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At least 199 records · Page 11Linked to original sources

PubMed2002

General practice research: attitudes and involvement of Queensland general practitioners.

OBJECTIVES: To determine general practitioners' (GPs') attitudes towards and involvement in general practice research. DESIGN: Postal survey and semi-structured interviews conducted from May to September 2001. PARTICIPANTS AND SETTING: 467 of 631 GPs in four Queensland Divisions of General Practice responded to the survey (74% response rate); 18 selected GPs were interviewed. MAIN OUTCOME MEASURES: Survey - attitudes to research; access to information resources; and involvement in research. Interviews - the need for general practice research; barriers against and factors enabling greater participation in research. RESULTS: 389/463 (84%) GPs, especially younger and more recent graduates, had positive attitudes to research, but only 29% wanted more involvement. 223/462 (48%) were aware they had access to MEDLINE, although presumably all those with Internet access (89%) would have free access via PubMed. Barriers included the general practice environment (especially fee-for-service funding), and the culture of general practice. Enabling factors included academic mentors; opportunities to participate in reputable, established research activities relevant to general practice; and access to information resources. CONCLUSIONS: Although Australian general practice has a weak research culture, about a third of GPs would like to increase their involvement in research. However, the research must be perceived as relevant, and structured to minimise the inherent barriers in the environment and culture of general practice.

Adult↗

PubMedDate not supplied

Community-oriented primary care: critical assessment and implications for resident education.

BACKGROUND: Community-oriented primary care (COPC) is a systematic approach to health care based on principles derived from epidemiology, primary care, preventive medicine, and health promotion that has been shown to have positive health benefits for communities in the United States and worldwide. METHODS: MEDLINE was searched using the key phrase "community-oriented primary care." Other sources of information were books and other documents. RESULTS AND CONCLUSIONS: Because of lack of predictable reimbursement for COPC services and difficulties encountered incorporating COPC in medical and residency curricula, widespread application of COPC has not occurred. Recent trends in public health initiatives, managed health care, and information technology provide an environment ripe for application of COPC in medical practice. Also, recent recommendations made by the Strategic Planning Working Group of the Academic Family Medicine Organizations and the Association of Family Practice Residency Directors regarding specific community competencies for residency training have direct bearing on COPC and family medicine educators. These trends and recommendations, properly configured, will produce a medical training and practice environment conducive to COPC.

Community Health Planning↗

PubMed2004

Variations in nurse practitioner use in Veterans Affairs primary care practices.

BACKGROUND: Increasingly, primary care practices include nurse practitioners (NPs) in their staffing mix to contain costs and expand primary care. To achieve these aims in U.S. Department of Veterans Affairs medical centers (VAMCs), national policy endorsed involvement of NPs as primary care (PC) providers. OBJECTIVES: To evaluate the degree to which VAMCs incorporated NPs into PC practices between 1996 and 1999, and to identify the internal and external practice environment features associated with NP use. STUDY DESIGN: We surveyed 131 PC directors of all VAMCs in 1996 and 1999 to ascertain the staffing and characteristics of the PC practice and parent organization (e.g., academic affiliation, level of physician staffing, use of managed care arrangements), and drew on previously published studies and HRSA State Health Workforce Profiles to characterize each practice's regional health care environment (e.g., geographic region, state NP practice laws, state managed care penetration). Using multivariate linear regression, we evaluate the contribution of these environmental and organizational factors on the number of NPs/10,000 PC patients in 1999, controlling for the rate of NP use in 1996. PRINCIPAL FINDINGS: From 1996-1999, NP use increased from 75 percent to 90 percent in VA PC practices. The mean number of NPs per practice increased by about 60 percent (2.0 versus 3.2; p<.001), while the rate of NPs/10,000 PC patients trended upward (2.2 versus 2.7; p=.09). Staffing of other primary care clinicians (e.g., physicians and physician assistants per practice) remained stable, while the NP-per-physician rate increased (0.2 versus 0.4; p<.001). After multivariate adjustment, greater reliance on managed-care-oriented provider education programs (p=.02), the presence of NP training programs (p=.05), and more specialty-trained physicians/10,000 PC patients (p=.09) were associated with greater NP involvement in primary care. CONCLUSIONS: Staffing models in VA PC practices have, in fact, changed, with NPs having a greater presence. However, we found substantial practice-based variations in their use, suggesting that more research is needed to better understand how they have been integrated into practice and what impact their involvement has had on the VA's ability to achieve its restructuring goals.

Hospitals, Veterans↗

PubMed2003

Learning circles: collaborating to promote RN and LPN role enhancement.

