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Peters MDJ, Marnie C, Helms C. Enablers and barriers to nurse practitioners working in Australian aged care: A scoping review. Int J Nurs Stud 2024; 158:104861. [PMID: 39121578 DOI: 10.1016/j.ijnurstu.2024.104861] [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] [Received: 08/09/2023] [Revised: 06/19/2024] [Accepted: 07/13/2024] [Indexed: 08/12/2024]
Abstract
OBJECTIVE To identify evidence reporting on nurse practitioners working in aged care in Australia and to categorise the reported factors found to be barriers or facilitators to operation in terms of establishment, sustainability, and expansion. INTRODUCTION Nurse practitioners work in a variety of aged care contexts throughout Australia but are underutilised and uncommon. Despite evidence for their effectiveness, it is unclear what barriers or enabling factors contribute to the successful and sustainable implementation of nurse practitioners working in this sector. METHODS Based on an a-priori protocol the JBI methodology for scoping reviews was used and the review reported against the PRISMA extension for scoping reviews (PRISMA-ScR). Databases searched included MEDLINE, Embase, Emcare, Web of Science, and Scopus. Peer reviewed and grey literature describing the role of Australian nurse practitioners in aged care were included. RESULTS Of 2968 retrieved sources, 18 were included representing studies of a variety of designs from all Australian states and territories. Residential care and in-home care contexts as well as metropolitan, regional, and remote locations were represented. Overall, 123 individual barriers and facilitators were identified across seven inductively derived categories: staff/individual, organisational, system, operational, resource, data, and consumers/clients/residents. In many cases, factors appeared across both positive (facilitators) and negative (barriers) categories. CONCLUSIONS Nurse practitioners can improve the quality of care being provided to older people accessing aged care in Australia. When establishing or maintaining nurse practitioner roles in aged care knowledge users should have a comprehensive understanding of the range of factors potentially contributing to or limiting success or sustainability. As implementation is highly contextual, various types of organisational and sectoral factors as well as individual and overarching factors related to the regulation of nurse practitioners practice should be considered.
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Affiliation(s)
- Micah D J Peters
- University of South Australia, UniSA Clinical and Health Sciences, Rosemary Bryant AO Research Centre, Adelaide, South Australia, Australia; Australian Nursing and Midwifery Federation (Federal Office), Melbourne, Victoria, Australia; University of Adelaide, School of Public Health, Health Evidence Synthesis, Recommendations and Impact (HESRI), Adelaide, South Australia, Australia; University of Adelaide, Faculty of Health and Medical Sciences, Adelaide Nursing School, Adelaide, South Australia, Australia; The Danish Centre of Systematic Reviews: a Joanna Briggs Institute Centre of Excellence, Department of Clinical Medicine, Aalborg University, Denmark.
| | - Casey Marnie
- University of South Australia, UniSA Clinical and Health Sciences, Rosemary Bryant AO Research Centre, Adelaide, South Australia, Australia; Australian Nursing and Midwifery Federation (Federal Office), Melbourne, Victoria, Australia
| | - Christopher Helms
- Charles Darwin University, Faculty of Health, School of Nursing, Australia
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Woods L, Martin P, Khor J, Guthrie L, Sullivan C. The right care in the right place: a scoping review of digital health education and training for rural healthcare workers. BMC Health Serv Res 2024; 24:1011. [PMID: 39223581 PMCID: PMC11370102 DOI: 10.1186/s12913-024-11313-4] [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] [Received: 03/13/2024] [Accepted: 07/15/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Digital health offers unprecedented opportunities to enhance health service delivery across vast geographic regions. However, these benefits can only be realized with effective capabilities and clinical leadership of the rural healthcare workforce. Little is known about how rural healthcare workers acquire skills in digital health, how digital health education or training programs are evaluated and the barriers and enablers for high quality digital health education and training. OBJECTIVE To conduct a scoping review to identify and synthesize existing evidence on digital health education and training of the rural healthcare workforce. INCLUSION CRITERIA Sources that reported digital health and education or training in the healthcare workforce in any healthcare setting outside metropolitan areas. METHODS We searched for published and unpublished studies written in English in the last decade to August 2023. The databases searched were PubMed, Embase, Scopus, CINAHL and Education Resources Information Centre. We also searched the grey literature (Google, Google Scholar), conducted citation searching and stakeholder engagement. The JBI Scoping Review methodology and PRISMA guidelines for scoping reviews were used. RESULTS Five articles met the eligibility criteria. Two case studies, one feasibility study, one micro-credential and one fellowship were described. The mode of delivery was commonly modular online learning. Only one article described an evaluation, and findings showed the train-the-trainer model was technically and pedagogically feasible and well received. A limited number of barriers and enablers for high quality education or training of the rural healthcare workforce were reported across macro (legal, regulatory, economic), meso (local health service and community) and micro (day-to-day practice) levels. CONCLUSIONS Upskilling rural healthcare workers in digital health appears rare. Current best practice points to flexible, blended training programs that are suitably embedded with interdisciplinary and collaborative rural healthcare improvement initiatives. Future work to advance the field could define rural health informatician career pathways, address concurrent rural workforce issues, and conduct training implementation evaluations. REVIEW REGISTRATION NUMBER Open Science Framework: https://doi.org/10.17605/OSF.IO/N2RMX .
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Affiliation(s)
- Leanna Woods
- Queensland Digital Health Centre, The University of Queensland, Brisbane, Australia.
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
| | - Priya Martin
- Rural Clinical School, Faculty of Medicine, The University of Queensland, Toowoomba, Australia
| | - Johnson Khor
- Queensland Digital Health Centre, The University of Queensland, Brisbane, Australia
- Ochsner Clinical School, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Lauren Guthrie
- Queensland Digital Health Centre, The University of Queensland, Brisbane, Australia
| | - Clair Sullivan
- Queensland Digital Health Centre, The University of Queensland, Brisbane, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Metro North Hospital and Health Service, Herston, Australia
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Haslam-Larmer L, Krassikova A, Spengler C, Wills A, Keatings M, Babineau J, Robert B, Heer C, McAiney C, Bethell J, Kay K, Kaasalainen S, Feldman S, Martin-Misener R, Katz P, May K, McGilton KS. What Do We Know About Nurse Practitioner/Physician Care Models in Long-Term Care: Results of a Scoping Review. J Am Med Dir Assoc 2024; 25:105148. [PMID: 39009065 DOI: 10.1016/j.jamda.2024.105148] [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] [Received: 04/10/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES Due to the rise of the nurse practitioner (NP) role in long-term care settings, it is important to understand the underlying structures and processes that influence NP and physician care models. This scoping review aims to answer the question, "What are the structures, processes, and outcomes of care models involving NPs and physicians in long-term care (LTC) homes?" A secondary aim was to describe the structural enablers and barriers across care models. RESEARCH DESIGN AND METHODS Seven databases were searched. Studies that described NPs and physicians working in LTC were identified and included in the review. We stratified the findings by care model and synthesized using the Donabedian model, which evaluates health care quality based on 3 dimensions: structure, process, and outcome. We then categorized macro, meso, and micro structural enablers and barriers. RESULTS Sixty papers were included in the review. The main structural influencers within 5 care models included policies on scope of practice, clarity of role description, and workload. A limited number of papers referred to the process of enabling the development of a working relationship. Thirty-five (49%) studies described resident, staff, and health system outcomes. CONCLUSIONS AND IMPLICATIONS Although structural characteristics of NP and physician care models are described in-depth, there is less detail on the processes that occur within the NP and physician care models. We highlight structural barriers and enablers within the care models, allowing for recognition of the importance of organizational influence on the NP and physician relationship. Future work should focus on the processes of the relationships in the models by identifying the drivers and initiators of collaboration between NPs and physicians and how these relationships influence outcomes.
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Affiliation(s)
- Lynn Haslam-Larmer
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Alexandra Krassikova
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Claudia Spengler
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Aria Wills
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Margaret Keatings
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Jessica Babineau
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | | | - Carrie Heer
- Brant Community Healthcare System, Brantford, Ontario, Canada
| | - Carrie McAiney
- University of Waterloo and Schlegel-UW Research Institute for Aging, Waterloo, Ontario, Canada
| | - Jennifer Bethell
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Kelly Kay
- Provincial Geriatrics Leadership Ontario, Ontario, Canada
| | | | - Sid Feldman
- Baycrest Health Sciences, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | | | - Paul Katz
- Department of Geriatrics, Florida State University, Tallahassee, FL, USA
| | - Kathryn May
- The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Katherine S McGilton
- KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
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Kettlewell J, Radford K, Timmons S, Jones T, Fallon S, Westley R, White S, Kendrick D. What affects implementation of the UK major trauma rehabilitation prescription? A survey informed by the behaviour change wheel. Injury 2024; 55:111722. [PMID: 39019749 DOI: 10.1016/j.injury.2024.111722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/26/2024] [Accepted: 07/05/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE Major trauma 'Rehabilitation Prescriptions' aim to facilitate continuity of care and describe patient needs following discharge from UK Major Trauma Centre (MTCs), however research suggests rehabilitation prescriptions are not being implemented as intended. We aimed to identify factors influencing completion and use of rehabilitation prescriptions using the Behaviour Change Wheel (BCW) and Theoretical Domains Framework (TDF). DESIGN Online survey informed by the TDF and BCW. SETTING UK trauma rehabilitation pathway. POPULATION Rehabilitation and trauma service providers involved in completing and/or using rehabilitation prescriptions (n = 78). ANALYSIS Mean scores were calculated for TDF behavioural domains, identifying facilitators (score ≥5) and barriers (≤3.5) to rehabilitation prescription implementation. Thematic analysis of free text data informed by the BCW/TDF identified further facilitators and barriers, plus potential behaviour change strategies. RESULTS Most respondents worked in UK MTCs (n = 63) and were physiotherapists (n = 34), trauma rehabilitation coordinators (n = 16) or occupational therapists (n = 15). 'Social/professional role and identity', 'knowledge' and 'emotion' (the highest-scoring TDF domains) were facilitators to implementing rehabilitation prescriptions. Qualitative data identified barriers to rehabilitation prescription completion, including 'seen as tick-box exercise','not a priority', lack of resources (IT and workforce), poor inter-service communication, limited knowledge/training. Facilitators included therapist buy-in, standardised training, easy inter-service rehabilitation prescription transfer, usefulness for sharing patient needs. CONCLUSIONS Although rehabilitation prescriptions are valued by some service providers, their effectiveness is hindered by negative attitudes, limited knowledge and poor communication. Uncertainties exist about whether rehabilitation prescriptions achieve their goals, particularly in documenting patient needs, engaging patients in rehabilitation, and informing onward referrals following MTC discharge. Improving IT systems, empowering patients, redirecting funding, and providing training might improve their usage. Further research should explore service provider and patient perspectives, and prospective long-term follow-up on outcomes of rehabilitation prescription recommendations.
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Affiliation(s)
- Jade Kettlewell
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK.
| | - Kate Radford
- Centre for Rehabilitation & Ageing Research, School of Medicine, University of Nottingham, UK
| | - Stephen Timmons
- Nottingham University Business School, University of Nottingham, UK
| | - Trevor Jones
- School of Medicine, University of Nottingham, UK
| | | | - Ryan Westley
- School of Medicine, University of Nottingham, UK
| | - Susan White
- School of Medicine, University of Nottingham, UK
| | - Denise Kendrick
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, UK
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Mazurenko O, O'Brien E, Beug A, Smith SM, McCarthy C. Recommendations for managing adults with chronic non-cancer pain in primary care: A systematic clinical guideline review. J Eval Clin Pract 2024. [PMID: 39104080 DOI: 10.1111/jep.14118] [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: 06/07/2024] [Accepted: 07/18/2024] [Indexed: 08/07/2024]
Abstract
RATIONALE Chronic non-cancer pain (CNCP) is a leading driver of disability. Primary care clinicians treat most patients with CNCP. Yet, they are often unable to identify appropriate pain treatments, mainly due to concerns about the safety and effectiveness of available medications. Clinical practice guidelines (CPGs) can be useful tools to guide primary care clinicians in selecting pain treatments based on the best available evidence. OBJECTIVES To undertake a systematic review of CPGs that address the management of adults with CNCP, regardless of underlying condition type, in primary care. METHOD We systematically reviewed and synthesised current CPGs for managing adults with CNCP in primary care (2013-2023). We followed a stepwise systematic process to synthesise key CPG recommendations: extracted and analysed each recommendation, synthesised by compiling similar recommendations using a thematic analysis approach, and assessed the strength of CPG recommendations to create a final, unified set of recommendations. We focused on identifying CPGs containing recommendations on the following topics: (a) opioid pain management, (b) non-opioid pharmacological pain management, (c) non-pharmacological pain management, and (d) patient-centred communication around pain management, prevention, and organisation of care. RESULTS We included 13 CPGs, 8 of which focused solely on use of opioids, emphasising the lack of long-term effectiveness and safety concerns, being mainly based on the expert consensus. As an exception, high-quality evidence recommended referring patients with suspected opioid use disorder to specialist addiction services for medication-assisted treatment. Recommendations for non-opioid pain management were often contradictory and based on the expert consensus. Patient-centred pain management combined with exercise-based interventions and psychological therapies are appropriate strategies for managing patients with CNCP. CONCLUSION Most CPGs focused on opioid management, with contradictory recommendations for non-opioid management based on low-quality evidence. Additional research is needed to strengthen the evidence for using non-opioid and non-pharmacological interventions to manage patients with CNCP.
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Affiliation(s)
- Olena Mazurenko
- Department of Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health - Indianapolis, Indianapolis, Indiana, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Emer O'Brien
- Department of General Practice, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Mercer Building, Dublin, Ireland
| | - Anna Beug
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Susan M Smith
- Discipline of Public Health and Primary Care, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Caroline McCarthy
- Department of General Practice, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Mercer Building, Dublin, Ireland
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Tower M, Hyun A, Denton M, Cottle-Quinn A. Implementation of a nurse practitioner service in a rural setting: a qualitative analysis of healthcare practitioners' experiences. Contemp Nurse 2024; 60:345-355. [PMID: 38377070 DOI: 10.1080/10376178.2024.2316597] [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] [Received: 03/09/2023] [Accepted: 02/04/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Nurse Practitioners work independently and collaboratively within multidisciplinary teams to fill unmet service delivery needs. Despite strong evidence of the benefits of the nurse practitioner service model, organisational support for nurse practitioners varies in terms of resources and support from leadership and other healthcare professionals. AIMS The study aimed to explore healthcare practitioners' experiences of implementation of a NP service in a rural setting. METHODS Semi-structured interviews were conducted with ten healthcare practitioners to investigate their perspectives of a recently implemented NP service. Data were analysed inductively using thematic analysis. FINDINGS Themes emerged related to facilitating collaborative practice, person-centred continuity of care and positive health outcomes for the community. Challenges and limitations related to operational role clarity, scopes of practice and leadership. CONCLUSION Healthcare practitioners were mostly satisfied with the service however challenges caused tension. Change management principles provide a framework to strengthen the effective clinical alignment of the service.
