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PubMed2005

Motivational interviewing in community-based research: experiences from the field.

Motivational Interviewing (MI) has been established as an effective psychotherapeutic treatment for problem drinking in clinical settings. Consequently, there is a growing interest in applying MI to facilitate change across other health behaviors, such as tobacco use, eating habits, and physical activity in a variety of community-based research settings. These extended applications pose new challenges regarding implementation and evaluation. For instance, investigators must consider how best to train intervention counselors; implement strategies for preserving the MI spirit, despite limited client contact time; incorporate adjunctive strategies that support brief MI sessions; and develop a plan for monitoring and evaluating MI treatment fidelity. This article highlights specific examples of how several behavior change research projects applied MI across a variety of settings and populations, provides lessons learned from our experience as a collaborative workgroup, and offers strategies for consideration in future community-based research.

Alcohol Drinking↗

PubMed2006

Reconnaissance assessment of risks for HIV transmission through health care and cosmetic services in India.

Available information shows frequent unsterile medical injections in India, but less is known about other invasive procedures. To assess the variety and frequency of blood exposures in health care and cosmetic services, we interviewed people living with HIV/AIDS in four districts with high HIV prevalence. Eighty percent reported from 1-300 injections in the five years before testing HIV-positive. Common lifetime exposures include dental care (31%), surgery (20%), blood tests (100%), and tattooing (47%). Through observation and interviews with doctors, dentists, and others, we found evidence for common to routine re-use of unsterilized equipment for blood tests (lancets), dental care, tattoos, and surgery. Health-care professionals and the public are misinformed about HIV survival outside the body and underestimate HIV transmission efficiency through blood exposures. The challenge to implement infection control for all invasive procedures remains undefined, while attention focuses on partial solutions, including single use of disposable syringes.

Acquired Immunodeficiency Syndrome↗

PubMed2004

A survey to investigate the role of the district nurse in stroke care.

The long-term needs of people who have had a stroke and their carers are not being adequately addressed. A stroke care coordinator based in primary care might improve service delivery: the district nurse has been suggested as a possible candidate. A postal survey was conducted with three primary care trusts in Bradford to investigate the current role of the district nurse in stroke care and to examine their potential as stroke care coordinator. District nurses from 24 (59%) teams responded to the survey. Twenty-two (44%) were aware of the national clinical guidelines for stroke and five (10%) had received stroke-related training within the previous year. The district nurses demonstrated insight into the types of longer term problems experienced by people who have had a stroke and their carers. While findings of the survey suggests that they would be a likely candidate for the stroke care coordinator role, there are major educational, training and organizational challenges to implementing this change.

Community Health Nursing↗

PubMedDate not supplied

Moving and handling practice in neuro-disability nursing.

This article examines the challenge of implementing a safer handling policy in an environment which caters for the needs of people who have complex and profound disability. It explores how a moving and handling educational strategy has been developed and the effectiveness of the strategies employed. The impact of changing practice at ward level and the difficulties encountered will be discussed in light of the patients' complex needs. The effects of the strategy are outlined with regard to accident reporting and the impact of legislation regarding moving and handling in an environment where patients' needs have to be balanced with staff safety are considered.

Persons with Disabilities↗

PubMedDate not supplied

The challenge of evidence-based practice for learning disabilities.

There is an ever-increasing pressure on professionals within both health and social care settings to demonstrate evidence-based practice. The main aim of this article is to consider as problematic the challenge of evidence-based practice for both health and social care professionals, with particular reference to those working in the field of learning disabilities. The article addresses a number of issues, including the nature of evidence, the different types of evidence that professionals have at their disposal, and issues of reliability and validity concerning the kinds of approaches used to obtain such evidence. The challenges of implementing evidence into practice are also discussed in relation to ideology, organizational implications, and educational issues.

Bias↗

PubMed2003

An evaluation-based model for palliative care education: making a difference to practice.

