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Ekhammar A, Larsson MEH, Bernhardsson S, Holmgren K. The PREVSAM model, "prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders", is seen as beneficial for patients risking persistent musculoskeletal disorders but may be difficult to implement - a focus group study. Disabil Rehabil 2024:1-11. [PMID: 38800999 DOI: 10.1080/09638288.2024.2356011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE The rehabilitation model "Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders" (PREVSAM) was tested in a randomised controlled trial. This study aimed to explore participating healthcare professionals' experiences of working according to the PREVSAM model, and their perceptions of its clinical benefit and feasibility in primary care rehabilitation. METHODS A focus group study including 12 healthcare professionals from five primary care rehabilitation clinics was analysed according to the focus group methodology described by Krueger and Casey. RESULTS Four themes were identified. A clear framework describes how PREVSAM facilitates person-centred teamwork. The value of teamwork highlights benefits and challenges with teamwork. Through thick and thin discusses perceived patient benefits. In the ideal world focusses on feasibility of implementing the model. CONCLUSIONS The participants experienced that the PREVSAM model may be beneficial for the patients, for their own work situation and workplace, and for society. Identifying psychological risk factors was perceived as helpful, but not enough to capture patients in need of team-based rehabilitation. While considered feasible, barriers for implementing the model were identified. Managers and healthcare policy makers must prioritise and create appropriate conditions for team-based musculoskeletal rehabilitation in primary care.
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Affiliation(s)
- Annika Ekhammar
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Primary Care Rehabilitation, Gothenburg, Sweden
| | - Maria E H Larsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
| | - Susanne Bernhardsson
- Unit of Physiotherapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
| | - Kristina Holmgren
- Unit of Occupational Therapy, Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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McPake B, Dayal P, Zimmermann J, Williams GA. How can countries respond to the health and care workforce crisis? Insights from international evidence. Int J Health Plann Manage 2024; 39:879-887. [PMID: 38278780 DOI: 10.1002/hpm.3766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/28/2024] Open
Abstract
Future global health security requires a health and care workforce (HCWF) that can respond effectively to health crises as well as to changing health needs with ageing populations, a rise in chronic conditions and growing inequality. COVID-19 has drawn attention to an impending HCWF crisis with a large projected shortfall in numbers against need. Addressing this requires countries to move beyond a focus on numbers of doctors, nurses and midwives to consider what kinds of healthcare workers can deliver the services needed; are more likely to stay in country, in rural and remote areas, and in health sector jobs; and what support they need to deliver high-quality services. In this paper, which draws on a Policy Brief prepared for the World Health Organization (WHO) Fifth Global Forum on Human Resources for Health, we review the global evidence on best practices in organising, training, deploying, and managing the HCWF to highlight areas for strategic investments. These include (1). Increasing HCWF diversity to improve the skill-mix and provide culturally competent care; (2). Introducing multidisciplinary teams in primary care; (3). Transforming health professional education with greater interprofessional education; (4). Re-thinking employment and deployment systems to address HCWF shortages; (5). Improving HCWF retention by supporting healthcare workers and addressing migration through destination country policies that limit draining resources from countries with greatest need. These approaches are departures from current norms and hold substantial potential for building a sustainable and responsive HCWF.
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Affiliation(s)
- Barbara McPake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Prarthna Dayal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Julia Zimmermann
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
| | - Gemma A Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
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Karassava H, Agorgianitis L, Mavrommatis E. The Genesis of Multidisciplinary Health Professionals Teams for Pain Management. A History from the Hellenic Antiquity to Modern Palliative Medicine. Acta Med Acad 2024; 53:114-118. [PMID: 38984701 PMCID: PMC11237910 DOI: 10.5644/ama2006-124.439] [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: 12/31/2023] [Accepted: 04/04/2024] [Indexed: 07/11/2024] Open
Abstract
The aim of our article is to highlight the history of pain management. The multidisciplinary team (MDT) concept in confronting pain was first conceptualized by the Hippocratics, and has evolved through time and become a trend in medicine over recent decades. Documentary research was conducted to unveil the story of the evolution of MDTs. From the early 1950's the idea of an MDT approach to deal with various types of pain was sporadically introduced in medicine. Studies encouraged health institutions to support this concept by providing health professionals with training, alongside the necessary facilities and resources. Specialized care programs started with Dame Cicely Mary Strode Saunders as one of the pioneers. CONCLUSIONS: Team work and continuous interdisciplinary treatment of pain have rendered MDTs essential for health systems. Barriers in flexibility, information flow and personal issues give rise to the need for better organization and training. Pain and terminal disease palliation call for MDTs, and educated leaders to run them. Present and future health MDTs are considered necessary in all medical fields.
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Affiliation(s)
- Heleni Karassava
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Loukas Agorgianitis
- Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Wang F, Gao J, Hao S, Tsang KT, Wong JPH, Fung K, Li ATW, Jia C, Cheng S. Empowering Chinese university health service providers to become mental health champions: insights from the ACE-LYNX intervention. Front Psychiatry 2024; 15:1349476. [PMID: 38585479 PMCID: PMC10995288 DOI: 10.3389/fpsyt.2024.1349476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/28/2024] [Indexed: 04/09/2024] Open
Abstract
Background Evidence shows that there is a high prevalence of mental health challenges including depression and anxiety, among Chinese university students. Providing mental health care providers with professional training is crucial to implementing effective mental health promotion initiatives in university settings. Globally, the focus of the mental health system is shifting to recovery and the importance of empowerment is increasingly being emphasized. There is a call to integrate empowerment education into professional training programs for health service providers with the goal of mobilizing them to become mental health champions capable of advancing mental health care. Method The ACE-LYNX (Acceptance and Commitment to Empowerment-Linking Youth and Xin i.e., "heart(s)" in Chinese) intervention took place at six universities in Jinan, Shandong Province, China. It aimed to promote mental health literacy and build capacity among mental health service providers (MHSPs) to enable them to become mental health champions at their universities and beyond. A total of 139 university MHSPs participated. We collected pre-, immediate post- and three-month-post-surveys. In addition, we recruited forty-five participants to take part in three-month- post-intervention focus group interviews to explore their experiences taking part in ACE-LYNX and applying the knowledge, skills, and insights they gained from the intervention. Result This paper reports on the effects of empowerment education, which is a key component of ACE-LYNX, on the MHSPs. Four themes were identified: 1) conscious awareness and behavioral change through psychological empowerment users; 2) professional insights and motivation for organizational empowerment; 3) non-self in the continuum of collective empowerment; and 4) interdisciplinary challenges and divergences in empowerment action. Discussion We found that it is critical to integrate empowerment education into professional training. The process of MHSPs developing their empowerment practice is characterized by their moving from individual to collective empowerment along a continuum, with organizational and collective empowerment taking place in a longer time frame. Experiential learning, empathy education, and critical reflection accelerated the continuous iterative transformative process of empowerment practices. To advance the integration of empowerment into mental health care, the engagement of organizational decision-makers and policy makers in empowerment training is critical to ensure alignment of empowerment values and competence at all levels of service provision.
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Affiliation(s)
- Fenghua Wang
- Department of Social Work, School of Philosophy and Social Development, Shandong University, Jinan, Shandong, China
| | - Jianguo Gao
- Department of Social Work, School of Philosophy and Social Development, Shandong University, Jinan, Shandong, China
| | - Suyu Hao
- Department of Social Work, Law School, Qingdao University of Science and Technology, Qingdao, Shandong, China
| | - Ka Tat Tsang
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | | | - Kenneth Fung
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Alan Tai-Wai Li
- Primary Care, Regent Park Community Health Centre, Toronto, ON, Canada
| | - Cunxian Jia
- Department of Epidemiology, School of Public Health, Shandong University, Jinan, Shandong, China
| | - Shengli Cheng
- Department of Social Work, School of Philosophy and Social Development, Shandong University, Jinan, Shandong, China
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Yang W, Li Z, Yang T, Li Y, Xie Z, Feng L, Peng Z, Liu J. Experts' Consensus on the Management of Respiratory Disease Syndemic. China CDC Wkly 2024; 6:131-138. [PMID: 38476822 PMCID: PMC10926044 DOI: 10.46234/ccdcw2024.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/13/2024] [Indexed: 03/14/2024] Open
Affiliation(s)
- Weizhong Yang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China
| | - Zhongjie Li
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China
| | - Ting Yang
- National Center for Respiratory Diseases, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yanming Li
- Department of Pulmonary and Critical Care Medicine, National Center of Gerontology, Beijing Hospital, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhengde Xie
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, National Key Discipline of Pediatrics (Capital Medical University), Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Luzhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- State Key Laboratory of Respiratory Health and Multimorbidity, Beijing, China
- Key Laboratory of Pathogen Infection Prevention and Control, Peking Union Medical College, Ministry of Education, Beijing, China
| | - Zhibin Peng
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jue Liu
- Department of Epidemiology and Biostatistics, School of PublicHealth, Key Laboratory of Epidemiology of Major Diseases, Ministry of Education, Peking University Health Science Center-Weifang Joint Research Center for Maternal and Child Health,Peking University, Beijing, China
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Grant A, Kontak J, Jeffers E, Lawson B, MacKenzie A, Burge F, Boulos L, Lackie K, Marshall EG, Mireault A, Philpott S, Sampalli T, Sheppard-LeMoine D, Martin-Misener R. Barriers and enablers to implementing interprofessional primary care teams: a narrative review of the literature using the consolidated framework for implementation research. BMC PRIMARY CARE 2024; 25:25. [PMID: 38216867 PMCID: PMC10785376 DOI: 10.1186/s12875-023-02240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/11/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Interprofessional primary care teams have been introduced across Canada to improve access (e.g., a regular primary care provider, timely access to care when needed) to and quality of primary care. However, the quality and speed of team implementation has not kept pace with increasing access issues. The aim of this research was to use an implementation framework to categorize and describe barriers and enablers to team implementation in primary care. METHODS A narrative review that prioritized systematic reviews and evidence syntheses was conducted. A search using pre-defined terms was conducted using Ovid MEDLINE, and potentially relevant grey literature was identified through ad hoc Google searches and hand searching of health organization websites. The Consolidated Framework for Implementation Research (CFIR) was used to categorize barriers and enablers into five domains: (1) Features of Team Implementation; (2) Government, Health Authorities and Health Organizations; (3) Characteristics of the Team; (4) Characteristics of Team Members; and (5) Process of Implementation. RESULTS Data were extracted from 19 of 435 articles that met inclusion/exclusion criteria. Most barriers and enablers were categorized into two domains of the CFIR: Characteristics of the Team and Government, Health Authorities, and Health Organizations. Key themes identified within the Characteristics of the Team domain were team-leadership, including designating a manager responsible for day-to-day activities and facilitating collaboration; clear governance structures, and technology supports and tools that facilitate information sharing and communication. Key themes within the Government, Health Authorities, and Health Organizations domain were professional remuneration plans, regulatory policy, and interprofessional education. Other key themes identified in the Features of Team Implementation included the importance of good data and research on the status of teams, as well as sufficient and stable funding models. Positive perspectives, flexibility, and feeling supported were identified in the Characteristics of Team Members domain. Within the Process of Implementation domain, shared leadership and human resources planning were discussed. CONCLUSIONS Barriers and enablers to implementing interprofessional primary care teams using the CFIR were identified, which enables stakeholders and teams to tailor implementation of teams at the local level to impact the accessibility and quality of primary care.
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Affiliation(s)
- Amy Grant
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Julia Kontak
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elizabeth Jeffers
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Adrian MacKenzie
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Kelly Lackie
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Amy Mireault
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Susan Philpott
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | | | | | - Ruth Martin-Misener
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
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Wu YH, Hsieh HY, Kuo YL, Wu CY. The experiences and needs of nurses providing home-based palliative care: A qualitative meta-synthesis. J Palliat Care 2023; 38:490-502. [PMID: 35642265 DOI: 10.1177/08258597221105167] [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: 11/17/2022]
Abstract
Objective(s): We conducted a qualitative meta-synthesis of qualitative studies on nurses' experiences when caring for palliative patients to (1) identify the needs of nurses and (2) describe their experiences to provide more in-depth information. Methods: Qualitative articles published in English from 2000 to 2022 were identified from several databases through a searching strategy. Authors screened through the title, abstract, and full text of relevant studies. Articles were read repeatedly and discussed. The thematic analysis methodology was adopted to analyze the data. Results: Of 967 articles, 22 were included in our review. Notions reflecting community nurses providing palliative home care were clustered into four themes: (1) nature of community-based palliative nursing, (2) teamwork, (3) relationship with patient and family, and (4) resources. Findings also suggest establishing a sound support system, strengthening palliative education, and creating more decisive referral criteria and systems. Conclusions: The growing need for palliative home care has become challenging for community health care systems. Our study summarized various aspects of nurses providing home-based palliative care. The findings provide information for health care and education settings to improve home care systems and recruit more staff to meet the needs.