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Affiliation(s)
- Marion Tower
- School of Nursing, Midwifery & Social Work, The University of Queensland, Brisbane, Australia
| | - Areum Hyun
- School of Nursing, Midwifery & Social Work, The University of Queensland, Brisbane, Australia
| | - Michelle Denton
- School of Nursing, Midwifery & Social Work, The University of Queensland, Brisbane, Australia
| | - Amanda Cottle-Quinn
- School of Nursing, Midwifery & Social Work, The University of Queensland, Brisbane, Australia
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Babu D, Rowett D, Kalisch Ellett L, Marotti S, Wisdom A, Lim R, Harmon J. Exploration of 'micro' level factors that affect the involvement of clinical pharmacists in interprofessional ward rounds in hospitals: Through the lens of social cognitive theory. Res Social Adm Pharm 2024; 20:654-664. [PMID: 38627153 DOI: 10.1016/j.sapharm.2024.04.007] [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] [Received: 02/07/2024] [Revised: 04/05/2024] [Accepted: 04/07/2024] [Indexed: 06/18/2024]
Abstract
BACKGROUND Macro and meso level factors that influence the participation by clinical pharmacists in ward rounds include pharmacy management culture, commitment to ward rounds and adequate time for ward rounds being included in workload models. The 'micro' level factors that affect the involvement of clinical pharmacists in ward rounds have not been widely explored. OBJECTIVE Explore 'micro' level factors to gain insight into clinical pharmacists' participation in interprofessional ward rounds in inpatient settings through the lens of social cognitive theory. METHOD A qualitative focused ethnographic study with five clinical pharmacists, four medical practitioners, one allied health professional and one nurse was conducted in three metropolitan hospitals in Southern Australia. Seven hours of semi-structured interview (n = 11) and 76-h of observations (n = 5) were conducted. A qualitative descriptive analysis was conducted (guided by Spradley) followed by reflexive thematic-analysis (according to Braun and Clarke's technique). RESULTS Three micro level factors influencing clinical pharmacist participation in ward rounds are: (1) Cognitive mindset of clinical pharmacists, (2) Behavioural conduct of clinical pharmacists, and (3) Social rules of the ward. Clinical pharmacists that did not participate in ward round reconciled their moral distress by transferring information without clinical judgement or interpretation of the patient scenario to medical practitioners. Clinical pharmacists that did participate in ward rounds demonstrated credibility by making relevant recommendations with a holistic lens. This enabled clinical pharmacists to be perceived as trustworthy by medical practitioners. Positive experiences of participating in ward rounds contributed to their cognitive upward spiral of thoughts and emotions, fostering continued participation. CONCLUSION Clinical pharmacists participate in ward rounds when they develop a positive mindset about ward round participation and perceive ward rounds as an enabler to the establishment of trusted professional relationships with medical practitioners. This trusted relationship creates an environment where the pharmacist develops confidence in making relevant recommendations.
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Affiliation(s)
- Dona Babu
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; SA Pharmacy, SA Health, Adelaide, SA, 5000, Australia.
| | - Debra Rowett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; Drug and Therapeutics Information Service, Southern Adelaide Local Health Network, Adelaide, SA, 5000, Australia
| | - Lisa Kalisch Ellett
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Sally Marotti
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia; SA Pharmacy, SA Health, Adelaide, SA, 5000, Australia
| | - Alice Wisdom
- SA Pharmacy, SA Health, Adelaide, SA, 5000, Australia
| | - Renly Lim
- Quality Use of Medicines and Pharmacy Research Centre, UniSA Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
| | - Joanne Harmon
- Rosemary Bryant AO Research Centre, Clinical and Health Sciences, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia
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Garuma D, Lamba D, Abessa TG, Bonnechère B. Advancing public health: enabling culture-fair and education-independent automated cognitive assessment in low- and middle-income countries. Front Public Health 2024; 12:1377482. [PMID: 39005983 PMCID: PMC11239414 DOI: 10.3389/fpubh.2024.1377482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 06/10/2024] [Indexed: 07/16/2024] Open
Affiliation(s)
- Desalegm Garuma
- Department of Psychology, College of Education and Behavorial Sciences, Jimma University, Jimma, Ethiopia
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Dheeraj Lamba
- Department of Physiotherapy, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Teklu Gemechu Abessa
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Department of Special Needs and Inclusive Education, Jimma University, Jimma, Ethiopia
| | - Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Sciences Institute, Hasselt University, Diepenbeek, Belgium
- Centre of Expertise in Care Innovation, Department of PXL–Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Belgium
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Aly M, Schneider CR, Sukkar MB, Lucas C. Development of an adaptation framework to implement a new professional pharmacy service (PPS) to a new environment. Res Social Adm Pharm 2024; 20:165-169. [PMID: 38438294 DOI: 10.1016/j.sapharm.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/12/2024] [Accepted: 02/13/2024] [Indexed: 03/06/2024]
Abstract
The effective provision of professional pharmacy services is critical to support the delivery of primary health care. Structured frameworks and theoretical strategies are required to facilitate successful service implementation processes, outcomes and sustainability. This commentary discusses the considerations of what framework (adoption versus adaptation) would be suitable when implementing a new professional pharmacy service to a new environment. Utilizing Minor Ailments Services (MASs) as an exemplar as a professional pharmacy service case study, the research that underpinned these considerations enabled the development of a sequential, phased framework. There is the potential to utilize this framework for future evolving professional pharmacy services in the new setting.
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Affiliation(s)
- Mariyam Aly
- Pharmaceutical Society of Australia, 32 Ridge St, North Sydney, New South Wales, Australia, 2060.
| | - Carl R Schneider
- The University of Sydney School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Sydney New South Wales, Australia.
| | - Maria B Sukkar
- The University of Technology Sydney, School of Life Sciences, Faculty of Science, 15 Broadway, Ultimo, NSW, 2007, Australia.
| | - Cherie Lucas
- The University of Technology Sydney, Faculty of Health, 15 Broadway, Ultimo, NSW, 2007, Australia; University of NSW (UNSW) Sydney, School of Population Health, Faculty of Medicine and Health, Sydney, NSW, Australia.
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Ljungbeck B, Carlson E, Forss KS. Swedish stakeholders' views of the preparatory work needed before introducing the nurse practitioner role in municipal healthcare-A focus group study. Scand J Caring Sci 2024; 38:284-293. [PMID: 37984433 DOI: 10.1111/scs.13224] [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] [Received: 02/03/2023] [Revised: 09/30/2023] [Accepted: 10/28/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The nurse practitioner role has become important globally in handling the growing healthcare needs of older adults with chronic diseases. Nevertheless, research shows that introducing the role is a complex process, and more studies are needed to prepare for its introduction into different healthcare contexts, such as municipal healthcare. AIM The aim is to investigate what Swedish stakeholders identify as the preparatory work needed before introducing the nurse practitioner role into municipal healthcare. METHODS Data were collected through four focus group interviews conducted virtually on the TEAMS digital platform, with three to six participants in each group and 18 participants total. The transcribed interviews were analysed using a six-step thematic approach: familiarisation with the data, coding the data, generating initial themes, reviewing themes, defining and naming the themes and producing the report. FINDINGS The findings are divided into two main themes, each with two sub-themes. In the first, clarifying why the nurse practitioner role is needed, participants stressed the importance of having a clear intention for introducing the role. The second, ensure a national framework to bolster the introduction at the local level, demonstrates the need for collaboration among national actors to clarify the role's mandate and authority before its introduction. CONCLUSIONS Adding the nurse practitioner role to municipal healthcare can help increase the supply of nursing competence and the quality of patient care, but preparation for introducing the role requires extensive work. The development of the nurse practitioner role requires decision-makers and leaders to take primary responsibility for its introduction. This study can support countries in the early phase of developing the nurse practitioner role by identifying both best practices and pitfalls.
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Affiliation(s)
- Birgitta Ljungbeck
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmo, Sweden
- Municipal Healthcare in Hässleholm, Management of Care and Welfare, Malmo, Sweden
| | - Elisabeth Carlson
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmo, Sweden
| | - Katarina Sjögren Forss
- Department of Care Science, Faculty of Health and Society, Malmö University, Malmo, Sweden
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Hemrage S, Parkin S, Kalk NJ, Shah N, Deluca P, Drummond C. Inequity in clinical research access for service users presenting comorbidity within alcohol treatment settings: findings from a focused ethnographic study. Int J Equity Health 2024; 23:103. [PMID: 38778351 PMCID: PMC11110345 DOI: 10.1186/s12939-024-02197-1] [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: 01/23/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND While healthcare policy has fostered implementation strategies to improve inclusion and access of under-served groups to clinical care, systemic and structural elements still disproportionately prevent service users from accessing research opportunities embedded within clinical settings. This contributes to the widening of health inequalities, as the absence of representativeness prevents the applicability and effectiveness of evidence-based interventions in under-served clinical populations. The present study aims to identify the individual (micro), organisational (meso) and structural (macro) barriers to clinical research access in patients with comorbid alcohol use disorder and alcohol-related liver disease. METHODS A focused ethnography approach was employed to explore the challenges experienced by patients in the access to and implementation of research processes within clinical settings. Data were collected through an iterative-inductive approach, using field notes and patient interview transcripts. The framework method was utilised for data analysis, and themes were identified at the micro, meso and macro levels. RESULTS At the micro-level, alcohol-related barriers included encephalopathy and acute withdrawal symptoms. Alcohol-unrelated barriers also shaped the engagement of service users in research. At the meso-level, staff and resource pressures, as well as familiarity with clinical and research facilities were noted as influencing intervention delivery and study retention. At the wider, macro-level, circumstances including the 'cost of living crisis' and national industrial action within healthcare settings had an impact on research processes. The findings emphasise a 'domino effect' across all levels, demonstrating an interplay between individual, organisational and structural elements influencing access to clinical research. CONCLUSIONS A combination of individual, organisational and structural barriers, exacerbated by the COVID-19 pandemic, and the socioeconomic landscape in which the study was conducted further contributed to the unequal access of under-served groups to clinical research participation. For patients with comorbid alcohol use disorder and alcohol-related liver disease, limited access to research further contributes towards a gap in effective evidence-based treatment, exacerbating health inequalities in this clinical population.
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Affiliation(s)
- Sofia Hemrage
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Stephen Parkin
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Nicola J Kalk
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Naina Shah
- Institute of Liver Studies, Cheyne Wing (Third Floor), King's College Hospital, London, UK
| | - Paolo Deluca
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Colin Drummond
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Team L, Bloomer MJ, Redley B. Nurses' roles and responsibilities in cardiac advanced life support: A single-site eDelphi study. Nurs Crit Care 2024; 29:466-476. [PMID: 36938931 DOI: 10.1111/nicc.12897] [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] [Received: 06/09/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND Nurses are often the first responders to in-hospital cardiac arrest in postoperative cardiac surgical patients. Poor clarity about role expectations and responsibilities can hinder nurses' performance during cardiac advanced life support (CALS) procedures. AIM To seek expert consensus on nurses' roles and responsibilities in CALS for patients in postoperative cardiac surgical patients. STUDY DESIGN A two-round modified eDelphi survey. Delphi items were informed by guideline literature, an audit of resuscitation records and expert interviews. Panellists, drawn from a single site of a large tertiary health service in metropolitan Melbourne, included nurses, doctors and surgeons familiar with the management of cardiac arrest in post-operative cardiac surgical patients. RESULTS The two rounds of the modified eDelphi generated 55 responses. A consensus of >80% agreement was reached for 24 of the 41 statements in Round 2. All items related to nurses' roles and responsibilities during nurses pre- and post-arrest phases reached consensus. In contrast, only 29% (n = 4/14) of items related to peri-arrest, and 36% of those related to nurse scope of practise in CALS arrest (n = 4/11) reached consensus. CONCLUSION The study's aim was only partially achieved. Findings indicate high agreement about nurses' roles and responsibilities before and immediately after a cardiac arrest, but limited clarity about nurses' roles when implementing the CALS protocol, such as resternotomy and internal cardiac massage. There is an urgent need to address uncertainty about nurses' roles and scope of practice in CALS, which is essential to the recognition of nurses' contribution to the cardiac specialty workforce. RELEVANCE TO CLINICAL PRACTISE Uncertainty about nurses 'roles and responsibilities when implementing the CALS protocol may hinder their performance to their full scope of practice, leading to poor patient outcomes.
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Affiliation(s)
- Lydia Team
- Monash Health, Clayton, Victoria, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
- Intensive Care Unit, Princess Alexandra Hospital, Metro South Health, Woolloongabba, Queensland, Australia
| | - Bernice Redley
- School of Nursing and Midwifery, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research-Monash Health Partnership, Monash Health, Clayton, Victoria, Australia
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Maximos M, Dal Bello-Haas V, Tang A, Stratford P, Kalu M, Virag O, Kaasalainen S, Gafni A. Barriers and Facilitators of a Community-Based, Slow-Stream Rehabilitation, Hospital-to-Home Transition Program for Older Adults: Perspectives of a Multidisciplinary Care Team. Can J Aging 2024; 43:124-140. [PMID: 37665030 DOI: 10.1017/s0714980823000442] [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: 09/05/2023] Open
Abstract
The purpose of this study was to examine the perspectives of support staff, health care professionals, and care coordinators working in or referring to a community-based, slow-stream rehabilitation, hospital-to-home transition program regarding gaps in services, and barriers and facilitators related to implementation and functioning of the program. This was a qualitative descriptive study. Recruitment was conducted through purposive sampling, and 23 individuals participated in a focus groups or individual semi-structured interview. Transcripts were analyzed by six researchers using inductive thematic analysis. Themes that emerged were organized based on a socio-ecological framework. Themes were categorized as: (1) macro level, meaning gaps while waiting for program, limited program capacity, and gaps in service post-program completion; (2) meso level, meaning lack of knowledge and awareness of the program, lack of specific referral process and procedures, lack of specific eligibility criteria, and need for enhanced communication among care settings; or (3) micro level, meaning services provided, program participant benefits, person-centred communication, program structure constraints, need for use of outcome measures, and follow-up or lack of follow-up. Implementation of seamless patient information sharing, documentation, use of specific referral criteria, and use of standardized outcome measures may reduce the number of unsuitable referrals and provide useful information for referral and program staff.