Recent events in the Newfoundland and Labrador healthcare system, including changes to nursing scope of practice, have had a profound effect on practice environments for direct care registered nurses (RNs) and Licensed practical nurses (LPNs). This article describes an initiative introduced by the Association of Registered Nurses of Newfoundland and Labrador (ARNNL) and the Council for Licensed Practical Nurses (CLPN) in response to concerns raised by healthcare providers related to collaboration and teamwork between RNs and LPNs. Through the Learning Circles Project, the ARNNL and CLPN committed to fostering an improved working relationship for nursing team members based on the values of working together, mutual respect and an enhanced working environment.

Cooperative Behavior↗

PubMed1995

A comparison of quality and utilization problems in large and small group practices.

Physicians practicing in large, multispecialty medical groups share an organizational culture that differs from that of physicians in small or independent practices. Since 1980, there has been a sharp increase in the size of multispecialty group practice organizations, in part because of increased efficiencies of large group practices. The greater number of physicians and support personnel in a large group practice also requires a relatively more sophisticated management structure. The efficiencies, conveniences, and management structure of a large group practice provide an optimal environment to practice medicine. However, a search of the literature found no data linking a large group practice environment to practice outcomes. The purpose of the study reported in this article was to determine if physicians in large practices have fewer quality and utilization problems than physicians in small or independent practices.

Centers for Medicare and Medicaid Services, U.S.↗

PubMedDate not supplied

The changing face of nurses in Australian general practice.

OBJECTIVE: To describe the workforce characteristics and current responsibilities of nurses working in Australian general practice settings. DESIGN: Survey research combining qualitative and quantitative data collected through telephone interview. SUBJECTS: 222 enrolled (RN Division 2 in Victoria) and registered nurses (RN Division 1 in Victoria) working in general practice in rural and urban areas of Australia. RESULTS: General practice nurses in Australia are likely to be RNs (84.7%) who work on a part-time basis (75.3%) in a medium to large practice (93.7%). Often the nurse has worked less than five full time equivalent years (52.3%) in a general practice environment and is likely to work in a practice where at least one other nurse works (64.4%). The nurse is likely to have some post-basic formal education (65.9%), and to have participated in professional development in the past two years (94.9%). The nurse performs a diverse range of activities within the general practice. No substantial differences were found in the workforce characteristics or role of urban and rural general practice nurses. CONCLUSION: It appears that nurses working in general practice are no longer the 'handmaiden' to the doctor but are professionals who perform a vast range of clinical, administrative and organisational responsibilities within the general practice primary health care setting.

Australia↗

PubMed1995

Challenges to generalism: views from the delivery system.

The declining interest in primary care among U.S. medical students is an ominous trend for the national health system. The medical school environment, the powerful financial incentives promoting specialism, and the practice environment itself have contributed to the decline of generalism. During a day-long meeting sponsored by the Robert Wood Johnson Foundation, representatives of group practices, HMOs, community health centers, and military medicine noted the universal shortage of primary care physicians, the fact that medical education does not prepare physicians for the realities of practice, the concern that "burnout" is a significant problem for retention and physician satisfaction, and the problem that the optimal design of primary care practice is not yet known. To reverse these trends, concerted action must take place within academic medicine, by public policy makers, and by the delivery system itself.

Burnout, Professional↗

PubMed2001

Good practice in health, environment and safety management in enterprise.

Good practice in health, environment and safety management in enterprise (GP HESME) is a process that aims at continuous improvement in health, environment and safety performance, involving all stakeholders within and outside the enterprise. This WHO program is supported by other international organizations, and the declaration of Ministers of Health and Ministers of Environment adopted in 1999. The basic issues of the GP HESME concept are presented as well as its prerequisites, benefits and participants. The key partners in GP HESME are employers and their organizations, representatives of employees, governmental agencies, local authorities, financial and insurance institutions, occupational health services, environmental and social services, associations of professionals, research and training institutions. The HESME system is intended to function at different levels: international, national, local community, and enterprise settings. The lists of expected benefits for each group of stakeholders are discussed. Evaluation of GP HESME is based on the criteria and indicators, the most important of them are briefly presented.

Europe↗

PubMed1996

Managing the occupational environment of managed care.

The emergence of managed care has resulted in a practice environment buffeted by rapid and sweeping changes. Shifts in philosophy and approach to payment for health care affect the nature of the service and the method of its delivery. The occupational adaptation frame of reference is used to illustrate the challenges imposed by the physical, social, and cultural components of the changing occupational environment. Perceptions, observations, and concerns of middle level occupational therapy, physical therapy, social work, and nursing managers illustrate the impact of this new environment. Therapists are challenged to understand their own changing work setting and to apply the same effort to mastering its challenges as they would to examining the context of their patient's occupational performance and to designing and implementing an appropriate clinical intervention.

