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At least 379 records · Page 21Linked to original sources
PubMed2001

Patient characteristics and physicians' practice activities for patients with chronic low back pain: a practice-based study of primary care and chiropractic physicians.

BACKGROUND: Chronic low back pain sufferers are among those who account for the greatest usage of health care resources. Primary care medical (MD) physicians and chiropractic (DC) physicians treat most of these patients. OBJECTIVES: To study patient characteristics and physician practice activities for patients with chronic low back pain treated by DC physicians and MD physicians. METHODS: A longitudinal, practice-based observational study was undertaken in 14 general practice and 51 DC community-based clinics. A total of 2945 consecutive patients with ambulatory low back pain of mechanical origin were enrolled; 835 patients were in the chronic subgroup. Patients were followed for 12 months. Data were obtained on all of the following: patient demographics, health status, and psychosocial characteristics; history, duration, and severity of low back pain and disability; physicians' practice activities; and low back complaint status at 1 year. RESULTS: Patients treated by MD physicians were younger and had lower incomes; their care was more often paid for by a third party; their baseline pain and disability were slightly greater. In addition, patients treated by MD physicians had one fourth as many visits as patients treated by DC physicians. Utilization of imaging procedures by enrolling physicians was equivalent for the two provider groups. Medications were prescribed for 80% of the patients enrolled by MD physicians; spinal manipulation was administered to 84% of patients enrolled by DC physicians. Physical modalities, self-care education, exercise, and postural advice characterized low back pain management in both provider groups. Patients' care-seeking was not exclusive to one provider type. Most patients experienced recurrences (patients treated by MD physicians, 59.3%; patients treated by DC physicians, 76.4%); 34.1% of patients treated by MD physicians and 12.7% of patients treated by DC physicians reported 12 months of continuous pain. Only 6.7% of patients treated by MD physicians and 10.9% of patients treated by DC physicians reported 1 resolved episode during the year. CONCLUSIONS: Differences in sociodemographics, present pain intensity, and functional disability may distinguish patients with chronic low back pain seeking care from primary care medical physicians from those seeking care from DC physicians. Although the primary treatment modality differs, the practice activities of MD physicians and DC physicians have much in common. Long-term evaluation suggests that chronic back pain is persistent and difficult to treat for both provider types.

Adult↗
PubMed1993

A national survey of attitudes and practices of primary-care physicians relating to nutrition: strategies for enhancing the use of clinical nutrition in medical practice.

A nationwide mail survey was used to determine the degree to which primary-care physicians indicated that they practice the "core competencies" in clinical nutrition identified by Young et al (Am J Clin Nutr 1983;38:800-10). We also surveyed the nutrition-related attitudes of these physicians. Although the 3416 physicians who responded to the survey tended to report favorable attitudes toward using nutrition in their practice, these favorable attitudes were not consistent with their own reports of clinical performance. Neither the positive- or negative-attitude score correlated highly with the reported behavior-practice score. The clinical practices reported by those surveyed are well below the minimum level defined by the Young et al essential core competencies in clinical nutrition. The attitudes, practices, and demographic characteristics associated with the clinical performance variables suggest educational strategies for improving the competence of primary-care physicians and medical students in clinical nutrition.

Adult↗
PubMed1993

Implementation of the national cervical cancer screening in general practice and feasibility of a general practice-based call system: the GP's opinion.

Thus far, the response to the nationwide screening programme for cervical cancer in The Netherlands, which was started in 1989, has been disappointing. One way to improve response is to involve general practitioners in the call system. A postal survey was conducted to review the implementation of the current screening programme in general practice and to examine the willingness of general practitioners to participate in a general practice-based call system. The response rate to the survey was 90%. The general practitioners were dissatisfied with follow-up, cost and time spent and compliance of women. Of all respondents 60% had already set up a call system within the practice or were willing to do so; another 31% were willing to participate in a regionally organized practice-based call system. On the basis of the results of this study a centralized general practice-based call system is recommended. The next step is to study the applicability of this system in a pilot programme.

Adult↗
PubMed2000

Observational study of home visits in Slovene general practice: patient characteristics, practice characteristics and health care utilization.

BACKGROUND: Home visits are an important way of delivering primary health care, but there is a long-term decrease in home visit rates in many countries. OBJECTIVE: The aim of this study was to evaluate patient characteristics, morbidity, functional status, quality of life, satisfaction with care, practice characteristics and health care utilization in general practice patients visited at home at least once in a study year. METHODS: The design of the study was a cross-sectional survey of the patients of a stratified sample of 36 GP offices in Slovenia using a self-administered questionnaire. Sixty consecutive patients in sampled practices contacting the doctor in the office in the study period in March 1998 were included in the analysis. The age, sex, educational status, residence, presence of chronic condition, measures of anxiety or depressive symptoms, rates of patients who expressed a need for emergency care in 1 year, rates of self-care, measures of functional status, quality of life, satisfaction with care, rates of using GP practice visits and out-of-hours services and rates of using specialist or hospital services were recorded in a home-visited group versus a non-visited group. RESULTS: A total of 277 patients (15.4%) were reported to have at least one visit in the study year. Patients visited in their homes were older, predominantly female, better educated, had lower perceptions of their functional status and well-being and they used primary health services more frequently than others. Their GPs were more likely to be males, and were more likely to practise in rural areas, in solo practices as private practitioners. CONCLUSION: Home visits remain an important part of GP work in countries in transition, such as Slovenia, especially for more seriously ill patients.