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Affiliation(s)
- Melody Maximos
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Vanina Dal Bello-Haas
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Ada Tang
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Paul Stratford
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Michael Kalu
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Olivia Virag
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Sharon Kaasalainen
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
| | - Amiram Gafni
- School of Rehabilitation Science, Faculty of Health Sciences, McMaster University, Institute of Applied Health Science, Hamilton, ON, Canada
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Naja F, Abbas N, Khaleel S, Zeb F, Osaili TAH, Obaid RS, Faris M, Radwan H, Ismail LC, Hassan H, Hashim M, AlZubaidi H. Beyond pillbox: a national cross-sectional study on the attitudes, practices, and knowledge of community pharmacists regarding complementary and alternative medicine. BMC Complement Med Ther 2024; 24:107. [PMID: 38418995 PMCID: PMC10902973 DOI: 10.1186/s12906-024-04391-8] [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: 10/29/2023] [Accepted: 02/06/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND While community pharmacists are uniquely positioned to promote the safe and effective use of complementary and alternative medicine, their potential role remains largely untapped. The objective of this study was to assess the knowledge, attitudes, and practices related to complementary and alternative medicine products among community pharmacists in the United Arab Emirates and explore the correlates of knowledge in the study sample. METHODS Using a stratified random sampling frame, a national survey of community pharmacists was conducted in the United Arab Emirates. In a face-to-face interaction, participants completed a multi-component questionnaire consisting of four sections: sociodemographic and general characteristics; knowledge of complementary and alternative medicine products and usage; attitudes towards complementary and alternative medicine and practices related to complementary and alternative medicine. Based on participants' answers, scores were calculated with higher scores indicating more positive knowledge, attitudes, and practices. RESULTS 373 community pharmacists participated in the study (response rate: 83%). For the knowledge questions, more than 50% of community pharmacists correctly answered the functions of complementary and alternative medicine, however lower percentages were noted for the side effects and drug interactions questions. Most community pharmacists had positive attitudes towards complementary and alternative medicine, except for particular aspects such as efficacy, where 40% agreed that complementary and alternative medicine is only effective in treating minor complaints. As for practices, while more than 70% of participants counseled patients on complementary and alternative medicine use, only 47% reported the toxic effects when encountered. Multiple linear regressions showed that community pharmacists working in independent pharmacies, those with fewer years of experience, and those who did not receive complementary and alternative medicine education during their academic degree had lower knowledge scores (p < 0.05). CONCLUSIONS The findings of this study showed that community pharmacists in the United Arab Emirates have good knowledge of complementary and alternative medicine functions and generally positive attitudes and practices, with few gaps identified in each. Together, these findings provide critical evidence for the development of targeted interventions to promote the role of community pharmacists towards safe and effective complementary and alternative medicine use in the country.
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Affiliation(s)
- Farah Naja
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Department of Nutrition and Food Sciences, American University of Beirut, P.O.Box 110236, Beirut, Lebanon
| | - Nada Abbas
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Sharfa Khaleel
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Falak Zeb
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Tareq A H Osaili
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Department of Nutrition and Food Technology, Faculty of Agriculture, Jordan University of Science and Technology, P.O. Box 3030, Irbid, 22110, Jordan
| | - Reyad Shaker Obaid
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - MoezAlIslam Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Hadia Radwan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Leila Cheikh Ismail
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Haydar Hassan
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Mona Hashim
- Department of Clinical Nutrition and Dietetics, College of Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
- Research Institute of Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates
| | - Hamzah AlZubaidi
- Research Institute of Medical and Health Sciences, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates.
- Department of Pharmacy Practice and Pharmacotherapeutics, University of Sharjah, P.O. Box 27272, Sharjah, United Arab Emirates.
- School of Medicine, Deakin Rural Health, Deakin University Faculty of Health, Warrnambool, VIC, 3216, Australia.
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Makrides T, Law MP, Ross L, Gosling C, Acker J, O'Meara P. Shaping the future design of paramedicine: A knowledge to action framework to support paramedic system modernization. Australas Emerg Care 2023; 26:296-302. [PMID: 36931964 DOI: 10.1016/j.auec.2023.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Over the past two decades, the demands placed on modern paramedic systems has changed. Paramedic services can no longer continue to operate on a traditional response model where more ambulances are deployed to meet the rising demand of patients calling for their health needs. Recent research has explored system design in paramedicine and its relationship with organizational performance. Two subsequent paramedic systems have been identified with one, the Professionally Autonomous paramedic system, being linked to higher performance. Yet, how to operationalize this model for system modernization continues to be a gap in practice. OBJECTIVE To provide health leaders and policy makers with a framework from which to drive paramedic system modernization. METHODS This study uses the Knowledge to Action framework to develop an implementation plan for systems that seek to modernize their service delivery model toward that of a Professionally Autonomous paramedic system. RESULTS A detailed plan of the steps required to undertake system transformation are outlined. Whilst this framework outlines the components required for system modernization, it does not propose an in-depth outline of each of the steps required to achieve each component. Rather, end users are encouraged to develop individual implementation plans tailored to the local context using the comprehensive tools outlined within. CONCLUSION This knowledge to action framework provides health leaders and policy makers with a uniform roadmap for paramedic system modernization intended to improve health (clinical) outcomes as well as health system outcomes through the Professional Autonomous paramedicine model.
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Affiliation(s)
- Timothy Makrides
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing & Health Science, Monash University, Clayton, Australia; British Columbia Emergency Health Services, Vancouver, Canada.
| | - Madelyn P Law
- Brock University, Department of Health Sciences, St Catherines, Canada
| | - Linda Ross
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing & Health Science, Monash University, Clayton, Australia
| | - Cameron Gosling
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing & Health Science, Monash University, Clayton, Australia
| | - Joseph Acker
- University of British Columbia, Faculty of Medicine, Vancouver, Canada; Charles Sturt University, School of Biomedical Sciences, Port Macquarie, Australia; Ambulance Tasmania, Hobart, Australia
| | - Peter O'Meara
- Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing & Health Science, Monash University, Clayton, Australia
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Bonner A, Douglas B, Brown L, Harvie B, Lucas A, Tomlins M, Gillespie K. Understanding the practice patterns of nephrology nurse practitioners in Australia. J Ren Care 2023; 49:278-287. [PMID: 36210458 DOI: 10.1111/jorc.12444] [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] [Received: 05/29/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Nurse practitioners (NP) have an expanded scope of practice beyond that of a registered nurse. In kidney care, nephrology NP can manage patients at various points along the chronic kidney disease (CKD) trajectory. OBJECTIVES To profile the characteristics, service patterns, and domains of practice of nephrology NP in Australia. DESIGN A cross-sectional online secure survey. PARTICIPANTS Nephrology NP (NP students) who were members of the Renal Society of Australasia and working in Australia (n = 73). MEASUREMENTS Data collected were demographic and practice characteristics, and domains of practice (using the modified Strong Model of Advanced Practice). The survey also sought qualitative perspectives of the enablers and barriers to sustainability nurse practitioner healthcare delivery services. RESULTS Nephrology NP (n = 45) primarily worked in adult services, managing those receiving haemodialysis, peritoneal dialysis, or patients with earlier grades of CKD. Providing direct comprehensive care was the dominant domain of advanced practice although administrative activities took up considerable time each week. Support from nurse leaders and medical colleagues was identified as key enablers for sustainability of these services whereas succession planning, and workload were the main barriers. CONCLUSIONS This study found a highly qualified, experienced but older nephrology nurse practitioner workforce who provide an additional model of health service delivery which can meet the growing CKD burden. Internationally, this level of nurse provides an opportunity for a career pathway to maintain nurses in direct clinical roles and to expand the nephrology nursing workforce.
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Affiliation(s)
- Ann Bonner
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
- Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
- Kidney Health Service, Metro North Health, Brisbane, Queensland, Australia
| | - Bettina Douglas
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland, Australia
| | - Leanne Brown
- Cape York Kidney Care, Torres and Cape Hospital and Health Service, Weipa, St Lucia, Australia
| | - Barbara Harvie
- School of Nursing and Midwifery, University of Tasmania, Hobart, Tasmania, Australia
| | - Anthony Lucas
- Department of Renal Medicine, Cairns and Hinterland Hospital and Health Service, Cairns, Queensland, Australia
| | - Melinda Tomlins
- Department of Nephrology, Hunter New England Health District, Newcastle, New South Wales, Australia
| | - Kerri Gillespie
- School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia
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Ilie G, MacDonald C, Richman H, Rendon R, Mason R, Nuyens A, Bailly G, Bell D, Patil N, Bowes D, Champion E, Wilke D, Massoeurs L, Hassan N, Rutledge RDH. Assessing the Efficacy of a 28-Day Comprehensive Online Prostate Cancer Patient Empowerment Program (PC-PEP) in Facilitating Engagement of Prostate Cancer Patients in Their Survivorship Care: A Qualitative Study. Curr Oncol 2023; 30:8633-8652. [PMID: 37754541 PMCID: PMC10528560 DOI: 10.3390/curroncol30090626] [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] [Received: 08/18/2023] [Revised: 09/18/2023] [Accepted: 09/19/2023] [Indexed: 09/28/2023] Open
Abstract
A 28-day Prostate Cancer-Patient Empowerment Program (PC-PEP) developed through patient engagement was successful at promoting mental and physical health. Thirty prostate cancer patients from Halifax, Canada participated in the 28-day PC-PEP intervention in early 2019. PC-PEP encompassed daily patient education and empowerment videos, prescribed physical activities (including pelvic floor exercises), a mostly plant-based diet, stress reduction techniques, intimacy education, social connection, and support. Quantitative exit surveys and semi-structured interviews (conducted in focus groups of ten) were used to assess perceived factors that facilitated or impeded adherence to the program. The program received high praise from the patients and was deemed extremely useful by the participating men, who rated it 9 out of 10. Patients expressed that the multifaceted, online, home-based nature of the program helped them adhere to it better than they would have had to a single or less comprehensive intervention. Feedback from the participants indicated that the program, when viewed as a whole, was perceived as greater than the sum of its individual parts. Furthermore, the program addressed various issues, including emotional vulnerability and distress, physical fitness, urinary incontinence, challenges in expressing emotions, perceived lack of control over healthcare decisions, emotional fragility, and hesitancy to discuss prostate cancer-related matters in social settings. Patients highly (9.6/10) endorsed integrating the program into the standard care regimen from the very beginning of diagnosis. However, challenges such as work commitments were noted. Patients' high endorsement of PC-PEP suggests that its implementation into the standard of care from day one of diagnosis may be warranted.
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Affiliation(s)
- Gabriela Ilie
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.M.); (H.R.); (A.N.); (L.M.); (N.H.)
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Cody MacDonald
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.M.); (H.R.); (A.N.); (L.M.); (N.H.)
| | - Hal Richman
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.M.); (H.R.); (A.N.); (L.M.); (N.H.)
| | - Ricardo Rendon
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Ross Mason
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Alexandra Nuyens
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.M.); (H.R.); (A.N.); (L.M.); (N.H.)
| | - Greg Bailly
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - David Bell
- Department of Urology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Nikhilesh Patil
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - David Bowes
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | | | - Derek Wilke
- Department of Radiation Oncology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada
| | - Lia Massoeurs
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.M.); (H.R.); (A.N.); (L.M.); (N.H.)
| | - Nada Hassan
- Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada; (C.M.); (H.R.); (A.N.); (L.M.); (N.H.)
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Leslie K, Bourgeault IL, Carlton AL, Balasubramanian M, Mirshahi R, Short SD, Carè J, Cometto G, Lin V. Design, delivery and effectiveness of health practitioner regulation systems: an integrative review. HUMAN RESOURCES FOR HEALTH 2023; 21:72. [PMID: 37667368 PMCID: PMC10478314 DOI: 10.1186/s12960-023-00848-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/23/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Health practitioner regulation (HPR) systems are increasingly recognized as playing an important role in supporting health workforce availability, accessibility, quality, and sustainability, while promoting patient safety. This review aimed to identify evidence on the design, delivery and effectiveness of HPR to inform policy decisions. METHODS We conducted an integrative analysis of literature published between 2010 and 2021. Fourteen databases were systematically searched, with data extracted and synthesized based on a modified Donabedian framework. FINDINGS This large-scale review synthesized evidence from a range of academic (n = 410) and grey literature (n = 426) relevant to HPR. We identified key themes and findings for a series of HPR topics organized according to our structures-processes-outcomes conceptual framework. Governance reforms in HPR are shifting towards multi-profession regulators, enhanced accountability, and risk-based approaches; however, comparisons between HPR models were complicated by a lack of a standardized HPR typology. HPR can support government workforce strategies, despite persisting challenges in cross-border recognition of qualifications and portability of registration. Scope of practice reform adapted to modern health systems can improve access and quality. Alternatives to statutory registration for lower-risk health occupations can improve services and protect the public, while standardized evaluation frameworks can aid regulatory strengthening. Knowledge gaps remain around the outcomes and effectiveness of HPR processes, including continuing professional development models, national licensing examinations, accreditation of health practitioner education programs, mandatory reporting obligations, remediation programs, and statutory registration of traditional and complementary medicine practitioners. CONCLUSION We identified key themes, issues, and evidence gaps valuable for governments, regulators, and health system leaders. We also identified evidence base limitations that warrant caution when interpreting and generalizing the results across jurisdictions and professions. Themes and findings reflect interests and concerns in high-income Anglophone countries where most literature originated. Most studies were descriptive, resulting in a low certainty of evidence. To inform regulatory design and reform, research funders and governments should prioritize evidence on regulatory outcomes, including innovative approaches we identified in our review. Additionally, a systematic approach is needed to track and evaluate the impact of regulatory interventions and innovations on achieving health workforce and health systems goals.
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Affiliation(s)
- Kathleen Leslie
- Athabasca University, Athabasca, Canada.
