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At least 199 records · Page 11Linked to original sources
PubMed2002

Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

BACKGROUND: Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. AIM: To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. DESIGN OF STUDY: A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. SETTING: Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. METHOD: Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. RESULTS: The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. CONCLUSION: A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children.

Adult↗
PubMed2004

Multijurisdictional practice and the health lawyer: will your practice benefit from the new ABA model rules of professional conduct?

At the end of the twentieth century, bar scholars and regulators were reexamining two traditionally improper aspects of legal practice. The first was the multidisciplinary practice of law, which would permit lawyers to offer accounting and other professional services to their clients, and allow lawyers to share fees with non-lawyers. The second was the multijurisdictional practice of law, which would permit a lawyer licensed in one jurisdiction to practice law in other jurisdiction in which he was not admitted to the bar. Enron and other corporate scandals deflated the movement towards multidisciplinary practice, but the movement to allow multijurisdictional practice bore some limited, yet important, results. This Article argues that the American Bar Association's new Model Rules 5.5 and 8.5, which broaden the ability of healthcare lawyers to practice outside of the states in which they are admitted, are a suitable accommodation to today's mode of practice, while still preserving the states' ability to regulate lawyers and protect clients.

Delivery of Health Care↗
PubMedDate not supplied

Colposcopy practice and training in family practice residency programs.

BACKGROUND: The potential growth of colposcopy as a family medicine procedural skill is directly related to the training currently offered to family practice residents. To define whether these skills are being adequately offered to physicians who want to perform this procedure for their patients, a study was designed to investigate the current status of colposcopy practice and training in family practice residency programs. METHODS: A 16-item survey sent to 356 family practice residency directors in the United States included items concerning colposcopy practice, training, educational programs and strategies, colposcopy coordinator educational background, and colposcopic resource materials and equipment. RESULTS: Surveys were returned from 204 (57 percent) family practice residencies. Colposcopy was performed at 45 percent of the residencies that responded. Ninety-six percent of the respondents who did not perform colposcopy believed colposcopy is a procedure that should be performed by family physicians. Clinical teaching and supervision was the most common method of resident training (74 percent). Colposcopy training coordinators were usually family physicians (72 percent), primarily trained by gynecologists. Assistance with implementing a colposcopy training program was requested by 85 percent of those programs presently not performing colposcopy. CONCLUSIONS: This study indicates that there are opportunities for further development of colposcopy practice and training in family practice residencies.

Attitude of Health Personnel↗
PubMed2005

[Current hygiene status in endoscopic practice. Results from monitoring the reprocessing of flexible endoscopes in hospitals and private practices in Frankfurt on the Main, Germany, 2003/4].

Flexible endoscopy is essential for the practice of modern medicine. However, with inadequate reprocessing of endoscopes and additional instruments, infections can be transmitted. Therefore, guidelines for reprocessing flexible endoscopes have been published in many countries. The goal of the present survey was to examine the current compliance with German Guidelines in a German urban region, covering all hospitals (15 hospitals) and private practices (23 practices) of this area, without any exception. All endoscopic units in Frankfort on the Main were visited by members of the Public Health Service, using a checklist based on the recommendations of the German Guidelines. In 2004, a reevaluation of 14 hospitals and 20 private practices took place, either by analysing the written reports of the institutions or by revisiting the institutions. In 2003, compliance with the guidelines in hospitals was satisfactory. In practices, however, many problems were identified in 2003. Between 2003 and 2004, great improvements could be seen (data of 2003 in parentheses). At the end of 2004, in 90% of the practices adequate storage of the endoscope without risk of recontamination (2003:52%), correct reprocessing the bottle and the tube for air/water channel flushing including filling with sterilized water was observed (2003:74% and 52%). In 100% of the practices, ultrasonic cleaning (2003:26%) and sterilizing of endoscopic accessories was guaranteed (2003:57%) and routine tests of endoscopes after reprocessing (2003:56%) were performed. In conclusion the relevance and the effect of the advising and control of public health have been so efficient that between 2003 and 2004 most faults have been corrected. Therefore control visits of the Public Health Services should not only cover hygiene in reprocessing the endoscopes but also hygiene in reprocessing endoscopic accessories as well.

Endoscopy↗
PubMed1986

A comparison of the patients and practices of recent graduates of family practice and general internal medicine residency programs.