Activities of Daily Living↗
PubMed2005

Listening to bowel sounds: an evidence-based practice project: nurses find that a traditional practice isn't the best indicator of returning gastrointestinal motility in patients who've undergone abdominal surgery.

Nurses' practice of listening to bowel sounds was first proposed in 1905 and continues today, largely unquestioned. The authors developed a project to determine whether any compelling evidence exists for using this method to assess for the return of gastrointestinal (GI) motility following abdominal surgery. Literature on the subject was evaluated and an assessment of nursing practice was conducted. Based on the literature review and the assessment, a nursing practice guideline was developed, implemented, and evaluated. (Note that the nursing practice guideline outlined in this article was evaluated for use with abdominal surgery patients only and has not been evaluated in and may not be appropriate for other patient populations). The results were positive and indicate that clinical parameters other than bowel sounds, such as the return of flatus and the first postoperative bowel movement, are appropriate in assessing for the return of GI motility after abdominal surgery. Bowel sound assessment was discontinued and patient outcomes were evaluated to make sure that the practice change had no adverse effect on patients' recovery.

Abdomen↗
PubMed2000

Consensual validation of clinical practice model practice guidelines.

Clinical Practice Model (CPM) Practice Guidelines facilitate the delivery of consistent, high-quality patient care by clarifying nursing services and supporting the practice and documentation of each step of the nursing process. CPM Practice Guidelines are unique because they are part of an integrated interactive systems thinking framework to support professional practice; they are reviewed and improved routinely using multiple sources of data and are used by hundreds of nurses daily throughout the United States and Canada. Guidelines are developed using a rigorous standardized format and process. Consensual validation is an important part of establishing and maintaining the credibility of these Guidelines.

Humans↗
PubMedDate not supplied

Measuring leadership practices of nurses using the Leadership Practices Inventory.

BACKGROUND: Originally developed for educational use, the Leadership Practice Inventory (LPI) is used to measure leadership practices in nursing research. There is limited reporting of LPI psychometric properties when used to measure leadership practices of nurses. OBJECTIVE: This study aimed to investigate psychometric properties of the LPI when used to measure the leadership practices of nurses. METHOD: Data from 67 LPI-self and 347 LPI-observer respondents were used to establish LPI psychometric properties. Dimensionality of the LPI was investigated using exploratory principal components analysis, and LPI construct validity was established by exploring correlations with theoretically related concepts and a known-groups approach. The predictive validity of the LPI was investigated using regression analysis to determine whether observer-reported leadership practices of established and aspiring nurse leaders predict observer ratings of the effectiveness of the organization environment. Reliabilities of the new factor solution were explored. RESULTS: Factor analysis found that the identified three-factor solution has psychometric properties at least as strong as those found with the original five-factor LPI solution. DISCUSSION: The three-factor solution is advocated for use in nursing research because of the strong psychometric properties, lighter respondent burden, and decrease in research costs, as compared with the traditional five-factor solution. When used as an educational tool, the five-factor LPI may be preferred because it may be more useful for examining a greater number of leadership behaviors.

Adult↗
PubMedDate not supplied

Positioning advanced practice nurses for financial success in clinical practice.

Advanced practice nurses (APNs) are well prepared for patient care, but not for the financial aspects of clinical practice. A lack of reimbursement knowledge and skills limits the prospects for APNs to be key players in business and practice ventures. Faculty are challenged to strengthen the advanced practice reimbursement component of the financial management core to promote the reimbursement competency of APNs. The author discusses 4 primary content categories that are critical to financial success in clinical practice.

Current Procedural Terminology↗
PubMedDate not supplied

Care bundles in critical care: a practical approach to evidence-based practice.

The care bundle is a new concept in critical care, which is currently being promoted by the National Health Service Modernisation Agency for Critical Care. Care bundles originated in North America and are described best as groups of evidence-based practice interventions. The theory behind care bundles is that when several evidence-based interventions are grouped together in a single protocol, it will improve patient outcome. Care bundles are relatively easy to develop, implement and audit, and provide practitioners with a practical method for implementing evidence-based practice. This article describes the care bundle and offers practical suggestions about how to develop, implement and audit them in practice.