- Canadian Health Workforce Network, Ottawa, Canada.
| | - Ivy Lynn Bourgeault
- University of Ottawa, Ottawa, Canada
- Canadian Health Workforce Network, Ottawa, Canada
| | - Anne-Louise Carlton
- Royal Melbourne Institute of Technology (RMIT) University, Melbourne, Australia
| | - Madhan Balasubramanian
- College of Business, Government and Law, Flinders University, Adelaide, Australia
- Menzies Centre for Health Policy and Economics, The University of Sydney, Sydney, Australia
| | - Raha Mirshahi
- University of Ottawa, Ottawa, Canada
- Canadian Health Workforce Network, Ottawa, Canada
| | | | - Jenny Carè
- University of Technology Sydney, Sydney, Australia
| | | | - Vivian Lin
- University of Hong Kong, Hong Kong, China
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Burgmann S, Paier-Abuzahra M, Sprenger M, Avian A, Siebenhofer A. Identifying key policy objectives for strong primary care: a cross-sectional study. Prim Health Care Res Dev 2023; 24:e52. [PMID: 37577950 PMCID: PMC10466205 DOI: 10.1017/s1463423623000403] [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] [Received: 08/07/2022] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 08/15/2023] Open
Abstract
AIM The aim of this study was to identify key policy objectives by investigating the perception of important stakeholders and affected professionals concerning relevance and feasibility of a successful primary care (PC) reform. BACKGROUND Since 2013, the Austrian PC system has been undergoing a reform process to establish multiprofessional primary care units. The reforms have various defined objectives and lack clear priorities. METHODS After the definition and consensus-based selection of 12 policy objectives, a cross-sectional online survey on their relevance and feasibility was distributed via email and social media to PC and public health networks. The survey was conducted in the period from January to February 2020. Results were analyzed descriptively, and further, Pearson Chi-Square Test or Fisher's Exact Test was performed for group comparison regarding respondents' characteristics. Open-ended responses were analyzed using qualitative content analysis. FINDINGS In total, 169 questionnaires were completed. A total of 46.3% of the responders had more than 20 years of professional experience (female: 60.5%). A mandatory internship in general practice, vocational training for general practice, and a modern remuneration system were the three top-rated policy objectives regarding relevance. A mandatory internship in general practice, specialization in general practice, and coding of services and diagnosis were assessed as the most feasible objectives. The group comparisons regarding working field, years of professional experience, age, and sex did not show any meaningful results in the evaluation of relevance and feasibility. DISCUSSION In the view of the study participants, easily obtainable objectives include adapting the duration and setting of internships for medical students, as well as mandatory vocational training for GP trainees. Further efforts are necessary to achieve complex objectives such as the adoption of a modern remuneration scheme and a comprehensive quality assurance program. Building capacity and creating team-oriented environments are also important aspects of a successful PC reform.
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Affiliation(s)
- Sarah Burgmann
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Muna Paier-Abuzahra
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Martin Sprenger
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Andrea Siebenhofer
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
- Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Frankfurt60590, Germany
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Geurkink TH, Marang-van de Mheen PJ, Nagels J, Poolman RW, Nelissen RG, van Bodegom-Vos L. Impact of Active Disinvestment on Decision-Making for Surgery in Patients With Subacromial Pain Syndrome: A Qualitative Semi-structured Interview Study Among Hospital Sales Managers and Orthopedic Surgeons. Int J Health Policy Manag 2023; 12:7710. [PMID: 38618816 PMCID: PMC10590240 DOI: 10.34172/ijhpm.2023.7710] [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] [Received: 09/29/2022] [Accepted: 07/31/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Withdrawal of reimbursement for low-value care through a policy change, ie, active disinvestment, is considered a potentially effective de-implementation strategy. However, previous studies have shown conflicting results and the mechanism through which active disinvestment may be effective is unclear. This study explored how the active disinvestment initiative regarding subacromial decompression (SAD) surgery for subacromial pain syndrome (SAPS) in the Netherlands influenced clinical decision-making around surgery, including the perspectives of orthopedic surgeons and hospital sales managers. METHODS We performed 20 semi-structured interviews from November 2020 to October 2021 with ten hospital sales managers and ten orthopedic surgeons from twelve hospitals across the Netherlands as relevant stakeholders in the active disinvestment process. The interviews were video-recorded and transcribed verbatim. Inductive thematic analysis was used to analyse interview transcripts independently by two authors and discrepancies were resolved through discussion. RESULTS Two overarching themes were identified that negatively influenced the effect of the active disinvestment initiative for SAPS. The first theme was that the active disinvestment represented a "Too small piece of the pie" indicating little financial consequences for the hospital as it was merely used in negotiations with healthcare insurers to reduce costs, required a disproportionate amount of effort from hospital staff given the small saving-potential, and was not clearly defined nor enforced in the overall healthcare insurer agreements. The second theme was "They [healthcare insurer] got it wrong," as the evidence and guidelines had been incorrectly interpreted, the active disinvestment was at odds with clinician experiences and beliefs and was perceived as a reduction in their professional autonomy. CONCLUSION The two overarching themes and their underlying factors highlight the complexity for active disinvestment initiatives to be effective. Future de-implementation initiatives including active disinvestment should engage relevant stakeholders at an early stage to incorporate their different perspectives, gain support and increase the probability of success.
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Affiliation(s)
- Timon H. Geurkink
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Perla J. Marang-van de Mheen
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Jochem Nagels
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rudolf W. Poolman
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Rob G.H.H. Nelissen
- Department of Orthopaedics, Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Biomedical Data Sciences, Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
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Sono TM, Yeika E, Cook A, Kalungia A, Opanga SA, Acolatse JEE, Sefah IA, Jelić AG, Campbell S, Lorenzetti G, Ul Mustafa Z, Marković-Peković V, Kurdi A, Anand Paramadhas BD, Rwegerera GM, Amu AA, Alabi ME, Wesangula E, Oluka M, Khuluza F, Chikowe I, Fadare JO, Ogunleye OO, Kibuule D, Hango E, Schellack N, Ramdas N, Massele A, Mudenda S, Hoxha I, Moore CE, Godman B, Meyer JC. Current rates of purchasing of antibiotics without a prescription across sub-Saharan Africa; rationale and potential programmes to reduce inappropriate dispensing and resistance. Expert Rev Anti Infect Ther 2023; 21:1025-1055. [PMID: 37740561 DOI: 10.1080/14787210.2023.2259106] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 09/07/2023] [Indexed: 09/24/2023]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) is a global concern. Currently, the greatest mortality due to AMR is in Africa. A key driver continues to be high levels of dispensing of antibiotics without a prescription. AREAS COVERED A need to document current rates of dispensing, their rationale and potential ways forward including antimicrobial stewardship programmes (ASPs). A narrative review was undertaken. The highest rates of antibiotic purchasing were in Eritrea (up to 89.2% of antibiotics dispensed), Ethiopia (up to 87.9%), Nigeria (up to 86.5%), Tanzania (up to 92.3%) and Zambia (up to 100% of pharmacies dispensing antibiotics without a prescription). However, considerable variation was seen with no dispensing in a minority of countries and situations. Key drivers of self-purchasing included high co-payment levels for physician consultations and antibiotic costs, travel costs, convenience of pharmacies, patient requests, limited knowledge of antibiotics and AMR and weak enforcement. ASPs have been introduced in some African countries along with quality targets to reduce inappropriate dispensing, centering on educating pharmacists and patients. EXPERT OPINION ASP activities need accelerating among community pharmacies alongside quality targets, with greater monitoring of pharmacists' activities to reduce inappropriate dispensing. Such activities, alongside educating patients and healthcare professionals, should enhance appropriate dispensing of antibiotics and reduce AMR.
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Affiliation(s)
- Tiyani Milta Sono
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Saselamani Pharmacy, Saselamani, South Africa
| | - Eugene Yeika
- Programs coordinator/Technical supervisor for HIV/Malaria, Delegation of Public Health, Cameroon
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Aubrey Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
| | - Sylvia A Opanga
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | | | - Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ho, Ghana
| | - Ana Golić Jelić
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
| | - Stephen Campbell
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Zia Ul Mustafa
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Gelugor, Penang, Malaysia
- Department of Pharmacy Services, District Headquarter (DHQ) Hospital, Pakpattan, Pakistan
| | - Vanda Marković-Peković
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia & Herzegovina
| | - Amanj Kurdi
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
- College of Pharmacy, Al-Kitab University, Kirkuk, Iraq
| | - Bene D Anand Paramadhas
- Department of Health Services Management, Central Medical Stores, Ministry of Health, Gaborone, Botswana
| | - Godfrey Mutashambara Rwegerera
- Faculty of Medicine, Department of Internal Medicine, University of Botswana, Gaborone, Botswana
- DestinyMedical and Research Solutions Proprietary Limited, Gaborone, Botswana
| | - Adefolarin A Amu
- Pharmacy Department, Eswatini Medical Christian University, Mbabane, Kingdom of Eswatini
| | - Mobolaji Eniola Alabi
- School of Pharmaceutical Sciences, College of Health Sciences,University of Kwazulu-natal (UKZN), Durban, South Africa
| | - Evelyn Wesangula
- East Central and Southern Africa Health Community, Arusha, Tanzania
| | - Margaret Oluka
- Department of Pharmacology, Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi, Kenya
| | - Felix Khuluza
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Ibrahim Chikowe
- Pharmacy Department, Kamuzu University of Health Sciences (KUHeS) (formerly College of Medicine), Blantyre, Malawi
| | - Joseph O Fadare
- Department of Pharmacology and Therapeutics, Ekiti State University, Ado-Ekiti, Nigeria
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Uganda
| | - Dan Kibuule
- Department of Pharmacology & Therapeutics, Busitema University, Mbale, Uganda
| | - Ester Hango
- Department of Pharmacy Practice and Policy, School of Pharmacy, Faculty of Health Sciences, University of Namibia, Windhoek, Namibia
| | - Natalie Schellack
- Department of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, SouthAfrica
| | - Nishana Ramdas
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
| | - Amos Massele
- Department of Clinical Pharmacology and Therapeutics, Hurbert Kairuki Memorial University, Dar Es Salaam, Tanzania
| | - Steward Mudenda
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, Zambia
- Africa Center of Excellence for Infectious Diseases of Humans and Animals, School of Veterinary Meicine, University of Zambia, Lusaka, Zambia
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, Tirana, Albania
| | - Catrin E Moore
- Centre for Neonatal and Paediatric Infection, Institute of Infection and Immunity, St. George's University of London, London, UK
| | - Brian Godman
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - Johanna C Meyer
- Department of Public Health Pharmacy and Management, Schoolof Pharmacy, Sefako Makgatho Health Sciences University, Garankuwa, Pretoria, South Africa
- South African Vaccination and Immunisation Centre, Sefako Makgatho HealthSciences University, Garankuwa, Pretoria, South Africa
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Hawley G, Grogan A, McGuire T, van Driel M, Hollingworth S. Nurse practitioner and midwife antibiotic prescribing in Australia. Eur J Midwifery 2023; 7:11. [PMID: 37250143 PMCID: PMC10214476 DOI: 10.18332/ejm/162439] [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: 10/09/2022] [Revised: 03/16/2023] [Accepted: 04/14/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION Antimicrobial resistance is of global significance. To reduce the risk of harm associated with antibiotic prescribing in Australia, a recent strategy to tackle antimicrobial resistance has included non-medical prescribers. Traditionally, antibiotic prescribing has been the domain of the medical profession but, more recently, nurse practitioners and endorsed midwives have been authorized to prescribe antibiotics. This study describes the antibiotic prescribing practices by nurse practitioners and endorsed midwives in Australia, with clinical implications for international settings. METHODS This was a retrospective analysis of routinely collected aggregated data of anonymous individuals. Data on dispensed prescriptions of antibiotics were obtained from the Australian Department of Human Services, for the period 2005-2016. All antibiotics were allocated to a spectrum class (narrow, moderate, broad). Analysis using descriptive statistics was undertaken to determine the antibiotic prescribing patterns of nurse practitioners and endorsed midwives. RESULTS Nurse practitioners have been prescribing within Australia since 2000, and midwives since 2012. Nurse practitioner antibiotic written scripts increased from 3143 during 2005-2011 to 34615 in 2012-2016, while antibiotic written scripts by midwives increased from 2012 (n=2) to 2016 (n=469). Nurse practitioners and midwives prescribed similar classes of antibiotics. These professionals are important non-medical prescribers and are increasingly writing antibiotic prescriptions.Both nursing and midwifery cohorts complete accredited education programs, albeit with some differences in structure. CONCLUSIONS When prescribing antibiotics, nurse practitioners and midwives are following evidenced-based therapeutic guidelines. They are increasingly relevant clinicians prescribing antibiotics, particularly in acute and primary care settings, which has relevance in global antimicrobial strategies.