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Affiliation(s)
- Yu-Hsuan Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung,Taiwan
| | - Hui-Ya Hsieh
- Department of Specialist Nurse and Surgical Nurse Practitioner Office, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung,Taiwan
| | - Yu-Ling Kuo
- Department of Obstetrics and Gynecology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung,Taiwan
| | - Chien-Yi Wu
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung,Taiwan
- Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung,Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung,Taiwan
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Dufour E, Bolduc J, Leclerc-Loiselle J, Charette M, Dufour I, Roy D, Poirier AA, Duhoux A. Examining nursing processes in primary care settings using the Chronic Care Model: an umbrella review. BMC PRIMARY CARE 2023; 24:176. [PMID: 37661248 PMCID: PMC10476383 DOI: 10.1186/s12875-023-02089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 06/22/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND While there is clear evidence that nurses can play a significant role in responding to the needs of populations with chronic conditions, there is a lack of consistency between and within primary care settings in the implementation of nursing processes for chronic disease management. Previous reviews have focused either on a specific model of care, populations with a single health condition, or a specific type of nurses. Since primary care nurses are involved in a wide range of services, a comprehensive perspective of effective nursing processes across primary care settings and chronic health conditions could allow for a better understanding of how to support them in a broader way across the primary care continuum. This systematic overview aims to provide a picture of the nursing processes and their characteristics in chronic disease management as reported in empirical studies, using the Chronic Care Model (CCM) conceptual approach. METHODS We conducted an umbrella review of systematic reviews published between 2005 and 2021 based on the recommendations of the Joanna Briggs Institute. The methodological quality was assessed independently by two reviewers using the AMSTAR 2 tool. RESULTS Twenty-six systematic reviews and meta-analyses were included, covering 394 primary studies. The methodological quality of most reviews was moderate. Self-care support processes show the most consistent positive outcomes across different conditions and primary care settings. Case management and nurse-led care show inconsistent outcomes. Most reviews report on the clinical components of the Chronic Care Model, with little mention of the decision support and clinical information systems components. CONCLUSIONS Placing greater emphasis on decision support and clinical information systems could improve the implementation of nursing processes. While the need for an interdisciplinary approach to primary care is widely promoted, it is important that this approach not be viewed solely from a clinical perspective. The organization of care and resources need to be designed to support contributions from all providers to optimize the full range of services available to patients with chronic conditions. PROSPERO REGISTRATION CRD42021220004.
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Affiliation(s)
- Emilie Dufour
- Faculty of Nursing, Université de Montréal, Montréal, Canada.
| | - Jolianne Bolduc
- École de santé publique, Université de Montréal, Montréal, Canada
| | | | - Martin Charette
- School of Nursing, Université de Sherbrooke, Sherbrooke, Canada
| | - Isabelle Dufour
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
| | - Denis Roy
- Commissaire à la santé et au bien-être, Gouvernement du Québec, Montréal, Canada
| | | | - Arnaud Duhoux
- Faculty of Nursing, Université de Montréal, Montréal, Canada
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Batten M, Lewis J, Naunton M, Strickland K, Kosari S. Interprofessional collaboration between prescribers, managers, nursing staff and on-site pharmacists within residential aged care facilities: a mixed-methods study. Age Ageing 2023; 52:afad143. [PMID: 37598408 DOI: 10.1093/ageing/afad143] [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: 06/05/2022] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND A new on-site pharmacist (OSP) intervention within residential aged care facilities (RACFs) is being investigated to help improve medication management. Interprofessional collaboration amongst prescribers, nursing staff and pharmacists is critical to improving RACF medication management. OBJECTIVE To explore the extent of interprofessional collaboration and the nature of the working relationships between OSPs and prescribers, managers and nursing staff. METHODS A mixed-methods study was undertaken within the context of a 12-month cluster randomised controlled trial. Semi-structured interviews were conducted with data analysed using framework analysis, and a survey based upon the Physician-Pharmacist Collaboration Index (PPCI) was distributed at two time points (T1 at 3 months and T2 at 9 months after OSP commencement) across seven intervention RACFs. RESULTS The qualitative data (n = 33 interviews) findings related to the processes supportive of these relationships e.g. on-site proximity, OSP personality and perceived (or beneficial) benefits of OSPs working with health care team members (such as OSPs being trusted and providing reassurance to RACF health care team members). The PPCI survey mean scores at T1 (n = 33) and T2 (n = 19) suggested that OSPs were able to establish positive working relationships at 3 months and that positive relationships also existed at 9 months. The integrated findings suggested that the working relationships between OSPs and health care team members were generally positive. CONCLUSIONS This study is the first to explore interprofessional collaboration between OSPs and health-care team members in RACFs. The findings suggest that OSPs can positively contribute to interprofessional collaborative care within RACFs.
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Affiliation(s)
- Miranda Batten
- Health Research Institute, University of Canberra, Bruce, ACT 2617, Australia
| | - Joanne Lewis
- School of Nursing and Health, Avondale University, Wahroonga, NSW 2076, Australia
| | - Mark Naunton
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia
| | - Karen Strickland
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, ACT 2617, Australia
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, WA 6207, Australia
| | - Sam Kosari
- Discipline of Pharmacy, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia
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Schulz AA, Wirtz MA. Assessment of interprofessional obstetric and midwifery care from the midwives' perspective using the Interprofessional Collaboration Scale (ICS). Front Psychol 2023; 14:1143110. [PMID: 37284468 PMCID: PMC10240080 DOI: 10.3389/fpsyg.2023.1143110] [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: 01/12/2023] [Accepted: 05/03/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Interprofessional collaboration of physicians and midwives is essential for appropriate and safe care of pregnant and parturient women as well as their newborns. The complexity of woman-centered care settings requires the continuous exchange of information and the coordinated implementation of multi-and interprofessional care concepts. To analyze the midwives' perspective on the multi-and interprofessional care process during pregnancy, birth and postpartum period, we aimed to adapt and psychometrically evaluate the Interprofessional Collaboration Scale (ICS). Methods The ICS (13 items) was answered by 299 midwives for (i) prenatal and postpartum care as well as (ii) perinatal care. Three items on equitable communication (EC) identified in qualitative interviews with N = 6 midwives were added as further aspects of quality in collaborative midwifery care. Confirmatory factor analysis was used to test competing theoretically hypothesized factorial model structures, including both care settings simultaneously, i.e., birth and prenatal/postpartum. Results A two-dimensional structure assuming the 13 original ICS items and the 3 items on EC as psychometric distinct item groups accounts for the data best. After deleting 5 ICS items with insufficient indicator reliability, a very good-fitting model structure was obtained for both prenatal/postpartum as well as perinatal care: χ2df = 192 = 226.35, p = 0.045, CFI = 0.991, RMSEA = 0.025 (90%CI: [0.004; 0.037]). Both the reduced ICS-R and the EC scale (standardized response mean = 0.579/1.401) indicate significantly higher interprofessional collaboration in the birth setting. Responsibility in consulting, attitudes toward obstetric care and frequency of collaboration with other professional groups proved to be associated with the ICS-R and EC scale as expected. Discussion For the adapted ICS-R and the EC scale a good construct validity could be confirmed. Thus, the scales can be recommended as a promising assessment for recording the collaboration of midwives with physicians working in obstetric care from the perspective of midwives. The instrument provides a validated assessment basis in midwifery and obstetric care to identify potentially divergent perspectives within interprofessional care teams in woman's centered care.
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Leviton A, Patel AD, Loddenkemper T. Self-management education for children with epilepsy and their caregivers. A scoping review. Epilepsy Behav 2023; 144:109232. [PMID: 37196451 DOI: 10.1016/j.yebeh.2023.109232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023]
Abstract
Self-management education programs have been highly successful in preparing people to manage medical conditions with recurring events. A detailed curriculum for epilepsy patients, and their caretakers, is lacking. Here we assess what is available for patients who have disorders with recurring events and offer an approach to developing a potential self-care curriculum for patients with seizures and their caregivers. Among the anticipated components are a baseline efficacy assessment and training tailored to increasing self-efficacy, medication compliance, and stress management. Those at risk of status epilepticus will also need guidance in preparing a personalized seizure action plan and training in how to decide when rescue medication is appropriate and how to administer the therapy. Peers, as well as professionals, could teach and provide support. To our knowledge, no such programs are currently available in English. We encourage their creation, dissemination, and widespread use.
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Affiliation(s)
- Alan Leviton
- Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA.
| | - Anup D Patel
- Nationwide Children's Hospital, 700 Childrens Drive, Columbus, OH 43205, USA.
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Horstmannshoff C, Skudlik S, Petermann J, Kiesel T, Döringer T, Crispin A, Hermsdörfer J, Köberlein-Neu J, Jahn K, Schädler S, Bauer P, Voigt K, Müller M. Effectiveness of an evidence-based care pathway to improve mobility and participation in older patients with vertigo and balance disorders in primary care (MobilE-PHY2): study protocol for a multicentre cluster-randomised controlled trial. Trials 2023; 24:91. [PMID: 36747256 PMCID: PMC9902065 DOI: 10.1186/s13063-022-07017-x] [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: 10/26/2022] [Accepted: 12/15/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Vertigo, dizziness or balance disorders (VDB) are common leading symptoms in older people, which can have a negative impact on their mobility and participation in daily live, yet, diagnosis is challenging and specific treatment is often insufficient. An evidence-based, multidisciplinary care pathway (CPW) in primary care was developed and pilot tested in a previous study. The aim of the present study is to evaluate the effectiveness and safety of the CPW in terms of improving mobility and participation in community-dwelling older people with VDB in primary care. METHODS For this multicentre cluster randomised controlled clinic trial, general practitioners (GP) will be recruited in two regions of Germany. A total of 120 patients over 60 years old with VDB will be included. The intervention is an algorithmized CPW. GPs receive a checklist for standardise clinical decision making regarding diagnostic screening and treatment of VDB. Physiotherapists (PT) receive a decision tree for evidence-based physiotherapeutic clinical reasoning and treatment of VDB. Implementation strategies comprises educational trainings as well as a workshop to give a platform for exchange for the GPs and PTs, an information meeting and a pocket card for home care nurses and informal caregivers and telephone peer counselling to give all participants the capability, opportunity and the motivation to apply the intervention. In order to ensure an optimised usual care in the control group, GPs get an information meeting addressing the national guideline. The primary outcome is the impact of VDB on participation and mobility of patients after 6 month follow-up, assessed using the Dizziness Handicap Inventory (DHI) questionnaire. Secondary outcomes are physical activity, static and dynamic balance, falls and fear of falling as well as quality of life. We will also evaluate safety and health economic aspects of the intervention. Behavioural changes of the participants as well as barriers, facilitating factors and mechanisms of impact of the implementation will be investigated with a comprehensive process evaluation in a mixed-methods design. DISCUSSION With our results, we aim to improve evidence-based health care of community-dwelling older people with VDB in primary care. TRIAL REGISTRATION DRKS, DRKS00028524 retrospectively registered on March 24, 2022.
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Affiliation(s)
- Caren Horstmannshoff
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany. .,Department of Sport and Health Sciences, Chair of Human Movement Science, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany.
| | - Stefanie Skudlik
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany
| | - Jenny Petermann
- Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 1307, Dresden, Germany
| | - Theresia Kiesel
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany
| | - Tobias Döringer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany
| | - Alexander Crispin
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilian University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Joachim Hermsdörfer
- Department of Sport and Health Sciences, Chair of Human Movement Science, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Rainer-Gruenter-Str. 21, 42119, Wuppertal, Germany
| | - Klaus Jahn
- German Centre for Vertigo and Balance Disorders, Ludwig-Maximilian University of Munich, Marchioninistraße 15, 81377, Munich, Germany.,Schoen Clinic Bad Aibling, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Stefan Schädler
- Physiotherapie im Schloss, Schloss 88, 3454, Sumiswald, Switzerland
| | - Petra Bauer
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany
| | - Karen Voigt
- Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 1307, Dresden, Germany
| | - Martin Müller
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany.,Department of Primary Care and Health Services Research, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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13
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Gao H, Yous ML, Connelly D, Hung L, Garnett A, Hay M, Snobelen N. Implementation and impacts of virtual team-based care planning for older persons in formal care settings: A scoping review. Digit Health 2023; 9:20552076231151567. [PMID: 36714541 PMCID: PMC9880593 DOI: 10.1177/20552076231151567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 12/08/2022] [Indexed: 01/25/2023] Open
Abstract
Objective This scoping review aimed to summarize current knowledge about the implementation, impacts, facilitators and barriers of virtual team-based care planning for older persons in formal care settings (e.g. home and community, primary, long-term and acute care). Methods The Joanna Briggs Institute (JBI) methodology was used. The Arksey and O'Malley and Levac, Colquhoun, and O'Brien methodologies provided additional frameworks. Databases accessed included PubMed, EMBASE, CINAHL, AgeLine, PsycInfo and Scopus. Reference lists of selected articles and grey literature retrieved through Google and Google Scholar were also reviewed. Three researchers screened titles, abstracts and conducted full-text reviews. Extracted data were mapped in a table and analysed for summative themes. Older persons and family partners assisted in interpreting findings based on their lived experiences. Results A total of 27 studies were included. Virtual team-based care planning led to many positive outcomes for older persons (e.g. decreased depression, reduced falls and improved medication management) and their families (e.g. reduced caregiver stress and improved caregiving skills). Only four studies reported the involvement of older persons and/or families in virtual team-based care planning. Multiple barriers to adopting virtual team-based care planning were found including lack of education/training for older persons and families in using technology. Conclusion Despite the multiple advantages that virtual team-based care planning offers for older persons and families, it is important to ensure that this care can be offered to all. There is a need to ensure that health equity is addressed to promote access to care and respond to social determinants of health.
