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Supply, distribution, and capacity of optometrists in Indiana.

BACKGROUND: The Indiana Optometric Association and the Indiana Health Care Professional Development Commission identified a need to collect and analyze data on the health professions workforce for formulating goals and strategies to accommodate demands for health care services in Indiana. This study looks at the supply, distribution, and services of optometrists practicing in Indiana. METHODS: Data compiled by the Indiana State Department of Health, Indiana Health Care Development Commission, and the Project HOPE Center for Health Affairs were analyzed with the results of a survey of practitioner members of the Indiana Optometric Association. Supply, distribution, services, provider-to-population ratios, per capita demand, and optometric productivity were used to evaluate the current and future capacity of Indiana optometrists to the year 2010. RESULTS: An estimated 893 optometrists practiced in 86 of 92 counties and comprised 77% of the state's licensed eye and vision care workforce in 1995. Optometric workforce capacity appeared to be related to county population, but unrelated to the urban/rural classification or the per-capita income of Indiana counties. Contact lenses, disease, geriatrics, and pediatrics were the most prevalent areas of practice specialty. CONCLUSIONS: Optometrist capacity in Indiana is sufficient at both the state and county levels, and optometric services are appropriately distributed such that patient access to optometric care is geographically unburdened. Estimates regarding supply are elastic, depending on the assumptions applied.

Health Personnel↗

Task substitution: the view of the Australian Medical Association.

Technology, community expectations and an ageing population are driving the need for an expanded health care workforce. Doctors embrace task substitution wherever it can be done safely and effectively. Task substitution should occur in the context of: team care that synergises the different skills of doctors, nurses and other health professionals doctors retaining their central role increases in the capacity to extend medical services with efficiency gains no loss of patient safety no fragmentation of care The growth of task substitution could lead to workforce shortages in other health care areas. Public policy on task substitution must take full account of patient preferences and expectations.

Academies and Institutes↗

Why just prepare for emergencies when full use is possible?

Emergency preparedness, fits within the larger context of governmental public health preparedness. Full use of current, appropriations for learning management, education, and training systems designed for emergency preparedness can prepare and retain the current workforce to promote health and prevent disease, while recruiting the next generation to the governmental public health workforce.

Disaster Planning↗

NHS workforce issues: implications for future practice.

This analysis of the literature examines the implications of the changes in the National Health Service workforce and the ramifications for multi-professional working practices, patient care and delivery of health services. Changes in medical working practices and education, together with the increasing numbers of doctors, have resulted in proposals for nurses to extend their role and the removal of professional restrictions. Whilst the numbers of nurses in the workforce have marginally increased, the qualified nurse ratio has declined, as has the balance between medical and registered nurses. Few attempts have been made to evaluate these changes in relation to the quality of service and patient outcomes. The changing roles of nurses and their value need to be quantified. Demographic trends, together with international shortages and the lack of educational capacity have also been understated Adequate and accurate workforce information should be regularly collated and analysed.

Adult↗

A profile of public health educators in North Carolina's local health departments.

The purpose of this study was to provide a profile of the public health education workforce in North Carolina. A survey was administered to all practicing health educators at local health departments (LHDs) in North Carolina. The study specifically attempted to answer four questions: (1) Who functions as health educators in LHDs in North Carolina? (2) What is the educational background and professional training of North Carolina LHD health educators? (3) What are the characteristics of health educators' positions in North Carolina? and (4) How do these characteristics of health educators (demographics and education) as well as their titles, job responsibilities, and supervisory relationships differ according to the size of the LHD? The study showed that most public health educators in North Carolina are white females; most do not have Certified Health Education Specialist certification; that younger health educators are more likely to have health education degrees; and that almost two thirds of public health educators have administrative responsibilities.

Adult↗

Relationships of alcohol use, stress, avoidance coping, and other factors with mental health in a highly educated workforce.

