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PubMed2005

Evaluation of a postgraduate training programme for community mental health practitioners.

Government guidelines on mental health care in England have considerable implications for the level of competency required by the mental health workforce. Implementing these changes requires the widespread introduction of training initiatives whose effectiveness in improving staff performance need to be demonstrated through programme evaluation. This exploratory study evaluates the impact of a 2-year mental health training programme by measuring skill acquisition and skill application, by identifying the key ingredients for facilitating the transfer of learning into practice, and by examining differences in outcome between the academic and the non-academic students. High skill acquisition and application was reported in the majority of interventions, however, low skill application was reported for some key interventions (assertive outreach, dual diagnosis). Statistically significant differences were found between student cohorts in one intervention for skill acquisition (crisis intervention) and two interventions for skill application (client strengths model; medication management). The main ingredients for facilitating transfer were found to be the credibility of the trainers and training alongside colleagues from their own workplace. Some of the possible explanatory factors for these findings are discussed.

Adult↗
PubMed2005

The impact on rural New Mexico of a family medicine residency.

PURPOSE: To determine the impact on rural New Mexico of the large, decentralized University of New Mexico (UNM) family medicine residency. METHOD: A cross-sectional study was conducted of all 317 residency's graduates from 1974 to 2004. Location of current practice was correlated with the residents' gender, ethnicity, medical school of origin, and whether most training took place in the urban program or one of three rural programs. The residency's impact on rural communities was assessed. RESULTS: There was no significant gender difference between graduates who went into urban or rural practice. Compared with non-minority graduates, a significantly greater percentage of ethnic minority graduates were in rural and urban New Mexico practices and fewer in out-of-state practices. A greater percentage of graduates who had been medical students in New Mexico practiced in both rural and urban New Mexico areas compared with graduates of out of state medical schools. Finally, a greater percentage of graduates from the three rural family medicine residencies remained in the state and practiced in rural areas compared with graduates from the urban program. The graduates' contributions to the school of medicine and to rural New Mexico are described. CONCLUSIONS: Graduates of UNM's family medicine residency have contributed significantly to the state's rural health workforce. Ethnic minority status, graduation from New Mexico's medical school, and training in one of the three rurally based residencies favored in-state and rural retention, while gender had no significant effect. The rural orientation of the residencies offered rural communities economic benefits.

Career Choice↗
PubMed2005

Relative effectiveness of worker safety and health training methods.

OBJECTIVES: We sought to determine the relative effectiveness of different methods of worker safety and health training aimed at improving safety knowledge and performance and reducing negative outcomes (accidents, illnesses, and injuries). METHODS: Ninety-five quasi-experimental studies (n=20991) were included in the analysis. Three types of intervention methods were distinguished on the basis of learners' participation in the training process: least engaging (lecture, pamphlets, videos), moderately engaging (programmed instruction, feedback interventions), and most engaging (training in behavioral modeling, hands-on training). RESULTS: As training methods became more engaging (i.e., requiring trainees' active participation), workers demonstrated greater knowledge acquisition, and reductions were seen in accidents, illnesses, and injuries. All methods of training produced meaningful behavioral performance improvements. CONCLUSIONS: Training involving behavioral modeling, a substantial amount of practice, and dialogue is generally more effective than other methods of safety and health training. The present findings challenge the current emphasis on more passive computer-based and distance training methods within the public health workforce.

Humans↗
PubMed2006

The road to population health: using Healthy People 2010 in nursing education.

Healthy People 2010: Understanding and Improving Health and corresponding state health improvement plans provide roadmaps for planning, monitoring, and evaluating population health improvement in the United States. These documents offer relevant guidance for nursing education because they address health workforce education specifically, use a population perspective, and include evidence-based action priorities. However, information about how these documents are used in nursing education is limited. This article discusses the relevance of national and state health planning documents for nursing education. Nurse educators are encouraged to reflect on the alignment of current nursing education efforts with national and state health planning agendas. Suggestions for future use of national and state population health improvement planning documents in guiding strategic, curricular, and course planning are offered.

Community Health Planning↗
PubMed2001

National Public Health Performance Standards: workforce development and agency effectiveness in Florida.

The Florida Department of Health (FDOH) was the first state to pilot test both the Centers for Disease Control and Prevention (CDC) state agency and local Public Health System Performance Standards. The standards were found to be complementary and supportive of the FDOH quality performance improvement system, which had been in place for a decade, and the new Quality Management initiative. The pilot test found uneven performance across the state's county health departments and identified several areas, especially workforce development, that required additional efforts. The FDOH, in collaboration with the Center for Leadership in Public Health Practice at the College of Public Health in the University of South Florida, have collaborated and will continue to collaborate to design and deliver training in critical workforce development areas.

Efficiency, Organizational↗
PubMedDate not supplied

Public health infrastructure: creating a solid foundation.