This study compares the characteristics of the practices and patients of recent graduates of family practice and general internal medicine residency programs. National samples of 104 family physicians and 134 general internists completed questionnaires and provided log-diary data for more than 7,500 office visits and 1,100 hospitalized patients. Family physicians and general internists were generally similar in demographic and practice characteristics, though family physicians were more likely to have entered office-based practice (90% versus 70%). Among office-based physicians, family physicians saw more patients per week in ambulatory settings (117.3 versus 74.6), whereas general internists had more patients in the hospital (6.45 versus 3.81) and provided more hospital consultations per week (2.74 versus 0.45). Family physicians practiced in smaller communities and were more likely to practice on Saturday mornings, to accept walk-in patients, and to schedule appointments for new patients within 1 week. Both specialties functioned as first-contact generalists for at least 95% of office encounters. Although pediatrics and obstetrics are practiced only by family physicians and general internists see proportionately more older patients, within specific age groups the patients of general internists and family physicians were similar in terms of their main health problems, functional status, and diagnoses.

Data Collection↗
PubMed1975

New organizations out of old ones: teaching group practices out of private practice and outpatient departments.

A private group practice and a traditional hospital medical clinic are joined together as a teaching group practice for primary care (Internal Medical Associates). Responsible for revenues as well as costs, the practice is administered by a board of managers composed of physicians, nurses, and administrators in the practice. This decentralization of practice from the clinical department and hospital administration has resulted in (1) a reduction in the numbers of physicians needed for the practice, (2) a greater visit census with increased physician productivity, and (3) a reduced operating deficit and better understanding of transient and educational costs. The matrix organization of the board of managers has resulted in better communication and a commitment of the staff to common goals. Public demand for a single standard of care for patients of all backgrounds, professional aspirations to work in groups, and educators' interest in training outside the hospital converge to make such reorganizations of practical necessity.

Ambulatory Care↗
PubMed1992

Relationship between the number of partners in a general practice and the number of different drugs prescribed by that practice.

The objective of this study was to assess whether practice size, as measured by the number of doctors, had any bearing on the range of drugs prescribed. All practices in the northern and western health boards in Northern Ireland were included in the study--a total of 132 practices (362 doctors) serving a population of 628,249. Prescribing data, obtained from the Department of Health and Social Services (Northern Ireland) information technology unit database, were analysed retrospectively for the month of January 1989. The number of different preparations prescribed in each of 22 therapeutic groups were counted. Hence a measure of the range of prescribing was assessed. A significant correlation was found between the number of different preparations prescribed and the number of general practitioners working in the practice. However, no correlation was found between the number of different drugs prescribed and the mean prescribing cost per patient or the mean list size of the doctors in each practice. The use of a practice prescribing policy was found to have no influence on the range of drugs prescribed, nor on the prescribing costs. The inference is that formal therapeutic policies may be difficult to implement within group practices. These results are of importance to general practitioners since the greater the number of different drugs prescribed the greater will be the risk of side effects and dangerous interactions.

Drug Costs↗
PubMed2005

Novices in clinical practice settings: student nurses stories of learning the practice of nursing.

Drawing on 24 stories of clinical practice in an apprenticeship context of training in Israel, this qualitative study examined student nurses' perspectives towards learning to become a nurse, as revealed through the language and content of their written stories of clinical practice. As our findings suggest, student nurses' stories of learning to become a nurse in practice settings, are characterized by procedural language, by medical rather than nursing terminology, and by a focus on actions rather than on interactions. We have learned that, despite the rich content that characterizes clinical practice settings, the apprenticeship orientation of the training program, combined with student nurses' state of being a novice, yielded representations of the experience of learning to nurse which were characterized by an instrumental perspective towards the practice. We interpret these findings through four interrelated insights that emerge from the study: (1) an 'instrumental practice' orientation in the setting of caring, (2) knowledge of clinical facts-not knowledge of clinical principles, (3) the fragmented character of novices' learning to nurse in practice, and (4) rich content of practice alone does not yield rich content of learning.

Adaptation, Psychological↗
PubMedDate not supplied

The practice doctorate in nursing: approaches to transform nurse practitioner education and practice.

Ongoing challenges caused by increased complexity of care, changing patient demographics, and shifting health care delivery systems are necessitating a transformation of advanced practice. The practice doctorate has the potential to prepare graduates to meet these challenges now and in the future. This article conceptualizes the practice doctorate curriculum for nurse practitioners (NPs), with particular focus on how it will prepare NPs as expert clinicians with enhanced leadership and research skills. Nurse practitioner doctoral education and practice is articulated and differentiated from current NP education and practice, with distinguishing features clearly identified. A compelling argument is made for how this educational preparation will facilitate NPs in meeting future societal needs. The purpose of this article is to provide guidance for all advanced practice educational programs considering adoption of a practice doctorate, and to contribute to the advancement of thinking about the practice doctorate for clinicians as well as educators.