PURPOSE: The relationships of drinking, stress, life satisfaction, coping style, and antidepressant use to mental health were examined in a highly educated workforce. DESIGN: This study used a one-time mail-out, mail-back cross-sectional survey design to examine the relationships of mental health with three kinds of stress (life events, work stress, home stress); two kinds of life satisfaction (work and home); use of avoidance coping; and antidepressant use. SETTING: This study was conducted at a large worksite in northern California in which the workforce was comprised of predominantly highly educated employees. SUBJECTS: Questionnaires were mailed to a random sample of 10% of 8567 employees, and 504 were completed and returned by participants (59%). Complete data were provided by 460 participants (53%). MEASURES: Respondents completed the Mental Health Index, the Alcohol Use Disorders Identification Test (AUDIT), and measures of coping style, work and home stress and satisfaction, stressful life events, and antidepressant use. RESULTS: Mean Mental Health Index scores were at the 32nd percentile of the U.S. population-based norms, with low percentile values associated with worse mental health. Using multiple regression analysis, the factors examined in this study were significantly related to Mental Health Index scores as the dependent variable [F(16, 443) = 27.41, p < .001, adjusted overall R2 = .48]. Poor mental health scores were significantly related to the following: age (p < .05); screening positively for current harmful or hazardous drinking (p < .05); having high levels of stress at work (p < .05) or home (p < .01); experiencing dissatisfaction with work (p < .001) or home life (p = .01); engaging in avoidance coping (p < .001); and using antidepressants (p < .001). Employees currently using antidepressants had significantly more outpatient medical and mental health visits, indicating higher health costs. Furthermore, mental health status was also significantly related to the interactions between several pairs of these variables: education and gender, age and job stress, home satisfaction and work stress, home satisfaction and avoidance coping, and home satisfaction and use of antidepressants. CONCLUSION: Mental health status was poorer on average in a highly educated workforce compared with general U.S. norms. Most of the factors that were found to be associated with poorer mental health were ones that are potentially modifiable, such as experiencing more stress and less satisfaction in work and home life and engaging in current hazardous or harmful drinking. The findings that mental health is worse among individual employees who exhibit combinations of these factors suggest that we need to better understand possible effects of these factors in the context of one another. As interpretation of these results may be limited by the single worksite that participated in this study, future research should re-examine these relationships in other worksites varying from this one in geography and demographic characteristics.

Adaptation, Psychological↗

Making the most of an essential resource. Using skill mix for the benefit of staff and patients.

1. For skill mix to be an attractive commodity in the internal market, clinical managers need to adopt a systematic approach to human resource management. 2. Lewin's change theory offers direction to clinical managers who need to adopt a rational approach to skill mix management. 3. Clinical managers need to adopt a variety of managerial roles and respond proactively to the changes in service provision by promoting an understanding of the importance of a balanced, innovative and empowered skilled workforce.

Clinical Competence↗

Workforce competencies in behavioral health: an overview.

Competency-based training approaches are being used more in healthcare to guide curriculum content and ensure accountability and outcomes in the educational process. This article provides an overview of the state of competency development in the field of behavioral health. Specifically, it identifies the groups and organizations that have conducted and supported this work, summarizes their progress in defining and assessing competencies, and discusses both the obstacles and future directions for such initiatives. A major purpose of this article is to provide a compendium of current competency efforts so that these might inform and enhance ongoing competency development in the varied behavioral health disciplines and specialties. These varied resources may also be useful in identifying the core competencies that are common to the multiple disciplines and specialties.

Behavioral Medicine↗

[Aging of population and medical workforce: a prospective view of health care provision in France in the year 2025].

In 2011, the first generations of the French baby-boom will reach their 65th anniversary. In the same year the first cohorts of the French medical "graduate boom" (doctors graduated during the boom period 1974-1994) will reach their retirement age. From 2010 to 2025, French population will increase 4% but the French elderly will increase 40%. Depending on medical student intake policy adopted today, the French medical profession will decrease slowly or drastically. But the most striking feature of the period will be the aging of the medical workforce. Doctors aged 55 years and over will be between 42% and 47% of the medical workforce in 2025, as compared to 41% in 2010 and 14% in 2000. A great amount of factors--of which the demographic ones--will contribute to raise the demand for health care in the two coming decades. On the other side, the demographic change undergone by the medical profession (decrease of the total number, increase of the aged doctors, increase of the female doctors...) will decrease the amount of supply. However, the first problem facing the country is not how to raise the amount of supply but how to finance the forthcoming sharp growth of demand. The problem is not specific to France, as pointed out in a paper drafted twenty years ago.

