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PubMed2006

Evaluation of a model training program for respiratory-protection preparedness at local health departments.

Respiratory-protection programs have had limited application in local health departments and have mostly focused on protecting employees against exposure to tuberculosis (TB). The need to provide the public health workforce with effective respiratory protection has, however, been underscored by recent concerns about emerging infectious diseases, bioterrorism attacks, drug-resistant microbes, and environmental exposures to microbial allergens (as in recent hurricane flood waters). Furthermore, OSHA has revoked the TB standard traditionally followed by local health departments, replacing it with a more stringent regulation. The additional OSHA requirements may place increased burdens on health departments with limited resources and time. For these reasons, the North Carolina Office of Public Health Preparedness and Response and industrial hygienists of the Public Health Regional Surveillance Teams have developed a training program to facilitate implementation of respiratory protection programs at local health departments. To date, more than 1,400 North Carolina health department employees have been properly fit-tested for respirator use and have received training in all aspects of respiratory protection. This article gives an overview of the development and evaluation of the program. The training approach presented here can serve as a model that other health departments and organizations can use in implementing similar respiratory-protection programs.

Health Care Surveys↗

PubMed2006

Demographic change and the future demand for public hospital care in Australia, 2005 to 2050.

BACKGROUND: Over the next 45 years the Australian population will age rapidly as the baby boomer cohort moves into retirement and then old age. As the population ages there will be substantial growth in the demand for hospital bed-days, placing a corresponding demand on infrastructure and staffing. METHODS: Australian Bureau of Statistics population projections to 2050 and Australian Institute of Health and Welfare public hospital bed-day data from 1993-94 to 2003-04 were used to develop models of future demand and examine the sensitivity of the results to model assumptions. RESULTS: Over the long term, demand for public hospital bed-days was projected to grow faster than population growth. By 2050, ageing will increase the demand for bed-days by between 70% and 130% depending on the underlying assumptions, and the proportion of bed-days devoted to older people will increase from under 50% in 2005 to over 70%. CONCLUSIONS: Ageing of the population will increase the demand for health services just as it will become harder to recruit health professionals as the large baby boomer cohort retires from the health workforce. Accordingly, we need to plan now to ensure future needs of the ageing population are met.

Adolescent↗

PubMed2001

The development of advanced practice roles: implications in the international nursing community.

This article examined the critical elements that have been identified in the development of advanced practice roles of nurses in four countries: Brazil, Thailand, the United Kingdom and the United States of America. Several sociopolitical and professional forces were examined for possible insights and ways in which they may have shaped the development and evolution of the roles of advanced practice nurses (APNs). These forces were: the socio-political environment; the health needs of society; the health workforce supply and demand; governmental policy and support; intra- and interprofessional collaboration; the development of nursing education; and documentation of effectiveness of the advanced role. The development of APN roles in the four social systems was reviewed to illustrate how socio-political and professional forces may have shaped nursing roles in each health care delivery system. Commonalities and distinguishing features across the four health and social systems were analysed to assess the predictive forces that may be identified as advanced roles in nursing have evolved in the global community.

Community Health Nursing↗

PubMed1988

The AIDS crisis: a United States health care perspective.

The unanticipated onset of Acquired Immunodeficiency Syndrome in the United States, followed by its gradual progression into a full-blown, uncontrollable epidemic, has had severe economic and organizational consequences for the American health care system. AIDS has taken its toll on the health workforce as well in terms of stress, anxiety and workload demands. In the absence of adequate community-based treatment and care resources for persons with AIDS, hospitals had to assume the major burden for providing basic medical care and developing the needed range of services required. This expansion of responsibilities strained hospitals and other health care agencies beyond their capabilities. Some hospitals have faced economic and allocation dilemmas because of high occupancy rates by AIDS patients since there are no specialized reimbursement rates for the intensive resource utilization required for their care. These substantial burdens underscored the need for coordinated long-term planning for a continuum of in-patient, out-patient and community support services. A major response to the epidemic has been a restructuring of the health and social service delivery systems. Hospitals have had to maintain patients beyond their need for an acute level of care, develop infrastructures to manage the increasing numbers of patients, alter physical facilities, provide educational programs and support groups to increase staff's knowledge and decrease fears of AIDS, consider alternatives to in-patient medical management, and lobby with local, state and federal governments to obtain increased public monies for AIDS treatment and care. In the past year, there has been a discernible shift to widening the network of ambulatory medical services and community-based social and health care supports. A major focus of this paper is the social and organizational impact of this epidemic on the hospital and health care system and the systems' responses. Alternatives to an acute care treatment locus for persons with AIDS are explored. Recommendations for future directions for a comprehensive, coordinated health and social services delivery network are presented.