Certification↗
PubMed1999

Generalizing the results of clinical trials to actual practice: the example of clopidogrel therapy for the prevention of vascular events. CAPRA (CAPRIE Actual Practice Rates Analysis) Study Group. Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events.

PURPOSE: An important element in translating the results obtained in clinical trials of a new treatment to clinical practice is the estimated event rate in patients who would be eligible to receive that treatment. We estimated the effect of clopidogrel, compared with aspirin, in actual practice using the relative risk reduction observed in the Clopidogrel versus Aspirin in Patients at Risk of Ischaemic Events (CAPRIE) trial. SUBJECTS AND METHODS: Ischemic event rates were estimated for 12,931 aspirin users drawn from the Saskatchewan Health population between 1990 and 1995 who had an index diagnosis of myocardial infarction, ischemic stroke, or peripheral arterial disease. To estimate the absolute risk reduction, the 8.7% relative risk reduction from clopidogrel compared with aspirin that was observed in CAPRIE was applied to these rates. RESULTS: The rates of ischemic events were greater in actual practice than among the control patients in the CAPRIE trial. In the Saskatchewan population, patients experienced an outcome event (myocardial infarction, stroke including intracranial hemorrhage, or death) at a rate of 15.9 per 100 patient-years, compared with only 6.9 per 100 patient-years in CAPRIE. If the same 8.7% relative risk reduction seen in the CAPRIE trial is also true for patients seen in routine clinical practice, the greater absolute risk in actual practice would reduce the number needed to treat to prevent one event from 200 patients to 70 patients. CONCLUSION: Absolute risk rates may be substantially greater in clinical practice than in the selected patients enrolled in randomized trials. As a result, similar reductions in relative risk, if true for clinical practice, may yield substantially more benefit in clinical practice than in randomized trials.

Aged↗
PubMed1995

Theory from practice for practice: is this a reality?

Dickoff & James assert that theory comes from practice for practice. This paper will explore the reality of this statement in nursing today. The nature of nursing knowledge from an historical perspective facilitates an understanding of where nursing theory development is today. The purpose of theory is debated and the motivation for its development considered. Practice theory, theory which is developed from practice for practice, is analysed, and this is advocated as one method to reduce the theory-practice gap in nursing. Whether practitioners are able to undertake the development of practice theory is discussed and some obstacles identified. Reflection and action research have been offered as methods to facilitate the development of practice theory by practitioners.

Humans↗
PubMed1999

How can we achieve evidence-based practice if we have a theory-practice gap in nursing today?

The purpose of this paper is to discuss how nursing can achieve evidence-based practice when a theory-practice gap exists in nursing today. The paper commences with an introduction to the concept of evidence-based practice and a discussion of the relationships between theory, practice and the theory-practice gap. An analysis of the two concepts will then be presented from within the four pillars of nursing, namely management, practice, research and education. The paper will conclude with a discussion of whether evidence-based practice can be achieved in view of the theory-practice gap.

Education, Nursing↗
PubMedDate not supplied

Scholarship of practice for a practice profession.

At a time of shrinking resources, rapidly changing health care environments, and increased demands for solutions to pressing health issues, concerns regarding the relevance of nursing research for practice are again being raised. After the national debate surrounding definitions of scholarship across disciplines and having established respectability for past and current contributions to knowledge development, nursing may now begin to reconceptualize what constitutes scholarship in a practice profession. This article addresses two central questions related to the scholarship of nursing practice: (1) How is scholarship of practice in a practice of profession defined? and (2) What characteristics differentiate the new conceptualizations of scholarship of practice from traditional research models? The results include a delineation of scholarship of practice and a differentiation of characteristics between scholarship of practice and traditional research approaches. Implications for nursing education are also addressed.

Clinical Nursing Research↗
PubMed2005

The development of a screening tool to identify carers in a general practice by a large-scale mailed survey: the experience in one Scottish general practice.

AIMS AND OBJECTIVES: To determine the feasibility of a screening tool to identify carers in a general practice. BACKGROUND: The need to support informal carers is well established in policy and practice, but many carers continue to lack the support they need. Identifying carers is a fundamental precondition to providing them with support. Studies often recruit carers who are members of carers' organizations or via the care recipient in receipt of services. However, as nearly 60% of carers receive no support from the statutory services, this group of carers may not be representative of the majority of carers. This paper describes the results of a study undertaken to identify a broader group of carers in a general practice in a large Scottish city. DESIGN AND METHODS: A quantitative research design was employed using a mailed screening survey to identify carers within a general practice. Carers were systematically identified, independent of the care recipient, using a screening tool developed by the researcher which was sent to all adult patients registered with the practice. RESULTS: The response rate was 69%. Overall, 11% of the surgery population identified themselves as carers with a mean age of 55 years. The carers were involved in a range of caring activities of varying levels and duration. CONCLUSION: The screening exercise was time consuming and costly. However, it would be feasible and useful to identify carers in smaller groups. RELEVANCE TO PRACTICE: This study tackles issues that are pertinent to health policy and practice. Carers were systematically identified from a general practice population and included those at an early stage of the caring role, prior to being involved with service providers, as well as those established in their role. If carers are identified early in their caring career the primary health care team is more able to support them proactively.