Health Services Needs and Demand↗

PubMed2003

New device indications: impact on the individual electrophysiology (EP) practitioner in a predominantly managed care environment.

The high penetration of managed care as a payment source in cardiology practice is a fact of life in many areas of the country. Understanding the system of reimbursement used by managed care is helpful in order to maximize physician payment for work done, to minimize practice overhead, and to reduce physician and managerial frustration. The key ingredient for success in any cardiology practice environment is high quality procedural outcomes and good communication with patients and referring physicians. This is true in both a managed care and fee for service environment. This article describes the relationship between an indicated electrophysiology procedure (e.g., an implantable cardioverter defibrillator in a low ejection fraction coronary patient) at one end and its reimbursement by a local managed care payer to an electrophysiologist at the other end.

Defibrillators, Implantable↗

PubMed1993

Oral anticoagulation monitoring in a community pharmacy.

Efforts by pharmacists to become more involved in patient care move the profession beyond the traditional role of dispenser. These initiatives increase the professionalism of the pharmacist and carry the potential for monetary rewards. Monitoring oral anticoagulation therapy is an area in which pharmacists can use specialized drug knowledge and advances in technology to fulfill a special patient need in the community setting. This article has outlined factors that should be considered in the development of an oral anticoagulation therapy monitoring program. Pharmacists can apply these principles to their individual practice environments to determine whether such a program is feasible, practical, and profitable. Pharmacists interested in this type of program must then prepare themselves for the increased demands of documentation, quality assurance, and patient counseling. By implementing an anticoagulation service, pharmacists can improve patient outcomes and extend their practices into a new frontier of pharmaceutical care.

Administration, Oral↗

PubMed2003

Training in evidence-based practice.

Controversy surrounds the concept of EBP. Many individuals question whether research is capable of guiding decisions about diagnosis and treatment, or whether it simply gives oversimplified answers to highly complex questions about human behavior. These concerns aside, it is hard to envision a future in which consumers and payers do not demand that the health professions ground their interventions in an evidence base. It is sobering to recognize that training in EBP has been far from the norm in the various behavioral health disciplines. This is just one aspect of a much larger crisis in behavioral health workforce education. Graduate and residency programs have not kept pace with many of the changes in behavioral health care delivery over the past decade. The field continues to use continuing education strategies that are ineffective, and little training is offered to the paraprofessional and bachelor-prepared staff members who comprise a large segment of the workforce in public sector and inpatient settings. Broad strategies are needed to overcome the lethargy in behavioral health education and training programs to make them more relevant to contemporary clinical practice. Incorporating evidence-based approaches to treatment is one critical element of needed reforms. General medicine has laid a foundation that can be built on for teaching the process of EBP. Psychiatry and psychology have taken the lead in identifying those interventions to be taught that are evidence-based or empirically supported. Research on continuing education and adult learning illuminates the educational strategies that are likely effective in teaching evidence-based interventions and an evidence-based process of care. Additionally, the research on changing provider behavior shows the importance of ensuring practice environments that support and reinforce, rather than thwart, the practice of evidence-based treatment. There are many resources to draw on but the task facing educators is substantial.

Curriculum↗

PubMed1997

Moral imperatives for academic medicine.

As the health care system becomes dominated by managed care, academic medicine must do more than simply learn how to continue to offer the same level of care with ever-tightening resources and in new practice environments. Three moral imperatives must guide how medicine is practiced and taught: (1) patients' health and well-being must always be foremost, centered in quality of care and respect for life; (2) the emotional and spiritual needs of patients must be considered, not just the physical needs; (3) academic medicine must instill in its trainees discipline, passion, and skills to meet their obligation to be lifelong learners. These imperatives make it more important than ever for medical educators to tackle two crucial questions: What kind of person makes the best possible physician? And what constitutes the best possible training for that person? Taking these questions seriously in the new era of health care may mean that medical educators need to rethink the teaching of medicine. One example of how this might be done is the Curriculum for 2002 Committee recently formed at the Wake Forest University School of Medicine. It is becoming clear that medical educators can do a better and more comprehensive job of helping future physicians uncover and strengthen their own morality and, in the face of managed care's pressures, renew their loyalty to medicine as a service rather than a business. Morally sensitized physicians can better deal with the hard issues of medicine, such as euthanasia and abortion, and can help their students examine these issues. Most important, they can show their students that physicians are members of a moral community dedicated to something other than its own self-interest.

Attitude of Health Personnel↗

PubMed2001

Statutory and regulatory issues for clinical nurse specialist (CNS) practice: ensuring the public's access to CNS services.