The nation's public health system remains in disarray, despite the 1988 warning by the Institute of Medicine in its landmark report, "The Future of Public Health." Recent concerns about antibiotic resistance, inadequate disease surveillance capabilities, bioterrorism, and an increasing need for training the public health workforce have brought this problem into the forefront of congressional concern. Recent legislation aimed at addressing this problem was passed last Fall and signed into law. This program will take a significant step towards ensuring a solid public health system when it is fully implemented.

Communicable Disease Control↗
PubMed2005

Rethinking mental health nursing education in Australia: a case for direct entry.

Desperate times call for creative solutions. The mental health workforce shortage has created an opportunity to rethink current and future education and training needs in order to prepare competent and compassionate practitioners to meet the changing demands of consumers and their carers requiring mental heath treatment and support. This article urges consideration of an undergraduate direct entry mental health programme similar to that of midwifery or the nursing foundation/mental health branch programmes of the UK.

Australia↗
PubMed2005

Health promotion in the workplace--the merging of the paradigms.

PURPOSE: To synthesize the lessons from both occupational health and health promotion, to improve workplace health. APPROACH: This article briefly outlines the evolution in defining and understanding health promotion as well as current thinking in occupational health and safety. It also discusses an approach taken in the healthcare sector in British Columbia, Canada, where evidence-based practices and collaboration became the cornerstones to bringing about change and achieve impressive cost-beneficial results in healthcare workforce health. CONCLUSION: Traditionally, workplace health promotion and occupational health and safety have been two solitudes. Workplace health promotion is rooted in "wellness" and healthy lifestyle choices, while occupational health is heavily dictated by workplace health and safety requirements and legislation. Recently however, there has been increasing recognition of the need for a more holistic approach that focusses on workplace culture, addressing both primary and secondary prevention [1], as well as interventions aimed both at the individual as well as the organisation [2].

Canada↗
PubMed2006

The medical genetics workforce: an analysis of clinical geneticist subgroups.

PURPOSE: Clinical geneticists with a Doctor of Medicine degree face challenges to meet the growing population demand for genetic services. This study was designed to assist the profession with workforce planning by identifying clinically relevant subgroups of geneticists and describing their professional characteristics and clinical practices. Geneticists' patient care productivity is compared across subgroups and other medical specialists. METHODS: Part of a comprehensive national study of genetic services and the health workforce, this study uses data from a 2003 survey of geneticists certified by the American Board of Medical Genetics. This study includes 610 clinical geneticists who spend at least 5% of their time in direct patient-care services. An iterative approach was used to identify five subgroups based on the types of new patients seen. We conducted a descriptive analysis of subgroups by demographic, training, professional, and practice characteristics. RESULTS: The subgroups include general (36%), pediatric (28%), reproductive (15%), metabolic (14%), and adult (7%) geneticists. Clinically relevant variations across subgroups were noted in training, professional, and practice parameters. Subgroups vary across patient care hours (median, 15-33 hours/week) and total weekly work hours (52-60 hours). New patient visits (mean, 222-900/year) are higher than follow-up patient visits (mean, 155-405) for all subgroups except metabolic geneticists. CONCLUSION: Although many geneticists practice as generalist geneticists, this study provides an evidence base for distinguishing clinically relevant subgroups of geneticists. Geneticists provide similar numbers of new patient visits and far fewer follow-up visits than other medical specialists. These findings are relevant to geneticist workforce planning.

Data Collection↗
PubMedDate not supplied

Local public health cost study in Georgia.

Development of a uniform cost study methodology for local health department services in Georgia began with a desire to negotiate cost-based reimbursement from Medicaid. Managed care and the Health Insurance Portability and Accountability Act requirements for common coding standards added impetus to Georgia's efforts to document the cost of local public health. With a determination that the result was achievable, the Division of Public Health contracted with a medical practice management firm. What followed included a major team effort with active working groups of county, district, and state representatives. A template was developed by the consultants to compile the cost report and automated applications were installed. Statewide training engaged the local public health workforce and led to a successful pilot project. This article describes the interactive process that led ultimately to the ability of every county in the state to produce a valid cost report. The cost of direct services provided for individuals by county health departments can now be calculated with a cost per relative value unit. The cost report also includes the cost of environmental health, dental health, population-based services and all other local public health services. A brief description of the methodology is presented.

Accounting↗
PubMed2005

Nevada's academic-practice collaboration: public health preparedness possibilities outside an academic center.

The Nevada State Health Division developed a local academic-practice partnership with the University of Nevada Reno's Master of Public Health Program to assess the bioterrorism risk communication, information, response, and training needs of professional and public stakeholder groups throughout Nevada. Between October 16, 2002, and April 13, 2004, 22 needs assessment focus groups and 125 key informant interviews were conducted to gather information on the diverse needs of the stakeholders. The themes that emerged from these activities included the need for effective pre-event education and training; a coordinated and responsive public health preparedness infrastructure; honest, accurate, and timely communication in the event of a bioterrorism situation; and appropriate information dissemination methods and technology. The data collected through this needs assessment gave the Nevada State Health Division vital information to plan public health preparedness initiatives. The establishment of local academic-practice partnerships for states without a Centers for Disease Control and Prevention-funded Academic Center for Public Health Preparedness is an effective way for health departments to develop their public health preparedness infrastructure while simultaneously training the future public health workforce.