It has been recognized that education may be one way of improving the provision of palliative care to patients and their families. This article is the culmination of a multi-phase evaluation project that aimed to investigate the effectiveness of palliative care education provided by a hospice education network in the north west of England. Results from a study of 46 students over a three year period indicate that in order for education to be deemed effective, there are certain fundamental requirements. These include responding to the changing and individual needs of participants, competent teaching in theory and practice, and enabling students to make a difference to practice. This paper describes a model for providing palliative care education, which encompasses these fundamental requirements. It also meets the needs of stakeholder and provides evidence of improvements in clinical practice. In particular, it focuses on the challenges of implementing this model in the current climate of clinical effectiveness, evidence-based practice and value for money.

Attitude of Health Personnel↗

PubMedDate not supplied

Adapting psychosocial intervention research to urban primary care environments: a case example.

PURPOSE: We wanted to describe the unique issues encountered by our research team in testing an intervention to reduce perinatal depression in real-world community health centers. METHOD: We used a case study of an experience in conducting a randomized controlled trial designed to test the effectiveness of a low-cost multimodal psychosocial intervention to reduce prenatal and postpartum depression. Low-income minority women (N = 187) with low-risk pregnancies were randomly assigned to the intervention or treatment as usual. Outcomes of interest were depressive symptoms and social support assessed at 3 months' postpartum. RESULTS: Our intervention was not associated with changes in depressive symptoms or social support. Challenges in implementation were related to participant retention and intervention delivery. Turnover of student therapists affected continuity in participant-therapist relationships and created missed opportunities to deliver the intervention. The academic-community partnership that was formed also required more involvement of health center personnel to facilitate ownership at the site level, especially for fidelity monitoring. While attentive to cultural sensitivity, the project called for more collaboration with participants to define common goals and outcomes. Participatory research strategies could have anticipated barriers to uptake of the intervention and achieved a better match between outcomes desired by researchers and those of participants. CONCLUSION: Several criteria for future research planning emerged: assessing what the population is willing and able to accept, considering what treatment providers can be expected to implement, assessing the setting's capacity to accommodate intervention research, and collecting and using emerging unanticipated data.

Adult↗

PubMedDate not supplied

The FDA's regulation of health economic information.

Section 114 of the Food and Drug Administration Modernization Act of 1997 was intended to increase the flow of health economic information from pharmaceutical manufacturers to managed care decisionmakers. But the legislation raises a host of complex questions and has provoked diverse opinions from inside and outside the pharmaceutical industry. Moreover, the Food and Drug Administration (FDA) has yet to issue interpretative guidance on the subject. The challenge in implementing Section 114 lies in developing a policy that improves health economic information exchange while protecting consumers from misleading claims and preserving incentives for manufacturers to conduct rigorous studies.

Drug Industry↗

PubMedDate not supplied

The prevention challenge and opportunity.

In the United States, more money is spent on treating diseases and their complications than on preventing them in the first place. Prevention is both undervalued and poorly supported in our health system. In this Perspective I discuss how the McKinlay model can be used to illustrate the three levels at which we need to increase our investment in prevention. I recognize the many challenges in implementing programs of prevention, but I also note that these programs represent opportunities to improve health, prevent unnecessary pain and suffering, and, in time, develop a health system that is balanced and affordable.

Health Plan Implementation↗

PubMedDate not supplied

Millionaires and mental health: Proposition 63 in California.

In November 2004 California passed Proposition 63, a landmark piece of mental health and fiscal legislation. This initiative places a 1 percent tax on adjusted gross income over dollar 1 million, affecting about 30,000 taxpayers and raising dollar 1.8 billion (a 31 percent increase) in new revenues over the first three years to support county-operated mental health systems. Our analysis suggests that Proposition 63 passed with strong support from Democrats, urban dwellers, and social workers and in counties with high rates of homelessness. Proposition 63 faces challenges in implementation and provides unprecedented opportunities for transformation and change.

California↗

PubMedDate not supplied

Prevalence and types of disease management programs in community pharmacies in California.

