prado NMBL. Quality of Nursing Care Perceived by People With HIV in Brazil: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2024; 35:40-50. [PMID: 38015749 DOI: 10.1097/jnc.0000000000000440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
ABSTRACT We evaluated the quality of care provided by the nursing team within specialized care services (SCS) from the perspective of persons with HIV (PWH). A cross-sectional study was conducted in 25 SCS selected by a single-stage cluster sampling in 21 municipalities in Brazil. Systematic sampling was performed between October 2019 and March 2020 in the reception areas of SCS locations to choose the study population ( N = 377). The adapted and validated Quality of Care Through the Patient's Eyes-HIV (QUOTE-HIV) questionnaire was used to measure the quality of perceived care, and the Mann-Whitney test to compare the scores between men and women. Of the 377 PWH, most were women (57.71%), Black or Brown (85.9%), heterosexual (67.1%), and cisgendered (96.0%); the mean age was ≥30 years (76.1%). Users' evaluation of the care provided by SCS according to scores of importance and performance of the QUOTE-HIV instrument ranged from 5.60 to 8.95 and 0.03 to 0.76, respectively. The perception of PWH about the quality of care provided by the nursing team in SCS suggests that there are opportunities to improve.
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Affiliation(s)
- Adriano Maia Dos Santos
- Adriano Maia dos Santos, PhD, is a Professor, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Brazil. Laio Magno, PhD, is a Professor, Department of Life Sciences, State University of Bahia, Salvador, Brazil. Eduarda Ferreira dos Anjos, MSc, is a PhD Student, National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. Jessica Prates Porto, MSc, is a Researcher, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Brazil. Rosemary Rocha Fonseca Barroso, PhD, is a Professor, Nutrition School, Federal University of Bahia, Salvador, Brazil. Maria da Purificação Nazaré Araújo, PhD, is a Professor, Nutrition School, Federal University of Bahia, Salvador, Brazil. Bárbara Emanuely de Brito Guimarães, MSc, is a Researcher, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Brazil. Nília Maria Brito Lima Prado, PhD, is a Professor, Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Brazil
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Gonzalez JD, Eckhardt AL. Operationalization of Clinical Placements in Graduate Nursing. Nurse Educ 2024; 49:E32-E35. [PMID: 37442122 DOI: 10.1097/nne.0000000000001480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
BACKGROUND Nurse practitioner (NP) program accreditation standards require that programs secure clinical placements for all students. As NP programs increase enrollment to meet the demand for primary care providers, it is vital that they deploy a formalized clinical placement process that ensures all students have a clinical placement. PROBLEM Although NP programs have consistently increased enrollment, the shortage of clinical sites and preceptors continues to be a barrier to admission. APPROACH Described in this article is the operationalization of graduate nursing clinical placement at one large university with 7 NP tracks. OUTCOMES A formalized clinical placement process ensures that all students receive an appropriate placement and graduate on time. Having a dedicated team of NP faculty members to provide clinical placements services for NP students is highly effective.
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Affiliation(s)
- John D Gonzalez
- Clinical Associate Professor (Dr Gonzalez), School of Nursing, University of Texas Medical Branch at Galveston; and Clinical Associate Professor (Dr Eckhardt) and Interim Chair Department of Graduate Nursing (Dr Eckhardt), College of Nursing and Health Innovation, University of Texas at Arlington
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Kilpatrick K, Tchouaket E, Savard I, Chouinard MC, Bouabdillah N, Provost-Bazinet B, Costanzo G, Houle J, St-Louis G, Jabbour M, Atallah R. Identifying indicators sensitive to primary healthcare nurse practitioner practice: A review of systematic reviews. PLoS One 2023; 18:e0290977. [PMID: 37676878 PMCID: PMC10484467 DOI: 10.1371/journal.pone.0290977] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/20/2023] [Indexed: 09/09/2023] Open
Abstract
AIM To identify indicators sensitive to the practice of primary healthcare nurse practitioners (PHCNPs). MATERIALS AND METHODS A review of systematic reviews was undertaken to identify indicators sensitive to PHCNP practice. Published and grey literature was searched from January 1, 2010 to December 2, 2022. Titles/abstracts (n = 4251) and full texts (n = 365) were screened independently by two reviewers, with a third acting as a tie-breaker. Reference lists of relevant publications were reviewed. Risk of bias was examined independently by two reviewers using AMSTAR-2. Data were extracted by one reviewer and verified by a second reviewer to describe study characteristics, indicators, and results. Indicators were recoded into categories. Findings were summarized using narrative synthesis. RESULTS Forty-four systematic reviews were retained including 271 indicators that were recoded into 26 indicator categories at the patient, provider and health system levels. Nineteen reviews were assessed to be at low risk of bias. Patient indicator categories included activities of daily living, adaptation to health conditions, clinical conditions, diagnosis, education-patient, mortality, patient adherence, quality of life, satisfaction, and signs and symptoms. Provider indicator categories included adherence to best practice-providers, education-providers, illness prevention, interprofessional team functioning, and prescribing. Health system indicator categories included access to care, consultations, costs, emergency room visits, healthcare service delivery, hospitalizations, length of stay, patient safety, quality of care, scope of practice, and wait times. DISCUSSION Equal to improved care for almost all indicators was found consistently for the PHCNP group. Very few indicators favoured the control group. No indicator was identified for high/low fidelity simulation, cultural safety and cultural sensitivity with people in vulnerable situations or Indigenous Peoples. CONCLUSION This review of systematic reviews identified patient, provider and health system indicators sensitive to PHCNP practice. The findings help clarify how PHCNPs contribute to care outcomes. PROSPERO REGISTRATION NUMBER CRD42020198182.