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Affiliation(s)
- Harrison Gao
- Schulich School of Medicine and Dentistry, Western University,
London, ON, Canada,Denise Connelly, School of Physical
Therapy, Rm 1000 Elborn College, Western University, London, ON N6G 1H1, Canada.
| | - Marie-Lee Yous
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Denise Connelly
- School of Physical Therapy, Western University, London, ON,
Canada
| | - Lillian Hung
- School of Nursing, The University of British Columbia, Vancouver,
BC, Canada
| | - Anna Garnett
- Arthur Labatt Family School of Nursing, Western University, London,
ON, Canada
| | - Melissa Hay
- School of Physical Therapy, Western University, London, ON,
Canada
| | - Nancy Snobelen
- Registered Practical Nurses Association
of Ontario (WeRPN), Mississauga, ON, Canada
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14
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Clothes Make the Man-What Impact Does the Dress of Interprofessional Teams Have on Patients? Healthcare (Basel) 2022; 10:healthcare10102109. [PMID: 36292556 PMCID: PMC9601812 DOI: 10.3390/healthcare10102109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/04/2022] Open
Abstract
Physicians’ attire seems to play an important role in the success of patient treatment. The classic doctor’s white coat initiates a strong signal to the patient and can have a determining effect on a successful doctor–patient relationship. In a quantitative online questionnaire study comprising 52 questions, participants were shown four photos of an interprofessional German family medicine team in varying attire. One important study feature relating to the ongoing coronavirus pandemic was that the team was portrayed wearing FFP2 masks in one photo. We measured core values regarding the team’s perception in terms of sympathy, competence, trust, choosing the practice as a personal health care provider, and wanting to participate in the team. The questionnaire was posted online between March and May 2021. It was accessed 1435 times and 906 sheets were qualified for statistical analysis. For the first time in this field of research, a practice team’s attire was investigated. We found a significant influence of different clothing on the perception of sympathy, competence, trust, elective practice, and team participation. Wearing an FFP2 mask promotes feelings of security and competence. The study shows that in times of fast social changes due to rapid digitalization and an ongoing pandemic, we should present ourselves in different ways as a medical team depending on the patient groups we are targeting and the feelings we want to evoke.
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15
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Waller G, Crosbie T, Newbury-Birch D, Bandyopadhyay S, Ghanem DA, Jana A, Pillai GG, Krishna Priya GS, Sarkar A, Thomas N, Diba P, Divers A. What is in a Meter? A Qualitative Exploration into the Implementation of Electricity Metering Across Mumbai Communities Using Normalisation Process Theory. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2022; 2:361-370. [PMID: 36248403 PMCID: PMC9551251 DOI: 10.1007/s43477-022-00059-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 09/22/2022] [Indexed: 11/07/2022]
Abstract
Metering is fundamental in the efficient operation of electricity networks, as meters facilitate controlled usage and improve health and well-being. However, across the Global South, meters have often been found to be lacking or not fit for purpose. Therefore, this study sought to determine residents’ perceptions and access to electricity metering across a community in Mumbai, with the goal of developing recommendations to support the implementation of meters in the future. Fifty semi-structured interviews were conducted by phone, with participants from different areas and socioeconomic classes, within Greater Mumbai. The sample consisted of 20 low-income, 20 middle-income, and 10 high-income participants. The Normalisation Process Theory (NPT) was used to inform the interview schedule and to organise the thematic analysis. Meter accessibility and location was variable across the participant groups, as was the education and awareness of metering technology. Socio-political factors were found to directly affect the use of meters, specifically in the low-income group. The high cost associated with metering was a prominent finding; with a preconception that introducing meters would only increase utility expenditure. Future work should focus around ensuring meters are easy to use, practical and accessible to all residents and supporting education programmes around how to use a meter and how they can reduce utility expenditure. The cost of meters should also be investigated, to establish that the costs, associated with introducing new meters, are not passed disproportionately to consumers.
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Affiliation(s)
- Gillian Waller
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
| | - Tracey Crosbie
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
| | - Dorothy Newbury-Birch
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
| | - Santanu Bandyopadhyay
- Department of Energy Science and Engineering, Indian Institute of Technology Bombay, Mumbai, India
| | - Dana Abi Ghanem
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
| | - Arnab Jana
- Centre for Urban Science and Engineering, Indian Institute of Technology Bombay, Mumbai, India
| | - Gobind G. Pillai
- Centre for Sustainable Engineering, Teesside University, Middlesbrough, TS1 3BA UK
| | - G. S. Krishna Priya
- Centre for Urban Science and Engineering, Indian Institute of Technology Bombay, Mumbai, India
| | | | - Neenu Thomas
- Centre for Urban Science and Engineering, Indian Institute of Technology Bombay, Mumbai, India
| | - Parisa Diba
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
| | - Andy Divers
- School of Social Sciences, Humanities and Law, Teesside University, Middlesbrough, TS1 3BA UK
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16
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Gil-Girbau M, Peñarrubia-Maria MT, Carbonell-Simeón D, Rodríguez-Ferraz B, Contaldo SF, Iglesias-González M, Fernández-Vergel R, Blanco-García E, Baladon-Higuera L, Serrano-Blanco A, Rubio-Valera M. Assessment of a Primary Support Program: family physicians and mental health professionals' perspective. Fam Pract 2022; 39:920-931. [PMID: 35244164 DOI: 10.1093/fampra/cmac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Mental health (MH) disorders are increasingly prevalent in primary care (PC) and this has generated, in recent years, the development of strategies based on the collaborative model and the stepped care model. The Primary Support Program (PSP) was implemented in the community of Catalonia (Spain) during 2006 to improve, from the first level of care, treatment of the population with mild-moderate complexity MH problems along with identification and referral of severe cases to specialized care. The aim of the present study was to identify the strengths and limitations of the PSP from the perspective of health professionals involved in the programme. METHODS An explanatory qualitative study based on Grounded Theory. We conducted group semistructured interviews with 37 family physicians and 34 MH professionals. A constant comparative method of analysis was performed. RESULTS Operation of the PSP is influenced by internal factors, such as the programme framework, MH liaison, management of service supply and demand, and the professional team involved. Additionally, external factors which had an impact were related to the patient, the professionals, the Health System, and community resources. CONCLUSIONS The operation of the PSP could benefit from a review of the programme framework and optimization of MH liaison. Improvements are also proposed for MH training in PC, intraprofessional coordination, use of community resources, and creation of efficient continuous assessment systems.
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Affiliation(s)
- Montserrat Gil-Girbau
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,Grup ECONSAP, Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain
| | - Maria-Teresa Peñarrubia-Maria
- Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Grup ECONSAP, Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain.,Centre d'Atenció Primària Bartomeu Fabrés Anglada, Gavà, Spain.,Grup 58 del Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | | | | - Salvatore-Fabrizio Contaldo
- Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Psychiatry Department, CSMA d'Esplugues de Llobregat, Esplugues de Llobregat, Spain
| | - Maria Iglesias-González
- Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Grup 58 del Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Psychiatry Service, Hospital Universitari Germans Trias i Pujol, IGTP Campus Can Ruti, Badalona, Spain
| | - Rita Fernández-Vergel
- Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,Grup ECONSAP, Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain.,Centre d'Atenció Primària Bartomeu Fabrés Anglada, Gavà, Spain
| | - Elena Blanco-García
- Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Grup ECONSAP, Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain.,Centre d'Atenció Primària Bartomeu Fabrés Anglada, Gavà, Spain
| | - Luisa Baladon-Higuera
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,Grup ECONSAP, Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain.,Grup 58 del Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Antoni Serrano-Blanco
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Primary Care Prevention and Health Promotion Research Network (redIAPP), Barcelona, Spain.,Grup ECONSAP, Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain.,Grup 58 del Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Maria Rubio-Valera
- Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Grup de Recerca PRISMA (SGR1209), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Spain.,Grup ECONSAP, Institut Universitari d'Investigació en Atenció Primària (IDIAP Jordi Gol), Barcelona, Spain.,Grup 58 del Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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17
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Integrating Behavioral Health in Primary Care: Lessons from Interdisciplinary Collaboration in School Mental Health. Pediatr Clin North Am 2022; 69:709-723. [PMID: 35934495 DOI: 10.1016/j.pcl.2022.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Integrating behavioral health care into pediatric primary care (PPC) settings can increase access to behavioral health promotion services and treatment. Efficient models for integrated PPC are emerging. Recent reviews call for integrated PPC research to better identify efficient teaming and processes, particularly in areas of building integrated PPC team member capacity and adopting practices that promote "upstream" behavioral wellness specific to community needs. Research in integrating behavioral health in schools has identified key practices relevant to these gaps in integrated primary care (IPC) research. This article discusses possibilities to apply findings from integrated school behavioral health research to IPC settings.
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18
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Ludwick T, Endriyas M, Morgan A, Kane S, Kelaher M, McPake B. Challenges in Implementing Community-Based Healthcare Teams in a Low-Income Country Context: Lessons From Ethiopia's Family Health Teams. Int J Health Policy Manag 2022; 11:1459-1471. [PMID: 34273919 PMCID: PMC9808330 DOI: 10.34172/ijhpm.2021.52] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/27/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Addressing chronic diseases and intra-urban health disparities in low- and middle-income countries (LMICs) requires new health service models. Team-based healthcare models can improve management of chronic diseases/complex conditions. There is interest in integrating community health workers (CHWs) into these teams, given their effectiveness in reaching underserved populations. However healthcare team models are difficult to effectively implement, and there is little experience with team-based models in LMICs and with CHW-integrated models more generally. Our study aims to understand the determinants related to the poor adoption of Ethiopia's family health teams (FHTs); and, raise considerations for initiating CHW-integrated healthcare team models in LMIC cities. METHODS Using the Consolidated Framework for Implementation Research (CFIR), we examine organizational-level factors related to implementation climate and readiness (work processes/incentives/resources/leadership) and system-level factors (policy guidelines/governance/financing) that affected adoption of FHTs in two Ethiopian cities. Using semi-structured interviews/focus groups, we sought implementation perspectives from 33 FHT members and 18 administrators. We used framework analysis to deductively code data to CFIR domains. RESULTS Factors associated with implementation climate and readiness negatively impacted FHT adoption. Failure to tap into financial, political, and performance motivations of key stakeholders/FHT members contributed to low willingness to participate, while resource constraints restricted capacity to implement. Workload issues combined with no financial incentives/perceived benefit contributed to poor adoption among clinical professionals. Meanwhile, staffing constraints and unavailability of medicines/supplies/transport contributed to poor implementation readiness, further decreasing willingness among clinical professionals/managers to prioritize non-clinic based activities. The federally-driven program failed to provide budgetary incentives or tap into political motivations of municipal/health centre administrators. CONCLUSION Lessons from Ethiopia's challenges in implementing its FHT program suggest that LMICs interested in adopting CHW-integrated healthcare team models should closely consider health system readiness (budgets, staffing, equipment/medicines) as well as incentivization strategies (financial, professional, political) to drive organizational change.