Age Factors↗

Roles of nonphysician clinicians as autonomous providers of patient care.

Studies were undertaken to assess the practice prerogatives of nonphysician clinicians (NPCs) in 10 disciplines that, collectively, are the major nonphysician contributors to the delivery of medical and surgical services. These disciplines include nurse practitioners, physician assistants, nurse-midwives, chiropractors, acupuncturists, naturopaths, optometrists, podiatrists, nurse anesthetists, and clinical nurse specialists. Marked differences were found in the practice prerogatives that states granted NPCs in the various disciplines. For most disciplines, the magnitude of their prerogatives correlated with the numbers of NPCs practicing in each state. At their maximal levels, state practice prerogatives authorized a high degree of autonomy and a broad range of authority to provide discrete levels of uncomplicated primary and specialty care. The recent growth in these prerogatives is fostering new opportunities for NPCs; however, it also is creating a pluralism that has the potential to further fragment the US health care system. It is time for regulatory integration and professional collaboration so that a health care workforce that includes a diversity of disciplines can be assured of providing a coherent set of patient care services in the future.

Allied Health Personnel↗

Workforce requirements for a primary oral health care system.

AIM: To present the case for a primary health care (PHC) approach for dental care in Vietnam, and thereby contribute to a better understanding of the oral health problems that exist in many developing countries. METHODS: Information was obtained in Vietnam through discussions with dental and medical authorities of provincial health offices, educational institutions, hospitals, health centres and schools and by collecting data from record books and reports. FINDINGS: Dentistry lacks a PHC strategy and consequently urgent oral care and oral disease prevention and control are not available for the majority of the population in Vietnam. The curriculum of dental students and dental auxiliaries is not adequately directed to the oral health needs of the population. The present number of dental personnel is too low. CONCLUSION: A basic oral health care package (BOHCP) advocated by the WHO which could be incorporated into primary health services at sub-district level and in the school dental service would be most suitable to meet the oral health needs of the population in Vietnam. The oral health education component of the BOHCP may have more impact when it is conducted in close collaboration with non-dental health personnel and lay persons. The curriculum of dental personnel should be adjusted to meet the requirements of their future tasks. Dental auxiliaries, provided they are well trained can carry out the BOHCP. Consequently, there is a large need for this type of dental personnel in Vietnam.

Dental Auxiliaries↗

Multi-skilled health carers: nature, purpose and implications.

Multi-skilling has been the most enduring element of patient-focused care in the UK. A recent report from the Manchester University Health Service Management Unit (HSMU) extended the multi-skilling debate and offered a framework for changing National Health Service workforce policy along multi-skilling lines. Examines the main HSMU issues in the light of broader empirical and other evidence. Assesses the strengths, weaknesses, opportunities and threats to multi-skilling. Concludes that multi-skilling protagonists still face a number of challenges.

Clinical Competence↗

Accessibility to general practitioners in rural South Australia. A case study using geographic information system technology.

OBJECTIVE: To demonstrate the potential of GIS (geographic information system) technology and ARIA (Accessibility/Remoteness Index for Australia) as tools for medical workforce and health service planning in Australia. DESIGN: ARIA is an index of remoteness derived by measuring road distance between populated localities and service centres. A continuous variable of remoteness from 0 to 12 is generated for any location in Australia. We created a GIS, with data on location of general practitioner services in non-metropolitan South Australia derived from the database of RUMPS (Rural Undergraduate Medical Placement System), and estimated, for the 1170 populated localities in South Australia, the accessibility/inaccessibility of the 109 identified GP services. MAIN OUTCOME MEASURES: Distance from populated locality to GP services. RESULTS: Distance from populated locality to GP service ranged from 0 to 677 km (mean, 58 km). In all, 513 localities (43%) had a GP service within 20 km (for the majority this meant located within the town). However, for 173 populated localities (15%), the nearest GP service was more than 80 km away. There was a strong correlation between distance to GP service and ARIA value for each locality (0.69; P < 0.05). CONCLUSIONS: GP services are relatively inaccessible to many rural South Australian communities. There is potential for GIS and for ARIA to contribute to rational medical workforce and health service planning. Adding measures of health need and more detailed data on types and extent of GP services provided will allow more sophisticated planning.

Databases, Factual↗