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Affiliation(s)
- Kelley Kilpatrick
- Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Maisonneuve-Rosemont Hospital Site, Montréal, Québec, Canada
| | - Eric Tchouaket
- Department of Nursing, Université du Québec en Outaouais (UQO), St-Jérôme Campus, Saint-Jérôme, Québec, Canada
| | - Isabelle Savard
- Department of Nursing, Université du Québec en Outaouais (UQO), St-Jérôme Campus, Saint-Jérôme, Québec, Canada
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Maud-Christine Chouinard
- Faculté des Sciences Infirmières, Université de Montréal, Montréal, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l’Île-de-Montréal (CIUSSS-NIM), Montréal, Québec, Canada
| | - Naima Bouabdillah
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | | | - Gina Costanzo
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Julie Houle
- Department of Nursing, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ), Trois-Rivières, Québec, Canada
| | - Geneviève St-Louis
- Support and Development of Professional Practices in Nursing and Assistance Care and Infection Prevention Associate Directorate, Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie-et-du-Centre-du-Québec (CIUSSS-MCQ), Trois-Rivières, Québec, Canada
| | - Mira Jabbour
- Centre Intégré Universitaire de Santé et de Services Sociaux de l’Est-de-l’Île-de-Montréal (CIUSSS-EMTL), Maisonneuve-Rosemont Hospital Site, Montréal, Québec, Canada
| | - Renée Atallah
- Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
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Lippler N. [Advanced nursing practice in a medical-psychological center]. Soins Psychiatr 2023; 44:39-42. [PMID: 37328230 DOI: 10.1016/j.spsy.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The introduction of an advanced practice nurse in psychiatry and mental health (APN) at the University Hospital of Nîmes has made it possible to improve the quality and safety of care while controlling costs and ensuring the satisfaction of patients, partners and care teams. A favorable institutional policy, the involvement of the management, psychiatrists and the IPA PSM facilitated the acceptance of this new profession by the care teams and other professionals, despite the existence of statutory and logistical obstacles.
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Affiliation(s)
- Nadia Lippler
- Centre hospitalier universitaire de Nîmes, 4, rue du Professeur-Robert-Debré, 30900 Nîmes, France.
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McGilton KS, Haslam-Larmer L, Wills A, Krassikova A, Babineau J, Robert B, Heer C, McAiney C, Dobell G, Bethell J, Kay K, Keatings M, Kaasalainen S, Feldman S, Sidani S, Martin-Misener R. Nurse practitioner/physician collaborative models of care: a scoping review protocol. BMC Geriatr 2023; 23:98. [PMID: 36797669 PMCID: PMC9934505 DOI: 10.1186/s12877-023-03798-1] [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] [Received: 07/13/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Before the COVID-19 pandemic, many long-term care (LTC) homes experienced difficulties in providing residents with access to primary care, typically delivered by community-based family physicians or nurse practitioners (NPs). During the pandemic, legislative changes in Ontario, Canada enabled NPs to act in the role of Medical Directors thereby empowering NPs to work to their full scope of practice. Emerging from this new context, it remains unclear how NPs and physicians will best work together as primary care providers. NP/physician collaborative models appear key to achieving optimal resident outcomes. This scoping review aims to map available evidence on existing collaborative models of care between NPs and physicians within LTC homes. METHODS The review will be guided by the research question, "What are the structures, processes and outcomes of collaborative models of care involving NPs and Physicians in LTC homes?" This scoping review will be conducted according to the methods framework for scoping reviews outlined by Arksey and O'Malley and refined by Levac et al., Colquhoun et al., and Daudt et al., as well as the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Statement. Electronic databases (MEDLINE, Embase + Embase Classic, APA PsycInfo, Cochrane Central Register of Controlled Trials, AMED, CINAHL, Ageline, and Scopus), grey literature, and reference lists of included articles will be searched. English language studies that describe NP and physician collaborative models within the LTC setting will be included. DISCUSSION This scoping review will consolidate what is known about existing NP/physician collaborative models of care in LTC homes. Results will be used to inform the development of a collaborative practice framework for long-term care clinical leadership.