Benchmarking↗
PubMed2005

Treatment practices and barriers for depression and anxiety by primary care advanced practice nurses in Wyoming.

PURPOSE: The aim of this study was to investigate barriers to treatment and screening related to depression and anxiety and the diagnostic and treatment practices of primary care advanced practice nurses (APNs) in the state of Wyoming. DATA SOURCES: Every primary care APN in Wyoming received a mailed questionnaire asking them about treatment barriers, screening and treatment practices, and attitudes toward depression and anxiety. CONCLUSIONS: Wyoming APNs in primary care routinely identify, evaluate, and treat patients with both depression and anxiety. APNs generally felt positive about treating these patients, although they reported that their patients encounter a number of financial barriers in accessing treatment. Routine screening practices for depression and anxiety were relatively low among the APNs, and they used a wide variety of interventions for these patients. IMPLICATIONS FOR PRACTICE: The findings identify a lack of standardized approaches to assessment, referral, and treatment, especially pharmacologic intervention, and may indicate the need for alterations in the educational preparation of primary providers in order to improve clinical outcomes of treatment for depression and anxiety.

Adult↗
PubMed1985

Is the distribution of training practices appropriate for the needs of general practice?

The distribution of practices that train general practitioners in the west of Scotland was examined. The concentration of training practices is lowest in conurbations that are grossly deprived. Several topics require debate: should trainees be given experience in such areas as an elective? Should the criteria for selecting training practices be similar in all areas? Should practices in deprived areas be encouraged to apply to become training practices?

Education, Medical, Graduate↗
PubMed1996

Socioeconomic determinants of rates of consultation in general practice based on fourth national morbidity survey of general practices.

OBJECTIVE: To identify the socioeconomic determinants of consultation rates in general practice. DESIGN: Analysis of data from the fourth national morbidity survey of general practices (MSGP4) including sociodemographic details of individual patients and small area statistics from the 1991 census. Multilevel modelling techniques were used to take account of both individual patient data and small area statistics to relate socioeconomic and health status factors directly to a measure of general practitioner workload. RESULTS: Higher rates of consultations were found in patients who were classified as permanently sick, unemployed (especially those who became unemployed during the study year), living in rented accommodation, from the Indian subcontinent, living with a spouse or partner (women only), children living with two parents (girls only), and living in urban areas, especially those living relatively near the practice. When characteristics of individual patients are known and controlled for the role of "indices of deprivation" is considerably reduced. The effect of individual sociodemographic characteristics were shown to vary between different areas. CONCLUSIONS: Demographic and socioeconomic factors can act as powerful predictors of consultation patterns. Though it will always be necessary to retain some local planning discretion, the sets of coefficients estimated for individual level factors, area level characteristics, and for practice groupings may be sufficient to provide an indicative level of demand for general medical services. Although the problems in using socioeconomic data from individual patients would be substantial, these results are relevant to the development of a resource allocation formula for general practice.

Adolescent↗
PubMed2000

Economic impact of harmonizing medical practices: compliance with clinical practice guidelines in the follow-up of breast cancer in a French Comprehensive Cancer Center.

PURPOSE: The introduction of clinical practice guidelines (CPGs) and the increasing desire to harmonize clinical practices draw attention to the economic impact of these trends. In 1994, CPGs were introduced in a French Comprehensive Cancer Center (Centre Régional Léon Bérard, Lyon). We evaluated the application of these CPGs in addition to the consequences of harmonizing clinical practices with respect to the distribution of resources by specifically analyzing the posttherapeutic follow-up of patients with localized breast cancer. METHODS: A before-and-after analysis of the records of patients who received posttherapeutic follow-up for localized breast cancer as of either 1993 or 1995 was performed. Two hundred records were chosen at random, 100 from 1993 and 100 from 1995. Follow-up was continued for as long as possible and CPG compliance was studied for each year of the follow-up periods. RESULTS: Follow-up that was not CPG-compliant required a significantly greater amount of resources. This difference was due to neither consultations nor mammographies, but was due to other examinations that were systematically performed without any warning signs to justify them. Depending on the follow-up year, noncompliant follow-up cost the Social Security from 2.2 to 3.6 times more than compliant follow-up. A noticeable change in medical practices was observed after the introduction of CPGs in 1994. This was confirmed by a sharp decrease in mean Social Security expenditure per patient of more than one third between 1993 and 1995, regardless of the follow-up year considered. CONCLUSION: In the follow-up of patients with localized breast cancer, a large decrease in costs has been observed along with the evolution of medical practices toward CPG compliance. This finding is probably generalizable to other settings, but there is nothing that proves that it is applicable to other treatment strategies.

Aged↗
PubMed2000

Faculty practice: a model to bridge the theory-practice divide.