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Affiliation(s)
- Glenda Hawley
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Australia
| | - Aaron Grogan
- School of Nursing, Midwifery and Social Work, The University of Queensland, St Lucia, Australia
| | - Treasure McGuire
- School of Pharmacy, The University of Queensland, Woolloongabba, Australia
- Mater Pharmacy Services, Mater Health Services, South Brisbane, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Mieke van Driel
- Primary Care Clinical Unit, The University of Queensland, Herston, Australia
- General Practice Clinical Unit, Faculty of Medicine, University of Queensland, Brisbane, Australia
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23
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Boma PM, Panda J, Ngoy Mande JP, Bonnechère B. Rehabilitation: a key service, yet highly underused, in the management of young patients with sickle cell disease after stroke in DR of Congo. Front Neurol 2023; 14:1104101. [PMID: 37292134 PMCID: PMC10244556 DOI: 10.3389/fneur.2023.1104101] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 05/02/2023] [Indexed: 06/10/2023] Open
Affiliation(s)
- Paul Muteb Boma
- Reference Centre for Sickle Cell Disease of Lubumbashi, Institut de Recherche en Science de la Santé, Lubumbashi, Democratic Republic of Congo
| | - Jules Panda
- Reference Centre for Sickle Cell Disease of Lubumbashi, Institut de Recherche en Science de la Santé, Lubumbashi, Democratic Republic of Congo
- Department of Surgery, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Jean Paul Ngoy Mande
- Department of Neurology and Psychiatry, Faculty of Medicine, University of Lubumbashi, Lubumbashi, Democratic Republic of Congo
| | - Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, University of Hasselt, Hasselt, Belgium
- Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, University of Hasselt, Hasselt, Belgium
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Burgmann S, Huter S, Mayerl H, Paier-Abuzahra M, Siebenhofer A. Facilitators and barriers in general practitioners' choice to work in primary care units in Austria: a qualitative study. DAS GESUNDHEITSWESEN 2023; 85:e32-e41. [PMID: 37172594 PMCID: PMC10181885 DOI: 10.1055/a-2011-5362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
BACKGROUND Recent reforms in Austria have focused on establishing team-based care within multiprofessional primary care units, to enhance amongst others, the work attractiveness of general practice. Nearly 75% of qualified general practitioners are not working as contracted physicians with the social health insurance. This study aims to explore the facilitators of and barriers to non-contracted general practitioners to work in a primary care unit. METHODS We conducted twelve semi-structured, problem-centered interviews among purposively sampled non-contracted general practitioners. To extract categories of facilitators and barriers for working in a primary care unit, transcribed interviews were inductively coded using qualitative content analysis. Subcategories were grouped into factors (facilitators and barriers) of thematic criteria and mapped on the macro-, meso-, micro-, and individual levels. RESULTS We identified 41 categories, including 21 facilitators and 20 barriers. Most facilitators were located at the micro-level, while most barriers were located at the macro-level. Teamwork and associated conditions made primary care units attractive as workplaces and corresponded with individual demands. In contrast, system factors tended to reduce the attractiveness of working as a general practitioner. CONCLUSIONS Multifaceted efforts are needed to address relevant factors at all of the levels mentioned above. These need to be carried out and consistently communicated by all stakeholders. Efforts to strengthen the holistic approach in primary care, like modern remuneration and patient steering mechanisms, are essential. Financial support, consulting services as well as training on entrepreneurship, management, leadership, and team-based care may help to reduce the risk and burden of founding and running a primary care unit.
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Affiliation(s)
- Sarah Burgmann
- Planung und Systementwicklung, Koordination Primärversorgung, Gesundheit Österreich GmbH, Wien, Austria
- Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Graz, Austria
| | - Sebastian Huter
- Institut für Allgemein-, Familien- und Präventivmedizin, Paracelsus Medizinische Privatuniversitat, Salzburg, Austria
| | - Hannes Mayerl
- Institut für Sozialmedizin, Medizinische Universität Graz, Graz, Austria
| | - Muna Paier-Abuzahra
- Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Graz, Austria
| | - Andrea Siebenhofer
- Institut für Allgemeinmedizin und evidenzbasierte Versorgungsforschung, Medizinische Universität Graz, Graz, Austria
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Balfe J, Donnelly J, Tecklenborg S, Walsh A. Exploring the barriers and enablers experienced by people with Cystic Fibrosis and their healthcare professionals in accessing, utilising and delivering maternity and Cystic Fibrosis care during the pre-conception to post-partum period: A mixed methods systematic review protocol. HRB Open Res 2023; 5:22. [PMID: 37251363 PMCID: PMC10220422 DOI: 10.12688/hrbopenres.13500.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Background Cystic Fibrosis (CF) is an autosomal recessive inherited multi-system disease that primarily affects the lungs and digestive system. New drug therapies and treatments are improving the lives of many people with CF. With improved life expectancy and increased quality of life, many people with CF are now contemplating parenthood and becoming pregnant, an aspiration that decades ago was almost unheard of. Given this quickly evolving and more positive health landscape, it is vital to understand how people with CF experience the care they receive whilst accessing and utilising fertility and maternity services. It is also important to explore the experiences of healthcare professionals involved in providing care during this period. The overall aim of the mixed-methods systematic review will be to explore the barriers and enablers experienced by people with CF and the healthcare professionals involved in their care in the pre-conception to post-partum period. Methods The proposed review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for convergent integrated mixed methods systematic reviews. A systematic search of Medline (Ebsco), Cinahl, Embase, APA PsychINFO and Cochrane Library from inception to February 2022 will be conducted. Quantitative, qualitative and mixed methods studies pertaining to the experience of pre-conception to post-partum care for people with CF and their healthcare professionals will be included. Two independent reviewers will screen titles, abstracts and full texts with disagreements being resolved by a third reviewer. Conclusion This review will help to determine the potential barriers and facilitators experienced by people with Cystic Fibrosis and the health care professionals involved in their care during the pre-conception to post-partum period. The results will be of benefit specifically to the CF population and their healthcare providers when planning further studies in the area of fertility and pregnancy for this population and when delivering care.
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Affiliation(s)
- Jen Balfe
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Jennifer Donnelly
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Rotunda Hospital, Dublin, Ireland
- Mater Misericordiae University Hospital, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | | | - Aisling Walsh
- RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Kodi SM, Sharma SK, Basu S. Perception, perceived scope, and potential barriers towards developing nurse practitioners cadre among health care providers and beneficiaries: A pilot study from Northern India. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:92. [PMID: 37288389 PMCID: PMC10243426 DOI: 10.4103/jehp.jehp_1200_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/03/2022] [Indexed: 06/09/2023]
Abstract
BACKGROUND The role of nurse practitioner (NP) emerged in early 1965 when general practitioners began working with nurses. Evidence across the world highlights the benefits achieved by the NP role. The Indian Nursing Council (INC) implemented a country-wide NP in critical care (NPCC) program with the approval of the ministry of health and family welfare (MoHFW) in 2017. The NP role is in its infancy in India. Hence, there is a need to assess the perception among beneficiaries and healthcare personnel. This study was conducted to assess the perception, perceived scope, and potential barriers for developing the role of NPs in India among beneficiaries and healthcare providers. MATERIAL AND METHODS A descriptive, cross-sectional pilot study was conducted at AIIMS Rishikesh, Uttarakhand, India, among 205 participants (84 beneficiaries, 78 nurses, and 43 physicians) using a proportionate stratified random sampling technique. Likert scales and socio-demographic sheets were used to assess the perception, perceived scope of practice, and potential barriers in developing a NP cadre in India. Descriptive and inferential statistics were used for analyzing data. RESULTS The mean age of beneficiaries was 37.98, nurses was 27.58, and physicians was 28.13 years, respectively. 121 (61%) of participants were highly favored, and 77 (38%) were in favor of developing NP cadre in India. They considered it to be necessary, feasible, and acceptable in India. The feasibility and necessity of the perception domain were highly significant (P < 0.001 and P < 0.003, respectively). Nurses (mean ± SD: 35.36 ± 3.55) considered that NPs could have a wide range of practice followed by beneficiaries (mean ± SD: 38.17 ± 3.68) than physicians (mean ± SD: 34.75 ± 5.95). Lack of awareness, the nonexistence of cadre structure, lack of acceptance of the role of physicians, and lack of clear policy were the key potential barriers to develop an NP cadre in India. CONCLUSIONS In this study, participants had favorable views on employing NPs in India; thus, this role will improve healthcare access for beneficiaries. NPs can carry out a wide range of practices.However, a lack of awareness, no cadre structure, and a lack of a clear policy may hinder the development of the NP cadre in India.
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Affiliation(s)
- S Malar Kodi
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Suresh K. Sharma
- College of Nursing, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Somprakas Basu
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Bonnechère B, Kossi O, Mapinduzi J, Panda J, Rintala A, Guidetti S, Spooren A, Feys P. Mobile health solutions: An opportunity for rehabilitation in low- and middle income countries? Front Public Health 2023; 10:1072322. [PMID: 36761328 PMCID: PMC9902940 DOI: 10.3389/fpubh.2022.1072322] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/27/2022] [Indexed: 01/25/2023] Open
Abstract
Mobile health (mHealth) development has advanced rapidly, indicating promise as an effective patient intervention. mHealth has many potential benefits that could help the treatment of patients, and the development of rehabilitation in low- and middle-income countries (LMICs). mHealth is a low-cost option that does not need rapid access to healthcare clinics or employees. It increases the feasibility and rationality of clinical treatment expectations in comparison to the conventional clinical model of management by promoting patient adherence to the treatment plan. mHealth can also serve as a basis for formulating treatment plans and partially compensate for the shortcomings of the traditional model. In addition, mHealth can help achieve universal rehabilitation service coverage by overcoming geographical barriers, thereby increasing the number of ways patients can benefit from the rehabilitation service, and by providing rehabilitation to individuals in remote areas and communities with insufficient healthcare services. However, despite these positive potential aspects, there is currently only a very limited number of studies performed in LMICs using mHealth. In this study, we first reviewed the current evidence supporting the use of mHealth in rehabilitation to identify the countries where studies have been carried out. Then, we identify the current limitations of the implementation of such mHealth solutions and propose a 10-point action plan, focusing on the macro (e.g., policymakers), meso (e.g., technology and healthcare institutions), and micro (e.g., patients and relatives) levels to ease the use, validation, and implementation in LMICs and thus participate in the development and recognition of public health and rehabilitation in these countries.
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Affiliation(s)
- Bruno Bonnechère
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University (UHasselt), Hasselt, Belgium,Technology-Supported and Data-Driven Rehabilitation, Data Science Institute, UHasselt, Hasselt, Belgium,*Correspondence: Bruno Bonnechère ✉
| | - Oyene Kossi
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University (UHasselt), Hasselt, Belgium,ENATSE, National School of Public Health and Epidemiology, University of Parakou, Parakou, Benin
| | - Jean Mapinduzi
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University (UHasselt), Hasselt, Belgium,INSP, Institut National de la Santé Publique, Bujumbura, Burundi,CKAO-AMAHORO, Cabinet de Kinésithérapie et d'Appareillage Orthopédique, Bujumbura, Burundi
| | - Jules Panda
- University of Lubumbashi, Lubumbashi, Democratic Republic of Congo,Institut de Recherche en Science de la Santé, Lubumbashi, Democratic Republic of Congo
| | - Aki Rintala
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University (UHasselt), Hasselt, Belgium,Faculty of Social Services and Health Care, LAB University of Applied Sciences, Lahti, Finland
| | - Susanne Guidetti
- Department of Neurobiology, Care Sciences and Society, Division for Occupational Therapy, Karolinska Institutet, Stockholm, Sweden,Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Annemie Spooren
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University (UHasselt), Hasselt, Belgium
| | - Peter Feys
- REVAL Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University (UHasselt), Hasselt, Belgium
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Marchand K, Turuba R, Katan C, Fogarty O, Fairbank J, Tallon C, Mathias S, Barbic S. "The system always undermined what I was trying to do as an individual": identifying opportunities to improve the delivery of opioid use services for youth from the perspective of service providers in four communities across British Columbia, Canada. Addict Sci Clin Pract 2023; 18:1. [PMID: 36593469 PMCID: PMC9806820 DOI: 10.1186/s13722-022-00359-6] [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] [Received: 07/18/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Substance use among youth is a longstanding global health concern that has dramatically risen in the era of highly toxic and unregulated drugs, including opioids. It is crucial to ensure that youth using unregulated opioids have access to evidence-based interventions, and yet, youth encounter critical gaps in the quality of such interventions. This study aims to address these gaps by identifying opportunities to improve the quality of opioid use services from the perspective of service providers, a perspective that has received scant attention. METHODS This community-based participatory study was conducted in four communities in British Columbia (Canada), a province that declared a public health overdose emergency in 2016. Human-centered co-design workshops were held to understand service providers' (n = 41) experiences, needs, and ideas for improving the quality of youth opioid use services/treatments in their community. Multi-site qualitative analysis was used to develop overarching experiences and needs themes that were further contextualized in each local community. A blended deductive and inductive thematic analysis was used to analyze the ideas data. RESULTS Three overarching themes were identified, reflecting service providers' goals to respond to youth in a timely and developmentally appropriate manner. However, this was significantly limited by organizational and systems-level barriers, revealing service providers' priorities for intra- and inter-organizational support and collaboration and systems-level innovation. Across communities, service providers identified 209 individual ideas to address these prioritized needs and improve the quality of youth opioid use services/treatments. CONCLUSION These themes demonstrate a multi-level tension between macro-level systems and the meso-level organization of youth opioid use services, which undermine the quality of individual-level care service providers can deliver. These findings underscore the need for a coordinated multi-level response, such as developing youth-specific standards (macro-level), increasing inter-organizational activities and collaboration (meso-level), and creating programs that are specific to youths' needs (micro-level).
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Affiliation(s)
- Kirsten Marchand
- Foundry, 915-1045 Howe St, Vancouver, BC, V6Z 2A9, Canada. .,Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC, V6Z 1Y6, Canada.
| | - Roxanne Turuba
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Department of Occupational Science and Occupational Therapy, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Christina Katan
- Canadian Centre on Substance Use and Addiction, 500-75 Albert St, Ottawa, ON K1P 5E7 Canada
| | - Oonagh Fogarty
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada
| | - Jill Fairbank
- Canadian Centre on Substance Use and Addiction, 500-75 Albert St, Ottawa, ON K1P 5E7 Canada
| | | | - Steve Mathias
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.17091.3e0000 0001 2288 9830Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada ,grid.498725.5Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Providence Health Care, 1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,Providence Research, 1190 Hornby St, Vancouver, BC V6Z 1Y6 Canada
| | - Skye Barbic
- Foundry, 915-1045 Howe St, Vancouver, BC V6Z 2A9 Canada ,grid.498725.5Centre for Health Evaluation Outcome Sciences, 588-1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,grid.416553.00000 0000 8589 2327St. Paul’s Hospital, Providence Health Care, 1081 Burrard St, Vancouver, BC V6Z 1Y6 Canada ,Providence Research, 1190 Hornby St, Vancouver, BC V6Z 1Y6 Canada
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Wiggins D, Downie A, Engel RM, Brown BT. Factors that influence scope of practice of the five largest health care professions in Australia: a scoping review. HUMAN RESOURCES FOR HEALTH 2022; 20:87. [PMID: 36564798 PMCID: PMC9786531 DOI: 10.1186/s12960-022-00783-4] [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: 06/24/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION A well-functioning health system delivers quality services to all people when and where they need them. To help navigate the complex realm of patient care, it is essential that health care professions have a thorough understanding of their scope of practice. However, a lack of uniformity regarding scope of practice across the regulated health professions in Australia currently exists. This has led to ambiguity about what comprises scope of practice in some health care professions in the region. OBJECTIVE The objective of this review was to explore the literature on the factors that influence scope of practice of the five largest health care professions in Australia. METHODS This study employed scoping review methodology to document the current state of the literature on factors that influence scope of practice of the five largest health care professions in Australia. The search was conducted using the following databases: AMED (Allied and Complementary Medicine Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, EMBASE (Excerpta Medica Database), MANTIS (Manual, Alternative and Natural Therapy Index System), MEDLINE, PubMed, and SCOPUS. Additional data sources were searched from Google and ProQuest. RESULTS A total of 12 771 publications were identified from the literature search. Twenty-three documents fulfilled the inclusion criteria and were included in the final analysis. Eight factors were identified across three professions (nursing & midwifery, pharmacy and physiotherapy) that influenced scope of practice: education, competency, professional identity, role confusion, legislation and regulatory policies, organisational structures, financial factors, and professional and personal factors. CONCLUSION The results of this study will inform a range of stakeholders including the private and public arms of the healthcare system, educators, employers, funding bodies, policymakers and practitioners about the factors that influence scope of practice of health professions in Australia.