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Affiliation(s)
- Katherine S. McGilton
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8 Canada
| | - Lynn Haslam-Larmer
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8 Canada
| | - Aria Wills
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8 Canada
| | - Alexandra Krassikova
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
| | - Jessica Babineau
- grid.231844.80000 0004 0474 0428Library & Information Services, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.231844.80000 0004 0474 0428The Institute for Education Research, University Health Network, Toronto, Canada
| | - Ben Robert
- Perley Health, 1750 Russell Road, Ottawa, ON K1G 5Z6 Canada ,grid.28046.380000 0001 2182 2255Faculty of Medicine, University of Ottawa, 451 Smyth Road #2044, Ottawa, ON K1H 8M5 Canada
| | - Carrie Heer
- Brant Community Healthcare System, 200 Terrace Hill Street, Brantford, ON N3R 1G9 Canada ,grid.418792.10000 0000 9064 3333Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1 Canada
| | - Carrie McAiney
- grid.498777.2Schlegel-UW Research Institute for Aging, Waterloo, ON N2J 0E2 Canada ,grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Gail Dobell
- Ontario Health, 130 Bloor Street West, Toronto, ON M5S 1N5 Canada
| | - Jennifer Bethell
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada
| | - Kelly Kay
- Provincial Geriatrics Leadership Ontario, Toronto, Canada ,grid.17063.330000 0001 2157 2938Ontario Institute for Studies in Education and the Institute for Life Course and Aging, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
| | - Margaret Keatings
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Sharon Kaasalainen
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Sid Feldman
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON M6A2E1 Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, Temerty Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8 Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, 250 Victoria Street, Toronto, ON M5B 2K9 Canada
| | - Ruth Martin-Misener
- grid.55602.340000 0004 1936 8200School of Nursing, Dalhousie University, Room G26, Forrest Bldg., 5869 University Avenue, Halifax, NS B3H 4R2 Canada
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11
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Lehman KD. Evidence-based updates to the 2021 Surviving Sepsis Campaign guidelines Part 2: Guideline review and clinical application. Nurse Pract 2022; 47:28-35. [PMID: 36399145 DOI: 10.1097/01.npr.0000884888.21622.e3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
ABSTRACT NPs should be prepared to screen for sepsis, initiate treatment, and optimize care for sepsis survivors. The 2021 Surviving Sepsis Campaign guidelines offer best practices for identification and management of sepsis and septic shock. This article, second in a 2-part series, presents evidence updates and discusses implications for NPs.
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Affiliation(s)
- Karen D Lehman
- Karen D. Lehman is a hospitalist NP and PRN ED NP at NMC Health in Newton, Kan., an ED NP with Docs Who Care based in Olathe, Kan., and a hospice NP with Harry Hynes Memorial Hospice in Wichita, Kan
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12
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Hirschman KB, Rivera E, Sefcik JS, McCauley K, Hanlon AL, Pauly MV, Press MJ, Naylor MD. Older Adult and Family Caregiver Perspectives on Engagement in Primary Care. J Gerontol Nurs 2022; 48:7-13. [PMID: 36286501 PMCID: PMC10337119 DOI: 10.3928/00989134-20221003-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
The purpose of the current in-depth qualitative study was to explore the experiences of older adults and family caregivers in primary care. Twenty patients and caregivers from six Comprehensive Primary Care Plus (CPC+) practices' Patient and Family Advisory Councils within a large academic health system participated in telephone interviews from December 2018 to May 2019. Participants were mostly women (60%), with an average age of 71 years and nine chronic conditions. Transcripts were coded using conventional content analysis. Two key themes emerged related to person-centered care (PCC): Engagement in Health Care and Patient-Provider Relationship. Engagement in health care was defined by participants as: being proactive, centering on patient goals in treatment discussions, adherence, and self-triaging. Approximately all participants discussed the importance of the relationship and interactions with their provider as influencing their engagement. The identified themes offer recommendations for further improvement of primary PCC. [Journal of Gerontological Nursing, 48(11), 7-13.].