Acquired Immunodeficiency Syndrome↗

PubMed2006

Predictors of workforce turnover in a transported treatment program.

This study examined relations between workforce turnover and select clinician (demographic and professional characteristics and perceptions of treatment model features and job requirements) organizational (perceptions of organizational climate and structure) and program level (salary, case mix) variables in a sample of 453 clinicians across 45 organizations participating in a transportability study of an empirically supported adolescent treatment (i.e., MST). At 20% annually, turnover was lower than in the national mental health workforce (i.e., 50-60%). Clinician demographic, professional background, and perceptions of the treatment model and demands did not predict turnover. Perceptions of an emotionally demanding organizational climate, program salary level, and program case mix of youth did predict turnover.

Adult↗

PubMedDate not supplied

Training for crisis resolution home treatment teams.

The changing training needs of the mental health workforce have been increasingly highlighted in recent years with the national development of new services like crisis resolution/home treatment teams. This article presents some key changes made to short training courses in crisis resolution.

Attitude of Health Personnel↗

PubMed2006

Establishing evidence-informed core intervention competencies in psychological first aid for public health personnel.

A full-scale public health response to disasters must attend to both the physical and mental health needs of affected communities. Public health preparedness efforts can be greatly expanded to address the latter set of needs, particularly in light of the high ratio of psychological to physical casualties that often rapidly overwhelms existing mental health response resources in a large-scale emergency. Psychological first aid--the provision of basic psychological care in the short term aftermath of a traumatic event--is a mental health response skill set that public health personnel can readily acquire with proper training. The application of psychological first aid by public health workers can significantly augment front-line community-based mental health responses during the crisis phase of an event. To help achieve this augmented response, we have developed a set of psychological first aid intervention competencies for public health personnel. These competencies, empirically grounded and based on best practice models and consensus statements from leading mental health organizations, represent a necessary step for developing a public health workforce that can better respond to the psychological needs of impacted populations in disasters.

Clinical Competence↗

PubMed2002

Will the nation be ready for the next bioterrorism attack? Mending gaps in the public health infrastructure.

This paper provides an overview of critical weaknesses in existing public health preparedness capabilities and discusses current policy initiatives to address these shortcomings. It examines developmental needs related to communication and coordination, information systems, laboratories, the development and distribution of vaccines and other countermeasures, emergency medical preparedness and response, and the public health workforce. The paper summarizes the current status of federal and state plans to respond to these developmental needs and touches on the future challenges likely to emerge as these plans are implemented.

Bioterrorism↗

PubMed1998

Teaching hospital costs: implications for academic missions in a competitive market.

CONTEXT: As the managed care environment demands lower prices and a greater focus on primary care, the high cost of teaching hospitals may adversely affect their ability to carry out academic missions. OBJECTIVE: To develop a national estimate of total inpatient hospital costs related to graduate medical education (GME). DESIGN: Using Medicare cost report data for fiscal year 1993, we developed a series of regression models to analyze the relationship between inpatient hospital costs per case and explanatory variables, such as case mix, wage levels, local market characteristics, and teaching intensity (the ratio of interns and residents to beds). SETTING AND PARTICIPANTS: A total of 4764 nonfederal, general acute care hospitals, including 1014 teaching hospitals. MAJOR OUTCOME MEASURES: Actual direct GME hospital costs and estimated indirect GME-related hospital costs based on the statistical relationship between teaching intensity and inpatient costs per case. RESULTS: In 1993, academic medical center (AMC) costs per case were 82.9% higher than those for urban nonteaching hospitals (actual cost per case, $9901 vs $5412, respectively). Non-AMC teaching hospital costs per case were 22.5% higher than those for nonteaching hospitals (actual cost per differences in case, $6630 vs $5412, respectively). After adjustment for case mix, wage levels, and direct GME costs, AMCs were 44% more expensive and other teaching hospitals were 14% more costly than nonteaching hospitals. The majority of this difference is explained by teaching intensity. Total estimated US direct and indirect GME-related costs were between $18.1 billion and $22.8 billion in 1997. These estimates include some indirect costs, not directly educational in nature, related to clinical research activities and specialized service capacity. CONCLUSIONS: The cost of teaching hospitals relative to their nonteaching counterparts justifies concern about the potential financial impact of competitive markets on academic missions. The 1997 GME-related cost estimates provide a starting point as public funding mechanisms for academic missions are debated. The efficiency of residency programs, their consistency with national health workforce needs, financial benefits provided to teaching hospitals, and ability of AMCs to maintain higher payment rates are also important considerations in determining future levels of public financial support.