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Affiliation(s)
- Desmond Wiggins
- Department of Chiropractic, Macquarie University, Sydney, Australia.
| | - Aron Downie
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Roger M Engel
- Department of Chiropractic, Macquarie University, Sydney, Australia
| | - Benjamin T Brown
- Department of Chiropractic, Macquarie University, Sydney, Australia
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Ramanathan SA, Ling R, Tattersall A, Ingold N, De Silva MS, Close S, Searles A. Impact assessment of the medical practice assisting (MPA) program in general practice in the hunter New England and central coast regions of Australia. HUMAN RESOURCES FOR HEALTH 2022; 20:81. [PMID: 36471366 PMCID: PMC9721062 DOI: 10.1186/s12960-022-00781-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 11/10/2022] [Indexed: 05/19/2023]
Abstract
BACKGROUND A regional Australian Primary Health Network (PHN) has been subsidising administrative staff from local general practices to undertake the Medical Practice Assisting (MPA) course as part of its MPA Program. The MPA Program aimed to upskill administrative staff to undertake clinical tasks and fill in for busy or absent Practice Nurses (PNs), freeing up PNs to increase revenue-generating activity, avoiding casual replacement staff wages, and increasing patient throughput. An impact assessment was undertaken to evaluate the impact and estimate the economic costs of the MPA program to the PHN, general practices, and students to inform future uptake of the intervention. METHODS The Framework to Assess the Impact of Translational Health Research (FAIT) was utilised. Originally designed to assess the impact of health research, this was its first application to a health services project. FAIT combines three validated methods of impact assessment-Payback, economic analysis and narratives underpinned by a program logic model. Quantified metrics describe the impacts of the program within various "domains of benefit", the economic model costs the intervention and monetises potential consequences, and the narrative tells the story of the MPA Program and the difference it has made. Data were collected via online surveys from general practitioners (GPs), PNs, practice managers; MPA graduates and PHN staff were interviewed by phone and on Zoom. RESULTS FAIT was effective in evidencing the impacts and economic viability of the MPA Program. GPs and PNs reported greater work satisfaction, PNs reported less stress and reduced workloads and MPA graduates reported higher job satisfaction and greater confidence performing a range of clinical skills. MPA Program economic costs for general practices during candidature, and 12 month post-graduation was estimated at $69,756. With effective re-integration planning, this investment was recoverable within 12 months through increased revenue for practices. Graduates paid appropriately for their new skills also recouped their investment within 24 months. CONCLUSION Utilisation of MPA graduates varied substantially between practices and COVID-19 impacted on their utilisation. More strategic reintegration of the MPA graduate back into the practice to most effectively utilise their new skillset could optimise potential benefits realised by participating practices.
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Affiliation(s)
- Shanthi Ann Ramanathan
- Hunter Medical Research Institute, Newcastle, Australia.
- University of Newcastle College of Health, Medicine and Wellbeing, Newcastle, Australia.
| | - Rod Ling
- Hunter Medical Research Institute, Newcastle, Australia
- University of Newcastle College of Health, Medicine and Wellbeing, Newcastle, Australia
| | - Alison Tattersall
- Hunter New England Central Coast Primary Health Network, Newcastle, Australia
| | - Nicola Ingold
- Hunter New England Central Coast Primary Health Network, Newcastle, Australia
| | - Mary Sheffi De Silva
- Hunter Medical Research Institute, Newcastle, Australia
- University of Newcastle College of Health, Medicine and Wellbeing, Newcastle, Australia
| | - Shara Close
- Hunter Medical Research Institute, Newcastle, Australia
| | - Andrew Searles
- Hunter Medical Research Institute, Newcastle, Australia
- University of Newcastle College of Health, Medicine and Wellbeing, Newcastle, Australia
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Kim MJ, McKenna H, Davidson P, Leino-Kilpi H, Baumann A, Klopper H, Al-Gasseer N, Kunaviktikul W, Sharma SK, Ventura C, Lee T. Doctoral education, advanced practice and research: An analysis by nurse leaders from countries within the six WHO regions. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100094. [PMID: 38745635 PMCID: PMC11080457 DOI: 10.1016/j.ijnsa.2022.100094] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/17/2022] Open
Abstract
Doctoral education, advanced practice and research are key elements that have shaped the advancement of nursing. Their impact is augmented when they are integrated and synergistic. To date, no publications have examined these elements holistically or through an international lens. Like a three-legged stool they are inter-reliant and interdependent. Research is integral to doctoral education and influential in informing best practice. This significance and originality of this discussion paper stem from an analysis of these three topics, their history, current status and associated challenges. It is undertaken by renowned leaders in 11 countries within the six World Health Organisation (WHO) regions: South Africa, Egypt, Finland, United Kingdom, Brazil, Canada, United States, India, Thailand, Australia, and the Republic of Korea. The first two authors used a purposive approach to identify nine recognized nurse leaders in each of the six WHO regions. These individuals have presented and published papers on one or more of the three topics. They have led, or currently lead, large strategic organisations in their countries or elsewhere. All these accomplished scholars agreed to collect relevant data and contribute to the analysis as co-authors. Doctoral education has played a pivotal role in advancing nurse scholarship. Many Doctor of Philosophy (PhD) prepared nurses become faculty who go on to educate and guide future nurse researchers. They generate the evidence base for nursing practice, which contributes to improved health outcomes. In this paper, the development of nursing doctoral programmes is examined. Furthermore, PhDs and professional doctorates, including the Doctor of Nursing Practice, are discussed, and trends, challenges and recommendations are presented. The increasing number of advanced practice nurses worldwide contributes to better health outcomes. Nonetheless, this paper shows that the role remains absent or underdeveloped in many countries. Moreover, role ambiguity and role confusion are commonplace and heterogeneity in definitions and titles, and regulatory and legislatorial inconsistencies limit the role's acceptance and adoption. Globally, nursing research studies continue to increase in number and quality, and nurse researchers are becoming partners and leaders in interdisciplinary investigations. Nonetheless, this paper highlights poor investment in nursing research and a lack of reliable data on the number and amount of funding obtained by nurse researchers. The recommendations offered in this paper aim to address the challenges identified. They have significant implications for policy makers, government legislators and nurse leaders.
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Affiliation(s)
- Mi Ja Kim
- College of Nursing, University of Illinois at Chicago, United States of America
| | | | | | | | - Andrea Baumann
- Global Health, WHO Collaborating Centre in Primary Care Nursing & Health Human Resources, McMaster University, Canada
| | | | | | - Wipada Kunaviktikul
- Health Science Affairs and School of Nursing, Panyapiwat Institute of Management, Thailand
| | - Suresh K. Sharma
- College of Nursing, All India Institute of Medical Sciences, India
| | - Carla Ventura
- WHO Collaborating Center, College of Nursing, University of São Paulo at Ribeirão Preto, Brazil
| | - Taewha Lee
- College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, Republic of Korea
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Louazi A, Frías-Osuna A, López-Martínez C, Moreno-Cámara S. Perceptions, Motivations, and Empowerment Strategies of Midwives in Rural and Remote Areas of Northern Morocco. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14992. [PMID: 36429709 PMCID: PMC9690809 DOI: 10.3390/ijerph192214992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/02/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
The shortage of midwives is a problem in rural and remote areas. This is mainly the consequence of job insecurity and difficult living conditions. The present study aimed to identify and analyse the perceptions and motivations of midwives in rural and remote areas of northern Morocco on the quality of their working life and the motivational factors and empowerment strategies they use to maintain and develop their work. It is a qualitative study that follows Van Manen's hermeneutic phenomenology approach. Three focus groups and in-depth interviews were conducted with 15 midwives from rural and remote areas. The results indicate that midwives in rural and remote areas have a negative perception of the quality of the work and their personal life because of the scarcity of basic resources, unfavourable working conditions, and the personal sacrifices they have to make to support themselves. However, some factors favour their efforts. Therefore, there is a need to promote intersectoral policies that focus on improving material and human resources, as well as the working and personal conditions of midwives and the factors that support and empower them.
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Affiliation(s)
- Abdelouahid Louazi
- Higher Institute of Nursing Professions and Health Techniques of Tetouan (ISPITST), Tetouan 93020, Morocco
| | - Antonio Frías-Osuna
- Department of Nursing, School of Health Sciences, University of Jaén, 23071 Jaén, Spain
| | | | - Sara Moreno-Cámara
- Department of Nursing, School of Health Sciences, University of Jaén, 23071 Jaén, Spain
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Dreher A, Mambrey V, Loerbroks A. Changes of working conditions and job-related challenges due to the SARS-CoV-2 pandemic for medical assistants in general practices in Germany: a qualitative study. BMC PRIMARY CARE 2022; 23:273. [PMID: 36329407 PMCID: PMC9632591 DOI: 10.1186/s12875-022-01880-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
Background In Germany, general practices are usually contacted first by patients with health complaints, including symptoms characteristic of SARS-CoV-2. Within general practices, medical assistants (MAs) are the first contact person for patients and perform various tasks in close physical patient contact. Working conditions of MAs have been characterized as challenging, e.g., due to low salaries, a high workload, time pressure and frequent interruptions. The potential changes of working conditions and job-related challenges experienced by MAs due to the SARS-CoV-2 pandemic have not been fully explored. We aimed to address this knowledge gap among MAs working in general practices in Germany. Methods Semi-structured telephone interviews were conducted between March and April 2021 with 24 MAs. Medical assistants of legal age, who worked in general practices in Germany, and who were continuously employed and without change of employer in 2020 were eligible for participation. Interview recordings were transcribed verbatim and content-analyzed using MAXQDA, using deductive and inductive coding. Results The SARS-CoV-2 pandemic posed great challenges for MAs, including a dramatic increase in workload, changes in occupational tasks, increased hygiene measures, rearrangements of work organization, childcare issues, and structural and personnel challenges within their practice. Participants described both improved but also worsened collaboration with their employers and colleagues due to the pandemic. Many MAs complained about issues regarding SARS-CoV-2-related billing processes and an increase in unpleasant patient behavior, including disregard of practice rules or frequent verbal insults. Many also did not feel adequately appreciated by politics, media, or society for their efforts during the pandemic. Positive changes were perceived to be the expansion of digital communication channels and a growing social cohesiveness of practice teams. Conclusions Our study suggests that the SARS-CoV-2 pandemic posed great challenges for MAs. The pandemic seems to have worsened MAs’ working conditions, which had been described as challenging already prior to the pandemic. In order to improve job satisfaction and to prevent loss of healthcare personnel, measures must be taken to improve working conditions of MAs in general practices. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01880-y.
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Affiliation(s)
- Annegret Dreher
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
| | - Viola Mambrey
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
| | - Adrian Loerbroks
- Institute of Occupational, Social and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany
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What challenges and enablers elicit job satisfaction in rural and remote nursing in Australia: An Integrative review. Nurse Educ Pract 2022; 64:103454. [PMID: 36162301 DOI: 10.1016/j.nepr.2022.103454] [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: 03/10/2022] [Revised: 07/21/2022] [Accepted: 09/15/2022] [Indexed: 11/22/2022]
Abstract
AIM To explore challenges and stressors experienced by rural and remote area nurses and identify any interventions that aided in decreasing stress and increasing job satisfaction. BACKGROUND Demand for a generalist nursing workforce in rural and remote locations exposes nurses to the same conditions as people residing there: higher mortality rates and higher incidence of chronic diseases and inadequacies in accessing health services. DESIGN Christmals and Gross's integrative review framework was used with specified inclusion and exclusion criteria. Four databases were searched with no date limits. Only Australian studies were searched as international scope of practice differences for nurses could have distorted findings. FINDINGS Eighteen studies identified three broad themes: access to education; isolation (geographical, professional and personal) and recognition of role. DISCUSSION Interlinked themes showed positives and negatives from differing viewpoints. Ambivalence to education stemmed from inadequate exposure to learning and was linked with geographical isolation. Isolation was found to be less of a challenge to nurses who had an existing emotional connection with the community. CONCLUSION The themes identified were recurrent and interconnecting. The benefits of working in small rural and remote communities are being used as a driver for recruitment. These benefits include higher wages, providing a sense of belonging and allowing nurses to work to their full scope and develop generalist nursing skills. The geographical isolation generates challenges through inequality in access to education and professional support, working outside their scope of practice, safety and vulnerability that comes with living remotely and adapting to extreme weather conditions. TWEETABLE ABSTRACT What are the challenges and enablers of rural and remote working and living that influence job satisfaction for rural and remote area nurses in Australia?
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Kelson M, Nguyen A, Chaudhry A, Roth P. Improving Patient Satisfaction in the Hispanic American Community. Cureus 2022; 14:e27739. [PMID: 36106297 PMCID: PMC9445777 DOI: 10.7759/cureus.27739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 11/05/2022] Open
Abstract
Hispanic Americans are the fastest growing ethnic group in the United States, with an ever-growing gap in the communicative capacity between patients and healthcare providers. This leads to linguistic marginalization and worse healthcare outcomes. There is an increasing need for Spanish literacy in healthcare professionals, including medical students. However, approximately half of medical schools don’t offer a Spanish elective. We performed a scoping review of the literature to assess the relationship between medical Spanish electives, verbal fluency, auditory comprehension, and student comfort. This study was conducted using PubMed and Google Scholar to evaluate articles on Spanish electives in medical schools. Nine articles met inclusion criteria. Almost all studies demonstrated benefit as per outcome measures assessed with statistical significance. The available literature supports the need for Spanish elective courses, with numerous advantages conferred, e.g. increased self-perceived knowledge about specific health issues in the Hispanic American community and reduction in inadvertent communication errors in the patient-provider-interpreter interaction. However, most of the reports analyzed exhibited numerous limitations that warrant future research studies in order to eliminate variables such as bias and issues with generalizability. The authors suggest that more medical schools offer virtual Spanish electives with a focus on empathetic language strategies and patient satisfaction.