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Affiliation(s)
- Karen B. Hirschman
- University of Pennsylvania School of Nursing, NewCourtland Center for Transitions and Health, Philadelphia, PA
| | - Eleanor Rivera
- University of Illinois – Chicago, College of Nursing, Chicago, IL
| | - Justine S. Sefcik
- Drexel University College of Nursing and Health Professions, Philadelphia, PA
| | - Kathleen McCauley
- University of Pennsylvania School of Nursing, NewCourtland Center for Transitions and Health, Philadelphia, PA
| | - Alexandra L. Hanlon
- Virginia Polytechnic Institute and State University, Center for Biostatistics and Health Data Science, Roanoke, VA
| | - Mark V. Pauly
- Wharton School at the University of Pennsylvania, Philadelphia, PA
| | - Matthew J. Press
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Mary D. Naylor
- University of Pennsylvania School of Nursing, NewCourtland Center for Transitions and Health, Philadelphia, PA
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13
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The Power of Words. J Nurse Pract 2022. [DOI: 10.1016/j.nurpra.2022.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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14
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Abstract
BACKGROUND Super-utilizers of the health care system compose a small percentage of the population, yet use the most health care resources. Hotspotting addresses this issue by providing high-quality, personalized care to this population. PURPOSE This review examined how hotspotting has been defined, implemented, and measured. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guided this review. Twelve databases were searched for hotspotting interventions in practice settings. RESULTS Sixteen studies were included. Hotspotting was primarily defined by the Camden Coalition of Healthcare Providers and relied on multiple professions, including nursing. Hotspotting interventions addressed access to care, social determinants of health, patient engagement, and health literacy. Some studies indicated that hotspotting reduced readmissions and emergency department visits and increased use in social services. CONCLUSIONS Patients benefit from an interprofessional, personalized approach to their care planning. Hotspotting can lead to high-quality care through building trusted relationships.
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15
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Patel SY, Huskamp HA, Frakt AB, Auerbach DI, Neprash HT, Barnett ML, James HO, Mehrotra A. Frequency Of Indirect Billing To Medicare For Nurse Practitioner And Physician Assistant Office Visits. HEALTH AFFAIRS (PROJECT HOPE) 2022; 41:805-813. [PMID: 35666969 DOI: 10.1377/hlthaff.2021.01968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Nurse practitioners (NPs) and physician assistants (PAs) represent a growing share of the health care workforce, but much of the care they provide cannot be observed in claims data because of indirect (or "incident to") billing, a practice in which visits provided by an NP or PA are billed by a supervising physician. If NPs and PAs bill directly for a visit, Medicare and many private payers pay 85 percent of what is paid to a physician for the same service. Some policy makers have proposed eliminating indirect billing, but the possible impact of such a change is unknown. Using a novel approach that relies on prescriptions to identify indirectly billed visits, we estimated that the number of all NP or PA visits in fee-for-service Medicare data billed indirectly was 10.9 million in 2010 and 30.6 million in 2018. Indirect billing was more common in states with laws restricting NPs' scope of practice. Eliminating indirect billing would have saved Medicare roughly $194 million in 2018, with the greatest decrease in revenue seen among smaller primary care practices, which are more likely to use this form of billing.