OBJECTIVES: To (1) evaluate the prevalence and types of disease management (DM) programs provided by independent and chain community pharmacies in the state of California, (2) examine the interest among community pharmacists in establishing programs, and (3) assess perceived barriers to developing a successful DM program in community pharmacy. METHOD: An exploratory telephone survey was conducted from February 2003 to February 2004 to collect data from community (primarily independent and chainstore) pharmacies across California. The survey evaluated existence (or lack of) and types of DM programs in community pharmacies in California. Pharmacies that did not have a DM program were queried on their interest and decisionmaking authority in establishing new programs. Pharmacies that had existing DM programs were sent a follow-up survey to determine the details of the DM programs, including challenges in establishing DM programs, reimbursement issues, and program effectiveness. RESULTS: The sample comprised 1,875 pharmacies, 60 (3.2%) of which had existing DM programs. There were significantly more independent pharmacies (37) with DM programs than chain-store pharmacies (23), P<0.001. There was a statistically significant difference between independent and chain pharmacies in operating hours, number of pharmacist and nonpharmacist staff members per day, and proximity to a clinic or hospital (P<0.05). The most common type of DM program was diabetes, and the second most common type was asthma. Limited time, limited staff, and limited reimbursement were the 3 most commonly reported barriers to establishing new DM programs. About 20% of the sample that did not have a DM program reported interest in developing DM programs, and an equal percentage reported having the decision-making authority to start a program. There were no differences between independent and chain pharmacies on interest (P = 0.234); however, there were significantly more chain pharmacists that did not have the decision-making authority. Of the 18 of 60 pharmacies (30%) that had DM programs and responded to the follow-up survey, 9 respondents (50%) reported monitoring medications as part of their DM program. Fifteen of 18 (83%) perceived lack of reimbursement as a challenge to implementing DM programs. Only 2 pharmacies reported an increase in revenue as a gain from the program, and 2 reported cost savings. Improved patient satisfaction was reported by 16 of 18 respondents (89%) with DM programs, but only 8 (44%) reported that patient satisfaction was being measured. CONCLUSION: The study found that the prevalence of DM programs was very low among California community pharmacies and the interest in developing these programs moderate, attributable to several barriers such as lack of time, lack of reimbursement, and lack of trained personnel. Some of these barriers could be addressed to encourage the development and proliferation of DM programs that would improve patient outcomes and expand practice roles of pharmacists.

California↗

PubMed2004

Flexible client-driven in-home case management: an option to consider.

Changes in health services and care needs have created high demand for case management of in-home services. To address this challenge, several models of case management have been used. Evaluations to date suggest that clients need different approaches for different circumstances at different times to optimize cost-effectiveness. Accordingly, one Canadian home care program adopted flexible client-driven case management engaging clients as partners in flexibly selecting either an integrated team, consumer-managed or brokerage model of case management in keeping with their preferences and abilities. Using an exploratory, multimeasure quasi-experimental design, a generic model of program evaluation, and both quantitative and qualitative methods, researchers identified challenges in implementing this intervention, policy impediments the clients characteristically in each of the three case management models, and client, provider, and caregiver outcomes of flexible, client-driven care. While further longitudinal investigation is needed findings suggest several important considerations for those interested in this option for care management. Alternative case management models do attract different client groups, and having a choice does not alter care costs or outcomes. Flexible client-driven case management may be experienced positively by case managers and other providers.

Aged↗

PubMed2005

The WHO 'Roll Back Malaria Project': planning for adverse event monitoring in Africa.

Artemisinin combination therapies (ACTs) have been recommended for the treatment of malaria in countries where there is widespread resistance to commonly used antimalarial drugs. Several sub-Saharan African countries are, therefore, in the process of introducing ACTs in their malaria drug policies. However, there is limited information about the safety of ACTs outside South East Asia, where their use has been well documented. As with all other new medicinal compounds, the monitoring of a drug's safety or 'pharmacovigilance' is important, especially in areas where co-morbid conditions, such as HIV/AIDS, malnutrition and tuberculosis, are common. Because in most malaria endemic countries, particularly Africa, there are no pharmacovigilance programmes in place, it has been suggested that the introduction of ACTs offers an opportunity for these countries to put drug safety monitoring systems in place. Backed by the WHO Roll Back Malaria department and other international cooperating partners, five African countries, which are in the process of introducing ACTs (Burundi, Democratic Republic of the Congo, Mozambique, Zambia and Zanzibar), have drawn up action plans to introduce pharmacovigilance in their health sector. It is planned that once the safety monitoring of antimalarials has been established, these activities can then be extended to cover medicinal compounds used in other public health programmes, such as HIV/AIDS, tuberculosis and the immunisation programmes. This article looks at the rationale for pharmacovigilance, the process of setting up monitoring centres and the challenges of implementing the project in the region.