Bioterrorism↗
PubMed2005

Australian public health policy in 2003 - 2004.

In Australia, compared with other developed countries the many and varied programs which comprise public health have continued to be funded poorly and unsystematically, particularly given the amount of publicly voiced political support.In 2003, the major public health policy developments in communicable disease control were in the fields of SARS, and vaccine funding, whilst the TGA was focused on the Pan Pharmaceutical crisis. Programs directed to health maintenance and healthy ageing were approved. The tertiary education sector was involved in the development of programs for training the public health workforce and new professional qualifications and competencies. The Abelson Report received support from overseas experts, providing a potential platform for calls to improve national funding for future Australian preventive programs; however, inconsistencies continued across all jurisdictions in their approaches to tackling national health priorities. Despite 2004 being an election year, public health policy was not visible, with the bulk of the public health funding available in the 2004/05 federal budget allocated to managing such emerging risks as avian flu. We conclude by suggesting several implications for the future.

Editorial↗
PubMedDate not supplied

Indigenous health: chronically inadequate responses to damning statistics.

In the 10 years 1990-2000, despite improvements in some conditions, there has been little or no overall progress in the health of the Aboriginal and Torres Strait Islander populations of Australia. This is in stark contrast to the gains made in Indigenous health in other countries. The issue is one of lack of commitment to and implementation of already existing policies. We need to (i) fully and adequately fund the Primary Health Care Access Program to provide the out-of-hospital services for prevention and early treatment required to break the cycle of ill-health; (ii) implement a National Training Plan to train the necessary health workforce; and (iii) introduce a National Infrastructure Plan to rectify the continuing deficiencies in water supply, sanitation, education and other basic services.

Australia↗
PubMed2001

Training readiness of public health agencies: a framework for assessment.

The Healthy People 2010 Objectives and the Taskforce on Public Health Workforce Development both have recognized the important roles of state and local agencies in the education and training of their employees. This article describes an initial step in the development of a tool to assess agencies' training readiness using five factors derived from learning organization theory. These factors (resources, policies, learning culture, programs, and leadership) offer a useful framework for further development of a tool to assess training program readiness.

Education, Continuing↗
PubMed2006

Health sector reform and sexual and reproductive health services in Mongolia.

Since its transition to democracy, Mongolia has undergone a series of reforms, both at national level and in the health sector. This paper examines the pace and scope of these reforms, the ways in which they have impacted on sexual and reproductive health services and their implications for the health workforce. Formerly pro-natalist, Mongolia has made significant advances in contraceptive use, women's education and reductions in maternal mortality. However, rising adolescent pregnancy and sexually transmitted infections, and persisting high levels of abortion, remain challenges. The implementation of the National Reproductive Health Programme has targeted skills development, outreach and the provision of resources. Innovative adolescent-friendly health services have engaged urban youth, and the development of family group practices has created incentives to provide primary medical care for marginalised communities, including sexual and reproductive health services. The Health Sector Strategic Masterplan offers a platform for coordinated development in health, but is threatened by a lack of consensus in both government and donor communities, competing health priorities and the politicisation of emerging debates on fertility and abortion. With previous gains in sexual and reproductive health vulnerable to political change, these tensions risk the exacerbation of existing disparities and the development by default of a two-tiered health care system.

Abortion, Induced↗
PubMedDate not supplied

Addressing nursing shortages in sub-Saharan Africa.

The desperate situation of the health workforce in sub-Saharan Africa (SSA) cannot be overstated. This has been a significant and confounding factor in the decline in life expectancy in a number of SSA countries. This article identifies the reasons for the global shortage of nurses and recommends actions to address the crisis in Africa.

Africa South of the Sahara↗
PubMed2006

A systematic review of evidence about extended roles for allied health professionals.

OBJECTIVE: Extending the role of allied health professionals has been promoted as a key component of developing a flexible health workforce. This review aimed to synthesize the evidence about the impact of these roles. METHODS: A systematic review of extended scope of practice in five groups: paramedics, physiotherapists, occupational therapists, radiographers, and speech and language therapists. The nature and effect of these roles on patients, health professionals and health services were examined. An inclusive approach to searching was used to maximize potential sources of interest including multiple databases, 'grey' literature and subject area experts. An expanded Cochrane Collaboration method was used in view of the anticipated lack of randomized controlled trials and heterogeneity of designs. Papers were only excluded after the search stage for lack of relevance. RESULTS: A total of 355 papers was identified as meeting relevance criteria and 21 studies progressed to full review and data extraction. The primary reason for exclusion from data extraction was that the study included neither qualitative nor quantitative data or because methodological flaws compromised data quality. It was not possible to evaluate any pooled effects as patient health outcomes were rarely considered. CONCLUSIONS: A range of extended practice roles for allied health professionals have been promoted and are being undertaken, but their health outcomes have rarely been evaluated. There is also little evidence as to how best to introduce such roles, or how best to educate, support and mentor these practitioners.

Allied Health Personnel↗