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Affiliation(s)
- Sadiq Y Patel
- Sadiq Y. Patel, Harvard University, Boston, Massachusetts
| | | | - Austin B Frakt
- Austin B. Frakt, Veterans Affairs Boston Healthcare System, Harvard University, and Boston University, Boston, Massachusetts
| | - David I Auerbach
- David I. Auerbach, State of Massachusetts, Boston, Massachusetts
| | - Hannah T Neprash
- Hannah T. Neprash, University of Minnesota, Saint Paul, Minnesota
| | | | - Hannah O James
- Hannah O. James, Brown University, Providence, Rhode Island
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16
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Mutsekwa RN, Wright C, Byrnes JM, Canavan R, Angus RL, Spencer A, Campbell KL. Measuring performance of professional role substitution models of care against traditional medical care in healthcare-A systematic review. J Eval Clin Pract 2022; 28:208-217. [PMID: 34405492 DOI: 10.1111/jep.13613] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 07/26/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To identify outcome measures used to evaluate performance of healthcare professional role substitution against usual medical doctor or specialist medical doctor care to facilitate our understanding of the adequacy of these measures in assessing quality of healthcare delivery. METHODS Using a systematic approach, we searched Medline, Cochrane Central Register of Controlled Trials, Embase, CINAHL, and Web of Science from database inception until May 2020. Studies that presented original comparative data on at least one outcome measure were included following screening by two authors. Findings were synthesized, and outcome measures classified into six domains which included: effectiveness, safety, appropriateness, access, continuity of care, efficiency, and sustainability which were informed by the Institute of Medicine dimensions of healthcare quality, the Australian health performance framework, and Levesque and Sutherland's integrated performance measurement framework. RESULTS One thirty five articles met the inclusion criteria, describing 58 separate outcome measures. Safety of role substitution models of care was assessed in 80 studies, effectiveness (n = 60), appropriateness (n = 40), access (n = 36), continuity of care (n = 6), efficiency and productivity (n = 45). Two-thirds of the studies that assessed productivity and efficiency performed an economic analysis (n = 27). The quality and rigour of evaluations varied substantially across studies, with two-thirds of all studies measuring and reporting outcomes from only one or two of these domains. CONCLUSIONS There are a growing number of studies measuring the performance of non-medical healthcare professional substitution roles. Few have been subject to robust evaluations, and there is limited evidence on the scientific rigour and adequacy of outcomes measured. A systematic and coordinated approach is required to support healthcare settings in assessing the value of non-medical role substitution healthcare delivery models.
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Affiliation(s)
- Rumbidzai N Mutsekwa
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, Queensland, Australia
| | - Charlene Wright
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Joshua M Byrnes
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia
| | - Russell Canavan
- Gastroenterology Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Rebecca L Angus
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia.,School of Allied Health Sciences, Griffith University, Southport, Queensland, Australia
| | - Alan Spencer
- Nutrition and Food Service Department, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
| | - Katrina L Campbell
- Centre for Applied Health Economics, School of Medicine, Griffith University, Sir Samuel Griffith Centre, Nathan, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Healthcare Excellence and Innovation, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
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17
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Murfet G, Ostaszkiewicz J, Rasmussen B. Diabetes Capabilities for the Healthcare Workforce Identified via a 3-Staged Modified Delphi Technique. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1012. [PMID: 35055832 PMCID: PMC8775604 DOI: 10.3390/ijerph19021012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 11/29/2022]
Abstract
Consumers access health professionals with varying levels of diabetes-specific knowledge and training, often resulting in conflicting advice. Conflicting health messages lead to consumer disengagement. The study aimed to identify capabilities required by health professionals to deliver diabetes education and care to develop a national consensus capability-based framework to guide their training. A 3-staged modified Delphi technique was used to gain agreement from a purposefully recruited panel of Australian diabetes experts from various disciplines and work settings. The Delphi technique consisted of (Stage I) a semi-structured consultation group and pre-Delphi pilot, (Stage II) a 2-phased online Delphi survey, and (Stage III) a semi-structured focus group and appraisal by health professional regulatory and training organisations. Descriptive statistics and central tendency measures calculated determined quantitative data characteristics and consensus. Content analysis using emergent coding was used for qualitative content. Eighty-four diabetes experts were recruited from nursing and midwifery (n = 60 [71%]), allied health (n = 17 [20%]), and pharmacy (n = 7 [9%]) disciplines. Participant responses identified 7 health professional practice levels requiring differences in diabetes training, 9 capability areas to support care, and 2 to 16 statements attained consensus for each capability-259 in total. Additionally, workforce solutions were identified to expand capacity for diabetes care. The rigorous consultation process led to the design and validation of a Capability Framework for Diabetes Care that addresses workforce enablers identified by the Australian National Diabetes Strategy. It recognises diversity, creating shared understandings of diabetes across health professional disciplines. The findings will inform diabetes policy, practice, education, and research.
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Affiliation(s)
- Giuliana Murfet
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
- Diabetes Centre, Tasmanian Health Service, Burnie, TAS 7250, Australia
- School of Public Health, University of Technology Sydney, 15 Broadway, Ultimo, NSW 2007, Australia
| | - Joan Ostaszkiewicz
- National Aging Research Institute, Royal Melbourne Hospital, Parkville, VIC 3050, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
- Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, 1 Geringhap Street, Geelong, VIC 3220, Australia
- Western Health Partnership, 176 Furlong Road, St Albans, VIC 3021, Australia
- Department of Public Health, University of Copenhagen, Nørregade 10, DK-1017 Copenhagen, Denmark
- Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, DK-5230 Odense, Denmark
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