It has been suggested that as a result of nurse education withdrawing from the clinical setting and becoming established in institutions of higher education, there has been a separation of theory from practice. Recognition of the theory-practice gap by clinicians and professional bodies has led to calls for nurse educators to retain a clinical focus. Faculty practice is described and critically discussed as a model of practice to bridge the theory-practice divide. In this article, the author presents the results of a 6-month pilot study to implement such a model within a community trust, and suggests that the development of such initiatives will foster collaborative working and improve nurse education and patient care.

Attitude of Health Personnel↗
PubMed2004

Changing practice: use of audit to change oral care practice.

Although oral problems are common in palliative care, oral care can be a neglected area of practice. This article discusses the introduction of an oral care protocol and standard in one palliative care unit. The project used audit tools developed by Lee et al (2001) and involved a survey of the oral care knowledge of nursing and medical staff, and a retrospective survey of current practice using 50 sets of patients' notes. A standard and documentation were developed with the aim of ensuring oral care was both consistent and in line with best practice. Training was provided to all staff within the unit. Three months later oral care practice was audited. The results suggested improvement in all aspects of oral care practice. Dissemination of oral care documentation and training across the trust is underway. This article describes the processes used, highlighting the importance of assessment in oral care and the need for teamwork in rolling out changes both within and beyond a single unit.

Documentation↗
PubMed1998

Economic models to help periodontists evaluate their practices: how to analyze a practice to assess the potential impact of managed care contracts.

The purpose of this article is to examine 10 steps analyzing the financial impact on a periodontal practice accepting a proposed managed care dental plan. It is emphasized that this analysis should be conducted before formally agreeing to accept the proposed plan. The procedures for examining the 10 steps include the use of hypothetical data for a periodontal practice confronted with a discounted fee plan. Each step is identified, discussed, and the hypothetical data are used to develop results presented in a set of tables. The steps in the analysis process include constructing a practice profit and loss statement and developing a dataset of practice characteristics and productivity measures. Other estimates should be made of covered lives, new patient utilization, existing patient utilization, utilization of non-covered services, estimating other sources of revenue and expense, and the impact on capacity utilization of operatories and practice staff. Results are presented in a set of analysis tables. The importance of multiple analyses is discussed as is the importance of analyzing the impact on results from changing assumptions. Some of the higher risk variables faced by the practitioner are identified for submission to risk evaluation to examine the sensitivity of results. Finally, the relationship between the proposed plan and the additional time required by the periodontist to meet the plan's specifications is examined in light of the data developed in the 10 steps and the results tables.

Contract Services↗
PubMed2004

Complexity theory: a long-term care specialty practice exemplar for the education of advanced practice nurses.

This clinical exemplar highlights how an academic clinical practice supported gerontological nursing students as they learned evidence-based approaches to managing complex geriatric syndromes in long-term care. Urinary incontinence (UI), which occurs in more than two thirds of nursing home residents, was the focus of the faculty practice. Advanced practice nursing skills developed by students included advanced physical assessment and diagnostic reasoning techniques, critical appraisal of the scientific evidence for UI management, and the ability to teach evidence-based approaches to UI care to bedside nursing staff. Outcomes of the practice for the facilities included improved detection of urinary retention, reduced wetness rates, and strengthened systems of care for UI. Student outcomes included an increased sense of self-efficacy in management of UI and other complex geriatric problems. Complexity theory guides a discussion of how curriculum design and research-based practices can be implemented to enhance both student and facility outcomes.

Aged↗
PubMed1995

A critical incident study of general practice trainees in their basic general practice term.

OBJECTIVE: To obtain information on the experiences of general practice (GP) trainees during their first general practice (GP) attachment. DESIGN: Critical incident technique--a qualitative analysis of open-ended interviews about incidents which describe competent or poor professional practice. SUBJECTS: Thirty-nine Western Australian doctors from the Royal Australian College of General Practitioners' (RACGP) Family Medicine Program who were completing their first six months of general practice in 1992. RESULTS: Doctors reported 180 critical incidents, of which just over 50% involved problems (and sometimes successes) with: difficult patients; paediatrics; the doctor-patient relationship; counselling skills; obstetrics and gynaecology; relationships with other health professionals and practice staff; and cardiovascular disorders. The major skills associated with both positive and negative critical incidents were: the interpersonal skills of rapport and listening; the diagnostic skills of thorough clinical assessment and the appropriate use of investigations; and the management skills of knowing when and how to obtain help from supervisors, hospitals and specialists. Doctors reported high levels of anxiety over difficult management decisions and feelings of guilt over missed diagnoses and inadequate management. CONCLUSION: The initial GP term is a crucial transition period in the development of the future general practitioner. An analysis of commonly recurring positive and negative critical incidents can be used by the RACGP Training Program to accelerate the learning process of doctors in vocational training and has implications for the planning of undergraduate curricula.

Adult↗