Academic Medical Centers↗

PubMed2005

The burden of pain on employee health and productivity at a major provider of business services.

OBJECTIVE: The objective of this study was to examine the burden of pain on employee health and productivity at a Fortune 100 company headquartered in the northeastern United States to prioritize target areas for reducing this burden. METHODS: An electronic survey was conducted in late 2004, which produced a reasonably representative national sample of 1039 active employee respondents. RESULTS: A total of 28.6% of respondents met the study definition for pain. Pain was linked to: 1) drops of more than 45% and 23%, respectively, in Overall Physical and Mental Health; 2) a fivefold increase in health-induced limitations in work performance; and 3) nearly three and two thirds workdays lost to presenteeism and absenteeism over a 4-week period. Afflicted workers displayed considerable room for improvement in their capacity for pain control and management. CONCLUSIONS: The prevalence of pain and its impact on those with the condition combine to make it an area of much opportunity for improving workforce health and productivity. Musculoskeletal diseases offer a promising initial target for corporate intervention.

Absenteeism↗

PubMed2004

Delivery of the clinical components of the Newcastle University medical course in a multidisciplinary academic unit in Tamworth.

The University Department of Rural Health (UDRH), northern New South Wales, Australia, was established in late 2001 by the University of Newcastle in Tamworth, New South Wales (NSW). The UDRH is part of the Commonwealth Department of Health and Ageing's Health Workforce Undergraduate Initiative and was the eighth UDRH to be established in Australia. The UDRH northern NSW delivers medical education as part of a multidisciplinary academic unit. At the end of 2003, six medical students graduated having completed all of their clinical training based in Tamworth. Over 60% of the local medical community were teachers in the program. These students studied with final year dietetic, occupational therapy and radiography students co-located in Tamworth during 2002 and 2003. In 2004, ten new graduates from the program have chosen to commence employment in the New England Area Health Service, including two medical students completing their internship in 2004. This represents the first time that the full clinical curriculum of an Australian medical school has been delivered entirely in a single rural setting. It demonstrates a new way of funding medical education which embraces local clinicians as 'faculty' and provides a way for regional centres to develop their own future medical workforce.

Journal Article↗

PubMed1995

Helping the helpers. A unique colleague support system for mental health professionals-consumers.

1. There are many professionals in the mental health workforce who have a mental illness themselves (prosumers), but who do not disclose that fact to their employers or colleagues for fear of stigma and discrimination. 2. Prosumers are in a particularly difficult situation; if they disclose, they risk being viewed as their illness, and if they do not disclose, they may not get the kinds of reasonable accommodations and support that would make their job more manageable. 3. Mutual support groups of colleagues are a viable and valuable way for prosumers to assist each other in coping with the stigma and stressors inherent in working in the mental health field.

Adult↗

PubMedDate not supplied

State regulation, payment policies, and nurse-midwife services.

State regulatory and reimbursement policies continue to exert a strong influence on health workforce policy. Surveys conducted in 1991 and 1995 for the purpose of examining the impact of state regulation on the supply and practice of certified nurse-midwives (CNMs) showed that the single best predictor of the distribution and practice activities of CNMs was the degree to which state policies facilitated or restricted CNM practice.

Female↗

PubMed2006

U.S. genetics nurses in advanced practice.

PURPOSE: To describe characteristics and professional roles of genetics nurses in advanced practice. DESIGN: A cross-sectional descriptive survey administered in 2004 as one component of a comprehensive study of genetic services and the health workforce. The sample was 211 U.S. members of the International Society of Nurses in Genetics. METHODS: The survey included demographic characteristics, education, credentials, professional roles, and attitudes about genetic healthcare issues. FINDINGS: The majority of respondents had master's degrees and many had earned doctorates in nursing (20%) or other fields (12%). Thirty-one percent were certified as nurse practitioners; 57% provided direct patient care, with the largest percentage working in genetics (26%) or oncology (22%) settings. Over one-third were educators and 19% conducted genome-related research. CONCLUSIONS: Genetics nurses in advanced practice in the US focus on both genomic discoveries and clinical health care through the application of genomic knowledge into health care, research, and nursing education.

Adult↗

PubMed2006

Developing a national patient safety education framework for Australia.