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Khatri RB, Assefa Y. Access to health services among culturally and linguistically diverse populations in the Australian universal health care system: issues and challenges. BMC Public Health 2022; 22:880. [PMID: 35505307 PMCID: PMC9063872 DOI: 10.1186/s12889-022-13256-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/19/2022] [Indexed: 12/14/2022] Open
Abstract
Background About half of first- or second-generation Australians are born overseas, and one-in-five speak English as their second language at home which often are referred to as Culturally and Linguistically Diverse (CALD) populations. These people have varied health needs and face several barriers in accessing health services. Nevertheless, there are limited studies that synthesised these challenges. This study aimed to explore issues and challenges in accessing health services among CALD populations in Australia. Methods We conducted a scoping review of the literature published from 1st January 1970 to 30th October 2021 in four databases: PubMed, Scopus, Embase, and the Web of Science. The search strategy was developed around CALD populations and the health services within the Australian context. We used Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines for selection and Arksey and O’Malley framework for analysis of relevant articles. A narrative synthesis of data was conducted using inductive thematic analysis approach. Identified issues and challenges were described using an adapted socioecological model. Results A total of 64 studies were included in the final review. Several challenges at various levels were identified to influence access to health services utilisation. Individual and family level challenges were related to interacting social and health conditions, poor health literacy, multimorbidity, diminishing healthy migrants’ effect. Community and organisational level challenges were acculturation leading to unhealthy food behaviours and lifestyles, language and communication problems, inadequate interpretation services, and poor cultural competency of providers. Finally, challenges at systems and policy levels included multiple structural disadvantages and vulnerabilities, inadequate health systems and services to address the needs of CALD populations. Conclusions People from CALD backgrounds have multiple interacting social factors and diseases, low access to health services, and face challenges in the multilevel health and social systems. Health systems and services need to focus on treating multimorbidity through culturally appropriate health interventions that can effectively prevent and control diseases. Existing health services can be strengthened by ensuring multilingual health resources and onsite interpreters. Addressing structural challenges needs a holistic policy intervention such as improving social determinants of health (e.g., improving living and working conditions and reducing socioeconomic disparities) of CALD populations, which requires a high level political commitment. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13256-z.
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Affiliation(s)
- Resham B Khatri
- School of Public Health, the University of Queensland, Brisbane, Australia.
| | - Yibeltal Assefa
- School of Public Health, the University of Queensland, Brisbane, Australia
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Balfe J, Donnelly J, Tecklenborg S, Walsh A. Exploring the barriers and enablers experienced by people with Cystic Fibrosis and their healthcare professionals in accessing, utilising and delivering maternity and Cystic Fibrosis care during the pre-conception to post-partum period: A mixed methods systematic review protocol. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13500.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background Cystic Fibrosis (CF) is an autosomal recessive inherited multi-system disease that primarily affects the lungs and digestive system. New drug therapies and treatments are improving the lives of many people with CF. With improved life expectancy and increased quality of life, many people with CF are now contemplating parenthood and becoming pregnant, an aspiration that decades ago was almost unheard of. Given this quickly evolving and more positive health landscape, it is vital to understand how people with CF experience the care they receive whilst accessing and utilising fertility and maternity services. It is also important to explore the experiences of healthcare professionals involved in providing care during this period. The overall aim of the mixed-methods systematic review will be to explore the barriers and enablers experienced by people with CF and the healthcare professionals involved in their care in the pre-conception to post-partum period. Methods The proposed review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for convergent integrated mixed methods systematic reviews. A systematic search of Medline (Ebsco), Cinahl, Embase, APA PsychINFO and Cochrane Library from inception to February 2022 will be conducted. Quantitative, qualitative and mixed methods studies pertaining to the experience of pre-conception to post-partum care for people with CF and their healthcare professionals will be included. Two independent reviewers will screen titles, abstracts and full texts with disagreements being resolved by a third reviewer. Conclusion This review will help to determine the potential barriers and facilitators experienced by people with Cystic Fibrosis and the health care professionals involved in their care during the pre-conception to post-partum period. The results will be of benefit specifically to the CF population and their healthcare providers when planning further studies in the area of fertility and pregnancy for this population and when delivering care.
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Gaffar B, Farooqi FA, Nazir MA, Bakhurji E, Al-Khalifa KS, Alhareky M, Virtanen JI. Oral health-related interdisciplinary practices among healthcare professionals in Saudi Arabia: Does integrated care exist? BMC Oral Health 2022; 22:75. [PMID: 35300658 PMCID: PMC8928017 DOI: 10.1186/s12903-022-02113-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/04/2022] [Indexed: 11/26/2022] Open
Abstract
Background There is a bidirectional relation between oral and general health, therefore collaboration between healthcare providers is needed. This study investigated current interdisciplinary practices (IDP) and the associated factors among healthcare professionals in Saudi Arabia. Methods A cross-sectional study was conducted in the Eastern Saudi Arabia recruiting four groups of health professionals (nurses, physicians, pediatricians and Ear-Nose and Throat (ENT) specialists). A validated, self-administered questionnaire was distributed online and shared through social media platforms. The questionnaire explored predisposing factors (demographics) and facilitating factors (knowledge, attitudes, attendance of oral health training and source of knowledge) associated with IDP. Results A total of 1398 health professionals were recruited. Participants showed fair oral health knowledge (7.1 ± 2.1) and attitudes (22.2 ± 3). Three-fourths (74.6%) reported always providing oral health education (OHE) to their patients, more than half (59.6%) reported always conducting an oral health screening (OHS), two-thirds (66.7%) reported responding to patients’ questions about oral health or conditions and 58.7% reported referring patients to dentists. Pediatricians and physicians had greater odds of IDP compared to other health professionals. Source of oral health knowledge (Ministry of Health (MOH) and formal education) was significantly associated with increased odds of IDP. Participants with good oral health knowledge had greater odds of responding to patients’ oral health question as well as have more referral practices. Conclusion The results reveal a discrepancy between participants' IDP, knowledge, and attitudes. Incorporating dental component to medical curricula, continuous education and training programs targeting health professionals through Ministry of Health should be considered.
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Affiliation(s)
- Balgis Gaffar
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam Costal Street, B.O Box 1982, Dammam, Costal Code 31441, Saudi Arabia.
| | - Faraz Ahmed Farooqi
- Department of Dental Education, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muhammad Ashraf Nazir
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam Costal Street, B.O Box 1982, Dammam, Costal Code 31441, Saudi Arabia
| | - Eman Bakhurji
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam Costal Street, B.O Box 1982, Dammam, Costal Code 31441, Saudi Arabia
| | - Khalifa S Al-Khalifa
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam Costal Street, B.O Box 1982, Dammam, Costal Code 31441, Saudi Arabia
| | - Muhanad Alhareky
- Department of Preventive Dental Sciences, College of Dentistry, Imam Abdulrahman Bin Faisal University, Dammam Costal Street, B.O Box 1982, Dammam, Costal Code 31441, Saudi Arabia
| | - Jorma I Virtanen
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Faculty of Medicine, University of Turku, Turku, Finland
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Shaddock L, Smith T. Potential for Use of Portable Ultrasound Devices in Rural and Remote Settings in Australia and Other Developed Countries: A Systematic Review. J Multidiscip Healthc 2022; 15:605-625. [PMID: 35378744 PMCID: PMC8976575 DOI: 10.2147/jmdh.s359084] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/17/2022] [Indexed: 02/02/2023] Open
Abstract
Introduction Objective Methods Results Conclusion
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Affiliation(s)
- Liam Shaddock
- Medical Radiation Science, School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Tony Smith
- The University of Newcastle Department of Rural Health & School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia
- Correspondence: Tony Smith, The University of Newcastle Department of Rural Health, C/- 69A High Street, Taree, Newcastle, NSW, Australia, Tel +61 466 440 037, Email
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Pereira VC, Silva SN, Carvalho VKS, Zanghelini F, Barreto JOM. Strategies for the implementation of clinical practice guidelines in public health: an overview of systematic reviews. Health Res Policy Syst 2022; 20:13. [PMID: 35073897 PMCID: PMC8785489 DOI: 10.1186/s12961-022-00815-4] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 01/10/2022] [Indexed: 01/08/2023] Open
Abstract
Abstract
Background
As a source of readily available evidence, rigorously synthesized and interpreted by expert clinicians and methodologists, clinical guidelines are part of an evidence-based practice toolkit, which, transformed into practice recommendations, have the potential to improve both the process of care and patient outcomes. In Brazil, the process of development and updating of the clinical guidelines for the Brazilian Unified Health System (Sistema Único de Saúde, SUS) is already well systematized by the Ministry of Health. However, the implementation process of those guidelines has not yet been discussed and well structured. Therefore, the first step of this project and the primary objective of this study was to summarize the evidence on the effectiveness of strategies used to promote clinical practice guideline implementation and dissemination.
Methods
This overview used systematic review methodology to locate and evaluate published systematic reviews regarding strategies for clinical practice guideline implementation and adhered to the PRISMA guidelines for systematic review (PRISMA).
Results
This overview identified 36 systematic reviews regarding 30 strategies targeting healthcare organizations, healthcare providers and patients to promote guideline implementation. The most reported interventions were educational materials, educational meetings, reminders, academic detailing and audit and feedback. Care pathways—single intervention, educational meeting—single intervention, organizational culture, and audit and feedback—both strategies implemented in combination with others—were strategies categorized as generally effective from the systematic reviews. In the meta-analyses, when used alone, organizational culture, educational intervention and reminders proved to be effective in promoting physicians' adherence to the guidelines. When used in conjunction with other strategies, organizational culture also proved to be effective. For patient-related outcomes, education intervention showed effective results for disease target results at a short and long term.
Conclusion
This overview provides a broad summary of the best evidence on guideline implementation. Even if the included literature highlights the various limitations related to the lack of standardization, the methodological quality of the studies, and especially the lack of conclusion about the superiority of one strategy over another, the summary of the results provided by this study provides information on strategies that have been most widely studied in the last few years and their effectiveness in the context in which they were applied. Therefore, this panorama can support strategy decision-making adequate for SUS and other health systems, seeking to positively impact on the appropriate use of guidelines, healthcare outcomes and the sustainability of the SUS.
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Mirbahaeddin E, Chreim S. A Narrative Review of Factors Influencing Peer Support Role Implementation in Mental Health Systems: Implications for Research, Policy and Practice. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:596-612. [PMID: 35018509 PMCID: PMC8751663 DOI: 10.1007/s10488-021-01186-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2021] [Indexed: 01/22/2023]
Abstract
With increasing calls to incorporate recovery principles into conventional mental health care, the importance of peer support worker (PSW) services has gained attention. However, studies consistently show that PSWs remain underutilized. Although research addresses several factors that influence formal implementation of their role, there is lack of a comprehensive framework that synthesizes the factors and addresses their interlevel interactions. This paper provides a narrative review and synthesis of literature on multilevel factors that influence formal PSW role implementation in mental health systems. We conducted a search of literature and reviewed 38 articles that met inclusion criteria. Our thematic analysis involved identifying first and second order categories that applied across studies, and developing third order interpretations through iterations. We synthesized the findings in a multilevel framework consisting of macro, meso and micro level influences. Influencing factors at the macro level include broader socio-cultural factors (medical model, recovery values, professional power dynamics, training and certification), regulatory and political factors (policy mandates, political commitment), and economic and financial factors (funding, affordability of services). Factors at the meso level include organizational culture, organizational leadership, change management, and human resource management policies. Micro level influences pertain to relationships between PSWs and team members, and PSW wellbeing. Interlevel interactions are also outlined. Limitations and implications for research, policy and practice are addressed.
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Affiliation(s)
- Elmira Mirbahaeddin
- Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
| | - Samia Chreim
- Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, ON K1N 6N5 Canada
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Andersson M, Nordin A, Engström Å. Critical care nurses' experiences of working during the first phase of the COVID-19 pandemic - Applying the Person-centred Practice Framework. Intensive Crit Care Nurs 2021; 69:103179. [PMID: 34895797 PMCID: PMC8595352 DOI: 10.1016/j.iccn.2021.103179] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/24/2021] [Accepted: 10/31/2021] [Indexed: 11/19/2022]
Abstract
AIM The aim of the study was to deductively study person-centred care, based on critical care nurses' experiences during the first phase of the CoViD-19 pandemic. DESIGN The study used a qualitative design. METHOD Data collection was conducted as individual interviews and was analysed with qualitative content analysis with a deductive approach. PARTICIPANTS Six critical care nurses working in a special CoViD-19 intensive care unit during the first phase of the pandemic participated. FINDINGS The findings are presented within the four domains of person-centred practice: the prerequisites, the care environment, person-centred processes and person-centred outcomes. While the ambition and knowledge about how to work in accordance with person-centred practice were high, there were several obstacles to perform it. CONCLUSION We need to prepare ahead of time so that nurses have optimal organisational prerequisites to be able to work in accordance with person-centred practice, also during pandemics and other crisis, which means to be able to give nursing care in accordance with the ill person's needs and resources.
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Affiliation(s)
- Maria Andersson
- Lulea University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, SE-97187 Luleå, Sweden
| | - Anna Nordin
- Lulea University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, SE-97187 Luleå, Sweden; Karlstad University, Department of Health Science, Faculty of Health, Science, and Technology, Sweden
| | - Åsa Engström
- Lulea University of Technology, Department of Health, Education and Technology, Division of Nursing and Medical Technology, SE-97187 Luleå, Sweden.