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Affiliation(s)
- Teralynn Ludwick
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Misganu Endriyas
- Health Research and Technology Transfer Office, SNNPR Regional Health Bureau, Hawassa, Ethiopia
| | - Alison Morgan
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Sumit Kane
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Margaret Kelaher
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Barbara McPake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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19
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Herrmann TA, Gray N, Petrova O. Staff perceptions of interdisciplinary team training and its effectiveness in reducing medical errors. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2022. [DOI: 10.1080/20479700.2022.2097762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- T. Arien Herrmann
- Department of Management, Harrison College of Business and Computing, Southeast Missouri State University, Cape Girardeau, MO, USA
| | - Natallia Gray
- Department of Management and Entrepreneurship, Ivy College of Business, Iowa State University, Ames, IA, USA
| | - Olga Petrova
- Department of Economics, Sykes College of Business, The University of Tampa, Tampa, FL, USA
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20
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Sirsch E, Ludwig E, Müller K, Blumenberg P, Nitschke I, Büscher A. Förderung der Mundgesundheit in der Pflege – ein interprofessioneller Expertenstandard. Z Gerontol Geriatr 2022; 55:204-209. [PMID: 35403859 PMCID: PMC8995915 DOI: 10.1007/s00391-022-02053-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/08/2022] [Indexed: 12/03/2022]
Abstract
Hintergrund Menschen mit Pflege- oder Unterstützungsbedarf oder einer Behinderung haben einen schlechteren Mundgesundheitsstatus als Menschen ohne diesen Bedarf. Die zunehmende Anzahl älterer Menschen, die über eigene Zähne verfügen, erfordert spezifische Maßnahmen zur Förderung der Mundgesundheit. Während 1997 jeder 4. Mensch zwischen 65 und 74 Jahren zahnlos war, galt dies 2016 nur noch für jeden 8. Besondere Herausforderungen in der Mundpflege stellen sich bei älteren Menschen und Personen mit Demenz. Zur Bewältigung braucht es eine interprofessionelle Herangehensweise und Zusammenarbeit während der gesamten Versorgung. Zielsetzung Interprofessionelle Entwicklung eines Expertenstandards zur Förderung der Mundgesundheit durch Pflegefachpersonen mit Fokus auf ältere Menschen. Methoden Grundlage des Expertenstandards bildet eine systematische Literaturanalyse. Aufbauend auf den Ergebnissen formulierte eine interprofessionelle Expertinnen- und Expertenarbeitsgruppe unter Beteiligung von Pflege, Zahnmedizin und einem Vertreter aus der Selbsthilfe Empfehlungen zur Förderung der Mundgesundheit von Menschen mit pflegerischem Unterstützungsbedarf. Ergebnisse Die interprofessionelle Herangehensweise prägte die Auswahl der leitenden Fragen der Literaturrecherche, die Literaturauswertung und die Formulierung der Empfehlungen. Zu den leitenden Fragen des Expertenstandards konnten Maßnahmen zu Erhalt und Förderung der Mundgesundheit ausgewiesen werden, beispielsweise bei oralen Pilzerkrankungen, Mukositis oder Gingivitis sowie bei Begleiterscheinungen wie Mundtrockenheit und Schmerzen. Diskussion Maßnahmen zur Förderung der Mundgesundheit bei Menschen mit Pflege- oder Unterstützungsbedarf oder einer Behinderung konnten im pflegerischen Kontext vertieft fokussiert und durch eine interprofessionelle Gruppe formuliert werden.
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Affiliation(s)
- Erika Sirsch
- Fakultät für Pflegewissenschaft, Philosophisch-Theologische Hochschule Vallendar, Pallottistr. 3, 56179, Vallendar, Deutschland.
| | - Elmar Ludwig
- Ausschuss für Alterszahnheilkunde, Bundeszahnärztekammer, Berlin, Deutschland
| | | | - Petra Blumenberg
- Deutsches Netzwerk für Qualitätsentwicklung in der Pflege (DNQP), Hochschule Osnabrück, Osnabrück, Deutschland
| | - Ina Nitschke
- Klinik für Allgemein‑, Behinderten- und Seniorenzahnmedizin, Universität Zürich, Zürich, Deutschland
- Poliklinik für Zahnärztliche Prothetik und Werkstoffkunde, Universität Leipzig, Leipzig, Deutschland
| | - Andreas Büscher
- Deutsches Netzwerk für Qualitätsentwicklung in der Pflege (DNQP), Hochschule Osnabrück, Osnabrück, Deutschland
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21
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Pulido-Fuentes M, Palmar-Santos AM, Flores-Martos JA, Cipriano-Crespo C, Rubio LA, González LA, Navarta-Sánchez MV. Internal dynamics within primary care teams in two Spanish regions during the COVID-19 pandemic: a qualitative study. BMC PRIMARY CARE 2022; 23:64. [PMID: 35361146 PMCID: PMC8970064 DOI: 10.1186/s12875-022-01674-2] [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: 10/01/2021] [Accepted: 03/21/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Pandemics and epidemics have represented public health emergencies with severe consequences at a global level. Primary care teams have played a crucial role in disease surveillance and monitoring during the COVID-19 pandemic through early detection, contact tracing, and isolation of positive cases. The objective of this study was to explore the impact of the COVID-19 pandemic on primary care teams regarding their internal dynamics and their professional performance. METHODS Qualitative study carried out between July and December 2020 in two large central and southern Spanish regions (Castilla la Mancha and Madrid). Semi-structured interviews and focus groups were conducted with primary care workers. Data was analysed using thematic content analysis. Participants were accessed using purposive sampling. RESULTS A total of 53 primary care workers participated in the study, of which 38 were individually interviewed, and 15 participated in three focus groups.The analysis of their experiences revealed two main themes regarding the impact of the COVID-19 pandemic on primary care teams: 1) The need to reorganise traditional roles: Primary care settings closed their doors to the public and their workers restructured their roles to ensure the delivery of essential services; 2) The need to implement a new primary care delivery model: Each primary care team had to self-organise, making sure their reference population was cared for and developing resource optimisation strategies. CONCLUSIONS Primary care teams have quickly adapted their roles and internal dynamics to respond to the demands generated by COVID-19. In the new delivery model, some positive aspects could be highlighted - such as increased communication between professionals and the use of telemedicine for some cases. However, it is important to address the negative impact that the COVID-19 crisis has had on of the main functions of primary care. These measures are necessary to promote well-being in primary care teams, and to provide quality care that addresses the complex and individual needs of each person and reduces inequalities in healthcare delivery.
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Affiliation(s)
- Montserrat Pulido-Fuentes
- Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de La Reina, Spain Avenida Real Fábrica de Sedas S/N, 45600 ToledoTalavera de la Reina, Toledo, Spain
| | - Ana María Palmar-Santos
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
| | | | - Carmen Cipriano-Crespo
- Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de La Reina, Spain Avenida Real Fábrica de Sedas S/N, 45600 ToledoTalavera de la Reina, Toledo, Spain
| | - Laura Alicia Rubio
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
| | - Luisa Abad González
- Faculty of Education Sciences and Humanities, University of Castilla -La Mancha, 16071 Cuenca, Spain
| | - MVictoria Navarta-Sánchez
- Departamento de Enfermería, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo nº 4, 28029 Madrid, Spain
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Frennert S, Erlingsdóttir G, Muhic M, Rydenfält C, Milos Nymberg V, Ekman B. Embedding and Integrating a Digital Patient Management Platform Into Everyday Primary Care Routines: Qualitative Case Study. JMIR Form Res 2022; 6:e30527. [PMID: 35191845 PMCID: PMC8905477 DOI: 10.2196/30527] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/21/2021] [Accepted: 01/06/2022] [Indexed: 02/05/2023] Open
Abstract
Background Traditional primary care is characterized by patient consultations via phone and physical visits. However, the current development in Swedish primary care is to blend digital solutions with traditional solutions. This paper addresses this development by examining the normalization of embedding and integrating a digital health care platform into everyday care routines in a primary care clinic. The digital health care platform enables both synchronous (video calls) and asynchronous (chat) communication, as well as self-registration of patient data using automated questions and forms requiring the patient’s input. Objective This study aims to explore the work that health care professionals (HCPs) have to undertake to implement and sustain a digital health care platform as part of their everyday work practice. Methods HCPs were observed and interviewed to assess their individual and collective engagement and the mechanisms involved in the implementation of the digital platform and its effects on everyday work routines. The normalization process theory (NPT) was used to frame the data analysis. Results The analysis identified several themes related to the four NPT constructs: coherence, cognitive participation, collective action, and reflexive monitoring. The use of these constructs enabled the analysis to identify ways of supporting implementation. For example, it showed the benefits of having implementation champions and scheduling work hours for HCPs to use the platform. The analysis also revealed a theme of materiality that deviated from the NPT constructs, as NPT gives ontological priority to human actors and social structures. Conclusions Digital health care platform implementation is a complex process. Our findings provide insights into how individual and collective actions can be supported to embed and integrate a digital platform into everyday care routines. Primary health care organizations need to involve HCPs throughout the implementation process by reorganizing work and providing frequent feedback loops. HCPs are more likely to engage with and commit to changing practices if they perceive the digital platform to be beneficial compared with the current practice. However, they also need resources (eg, time, training, and continuous support) to put the platform into practice. Patient engagement and appraisal are important elements in implementation. Unless patients are willing to use the platform, there is no motivation for HCPs to embed the digital platform into everyday care practice.
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Affiliation(s)
| | | | - Mirella Muhic
- Department of Informatics, Umeå University, Umeå, Sweden
| | | | | | - Björn Ekman
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden
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Gaber J, Datta J, Clark R, Lamarche L, Parascandalo F, Di Pelino S, Forsyth P, Oliver D, Mangin D, Price D. Understanding how context and culture in six communities can shape implementation of a complex intervention: a comparative case study. BMC Health Serv Res 2022; 22:221. [PMID: 35177040 PMCID: PMC8855589 DOI: 10.1186/s12913-022-07615-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background Contextual factors can act as barriers or facilitators to scaling-up health care interventions, but there is limited understanding of how context and local culture can lead to differences in implementation of complex interventions with multiple stakeholder groups. This study aimed to explore and describe the nature of and differences between communities implementing Health TAPESTRY, a complex primary care intervention aiming to keep older adults healthier in their homes for longer, as it was scaled beyond its initial effectiveness trial. Methods We conducted a comparative case study with six communities in Ontario, Canada implementing Health TAPESTRY. We focused on differences between three key elements: interprofessional primary care teams, volunteer program coordination, and the client experience. Sources of data included semi-structured focus groups and interviews. Data were analyzed through the steps of thematic analysis. We then created matrices in NVivo by splitting the qualitative data by community and comparing across the key elements of the Health TAPESTRY intervention. Results Overall 135 people participated (39 clients, 8 clinical managers, 59 health providers, 6 volunteer coordinators, and 23 volunteers). The six communities had differences in size and composition of both their primary care practices and communities, and how the volunteer program and Health TAPESTRY were implemented. Distinctions between communities relating to the work of the interprofessional teams included characteristics of the huddle lead, involvement of physicians and the volunteer coordinator, and clarity of providers’ role with Health TAPESTRY. Key differences between communities relating to volunteer program coordination included the relationship between the volunteers and primary care practices, volunteer coordinator characteristics, volunteer training, and connections with the community. Differences regarding the client experience between communities included differing approaches used in implementation, such as recruitment methods. Conclusions Although all six communities had the same key program elements, implementation differed community-by-community. Key aspects that seemed to lead to differences across categories included the size and spread of communities, size of primary care practices, and linkages between program elements. We suggest future programs engaging stakeholders from the beginning and provide clear roles; target the most appropriate clients; and consider the size of communities and practices in implementation. Trial registration ClinicalTrials.gov: NCT03397836. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07615-0.
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Affiliation(s)
- Jessica Gaber
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada.
| | - Julie Datta
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada
| | - Rebecca Clark
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada
| | - Larkin Lamarche
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada
| | - Fiona Parascandalo
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada
| | - Stephanie Di Pelino
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada
| | - Pamela Forsyth
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada
| | - Doug Oliver
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada
| | - David Price
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, Hamilton, Ontario, L8P 1H6, Canada
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Adachi M, Tamakoshi K, Watai I. Hospital organizational structure factors related to discharge planning activities for alcoholics by nurses in Japan. Jpn J Nurs Sci 2022; 19:e12473. [PMID: 35112492 DOI: 10.1111/jjns.12473] [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: 09/19/2021] [Revised: 11/13/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
AIM Nurses play a significant role in providing discharge support for alcoholics. We aimed to explore the organizational structures of hospitals that are related to effective discharge planning activities provided by nurses. METHODS We conducted a cross-sectional survey of Japanese hospitals with psychiatric wards that accept alcoholics. The survey questionnaire was administered to one nurse per hospital from August to September 2019. The Discharge Planning Scale for Ward Nurses (DPWN) was used to assess the actual status of the hospital nurse teams' discharge planning activities. The DPWN consists of four subscales: subscale I, "collect information from patients and their families"; subscale II, "supports for decision-making for the patients and families"; subscale III, "utilization of social resources"; and subscale IV, "discharge guidance by cooperating with community support teams and multidisciplinary teams." RESULTS From the valid responses of 116 hospitals, scores on subscale IV were significantly lower than scores on subscales I, II, and III, indicating that medical care guidance through multidisciplinary collaboration between hospitals and the community was inadequate. In addition, multiple regression analysis showed that "hospital management and administrators understanding about nurses' discharge support activities," and "planning discharge schedules, such as using clinical paths" were significantly and independently related to the total DPWN and each of subscale scores, regardless of the hospital's establishment body and size. "Multidisciplinary discharge support" was significantly related to subscale II. CONCLUSIONS These findings have implications for the management of discharge planning activities provided by nurses for alcoholics through multidisciplinary collaboration.