Adverse Drug Reaction Reporting Systems↗

PubMed2005

Recruitment and retention of minority students: diversity in nursing education.

A culturally diverse nursing workforce is essential to meet the health needs of an increasingly diverse Canadian population. The recruitment and retention of nursing students representing diverse backgrounds are vital to the building of this diversified work force. Studies have shown that diversity within the student body benefits everyone. For example, students who study and work within a diverse environment are better able to understand and consider multiple perspectives and to appreciate the benefits inherent in diversity. This paper describes one school of nursing's project on the Recruitment and Retention of Black students into their Bachelor of Science Nursing (BScN) Program. The project goals are to increase diversity, foster student learning, and ultimately improve health care for the Black community. Presented in this paper are the project background, implementation process, challenges and outcomes. This may provide learned lessons and future directions for similar initiatives in other institutions.

Black or African American↗

PubMed2006

Detecting emerging diseases in farm animals through clinical observations.

Predicting emerging diseases is among the most difficult challenges facing researchers and health managers. We present available approaches and tools to detect emerging diseases in animals based on clinical observations of farm animals by veterinarians. Three information systems are described and discussed: Veterinary Practitioner Aided Disease Surveillance in New Zealand, the Rapid Syndrome Validation Project-Animal in the United States, and "émergences" in France. These systems are based on syndromic surveillance with the notification of every case or of specific clinical syndromes or on the notification of atypical clinical cases. Data are entered by field veterinarians into forms available through Internet-accessible devices. Beyond challenges of implementing new information systems, minimizing economic and health effects from emerging diseases in animals requires strong synergies across a group of field partners, in research, and in international animal and public health customs and practices.

Animals↗

PubMed2006

Using Theraplay in shelter settings with mothers & children who have experienced violence in the home.

This article describes a group program for women and children exposed to violence in the home. The program is primarily based on Theraplay, an attachment-based intervention approach for working with both adults and children who have a variety of emotional and behavioral difficulties. The theoretical and research bases, as well as the guiding principles of Theraplay, will be outlined and discussed, and the rationale for its application to a shelter setting will be highlighted. Finally, the benefits of and challenges to implementing such a program and the implications for practice and further evaluation will be explored.

Adult↗

PubMed2006

An inter-professional approach to children's nursing education.

Nurses caring for children and young people do not practice in isolation but work as members of a multi-professional healthcare team. The Inter-professional programme delivered at Canterbury Christ Church University offers pathways in midwifery, adult nursing, child nursing, medical imaging, occupational therapy, social work and operating department practice. Benefits include the focus on children and their families from the outset, and learning to nurse using a multi-professional approach. Challenges in implementing the programme include maintaining professional identity, changing patterns of teaching and learning, supporting clinical staff in adapting to early student placement and the multiprofessional focus.

Clinical Competence↗

PubMed2003

A process and outcome evaluation of a shelter for homeless young women.

To evaluate the processes and outcomes of a short-term shelter, both quantitative and qualitative data were gathered via participant observation, focus group interviews with shelter staff and residents, and individual interviews with a sample of 40 young women who had been homeless prior to using the shelter. The process evaluation showed that the shelter staff strived to utilize an empowerment philosophy in their relationships with residents, but that there were many challenges to implementing this philosophy. The outcome evaluation showed that, at a 3-month follow-up, the participants reported significant improvements in housing, income, independence, and life satisfaction, but most continued to experience poverty and a number of other difficulties. The results were discussed in terms of the implications for future research and the valueand limitations of shelters for dealing with homeless youth. The need for more sustained and comprehensive program interventions and supportive social policies was underscored.

Adolescent↗