The practice environment of healthcare in the United States is fluid, dynamic, and sometimes chaotic. Statutory, regulatory, and credentialing requirements are critical elements of this changeable environment affecting clinical nurse specialists (CNSs) and other advanced practice nurses (APNs). CNSs are estimated to comprise approximately 54,000 APNs, based on the 2000 National Sample Survey of Registered Nurses. Although statutes and regulations related to APNs are reviewed regularly, there has not been a critical analysis of statutes and regulations specifically governing CNS practice in the United States. This lack is largely due to the absence of a national association devoted to CNSs before 1995. However, recently there has been a resurgence of interest and need for CNS services. Therefore, it is particularly important that any statutory and/or regulatory barriers to CNS practice be removed. In 1998, the National Association of Clinical Nurse Specialists Legislative and Regulatory Committee embarked on a critical analysis of state statutes and regulations governing CNS practice. All 50 state boards of nursing and the District of Columbia board of nursing were requested to send copies of their statutes and regulations governing CNS practice. Responses were received from 48 states. This article summarizes the state of regulation of CNS practice and identifies significant barriers to CNS practice that should be systematically addressed. The patchwork quilt of CNS regulation that varies from state to state results in over-restrictive and underinclusive provisions that preclude ease of reciprocity and deprive the public full access to CNS services. Recommendations for addressing the barriers are made.

Humans↗

PubMed1998

Reducing malpractice risk and increasing quality in managed care.

The Early Diagnosis Project was established in an effort to improve quality and reduce malpractice risk in managed care practice environments. The first project, which addressed breast cancer, utilized practice guidelines, patient handouts, and follow-up forms in an integrated attempt to improve the quality of care and reduce litigation involving "failure-to-diagnose" claims.

Breast Neoplasms↗

PubMedDate not supplied

Experience of women in a surgical specialty.

The increasing number of female medical students is changing the profile of physicians and particularly surgeons practicing in the community. Medical education and the private practice environment must adapt and provide the same training and practice opportunities to women and men. Comparable demands for excellence, appropriate professional behavior, mentoring and networking will help all physicians flourish in delivering the best, most effective health care to their patients.

Clinical Competence↗

PubMed2000

Use of office-based smoking cessation activities in family practices.

BACKGROUND: Smoking is the leading cause of morbidity and mortality in the United States. Recommendations for increasing physician effectiveness in smoking cessation through the use of office-based activities have been disseminated, but the extent of implementation is unknown. We describe the degree to which selected family practices in Nebraska have implemented 15 specific office-based activities. METHODS: We employed a cross-sectional integrated multimethod design. A research nurse observed a target physician and his or her staff during a 1-day visit in a random sample of 89 family practices. Data collection consisted of focused observation of the practice environment, key informant interviews, medical record reviews, and in-depth interviews with the physicians. RESULTS: The majority of the practices sampled had an office environment that restricted smoking, but few used visual cessation messages or information in the waiting room offering help and encouraging patients to quit. Most had educational materials that were supplied by pharmaceutical companies for promoting nicotine replacement systems. These materials were easily accessible in more than half of the practices. Smoking cessation activities were initiated and carried out by physicians with minimal use of their staff. Smoking status was documented in 51% of the medical records reviewed but seldom in a place readily accessible to the physician. All physicians were very aware of the importance of smoking cessation counseling, and most felt confident in their skills. CONCLUSIONS: Despite identification of patient smoking as a problem, most practices were not using office-based activities to enhance and support physician counseling. New perspectives for helping practices with this task need to be explored.

Cross-Sectional Studies↗

PubMed2006

Changing the work environment in intensive care units to achieve patient-focused care: the time has come.

The American Association of Critical-Care Nurses Standards for Establishing and Sustaining Healthy Work Environments and the American College of Chest Physicians Patient-Focused Care project are complementary initiatives that provide a road map for creating practice environments where interdisciplinary, patient-focused care can thrive. Healthy work environments are so influential that failure to address the issue would result in deleterious effects for every aspect of acute and critical care practice. Skilled communication and true collaboration are crucial for transforming work environments. The American College of Chest Physicians project on patient-focused care was born out of a realization that medicine as currently practiced is too fragmented, too focused on turf battles that hinder communication, and too divorced from a real understanding of what patients expect and need from their healthcare providers. Communication as well as continuity and concordance with the patients' wishes are foundational premises of care that is patient-focused and safe. Some individuals may achieve some level of genuine patient-focused care even when they practice in a toxic work environment because they are gifted communicators who embrace true collaboration. At best, most likely those efforts will be hit-or-miss and such heroism will be impossible to sustain if the environment is not transformed into a model that reflects standards and initiatives set out by the American Association of Critical-Care Nurses and the American College of Chest Physicians. Other innovative models of care delivery remain unreported. The successes and failures of these models should be shared with the professional community.

Health Facility Environment↗