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Affiliation(s)
- Madoka Adachi
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Koji Tamakoshi
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Izumi Watai
- Faculty of Nursing, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Kip EC, Udedi M, Kulisewa K, Go VF, Gaynes BN. Barriers and facilitators to implementing the HEADSS psychosocial screening tool for adolescents living with HIV/AIDS in teen club program in Malawi: health care providers perspectives. Int J Ment Health Syst 2022; 16:8. [PMID: 35101066 PMCID: PMC8805413 DOI: 10.1186/s13033-022-00520-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents living with HIV (ALHIV) are at high risk of experiencing mental health problems. Depression is a major contributor to the burden of HIV-related disease amongst ALHIV and is significantly linked to non-adherence to anti-retroviral therapy (ART), yet it is under-recognized. In 2015, the Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) recommended that the psychosocial screening tool Home, Education, Activities, Drugs, Sexuality, Suicide/Depression (HEADSS) be used to screen ALHIV in Malawi who were part of an adolescent antiretroviral therapy program termed "Teen Club". However, the HEADSS tool has been substantially under-utilized. This study assessed barriers and facilitators to implementing HEADSS for ALHIV attending Teen Club Program in four selected health facilities in Malawi. METHODS We conducted a qualitative study using semi-structured interviews at four program sites (one district hospital and one health center each in two districts) between April and May 2019. Twenty key informants were purposively selected to join this study based on their role and experiences. We used the five domains of the Consolidated Framework for Implementation Research (CFIR) to guide the development of the interview guides, analysis and interpretation of results. RESULTS Barriers included inadequate planning for integration of the HEADSS approach; concerns that the HEADSS tool was too long, time consuming, lacked appropriate cultural context, and increased workload; and reports by participants that they did not have knowledge and skills to screen ALHIV using this tool. Facilitators to implementing the screening were that health care providers viewed screening as a guide to better systematic counselling, believed that screening could build better client provider relationship, and thought that it could fit into the existing work practice since it is not complex. CONCLUSIONS A culturally adapted screening tool, especially one that can be used by non-clinicians such as lay health workers, would improve the ability to address mental health needs of ALHIV in many primary care and social service settings where resources for professional mental health staff are limited. These findings are a springboard for efforts to culturally adapt the HEADSS screening tool for detection of mental and risky behaviors among ALHIV attending ART program in Malawi.
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Affiliation(s)
- Esther C Kip
- Malawi College of Medicine, Private Bag 360, Blantyre, Malawi.
| | - Michael Udedi
- Malawi College of Medicine, Private Bag 360, Blantyre, Malawi
- Malawi Ministry of Health, Lilongwe, Malawi
| | | | - Vivian F Go
- University of North Carolina, Chapel Hill, NC, USA
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Davidson AR, Kelly J, Ball L, Morgan M, Reidlinger DP. What do patients experience? Interprofessional collaborative practice for chronic conditions in primary care: an integrative review. BMC PRIMARY CARE 2022; 23:8. [PMID: 35172731 PMCID: PMC8759162 DOI: 10.1186/s12875-021-01595-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Improving the patient experience is one of the quadruple aims of healthcare. Therefore, understanding patient experiences and perceptions of healthcare interactions is paramount to quality improvement. This integrative review aimed to explore how patients with chronic conditions experience Interprofessional Collaborative Practice in primary care. METHODS An integrative review was conducted to comprehensively synthesize primary studies that used qualitative, quantitative, and mixed methods. Databases searched were Medline, Embase, CINAHL and Web of Science on June 1st, 2021. Eligible studies were empirical full-text studies in primary care that reported experiences or perceptions of Interprofessional Collaborative Practice by adult patients with a chronic condition, in any language published in any year. Quality appraisal was conducted on included studies using the Mixed Method Appraisal Tool. Data on patients' experiences and perceptions of Interprofessional Collaborative Practice in primary care were extracted, and findings were thematically analyzed through a meta-synthesis. RESULTS Forty-eight (n = 48) studies met the inclusion criteria with a total of n = 3803 participants. Study quality of individual studies was limited by study design, incomplete reporting, and the potential for positive publication bias. Three themes and their sub-themes were developed inductively: (1) Interacting with Healthcare Teams, subthemes: widening the network, connecting with professionals, looking beyond the condition, and overcoming chronic condition collectively; (2) Valuing Convenient Healthcare, subthemes: sharing space and time, care planning creates structure, coordinating care, valuing the general practitioner role, and affording healthcare; (3) Engaging Self-care, subthemes: engaging passively is circumstantial, and, engaging actively and leading care. CONCLUSIONS Patients overwhelmingly had positive experiences of Interprofessional Collaborative Practice, signaling it is appropriate for chronic condition management in primary care. The patient role in managing their chronic condition was closely linked to their experience. Future studies should investigate how the patient role impacts the experience of patients, carers, and health professionals in this context. SYSTEMATIC REVIEW REGISTRATION PROSPERO: CRD42020156536.
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Affiliation(s)
- Alexandra R Davidson
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
| | - Jaimon Kelly
- Centre for Online Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lauren Ball
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Mark Morgan
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Dianne P Reidlinger
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
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Eljiz K, Greenfield D, Vrklevski L, Derrett A, Ryan D. Large scale healthcare facility redevelopment: A scoping review. Int J Health Plann Manage 2021; 37:691-714. [PMID: 34779045 DOI: 10.1002/hpm.3378] [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: 11/16/2020] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 01/16/2023] Open
Abstract
Internationally, organisations are undertaking large scale facility redevelopment as a strategy for the transformation of care systems. Redeveloping facilities provides a once in a generation opportunity to transform health service delivery, typically, however, system level changes are poorly understood. To address this gap, our aim was to investigate the empirical knowledge base regarding large scale redevelopment of healthcare facilities. A scoping review was undertaken, guided by the redeveloped health service management (HSM) scoping review framework (HSM-SRF). Across 17 articles, five key concepts were identified, and they form the principles for successful redevelopment. First, establish a strong governance framework integrating diverse expertise and evidence base. Second, engage with internal and external stakeholders to build effectual relationships. Third, consult with end users, including clinicians and patients, to encourage the acceptance of the redevelopment and actively manage stakeholder dynamics, including politics and power undercurrents. Fourth, commit appropriate resources, including time, workforce, technology and finance to ensure redevelopment success. Finally, reimagine workflows through consultation with end users, including staff and consumers, allowing them to conceptualise how the space will be utilised. This scoping review is the first to synthesise the empirical knowledge base of the redevelopment of healthcare facilities.
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Affiliation(s)
- Kathy Eljiz
- Tasmanian School of Business and Economics, Australian Institute of Health Service Management, University of Tasmania, Sydney, TAS, Australia
| | - David Greenfield
- South Western Sydney Local Health District Capital Works, Liverpool, NSW, Australia
| | - Lila Vrklevski
- Mental Health SLHD, Australian Institute of Health Service Management, Tasmanian School of Business and Economics, Sydney Local Health District, University of Tasmania, Sydney, TAS, Australia
| | - Alison Derrett
- Western Sydney Local Health District, Australian Institute of Health Service Management, Tasmanian School of Business and Economics, University of Tasmania, Sydney, TAS, Australia
| | - David Ryan
- Faculty of Medicine, South Western Sydney Clinical School, University of New South Wales, Sydney, TAS, Australia
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Peña IDL, Koch J. Teaching Intellectual Humility Is Essential in Preparing Collaborative Future Pharmacists. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2021; 85:8444. [PMID: 34965915 PMCID: PMC8715963 DOI: 10.5688/ajpe8444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 02/23/2021] [Indexed: 06/14/2023]
Abstract
Interprofessional teams contribute significantly to patient care and safety. However, barriers to effective interdisciplinary collaboration have been identified, such as power dynamics and mistrust among team members, contrasting ideologies, interests and levels of engagement of clinicians, and disciplinary territoriality, which could negatively impact patient care. Teaching current health professional students behaviors and personal values that promote collaboration is critical in equipping them to function effectively in an interdisciplinary care setting. In this commentary, we put forward the idea that teaching intellectual humility is important in preparing collaborative future pharmacists. The core dimensions of intellectual humility, namely, open-mindedness, intellectual modesty, engagement, and corrigibility are important behaviors that could address the above-mentioned barriers, and promote successful interdisciplinary collaboration. Furthermore, we suggest strategies through which student pharmacists could be taught intellectual humility, mainly within the interprofessional education setting.
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Affiliation(s)
- Ike de la Peña
- Loma Linda University, School of Pharmacy, Loma Linda, California
| | - Jessa Koch
- Loma Linda University, School of Pharmacy, Loma Linda, California
- Loma Linda University, School of Medicine, Loma Linda, California
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Figueiredo MH, Ferreira MM, Silva MLD, Guedes VS. Self-perception of nurses' competence in family assessment and intervention. INVESTIGACION Y EDUCACION EN ENFERMERIA 2021; 39:e13. [PMID: 34822240 PMCID: PMC8912160 DOI: 10.17533/udea.iee.v39n3e13] [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: 02/25/2021] [Accepted: 09/03/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To describe nurses' self-perception of competence in family assessment and intervention. METHODS A sample of 551 Portuguese primary care nurses was selected. A Likert-type questionnaire with 11 items corresponding to the areas of care proposed by the Dynamic Model of Family Assessment and Intervention (MDAIF) was administered. Each item consists of 7 optional responses; a score equal to or greater than 4 denotes competence. RESULTS The nurses perceived themselves as competent in areas of care belonging to the development dimension of the MDAIF (parental role, adaptation to pregnancy, and family planning), as well as in the caregiver role (which belongs to the functional dimension). There was a progressive decline in self-perception of competence over the stages of the nursing process. CONCLUSIONS In this study, crucial aspects related to nurses' self-perception of their competence in family assessment and intervention were observed, and need to be addressed in the training of nurses in all areas of care included in the Model. This should facilitate awareness of the competences needed to provide the best care for families.
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Affiliation(s)
| | - Maria Manuela Ferreira
- Escola Superior de Saúde Norte da Cruz Vermelha Portuguesa, Portugal, manuela.ferreira@ essnortecvp.pt
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An Overview of Reviews on Interprofessional Collaboration in Primary Care: Barriers and Facilitators. Int J Integr Care 2021; 21:32. [PMID: 34220396 PMCID: PMC8231480 DOI: 10.5334/ijic.5589] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Interprofessional collaboration (IPC) is becoming more widespread in primary care due to the increasing complex needs of patients. However, its implementation can be challenging. We aimed to identify barriers and facilitators of IPC in primary care settings. Methods: An overview of reviews was carried out. Nine databases were searched, and two independent reviewers took part in review selection, data extraction and quality assessment. A thematic synthesis was carried out to highlight the main barriers and facilitators, according to the type of IPC and their level of intervention (system, organizational, inter-individual and individual). Results: Twenty-nine reviews were included, classified according to six types of IPC: IPC in primary care (large scope) (n = 11), primary care physician (PCP)-nurse in primary care (n = 2), PCP-specialty care provider (n = 3), PCP-pharmacist (n = 2), PCP-mental health care provider (n = 6), and intersectoral collaboration (n = 5). Most barriers and facilitators were reported at the organizational and inter-individual levels. Main barriers referred to lack of time and training, lack of clear roles, fears relating to professional identity and poor communication. Principal facilitators included tools to improve communication, co-location and recognition of other professionals’ skills and contribution. Conclusions: The range of barriers and facilitators highlighted in this overview goes beyond specific local contexts and can prove useful for the development of tools or guidelines for successful implementation of IPC in primary care.
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Molima CEN, Karemere H, Bisimwa G, Makali S, Mwene-Batu P, Malembaka EB, Macq J. Barriers and facilitators in the implementation of bio-psychosocial care at the primary healthcare level in South Kivu, Democratic Republic of Congo. Afr J Prim Health Care Fam Med 2021; 13:e1-e10. [PMID: 33881334 PMCID: PMC8063565 DOI: 10.4102/phcfm.v13i1.2608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 10/24/2020] [Accepted: 12/30/2020] [Indexed: 11/17/2022] Open
Abstract
Background In the Democratic Republic of Congo (DRC), healthcare services are still focused on disease control and mortality reduction in specific groups. The need to broaden the scope from biomedical criteria to bio-psychosocial (BPS) dimensions has been increasingly recognized. Aim The objective of this study was to identify the barriers and facilitators to providing healthcare at the health centre (HC) level to enable BPS care. Settings This qualitative study was conducted in six HCs (two urban and four rural) in South-Kivu (eastern DRC) which were selected based on their accessibility and their level of primary healthcare organization. Methods Seven focus group discussions (FGDs) involving 29 healthcare workers were organized. A data synthesis matrix was created based on the Rainbow Model framework. We identified themes related to plausible barriers and facilitators for BPS approach. Results Our study reports barriers common to a majority of HCs: misunderstanding of BPS care by healthcare workers, home visits mainly used for disease control, solidarity initiatives not locally promoted, new resources and financial incentives expected, accountability summed up in specific indicators reporting. Availability of care teams and accessibility to patient information were reported as facilitators to change. Conclusion This analysis highlighted major barriers that condition providers’ mindset and healthcare provision at the primary care level in South-Kivu. Accessibility to the information regarding BPS status of individuals within the community, leadership of HC authorities, dynamics of HC teams and local social support initiatives should be considered in order to develop an effective BPS approach in this region.