Adolescent↗
PubMedDate not supplied

Attitudes of practicing nurses towards theory-based nursing practice.

Theory-based nursing practice is a topic of current importance in Canadian nursing settings. Both the CNA and provincial regulating bodies have included the concept in their standards of practice. Current nursing education programs based on nursing models have produced a growing cadre of nurses familiar with formal nursing theory. However, practicing nurses' exposure to nursing theories varies and this population has not been systematically investigated. As part of a larger study, responses of 362 nurses from three Ontario cities to the Nursing Theories Questionnaire revealed a moderately positive attitude towards theory-based nursing practice. Attitudes were significantly more positive among nurses working in agencies which had implemented theory-based practice. Nurses believed that theory-based practice would help them collect useful data, plan comprehensive care, would result in better care, should not be left for nurse scholars and was important to the development of the nursing profession. Nurses were most familiar with theories of Neuman, Orem and Roy; least familiar with Parse and Rogers. Community nurses preferred Neuman's theory; hospital nurses preferred those of Roy and Orem. These findings provide information about factors associated with nurses' knowledge and attitudes towards theory-based nursing practice and may be useful for nurse administrators in planning strategies for implementing theory-based practice.

Adult↗
PubMedDate not supplied

Creating and validating practical measures for assessing public health practices in local communities.

Efforts to develop a surveillance system to measure local public health performance were initiated in 1991. The organizing framework for the proposed system consisted of three core functions formulated by the Institute of Medicine and linked with 10 practices previously defined. A surveillance protocol was developed using local public health jurisdictions rather than specific agencies within the jurisdictions, as the units of study. Selection of 84 indicators was assisted by follow-up study of a group of departments analyzed in 1979 and by review of recent public health literature. Each of the 84 performance indicators was linked to one of the 10 practices. Responses to the survey were obtained from local health department directors. Results yielded scores for the surveyed jurisdiction with regard to adequacy of performance for each practice, the proportional contribution to performance by the local health department, and the identification of other providers contributing to the coverage of each practice within the jurisdiction. A shortened version of the protocol (26 indicators) was tested in all local jurisdictions in six states and shown to correlate reliably with scores obtained from the longer protocol for overall public health performance, as well as for performance of each of the three core functions and for some of the 10 practices. A subset of four indicators was shown to predict reliably the overall score. The findings support the proposition that public health practice can be defined, measured, and monitored and that current widely accepted definitions of core functions and practices have utility. Measurement and surveillance tools for these functions and practices are available and tested.

Community Health Services↗
PubMed2004

Expense comparison of a telemedicine practice versus a traditional clinical practice.

This paper compares the expenses of a telemedicine program to those of a traditional clinical practice using data from two fiscal years (FY) 1998/1999 and 2000/2001. As part of that evaluation, we compared expenses of the University of Arizona's clinical practice group, the University Physicians Incorporated (UPI), to those of the Arizona Telemedicine Program (ATP) practice. For this study, we used the reporting categories published in the year-end UPI financial statement. These categories included clinical services, administration, equipment depreciation, and overhead. Results showed that clinical service expenses and administrative expenses for FY 2000/2001 were higher in the traditional UPI practice, whereas equipment depreciation and overhead expenses are higher in the telemedicine practice. This differs somewhat from FY 1998/1999, where clinical expenses and overhead were higher in the UPI practice and administration and equipment depreciation were higher in the telemedicine practice. We will discuss the relevance of these results and the critical factors that contribute to these differences.

Arizona↗
PubMed1999

Collaborative practice agreements for advanced practice nurses: what you should know.

Advanced practice nurses (APNs) seeking employment are often presented with employment practice agreements. A collaborative practice agreement is a written statement that defines the joint practice of a physician and an APN in a collaborative and complementary working relationship. It provides a mechanism for the legal protection of the APN and sets out the rights and responsibilities of each party involved. All APNs, regardless of practice setting, should be knowledgeable about aspects of a collaborative practice agreement before they sign one. The purposes of this article are to delineate basic guidelines for evaluating and developing a collaborative practice agreement and to identify areas of special concern for APNs.

Cooperative Behavior↗