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Poh L, Tan SY, Lim J. Governance of Assisted Living in Long-Term Care: A Systematic Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11352. [PMID: 34769868 PMCID: PMC8583175 DOI: 10.3390/ijerph182111352] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/17/2022]
Abstract
Assisted living (AL) is an emerging model of care in countries where long-term care needs are escalating, with emphasis given to promoting independence and autonomy among the residents to achieve active and healthy ageing. Unlike established nursing homes, the governance of AL is nebulous due to its novelty and diverse nature of operations in many jurisdictions. A comprehensive understanding of how AL is governed globally is important to inform regulatory policies as the adoption of AL increases. A systematic literature review was undertaken to understand the different levels of regulations that need to be instituted to govern AL effectively. A total of 65 studies, conducted between 1990 to 2020, identified from three major databases (PubMed, Medline, and Scopus), were included. Using a thematic synthesis analytical approach, we identified macro-level regulations (operational authorisation, care quality assessment and infrastructural requirements), meso-level regulations (operational management, staff management and distribution, service provision and care monitoring, and crisis management), and micro-level regulations (clear criteria for resident admission and staff hiring) that are important in the governance of AL. Large-scale adoption of AL without compromising the quality, equity and affordability would require clear provisions of micro-, meso- and macro-level regulations.
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Affiliation(s)
- Luting Poh
- Memory Aging and Cognition Centre, Department of Pharmacology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Dr., Singapore 119260, Singapore;
| | - Si-Ying Tan
- Leadership Institute for Global Health Transformation, Saw Swee Hock School of Public Health, National University of Singapore, 21 Lower Kent Ridge Rd., Singapore 119260, Singapore
| | - Jeremy Lim
- Leadership Institute for Global Health Transformation, Saw Swee Hock School of Public Health, National University of Singapore, 21 Lower Kent Ridge Rd., Singapore 119260, Singapore
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Cunningham J, M. Briggs A, Cottrell E, Doyle F, Dziedzic K, Finney A, Murphy P, Paskins Z, Sheridan E, Swaithes L, P. French H. Barriers and facilitators to the implementation of osteoarthritis management programmes in primary or community care settings: a systematic review and qualitative framework synthesis protocol. HRB Open Res 2021; 4:102. [PMID: 34746643 PMCID: PMC8543168 DOI: 10.12688/hrbopenres.13377.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2021] [Indexed: 12/29/2022] Open
Abstract
Despite consistent international guidelines for osteoarthritis (OA) management, evidence-based treatments are underutilised. OA management programmes (OAMPs) are being implemented internationally to address this evidence-practice gap. An OAMP is defined as a 'model of evidence-based, non-surgical OA care that has been implemented in a real-world setting'. Our objective is to identify, synthesise and appraise qualitative research identifying anticipated or experienced micro (individual/behavioural), meso (organisational) or macro (context/system) level barriers or facilitators to the implementation of primary or community care-based OAMPs. Five electronic databases will be searched for papers published between 2010 and 2021. Qualitative or mixed-methods studies that include qualitative data on the anticipated or experienced barriers or facilitators to the implementation of primary or community care-based OAMPs, from the perspective of service users or service providers, will be included. The review will be reported using the PRISMA and ENTREQ guidelines. A data extraction form will be used to provide details of the included studies. Data will be analysed and identified barriers and facilitators will be mapped onto an appropriate implementation framework, such as the Theoretical Domains Framework. The appropriate JBI critical appraisal tools will be used to assess methodological quality, while the GRADE-CERQual approach will be used to assess confidence in the findings. Translation of evidence-based guidelines into practice is challenging and reliant on the quality of implementation. By comparing and contrasting anticipated and experienced barriers, this review will determine the extent of congruence between the two, and provide valuable insights into the views and experiences of key stakeholders involved in the implementation of OAMPs. The mapping of identified barriers and facilitators to behaviour change theory will enhance the applicability and construct validity of our findings and will offer significant utility for future development and implementation of OAMPs. Registration: This protocol was registered with PROSPERO (CRD42021255698) on 15/07/21.
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Affiliation(s)
- Joice Cunningham
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Andrew M. Briggs
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Elizabeth Cottrell
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Frank Doyle
- Department of Health Psychology, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Krysia Dziedzic
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Andrew Finney
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Paul Murphy
- RCSI Library, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Zoe Paskins
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
- Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Stoke-on-Trent, ST6 7AG, UK
| | - Eoin Sheridan
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Laura Swaithes
- Impact Accelerator Unit, Versus Arthritis Primary Care Centre, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK
| | - Helen P. French
- School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
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Wilson E, Hanson LC, Tori KE, Perrin BM. Nurse practitioner led model of after-hours emergency care in an Australian rural urgent care Centre: health service stakeholder perceptions. BMC Health Serv Res 2021; 21:819. [PMID: 34391412 PMCID: PMC8364439 DOI: 10.1186/s12913-021-06864-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023] Open
Abstract
Background The challenges of providing and accessing quality health care in rural regions have long been identified. Innovative solutions are not only required but are also vital if effective, timely and equitable access to sustainable health care in rural communities is to be realised. Despite trial implementation of some alternative models of health care delivery, not all have been evaluated and their impacts are not well understood. The aim of this study was to explore the views of staff and stakeholders of a rural health service in relation to the implementation of an after-hours nurse practitioner model of health care delivery in its Urgent Care Centre. Methods This qualitative study included semi-structured individual and group interviews with professional stakeholders of a rural health service in Victoria, Australia and included hospital managers and hospital staff who worked directly or indirectly with the after-hours NPs in addition to local GPs, GP practice nurses, and paramedics. Thematic analysis was used to generate key themes from the data. Results Four themes emerged from the data analysis: transition to change; acceptance of the after-hours nurse practitioner role; workforce sustainability; and rural context. Conclusions This study suggests that the nurse practitioner-led model is valued by rural health practitioners and could reduce the burden of excessive after-hour on-call duties for rural GPs while improving access to quality health care for community members. As pressure on rural urgent care centres further intensifies with the presence of the COVID-19 pandemic, serious consideration of the nurse practitioner-led model is recommended as a desirable and effective alternative.
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Affiliation(s)
- Elena Wilson
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia.
| | - Lisa C Hanson
- La Trobe Rural Health School, Violet Vines Marshman Centre for Rural Health Research, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
| | - Kathleen E Tori
- School of Nursing, College of Health and Medicine, University of Tasmania, Locked Bag 1351, Launceston, Tasmania, 7250, Australia
| | - Byron M Perrin
- La Trobe Rural Health School, College of Science, Health and Engineering, La Trobe University, PO Box 199, Bendigo, Victoria, 3552, Australia
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Clinician experience, perceptions, and acceptance of paediatric complex care nurse practitioner roles. Collegian 2021. [DOI: 10.1016/j.colegn.2020.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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47
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Rangachari P, Mushiana SS, Herbert K. A Narrative Review of Factors Historically Influencing Telehealth Use across Six Medical Specialties in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094995. [PMID: 34066829 PMCID: PMC8125887 DOI: 10.3390/ijerph18094995] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022]
Abstract
Prior to the COVID-19 pandemic, studies in the US have identified wide variations in telehealth use across medical specialties. This is an intriguing problem, because the US has historically lacked a standardized set of telehealth coverage and reimbursement policies, which has posed a barrier to telehealth use across all specialties. Although all medical specialties in the US have been affected by these macro (policy-level) barriers, some specialties have been able to integrate telehealth use into mainstream practice, while others are just gaining momentum with telehealth during COVID-19. Although the temporary removal of policy (coverage) restrictions during the pandemic has accelerated telehealth use, uncertainties remain regarding future telehealth sustainability. Since macro (policy-level) factors by themselves do not serve to explain the variation in telehealth use across specialties, it would be important to examine meso (organizational-level) and micro (individual-level) factors historically influencing telehealth use across specialties, to understand underlying reasons for variation and identify implications for widespread sustainability. This paper draws upon the existing literature to develop a conceptual framework on macro-meso-micro factors influencing telehealth use within a medical specialty. The framework is then used to guide a narrative review of the telehealth literature across six medical specialties, including three specialties with lower telehealth use (allergy-immunology, family medicine, gastroenterology) and three with higher telehealth use (psychiatry, cardiology, radiology) in the US, in order to synthesize themes and gain insights into barriers and facilitators to telehealth use. In doing so, this review addresses a gap in the literature and provides a foundation for future research. Importantly, it helps to identify implications for ensuring widespread sustainability of telehealth use in the post-pandemic future.
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Affiliation(s)
- Pavani Rangachari
- Department of Interdisciplinary Health Sciences Augusta University, Augusta, GA 30912, USA
- Department of Family Medicine, Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-706-721-2622
| | - Swapandeep S. Mushiana
- School of Nursing and Health Professions, University of San Francisco, San Francisco, CA 94117, USA;
| | - Krista Herbert
- Department of Clinical Psychology, Rowan University, Glassboro, NJ 08028, USA;
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Campeau Calfat A, Duval C, Laberge M, Savard AM, Sirois C. Clinical services in community pharmacies: a scoping review of policy and social implications. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:116-125. [PMID: 33729524 DOI: 10.1093/ijpp/riaa007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/08/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Clinical services have allowed pharmacists to shift from product-oriented to patient-oriented services. However, the policy and social implications of clinical services in community pharmacies are not well described. The purpose of this scoping review was to identify these implications. KEY FINDINGS We searched Pubmed and Embase, from inception to March 2019, as well as grey literature for publications that discussed policy (e.g. pharmacy model and pharmacist status) or social (e.g. role of pharmacists and interprofessional collaboration) implications of clinical services. Publications had to address clinical services provided by pharmacists in community settings that target the global long-term care of patients. We extracted data related to the implications and classified them into themes thereafter. The search process identified 73 relevant publications, of which 13 were included in regard to policy implications and 60 relative to social implications. Two themes emerged from policy implications: implementation and characteristics of policies, and professional status. Pharmacists' independence from distribution, financial coverage of clinical services and innovative models of practice were addressed. Social implications involved three themes: roles and interprofessional collaboration, changes in practice and barriers and model of practices and services. Perceptions of pharmacists' skills, organisational barriers, time constraints, lack of self-confidence and cultural shifts required to implement clinical services were included in these themes. SUMMARY Our review demonstrates the changing role of community pharmacists in provision of clinical services within the healthcare system. The range of clinical services varies widely from one setting to another. The context of community pharmacy is not well suited to these changes in practice.
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Affiliation(s)
- Alexandre Campeau Calfat
- Department of Social and Preventive Medicine, Université Laval, Québec, Canada.,Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada.,Centre of Excellence on Aging of Quebec, CIUSSS-CN, Québec, Canada
| | - Cécile Duval
- Department of Social and Preventive Medicine, Université Laval, Québec, Canada
| | - Maude Laberge
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada.,Centre de recherche du Centre hospitalier universitaire de Québec - Université Laval, Québec, Canada.,Department of Operations and Decision Systems, Faculty of Business Administration, Université Laval, Québec, Canada
| | | | - Caroline Sirois
- Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Québec, Canada.,Centre of Excellence on Aging of Quebec, CIUSSS-CN, Québec, Canada.,Centre de recherche du Centre hospitalier universitaire de Québec - Université Laval, Québec, Canada.,Faculté de pharmacie, Université Laval, Québec, Canada
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Dwyer T, Craswell A, Browne M. Predictive factors of the general public's willingness to be seen and seek treatment from a nurse practitioner in Australia: a cross-sectional national survey. HUMAN RESOURCES FOR HEALTH 2021; 19:21. [PMID: 33596928 DOI: 10.1186/s12960-021-00562-711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/01/2021] [Indexed: 05/24/2023]
Abstract
BACKGROUND Health care delivery in Australia is experiencing challenges with services struggling to keep up with the increasing demands of an aging population, rising levels of chronic disease and limited funding for care. Where adjunct models of health care such as the Nurse Practitioner (NP) have the potential to address this gap, in Australia, they remain an underutilised service. Clarifying the nature of the consumers 'willingness' to be seen by NPs warrants further investigation. METHODS Australia-wide, cross-sectional population-based survey was undertaken using computer-assisted telephone interviewing technique. RESULTS While just over 53% of the general public participants (n = 1318) had heard of an NP, once they became aware of their scope of practice, the majority agreed or strongly agreed they were willing to be seen by an NP in the community (91.6%), the emergency department 88.2%), to manage chronic conditions (86%), to have scrips written and referrals made (85.3%), and if they did not have to wait so long to see a medical doctor (81%). Factors significantly predicting willingness were being: female, less than 65 years of age, native English speakers, or residents from town/regional and rural settings. CONCLUSION Despite limited awareness of the NP role, a large proportion of the Australian population, across different demographic groups, are willing to be seen and treated by an NP. Expansion of this role to support medical services in areas of need could improve healthcare delivery.
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Affiliation(s)
- Trudy Dwyer
- CQUniversity Australia, Building 18 Rockhampton Campus, Bruce Highway, Rockhampton, Q 4702, Australia.
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Q 4556, Australia
| | - Matthew Browne
- CQUniversity Australia, University Drive, Building 8/G.47, Branyan Australia, Bundaberg, Qld, 4670, Australia
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50
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Dwyer T, Craswell A, Browne M. Predictive factors of the general public's willingness to be seen and seek treatment from a nurse practitioner in Australia: a cross-sectional national survey. HUMAN RESOURCES FOR HEALTH 2021; 19:21. [PMID: 33596928 PMCID: PMC7890991 DOI: 10.1186/s12960-021-00562-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Health care delivery in Australia is experiencing challenges with services struggling to keep up with the increasing demands of an aging population, rising levels of chronic disease and limited funding for care. Where adjunct models of health care such as the Nurse Practitioner (NP) have the potential to address this gap, in Australia, they remain an underutilised service. Clarifying the nature of the consumers 'willingness' to be seen by NPs warrants further investigation. METHODS Australia-wide, cross-sectional population-based survey was undertaken using computer-assisted telephone interviewing technique. RESULTS While just over 53% of the general public participants (n = 1318) had heard of an NP, once they became aware of their scope of practice, the majority agreed or strongly agreed they were willing to be seen by an NP in the community (91.6%), the emergency department 88.2%), to manage chronic conditions (86%), to have scrips written and referrals made (85.3%), and if they did not have to wait so long to see a medical doctor (81%). Factors significantly predicting willingness were being: female, less than 65 years of age, native English speakers, or residents from town/regional and rural settings. CONCLUSION Despite limited awareness of the NP role, a large proportion of the Australian population, across different demographic groups, are willing to be seen and treated by an NP. Expansion of this role to support medical services in areas of need could improve healthcare delivery.
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Affiliation(s)
- Trudy Dwyer
- CQUniversity Australia, Building 18 Rockhampton Campus, Bruce Highway, Rockhampton, Q 4702, Australia.
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Q 4556, Australia
| | - Matthew Browne
- CQUniversity Australia, University Drive, Building 8/G.47, Branyan Australia, Bundaberg, Qld, 4670, Australia
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