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Affiliation(s)
- Christian E N Molima
- École Régionale de Santé Publique (ERSP), Faculté de Médecine, Université Catholique de Bukavu, Bukavu, The Democratic Republic of Congo; and, Institute of Health and Society (IRSS), Ecole de Santé Publique, Université Catholique de Louvain, Brussels.
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Moncatar TJRT, Nakamura K, Siongco KLL, Seino K, Carlson R, Canila CC, Javier RS, Lorenzo FME. Interprofessional collaboration and barriers among health and social workers caring for older adults: a Philippine case study. HUMAN RESOURCES FOR HEALTH 2021; 19:52. [PMID: 33874959 PMCID: PMC8056548 DOI: 10.1186/s12960-021-00568-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 02/18/2021] [Indexed: 05/25/2023]
Abstract
BACKGROUND There is limited information on how the barriers to interprofessional collaboration (IPC) across various professionals, organizations, and care facilities influence the health and welfare of older adults. This study aimed to describe the status of IPC practices among health and social workers providing care for older adults in the Philippines; investigate the perceived barriers to its implementation and perceived effects on geriatric care; and identify possible solutions to address the barriers limiting collaborative practice. METHODS A case study approach was utilized employing 12 semi-structured in-depth interviews and 29 focus group discussions with care workers from selected primary health care units, public and private hospitals, and nursing homes that are directly involved in geriatric care delivery in two cities in the Philippines. Overall, 174 health and social workers consented to participate in this study. All interviews were audio-recorded and transcribed verbatim. An inductive thematic analysis using NVivo 12® was used to identify and categorize relevant thematic codes. RESULTS Interprofessional geriatric care provided by health and social workers was observed to be currently limited to ad hoc communications typically addressing only administrative concerns. This limitation is imposed by a confluence of barriers such as personal values and beliefs, organizational resource constraints, and a silo system care culture which practitioners say negatively influences care delivery. This in turn results in inability of care providers to access adequate care information, as well as delays and renders inaccessible available care provided to vulnerable older adults. Uncoordinated care of older adults also led to reported inefficient duplication and overlap of interventions. CONCLUSION Geriatric care workers fear such barriers may aggravate the increasing unmet needs of older adults. In order to address these potential negative outcomes, establishing a clear and committed system of governance that includes IPC is perceived as necessary to install a cohesive service delivery mechanism and provide holistic care for older adults. Future studies are needed to measure the effects of identified barriers on the potential of IPC to facilitate an integrated health and social service delivery system for the improvement of quality of life of older adults in the Philippines.
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Affiliation(s)
- TJ Robinson T. Moncatar
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8519 Japan
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, 1000 Metro Manila, Philippines
| | - Keiko Nakamura
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8519 Japan
- World Health Organization Collaborating Centre for Healthy Cities and Urban Policy Research, Tokyo, 113-8519 Japan
| | - Kathryn Lizbeth L. Siongco
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8519 Japan
- College of Nursing, University of the Philippines Manila, 1000 Metro Manila, Philippines
| | - Kaoruko Seino
- Department of Global Health Entrepreneurship, Division of Public Health, Tokyo Medical and Dental University, Tokyo, 113-8519 Japan
- World Health Organization Collaborating Centre for Healthy Cities and Urban Policy Research, Tokyo, 113-8519 Japan
| | - Rebecca Carlson
- Institute of Global Affairs, Tokyo Medical and Dental University, Tokyo, 113-8519 Japan
| | - Carmelita C. Canila
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, 1000 Metro Manila, Philippines
| | - Richard S. Javier
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, 1000 Metro Manila, Philippines
| | - Fely Marilyn E. Lorenzo
- Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, 1000 Metro Manila, Philippines
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Furness K, Huggins C, Croagh D, Haines T. Exploring the Attitudes of Health Professionals Providing Care to Patients Undergoing Treatment for Upper Gastrointestinal Cancers to Different Models of Nutrition Care Delivery: A Qualitative Investigation. Nutrients 2021; 13:nu13031020. [PMID: 33809826 PMCID: PMC8004184 DOI: 10.3390/nu13031020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
Background: People with upper gastrointestinal cancer are at high risk for malnutrition without universal access to early nutrition interventions. Very little data exist on the attitudes and views of health professionals on providing nutrition care to this patient cohort delivered by electronic health methods. COVID-19 has fast-tracked the adoption of digital health care provision, so it is more important than ever to understand the needs of health professionals in providing health care via these modes. This study aimed to explore the perspectives of health professionals on providing nutrition care to upper gastrointestinal cancer patients by electronic methods to allow the future scaling-up of acceptable delivery methods. Methods: Semi-structured qualitative interviews were conducted face-to-face or by telephone and recorded, de-identified and transcribed. Thematic analysis was facilitated by NVivo Pro 12. Results: Interviews were conducted on 13 health professionals from a range of disciplines across several public and private health institutions. Thematic analysis revealed three main themes: (1) the ideal model, (2) barriers to the ideal model and (3) how to implement and translate the ideal model. Health professionals viewed the provision of nutrition interventions as an essential part of an upper gastrointestinal cancer patient’s treatment with synchronous, telephone-based internal health service models of nutrition care overwhelmingly seen as the most acceptable model of delivery. Mobile application-based delivery methods were deemed too challenging for the current population serviced by these clinicians. Conclusion: The use of novel technology for delivering nutrition care to people receiving treatment for upper gastrointestinal cancers was not widely accepted as the preferred method of delivery by health professionals. There is an opportunity, given the rapid uptake of digital health care delivery, to ensure that the views and attitudes of health professionals are understood and applied to develop acceptable, efficacious and sustainable technologies in our health care systems.
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Affiliation(s)
- Kate Furness
- Nutrition and Dietetics, Monash Health, Monash Medical Centre, Clayton, VIC 3168, Australia
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC 3199, Australia;
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC 3199, Australia
- Correspondence: ; Tel.: +61-(03)-9594-4180
| | - Catherine Huggins
- Department of Nutrition, Dietetics and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia;
| | - Daniel Croagh
- Upper Gastrointestinal and Hepatobiliary Surgery, Monash Medical Centre, Clayton, VIC 3168, Australia;
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VIC 3168, Australia
| | - Terry Haines
- Department of Physiotherapy, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC 3199, Australia;
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Frankston, VIC 3199, Australia
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Effect of the OPTIMAL programme on self-management of multimorbidity in primary care: a randomised controlled trial. Br J Gen Pract 2021; 71:e303-e311. [PMID: 33685920 PMCID: PMC7959668 DOI: 10.3399/bjgp20x714185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/02/2020] [Indexed: 11/19/2022] Open
Abstract
Background Effective primary care interventions for multimorbidity are needed. Aim To evaluate the effectiveness of a group-based, 6-week, occupational therapy-led self-management support programme (OPTIMAL) for patients with multimorbidity. Design and setting A pragmatic parallel randomised controlled trial across eight primary care teams in Eastern Ireland with 149 patients with multimorbidity, from November 2015 to December 2018. Intervention was OPTIMAL with a usual care comparison. Method Primary outcomes were health-related quality of life (EQ-5D-3L) and frequency of activity participation (Frenchay Activities Index [FAI]). Secondary outcomes included independence in activities of daily living, occupational performance and satisfaction, anxiety and depression, self-efficacy, and healthcare utilisation. Complete case linear regression analyses were conducted. Age (<65/≥65 years) and the number of chronic conditions (<4/≥4) were explored further. Results A total of 124 (83.2%) and 121 (81.2%) participants had complete data at immediate and 6-month post-intervention follow-up, respectively. Intervention participants had significant improvement in EQ-VAS (visual analogue scale) at immediate follow-up (adjusted mean difference [aMD] = 7.86; 95% confidence interval [CI] = 0.92 to 14.80) but no difference in index score (aMD = 0.04; 95% CI = −0.06 to 0.13) or FAI (aMD = 1.22; 95% CI = −0.84 to 3.29). At 6-month follow-up there were no differences in primary outcomes and mixed results for secondary outcomes. Pre-planned subgroup analyses suggested participants aged <65 years were more likely to benefit. Conclusion OPTIMAL was found to be ineffective in improving health-related quality of life or activity participation at 6-month follow-up. Existing multimorbidity interventions tend to focus on older adults; preplanned subgroup analyses results in the present study suggest that future research should target younger adults (<65 years) with multimorbidity.
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Izumi SI, Li Z, Sato A. Quantifying face-to-face communication among multidisciplinary medical professions in a convalescent rehabilitation ward by using a name tag-type information communication device: A pilot study. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2021. [DOI: 10.4103/jisprm-000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Alameddine M, Bou-Karroum K, Kassas S, Hijazi MA. A profession in danger: Stakeholders' perspectives on supporting the pharmacy profession in Lebanon. PLoS One 2020; 15:e0242213. [PMID: 33196652 PMCID: PMC7668569 DOI: 10.1371/journal.pone.0242213] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022] Open
Abstract
Background Lebanon boosts one of the highest pharmacists to population ratios globally (20.3/10,000). Yet, workforce analysis elicited serious concerns with the distribution, practice environments and regulation of Lebanese pharmacists. Recent workforce data shows that the profession has been majorly destabilized with hundreds of pharmacists closing their pharmacies or losing their employment. Proper planning for the future of the pharmacy profession in Lebanon necessitates a deeper understanding of the current challenges and the necessary policy and practice recommendations. The aim of this study is to examine stakeholders’ perspectives on the current pharmacist workforce challenges and the necessary measures to support the profession. Methods The research team carried out a series of semi-structured interviews with twenty-one key stakeholders within the pharmacy profession in Lebanon. We categorized stakeholders according to their experience as policy makers, practitioners, academicians, and media experts. The interview guide included questions about workforce trends, labor market challenges and recommendations for improvement. Interviews were transcribed and analyzed thematically. Results Four major themes emerged from this study: the oversupply of pharmacists in Lebanon, the demand supply imbalance, poor regulation of the pharmacy practice, and the difficult practice environment. There was a consensus among interviewees that the oversupply of pharmacists is due to the poor workforce planning and weak regulatory framework, combined with the easy integration of foreign-trained pharmacists into the labor market. The lack of coordination between the educational and practice sectors is further widening the demand-supply gap. Interviewees further revealed that the regulatory policies on pharmacy practice were outdated and/or weakly enforced which increases the risk of unethical practices and erodes the image of pharmacists in the society. With respect to the practice environment, there is an ongoing struggle by Lebanese pharmacists to maintain profitability and exercise their full scope of practice. Conclusion The poor pharmacy workforce planning and regulation is significantly weakening the pharmacy profession in Lebanon. A concerted effort between the various stakeholders is necessary to enhance workforce planning, regulate supply, optimize the integration of pharmacists into work sectors of need, and improve the financial and professional wellbeing of pharmacists in Lebanon.
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Affiliation(s)
- Mohamad Alameddine
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health Care City, Dubai, United Arab Emirates
| | - Karen Bou-Karroum
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Sara Kassas
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Mohamad Ali Hijazi
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Beirut Arab University, Beirut, Lebanon
- * E-mail:
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Carroll S, Moss-Morris R, Hulme K, Hudson J. Therapists' perceptions of barriers and facilitators to uptake and engagement with therapy in long-term conditions. Br J Health Psychol 2020; 26:307-324. [PMID: 33043530 DOI: 10.1111/bjhp.12475] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 07/24/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Improving Access to Psychological Therapies (IAPT) services in England have established a long-term condition (LTC) pathway in recent years, meaning that LTC therapies are now delivered via varied modes and by professionals with varied experiences. To gain insight into how this new pathway is functioning in practice, this study aimed to explore therapists' perceptions of barriers and facilitators to uptake and engagement with therapy in LTCs. DESIGN A qualitative design was employed using semi-structured interviews. METHODS Fifteen therapists were recruited from IAPT and physical health care settings. Interviews were first analysed using inductive thematic analysis. A deductive approach was then taken to map themes onto Normalisation Process Theory constructs (coherence, cognitive participation, collective action, reflective monitoring) to guide steps towards improving implementation. RESULTS Four key themes highlighted patient, therapist, and service-level factors related to uptake and engagement: Working flexibly with barriers within the National Health Service context; Acceptability of 'embedded' versus 'separate' psychological care; Confidence in working with people with LTCs; and Navigating implementation of online therapies. Therapists recognized the need for tailored LTC therapies, though opinions about online therapies varied. Therapists expressed commitment to flexibly adapting their practice to suit patient needs, but felt their flexibility was limited by system and service constraints. CONCLUSION Barriers to uptake and engagement need to be addressed to optimize LTC pathways. Findings demonstrated the importance of offering flexible, tailored therapy to people with LTCs, and equipping staff and services with adequate training and resources to improve functioning of LTC pathways in practice.