BACKGROUND: In 2004, The Australian Council for Safety and Quality in Health Care recognised that the lack of a comprehensive framework describing competencies for patient safety was a barrier to achieving a competent and safe health workforce. This article describes the building of a national patient safety education framework that describes the competencies for healthcare workers. AIM: Develop an educational framework that was patient centred and identified the knowledge, skills and behaviours required by healthcare workers irrespective of their profession, position or location. METHODS: The content of the framework was developed using a four-staged approach: literature review, development of learning areas and topics, classification into learning domains and, lastly, converting into a performance-sbased format. An extensive consultation and validation process was also undertaken. RESULTS: A national patient safety education framework was endorsed by The Australian Council for Safety and Quality in Health Care in 2005. The framework is already being used to develop curricula and train the trainer programmes in patient safety. CONCLUSIONS: The framework, which draws its educational approach from adult learning principles, was extensively researched and built on the experience of healthcare workers. The next challenge is to test different strategies for implementing the framework.

Adult↗

PubMedDate not supplied

[Medical doctors in private practice in the Greater Paris area. General presentation and overview of results].

The French physician workforce, after decades of growth, will be soon entering a decreasing era. The demographic revolution will affect all parts of the country, including the region Ile de France which has the highest physician/population ratio. An opinion survey conducted among a sample of 1700 physicians gathered 770 replies in March 2003. The difficulties most frequently mentioned by the surveyed doctors are heavy taxes and social contributions (mentioned by 77%), problems for finding locum tenens (52%), traffic jams (48%), irrelevant requests from patients (45%), problems for finding nurses to care patients (28%), conflicts with the sickness fund (24%), lack of security (23%). It is noteworthy that the problems related to locum tenens and nurses are directly associated to the demographic situation of French health workforce. When asked about the risks associated to medical practice, 62% of the surveyed physicians quote the difficulty to combine harmoniously professional practice and family life whereas 60% mention low occupational income. But the highest risk after the surveyed doctors is their legal responsibility (68%). Certain modifications of French regulation concerning medical practice to cope with the forthcoming decrease in the numbers of doctors are approved. In particular, the possibility for a doctor in private practice to hire the services of an other doctor (approved by 41%) and that of having several medical offices (31%).

Paris↗

PubMedDate not supplied

Employment of dental hygienists and registered dental assistants: highlights of the 1996 survey.

PURPOSE: The purpose of this study was to determine various employment characteristics of Minnesota's allied dental health workforce, specifically dental hygienists and registered dental assistants. METHODS: In 1995 and 1996, two questionnaires one-year period apart were mailed to all licensed dentists in the state, accompanied with a request that only one survey form per practice be returned. An estimated 73 percent and 65 percent of all practices reported in the two years respectively. RESULTS: Results suggest few changes over the two-year period. Information is reported on a wide variety of conditions, including practice configurations, workload distributions, turnover, salaries, and relative demand for hygienists and registered assistants. CONCLUSIONS: These studies provide a good baseline for future reports and suggest that, at present, patient demand is stable or strong, and that while an adequate supply of allied dental health workers is available statewide, some local supply problems exist.

Data Collection↗

PubMedDate not supplied

Developing a U.K. protocol for collaborative care: a qualitative study.

OBJECTIVE: This study aimed to explore the views of stakeholders including patients, general practitioners (GPs) and mental health workers on the feasibility, acceptability and barriers to a collaborative care model for treatment of depression within the context of U.K. primary health care. METHOD: We used semistructured interviews and focus groups with a purposive sample of 11 patients and 38 professionals from a wide selection of primary and secondary care mental health services, as well as framework analysis using a "constant comparative" approach to identify key concepts and themes. RESULTS: Regular contact for patients with depression is acceptable and valued by both patients and professionals. However, patients value support, whereas professionals focus on information. To be acceptable to patients, contacts about medication or psychosocial support must minimize the potential for patient disempowerment. The use of the telephone is convenient and lends anonymity, but established mental health workers think it will impair their judgments. While patients merely identified the need for skilled case managers, GPs preferred established professionals; however, these workers did not see themselves in this role. All involved were cautious about deploying new workers. Additional barriers included practical and organizational issues. CONCLUSIONS: Although a telephone-delivered mix of medication support and low-intensity psychological intervention is generally acceptable, significant issues to be addressed include the values of the current mental health workforce, fears about new workers' experience and competence, the balance of face-to-face and telephone contacts and case manager education in nonspecific skills necessary to develop a therapeutic alliance, as well as the knowledge and skills required for education, medication support and behavioral activation. Qualitative research can add value to careful modeling of collaborative care prior to international implementation.

Attitude of Health Personnel↗