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Affiliation(s)
- Susan Carroll
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - Rona Moss-Morris
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - Katrin Hulme
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
| | - Joanna Hudson
- Psychology Department, Institute of Psychiatry, Psychology & Neuroscience at King's College London, UK
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Ferguson J, Astbury J, Willis S, Silverthorne J, Schafheutle E. Implementing, embedding and sustaining simulation-based education: What helps, what hinders. MEDICAL EDUCATION 2020; 54:915-924. [PMID: 32306437 DOI: 10.1111/medu.14182] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 03/30/2020] [Accepted: 04/15/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Although there is much evidence to support the use of simulation-based education (SBE) in undergraduate education of health care professionals, less attention has been paid to how SBE, viewed as a complex intervention, is implemented and becomes embedded and sustained. This paper aims to explore factors that inhibited or promoted SBE becoming normal practice in undergraduate health care professional programmes. METHODS Participants involved in the organisation, design and delivery of SBE in the north of England were recruited purposefully from higher education institutions (HEI) and National Health Service (NHS) Trusts through local networks for qualitative telephone interviews. Transcripts were analysed inductively using a hybrid approach involving simultaneous inductive open coding and deductive coding using normalisation process theory (NPT) as a theoretical lens. FINDINGS A total of 12 NHS staff from 11 trusts and seven individuals from four HEIs were interviewed. There was considerable variation in the approach taken to implementation across organisations, which resulted in varying degrees of embeddedness. Implementation was challenged or enabled by organisational leadership, professional buy-in and the development and maturity of the strategic approach. Variation in understanding of the scope and pedagogical aims of SBE led to inequity between professions and organisations in investment and participation, as well as design and delivery of SBE. CONCLUSIONS Given the complexity of SBE, best practice in implementation should be considered fundamental to the successful delivery of SBE. The findings provide an explanation of how contextual factors can support or hinder implementation to maximise potential benefits and learning outcomes; this understanding can be used to better inform development of SBE strategies and highlight potential factors needed to navigate contextual barriers so that learning outcomes can be maximised.
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Affiliation(s)
- Jane Ferguson
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| | - Jayne Astbury
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| | - Sarah Willis
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| | - Jennifer Silverthorne
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
| | - Ellen Schafheutle
- Division of Pharmacy and Optometry, School of Health Sciences, Centre for Pharmacy Workforce Studies, The University of Manchester, Manchester, UK
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Waggie F, Arends NE. Exploring interprofessional teamwork at a tertiary public hospital in South Africa. J Interprof Care 2020; 35:672-681. [PMID: 32838588 DOI: 10.1080/13561820.2020.1803225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The landscape of health in South Africa has changed dramatically with the unprecedented rise in the burden of disease. Public health care facilities struggle to provide quality, patient-centered care to patients with complex health needs. Interprofessional teamwork is strongly advocated to improve the quality and patient-centeredness of care. This study explored the barriers and facilitators of interprofessional teamwork amongst health professionals working at a tertiary level public hospital in South Africa. The study employed a qualitative, descriptive, exploratory design. Data were collected during three focus group discussions with 14 purposively selected participants from several health professions. Barriers such as high patient turnover, lack of human resources, time, hierarchy, referral process, lack of knowledge of the roles and scopes of practice, negative attitudes, communication inefficiencies, language barriers, and professional jealousy were found to impede interprofessional teamwork. Facilitators of interprofessional teamwork included increased human resources, communication technology, respect, and relationship building. Although health professionals understand the barriers and facilitators of interprofessional teams in the provision of patient care, this study concludes that interprofessional capacity building is needed for successful interprofessional teamwork at a tertiary level public hospital setting.
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Affiliation(s)
- Firdouza Waggie
- Interprofessional Education Unit, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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Multidisciplinary approach between physicians and physiotherapists in urogynecology: how can we make it stronger? Int Urogynecol J 2020; 31:2187-2188. [PMID: 32681346 DOI: 10.1007/s00192-020-04417-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 05/28/2020] [Indexed: 10/23/2022]
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Burrows M, Gale N, Greenfield S, Litchfield I. A quantitative assessment of the parameters of the role of receptionists in modern primary care using the work design framework. BMC FAMILY PRACTICE 2020; 21:138. [PMID: 32650728 PMCID: PMC7353756 DOI: 10.1186/s12875-020-01204-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 06/22/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Amidst increased pressures on General Practice across England, the receptionist continues to fulfil key administrative and clinically related tasks. The need for more robust support for these key personnel to ensure they stay focussed and motivated is apparent, however, to be effective a more systematic understanding of the parameters of their work is required. Here we present a valuable insight into the tasks they fulfil, their relationship with colleagues and their organisation and their attitudes and behaviour at work collectively defined as their 'work design'. METHODS Our aim was to quantitatively assess the various characteristics of receptionists in primary care in England using the validated Work Design Questionnaire (WDQ) a 21 point validated questionnaire, divided into four categories: task, knowledge and social characteristics and work context with a series of sub-categories within each, disseminated online and as a postal questionnaire to 100 practices nationally. RESULTS Seventy participants completed the WDQ, 54 online and 16 using the postal questionnaire with the response rate for the latter being 3.1%. The WDQ suggested receptionists experience high levels of task variety, task significance and of information processing and knowledge demands, confirming the high cognitive load placed on receptionists by performing numerous yet significant tasks. Perhaps in relation to these substantial responsibilities a reliance on colleagues for support and feedback to help negotiate this workload was reported. CONCLUSION The evidence of our survey suggests that the role of modern GP receptionists requires an array of skills to accommodate various administrative, communicative, problem solving, and decision-making duties. There are ways in which the role might be better supported for example devising ways to separate complex tasks to avoid the errors involved with high cognitive load, providing informal feedback, and perhaps most importantly developing training programmes.
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Affiliation(s)
- Michael Burrows
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.,Present Address: School of Psychological, Social and Behavioural Sciences, Faculty of Health & Life Sciences, Coventry University, Priory St., Coventry, CV1 5FB, Birmingham, UK
| | - Nicola Gale
- School of Social Policy, HSMC Park House, University of Birmingham, Birmingham, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Ian Litchfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Henni SH, Kirkevold M, Antypas K, Foss C. Perceptions of the scope of practice of nurse practitioners caring for older adults: level of agreement among different healthcare providers. Scand J Caring Sci 2020; 35:492-501. [PMID: 32323373 DOI: 10.1111/scs.12861] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 03/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Globally, new nurse practitioner roles have been introduced into interdisciplinary teams. Research indicates that agreement among the different healthcare providers regarding one another's role and scope of practice is important for establishing interdisciplinary teamwork. Lack of agreement regarding a new nurse practitioner's scope of practice may hinder collaboration. AIM To investigate the level of agreement among advanced geriatric nurses (AGNs), their colleagues and their leaders regarding which activities related to direct and indirect care, teaching/supervision, coordination and research and development work are perceived as appropriate for AGNs. DESIGN A cross-sectional descriptive survey. METHODS The total population of AGNs in Norway (n = 26) and a sample of their colleagues, including leaders (n = 465), were invited to answer an online questionnaire. Twenty-three (88.5%) AGNs and 195 (42%) colleagues answered the questionnaires. A series of cross-tabulations were conducted to identify the respondents reporting on the appropriateness of different activities. RESULTS The respondents identified all of the activities related to coordination, teaching/supervision and research and development work as appropriate for AGNs. Although the respondents considered several of the direct and indirect care activities as appropriate, there were conflicting views on the activities that traditionally fall within the medical field vs. those that traditionally fall within the nursing field. The AGNs saw most of the nursing and medical activities as appropriate, but their colleagues and leaders saw only some of the nursing activities as appropriate. The results also showed that there was high disagreement among the leaders regarding appropriate activities. CONCLUSION The results indicate that healthcare providers agree on which activities related to teaching/supervision, coordination, and research and development work are appropriate to include in AGNs' scope of practice, but that there are conflicting views regarding activities related to direct and indirect care.
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Affiliation(s)
- Silje Havrevold Henni
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Marit Kirkevold
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Konstantinos Antypas
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christina Foss
- Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Valaitis R, Cleghorn L, Dolovich L, Agarwal G, Gaber J, Mangin D, Oliver D, Parascandalo F, Ploeg J, Risdon C. Examining Interprofessional teams structures and processes in the implementation of a primary care intervention (Health TAPESTRY) for older adults using normalization process theory. BMC FAMILY PRACTICE 2020; 21:63. [PMID: 32295524 PMCID: PMC7160930 DOI: 10.1186/s12875-020-01131-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 03/19/2020] [Indexed: 01/15/2023]
Abstract
BACKGROUND Many countries are engaged in primary care reforms to support older adults who are living longer in the community. Health Teams Advancing Patient Experience: Strengthening Quality [Health TAPESTRY] is a primary care intervention aimed at supporting older adults that involves trained volunteers, interprofessional teams, technology, and system navigation. This paper examines implementation of Health TAPESTRY in relation to interprofessional teamwork including volunteers. METHODS This study applied Normalization Process Theory (NPT) and used a descriptive qualitative approach [1] embedded in a mixed-methods, pragmatic randomized controlled trial. It was situated in two primary care practice sites in a large urban setting in Ontario, Canada. Focus groups and interviews were conducted with primary care providers, clinical managers, administrative assistants, volunteers, and a volunteer coordinator. Data was collected at 4 months (June-July 2015) and 12 months (February-March 2016) after intervention start-up. Patients were interviewed at the end of the six-month intervention. Field notes were taken at weekly huddle meetings. RESULTS Overall, 84 participants were included in 17 focus groups and 13 interviews; 24 field notes were collected. Themes were organized under four NPT constructs of implementation: 1) Coherence- (making sense/understanding of the program's purpose/value) generating comprehensive assessments of older adults; strengthening health promotion, disease prevention, and self-management; enhancing patient-focused care; strengthening interprofessional care delivery; improving coordination of health and community services. 2) Cognitive Participation- (enrolment/buy-in) tackling new ways of working; attaining role clarity. 3) Collective Action- (enactment/operationalizing) changing team processes; reconfiguring resources. 4) Reflective Monitoring- (appraisal) improving teamwork and collaboration; reconfiguring roles and processes. CONCLUSIONS This study contributes key strategies for effective implementation of interventions involving interprofessional primary care teams. Findings indicate that regular communication among all team members, the development of procedures and/or protocols to support team processes, and ongoing review and feedback are critical to implementation of innovations involving primary care teams. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT02283723 November 5, 2014. Prospectively registered.
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Affiliation(s)
- Ruta Valaitis
- Aging Community and Health Research Unit, School of Nursing, McMaster University, HSC 3N25, 1280 Main Street West, McMaster University, Hamilton, ON L8S4K1 Canada
| | - Laura Cleghorn
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON L8P 1H6 Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON L8P 1H6 Canada
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON L8P 1H6 Canada
| | - Jessica Gaber
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON L8P 1H6 Canada
| | - Derelie Mangin
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON L8P 1H6 Canada
| | - Doug Oliver
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON L8P 1H6 Canada
| | - Fiona Parascandalo
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON L8P 1H6 Canada
| | - Jenny Ploeg
- Aging Community and Health Research Unit, School of Nursing, McMaster University, HSC 3N25, 1280 Main Street West, McMaster University, Hamilton, ON L8S4K1 Canada
| | - Cathy Risdon
- Department of Family Medicine, McMaster University, David Braley Health Sciences Centre, 100 Main Street West, 5th floor, Hamilton, ON L8P 1H6 Canada
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Ngangue PA, Forgues C, Nguyen T, Sasseville M, Gallagher F, Loignon C, Stewart M, Belle Brown J, Chouinard MC, Fortin M. Patients, caregivers and health-care professionals' experience with an interdisciplinary intervention for people with multimorbidity in primary care: A qualitative study. Health Expect 2020; 23:318-327. [PMID: 32035012 PMCID: PMC7104629 DOI: 10.1111/hex.13035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background Multimorbidity challenges the health‐care system and requires innovative approaches. In 2015, a 4‐month patient‐centred interdisciplinary pragmatic intervention was implemented in primary care with the aim of supporting self‐management for patients with multimorbidity. Objective To explore the perceptions and experiences of health‐care professionals, patients and their caregivers with a 4‐month patient‐centred interdisciplinary pragmatic intervention in primary care. Design A descriptive, qualitative study using semi‐structured interviews was conducted. Setting and participants A purposive sample of 30 participants was recruited from seven family medicine groups including patients, caregivers and health‐care professionals (HCPs). Interviews were analysed using Thorne's interpretive description approach. Results Findings were grouped into the benefits and challenges of participating in the intervention. The programme allowed patients to adopt realistic and adapted objectives; to customize interventions to the patient's reality; and to help patients gain confidence, improve their knowledge, skills and motivation to manage their condition. Interprofessional collaboration eased the exchange of information via team meetings and electronic medical records. Challenges were related to collaboration, communication, coordination of work and integration of newly relocated HCPs mainly due to part‐time assignments and staff turnover. HCPs part‐time schedules limited their availability and hindered patients’ follow‐up. Discussion and conclusion This intervention was useful and rewarding from the HCPs, patients and caregivers’ perspective. However, to ensure the success of this complex interdisciplinary intervention, implementers and managers should anticipate organizational barriers such as availability and time management of relocated HCPs.
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Affiliation(s)
- Patrice Alain Ngangue
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Catherine Forgues
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Tu Nguyen
- Westmead Applied Research Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Maxime Sasseville
- Department of health sciences, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Frances Gallagher
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Christine Loignon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | | | - Martin Fortin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
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McLaughlin JE, Bush AA, Rodgers PT, Scott MA, Zomorodi M, Roth MT. Characteristics of High-Performing Interprofessional Health Care Teams Involving Student Pharmacists. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2020; 84:7095. [PMID: 32292183 PMCID: PMC7055411 DOI: 10.5688/ajpe7095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 09/20/2018] [Indexed: 05/13/2023]
Abstract
Objective. To identify key themes of interprofessional models of care that offer experiential education opportunities for pharmacy learners. Methods. Six pharmacists from four Area Health Education Centers in North Carolina participated in individual, 60-minute interviews. Using two pre-established frameworks, the data were analyzed qualitatively by two members of the research team to identify the characteristics of interdisciplinary care teams. Results. At the level of the organization or health care system, the theme of appropriate resources and procedures emerged. At the level of the team, the themes of appropriate resources and procedures, communication, appropriate skill mix, climate, quality and outcomes of care, and respecting and understanding roles emerged. At the level of the individual, the themes of communication, respecting and understanding roles, and individual characteristics emerged. Three themes identified in a previous study failed to emerge in the interviews: leadership and management; personal rewards, training and development; and clarity of vision. Conclusion. Although a growing body of evidence highlights the importance of designing practice models to achieve interdisciplinary care that is patient-centered and effective, capacity to support learners and effectively educate them in the principles and practices of team-based care is limited. This study provides critical insight into characterizations of interprofessional models that integrate pharmacy learners. Further research is needed to better understand the barriers to designing and implementing IPE in experiential settings.
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Affiliation(s)
| | - Antonio A Bush
- Association of American Medical Colleges, Washington, District of Columbia
- Guest Editor, American Journal of Pharmaceutical Education, Arlington, Virginia
| | - Philip T Rodgers
- University of North Carolina, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
| | - Mollie Ashe Scott
- University of North Carolina, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
- University of North Carolina, UNC School of Medicine, Chapel Hill, North Carolina
- Mountain Area Health Education Center, Asheville, North Carolina
| | - Meg Zomorodi
- University of North Carolina, School of Nursing, Chapel Hill, North Carolina
| | - Mary T Roth
- University of North Carolina, UNC Eshelman School of Pharmacy, Chapel Hill, North Carolina
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Tierney E, Hannigan A, Kinneen L, May C, O'Sullivan M, King R, Kennedy N, MacFarlane A. Interdisciplinary team working in the Irish primary healthcare system: Analysis of 'invisible' bottom up innovations using Normalisation Process Theory. Health Policy 2019; 123:1083-1092. [PMID: 31575445 DOI: 10.1016/j.healthpol.2019.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 06/26/2019] [Accepted: 09/12/2019] [Indexed: 11/15/2022]
Abstract
Interdisciplinary team working in primary care is a key policy goal across healthcare jurisdictions. The National Primary Care Strategy (2001) in Ireland is a top down policy for primary healthcare reform, which prioritised the development and implementation of interdisciplinary Primary Care Teams. The number of Primary Care Teams and features of their clinical meetings have been the key metric in Ireland for appraising progress with the implementation of the strategy. However, these have been challenging to organise in practice. The aim of this paper is to analyse empirical evidence of other forms of interdisciplinary working in Irish primary care, using Normalisation Process Theory. Drawing on data from an on-line survey (71 GPs and 498 other healthcare professionals), and an interview study (37 participants; 8 GPs, 7 practice managers/admin support and 22 health care professionals) in three of the four Health Service Executive (HSE) regions in Ireland, we analyse the nature of these other forms of interdisciplinary working and describe innovations for service delivery that have been developed 'from the ground up' as a result. We examine levers and barriers to the implementation of these bottom up innovations. The levers are that these innovations make sense to professionals, are based on local needs and focus on preventive patient-centred care. They are driven forward by small groups of professionals from different backgrounds with complementary skills. The evaluations show positive impacts of the innovative services for patients, however, many have ceased to operate due to negative effects of the recent economic recession on the Irish healthcare system. These flexible and localised innovations were shaped in part by the reforms set out in the 2001 Primary Care Strategy but also represent unintended effects of that policy because they are the result of bottom up interdisciplinary working that occurs alongside, or instead of, Primary Care Team clinical meetings. Furthermore, as they not captured by existing metrics, the interdisciplinary work and resultant services have been 'invisible' to senior management and policy makers. If appropriately acknowledged and supported, they can shape primary care in the future.
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Affiliation(s)
| | - Ailish Hannigan
- Biomedical Statistics, Graduate Entry Medical School and Health Research Institute, University of Limerick, Ireland.
| | | | - Carl May
- Medical Sociology London School of Hygiene and Tropical Medicine, London, UK.
| | | | - Rachael King
- Graduate Entry Medical School, University of Limerick, Ireland.
| | - Norelee Kennedy
- Department of Clinical Therapies School of Allied Health, University of Limerick, Ireland.
| | - Anne MacFarlane
- Primary Healthcare Research, Graduate Entry Medical School and Health Research Institute University of Limerick, Ireland.
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Mertens F, De Gendt A, Deveugele M, Van Hecke A, Pype P. Interprofessional collaboration within fluid teams: Community nurses' experiences with palliative home care. J Clin Nurs 2019; 28:3680-3690. [PMID: 31216390 DOI: 10.1111/jocn.14969] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 04/13/2019] [Accepted: 05/26/2019] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To explore how community nurses experience the collaboration with general practitioners and specialist palliative home care team nurses in palliative home care and the perceived factors influencing this collaboration. BACKGROUND The complexity of, and the demand for, palliative home care is increasing. Primary palliative care is provided by community nurses and general practitioners, often in collaboration with palliative home care team nurses. Although these professionals may each individually be part of a fixed team, a new temporary team is often composed for every new palliative patient. These membership changes, referred to as team membership fluidity, challenge professionals to work effectively. DESIGN AND METHODS A qualitative research design, using semi-structured interviews with community nurses. Participant selection happened through regional palliative care networks in Belgium. The network's palliative home care team nurses selected community nurses with whom they recently collaborated. Twenty interviews were conducted. A constant comparative analysis approach was used. Consolidated criteria for reporting qualitative research guidelines were followed. RESULTS Formal interprofessional team meetings were not common practice. The other's approachability and knowing each other positively influenced the collaboration. Time constraints, the general practitioners' lack of expertise, communication style, hierarchy perception and income dependency negatively influenced the collaboration with general practitioners and determined palliative home care team nurses' involvement. The coping strategies of community nurses balanced between a behaviour focused to the patient and to the professional relationship. Specialist palliative home care team nurses were relied upon for their expertise but also to mediate when community nurses disagreed with general practitioners. CONCLUSION Community nurses showed to be highly adaptable within the fluid team. Strikingly, dynamics described in the doctor-nurse game 50 years ago are still present today and affect the interprofessional communication. Interprofessional education interventions can contribute to improved interprofessional collaboration. RELEVANCE TO CLINICAL PRACTICE The study findings uncovered critical knowledge gaps in interprofessional collaboration in palliative home care. Insights are relevant for and related to professional well-being and workplace learning.
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Affiliation(s)
- Fien Mertens
- Department of Public Health and Primary Care, Ghent University, Belgium.,End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
| | - Anneleen De Gendt
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Myriam Deveugele
- Department of Public Health and Primary Care, Ghent University, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Belgium.,End-of-Life Care Research Group, Ghent University & Vrije Universiteit Brussel, Brussels, Belgium
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Liddle J, Clemson L, Mackenzie L, Lovarini M, Tan A, Pit SW, Roberts C, Tiedemann A, Sherrington C, Willis K. Influences on general practitioner referral to allied health professionals for fall prevention in primary care. Australas J Ageing 2019; 39:e32-e39. [DOI: 10.1111/ajag.12680] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/02/2019] [Accepted: 05/08/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Jeannine Liddle
- Faculty of Health Sciences The University of Sydney Lidcombe New South Wales Australia
| | - Lindy Clemson
- Faculty of Health Sciences The University of Sydney Lidcombe New South Wales Australia
- CEPAR—ARC Centre of Excellence in Population Ageing Research Sydney New South Wales Australia
| | - Lynette Mackenzie
- Faculty of Health Sciences The University of Sydney Lidcombe New South Wales Australia
| | - Meryl Lovarini
- Faculty of Health Sciences The University of Sydney Lidcombe New South Wales Australia
| | - Amy Tan
- Faculty of Health Sciences The University of Sydney Lidcombe New South Wales Australia
| | - Sabrina W. Pit
- University Centre for Rural Health, Sydney Medical School The University of Sydney Sydney New South Wales Australia
- School of Medicine, Medical School Western Sydney University Sydney New South Wales Australia
| | - Chris Roberts
- Sydney Medical School—Northern The University of Sydney Sydney New South Wales Australia
| | - Anne Tiedemann
- Institute for Musculoskeletal Health, School of Public Health The University of Sydney Sydney New South Wales Australia
| | - Cathie Sherrington
- Institute for Musculoskeletal Health, School of Public Health The University of Sydney Sydney New South Wales Australia
| | - Karen Willis
- School of Allied Health La Trobe University Melbourne Victoria Australia
- Allied Health Melbourne Health Melbourne Victoria Australia
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49
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Interdisciplinary Teams and Home-Based Medical Care: Secondary Analysis of a National Survey. J Am Med Dir Assoc 2019; 20:770-774. [DOI: 10.1016/j.jamda.2018.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/07/2018] [Accepted: 12/09/2018] [Indexed: 01/01/2023]
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50
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Wranik WD, Price S, Haydt SM, Edwards J, Hatfield K, Weir J, Doria N. Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis. Health Policy 2019; 123:550-563. [PMID: 30955711 DOI: 10.1016/j.healthpol.2019.03.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/11/2019] [Accepted: 03/23/2019] [Indexed: 01/19/2023]
Abstract
Interprofessional primary care (IPPC) teams are promoted as an alternative to single profession physician practices in primary care with focus on preventive care and chronic disease management. Characteristics of teams can have an impact on their performance. We synthesized quantitative, qualitative or mixed-methods evidence addressing the design of IPPC teams. We searched Ovid MEDLINE, Embase, CINAHL, and PAIS using search terms focused on IPPC teams. Studies were included if they discussed the influence of team structure, organization, financial arrangements, or policies and procedures, or either health care processes or outputs, health outcomes, or costs, and were conducted in Australia, Canada, the United Kingdom or New Zealand between 2003 and 2016. We screened 11,707 titles, 5366 abstracts, and selected 77 full text articles (38 qualitative, 31 quantitative and 8 mixed-methods). Literature focused on the implications of team characteristics on team processes, such as teamwork, collaboration, or satisfaction of patients or providers. Despite heterogeneity of contexts, some trends are observable: shared space, common vision and goals, clear definitions of roles, and leadership as important to good teamwork. The impacts of these on health care outputs or patient health are not clear. To move the state of knowledge beyond perception of what works well for IPPC teams, researchers should focus on quantitative causal inference about the linkages between team characteristics and patient health.
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Affiliation(s)
- Wiesława Dominika Wranik
- School of Public Administration, Faculty of Management, Dalhousie University, Canada; Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Canada.
| | - Sheri Price
- School of Nursing, Faculty of Health Professions, Dalhousie University, Canada
| | - Susan M Haydt
- School of Public Administration, Faculty of Management, Dalhousie University, Canada
| | | | - Krista Hatfield
- School of Journalism and Communication, Carleton University, Canada
| | - Julie Weir
- Halifax Partnership, Dalhousie University, Canada
| | - Nicole Doria
- Maritime SPOR Support Unit, Dalhousie University, Canada
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