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At least 415 records · Page 23Linked to original sources
PubMed1998

Frequency of patients' consulting in general practice and workload generated by frequent attenders: comparisons between practices.

BACKGROUND: Patients who attend frequently may present a problem for general practitioners (GPs) in several ways. The frequency of patients' consulting, comparisons between practices, and the effect of frequent consulting on the clinical workload have not been quantified previously. AIMS: To examine the distribution of the number of consultations per patient in four general practices. To estimate the clinical workload generated by frequent attenders. To model the data to demonstrate the contribution of age, sex, and practice on the likelihood of attending frequently. METHOD: Analysis and modelling of a validated data set of date records of consultations collected routinely over a 41-month period from four practices in and around Leeds, representing 44,146 patients and 470,712 consultations. RESULTS: A minority of patients consulted with extreme frequency. All practices had similar distributions but varied with respect to the numbers of frequent attenders, and the frequencies of their consulting. The most frequent 1% of attenders accounted for 6% of all consultations, and the most frequent 3% for 15% of all consultations. Females and older people were more likely to be frequent attenders. CONCLUSION: Frequent attenders have an important effect on GPs clinical workload. Between one in six and one in seven consultations are with the top 3% of attenders. Further research is needed to explain the behaviour underpinning frequent attendance in order to identify appropriate management strategies; such strategies could have an important effect on clinical workload.

Adolescent↗
PubMed1998

Telephone triage of acute illness by a practice nurse in general practice: outcomes of care.

BACKGROUND: Telephone working is an increasingly important way of managing general practice workload, particularly out of hours. The role of telephone triage, however, in managing acute consultations during the day has not been adequately researched. AIM: To determine the impact of telephone triage, conducted by a practice nurse, on the management of same day consultations in a general practice. METHOD: A general practice of 11,300 patients in South Tyneside collected prospective telephone and surgery consultation data over three months. Patient satisfaction, for those who had received only telephone advice, was measured using a postal questionnaire. Four outcomes were measured: changes in doctor and nurse workload; repeat consultations with the same problem; prescriptions issued; and patient satisfaction with the service. RESULTS: In three months, 1263 consultations were recorded. Doctor workload fell by 54%, from 1522 to 664 consultations, compared with the previous three months. A total of 325 (26%) telephone requests to see the doctor were managed by the nurse on the telephone without them visiting the surgery. Also, 273 (21%) patients saw the nurse in the surgery, 565 (45%) saw the doctor in the surgery, and 99 (8%) saw the doctor and the nurse in the surgery. The response rate to the postal questionnaire was 192/271 (71%); 154 (88%) were satisfied with nurse telephone advice. CONCLUSIONS: Telephone triage, by a practice nurse, of patients who wish to see the doctor on the same day, reduced doctor workload. This was a service that patients liked.

Family Practice↗
PubMed1998

[Practice is learned by practice].

Efficient continuing education for experienced physicians should build upon and reflect doctors' concrete everyday experiences and self-defined learning needs. Reciprocal practice visits among general practitioners, afford excellent opportunities for colleagues to see and be seen, to reflect, discuss, learn from each other and develop networks, using commonly experienced consultations as a starting point. Practice visits have been credited within the Norwegian continuing medical education system since 1989, but very few practitioners have made use of the method. We have developed a course where groups of 10-12 experienced general practitioners conduct four whole day practice visits over a 2-month period. Group sessions, totalling 20 hours, are used to develop cohesion and trust among colleagues through discussions and exercises. In the later stages, plenary sessions are used to present and discuss experiences from all of the practice visits, and participants are encouraged to develop ideas and strategies concerning their professional future. The participants in the three courses arranged so far (n = 31) were general practitioners with, on average, ten years of experience. Evaluations were positive, and emphasized the value of the course as an opportunity to break the relative isolation of general practice, and share experiences, insights, frustrations and ideas with colleagues.

Clinical Competence↗
PubMed1989

The influence of practitioner and practice characteristics on service activity levels in a New Zealand general practice sample.

The impact of practitioner and practice-related characteristics on service activity levels in general practice is assessed. It is hypothesized that while initial medical contact is largely patient-initiated and hence influenced by broader social factors, the subsequent provision of services within the medical system is more likely to be determined by organisational and professional factors. The data are drawn from a one per cent sample of all weekday general practice office encounters in the Hamilton Health District recorded over a twelve-month period from February 1979. The average encounter involved three services: typically a history or examination, a prescription and a request for follow-up. Activity levels were measured as the number of services received from the general practitioner by patients in the course of the medical encounter. The broad social characteristics of patients had little impact on activity level. Descriptors of patient health condition, and related attributes such as age and gender, were only moderately predictive of the number of services received. Practitioner and practice-related characteristics seemed to exert little influence, even after controlling for case mix. The strongest predictor of the number of services provided was the identity of the patient's doctor. Of the 30 per cent of variation in total service use explained by the model, half was accounted for by practitioner identity.

Age Factors↗
PubMedDate not supplied

Primary care physicians' knowledge and practice patterns in the treatment of chronic kidney disease: an Upstate New York Practice-based Research Network (UNYNET) study.

BACKGROUND: There is a steady increase in the prevalence of chronic kidney disease (CKD) in the United States. Primary care physicians (PCPs) can engage in strategies that are proven to be effective in reducing the progression rate of kidney disease. The National Kidney Foundation has released evidence-based guidelines called the Kidney Disease Outcome Quality Improvement Initiative (K/DOQI) that detail these strategies. No information exists regarding adoption of these guidelines in primary care. METHODS: A qualitative study in a practice-based research network (PBRN) was undertaken to explore common PCP practices and knowledge regarding CKD. A typical case sampling strategy was followed. Semi-structured interviews and exit surveys were conducted with 10 PCPs from randomly selected PBRN practices. Three reviewers conducted content analysis using the immersion-crystallization approach. RESULTS: Five general themes emerged as key findings: (1) lack of awareness of K/DOQI guidelines; (2) Desire for more CKD practice guidance; (3) persistence of traditional, less accurate, diagnostic procedure; (4) variability in the treatment of complications; and (5) uncertainty of timing for referral to a nephrologist. CONCLUSION: Facing a growing CKD incidence, PCPs can have an impact on preventing its progression and associated complications with increased familiarity of new guidelines.

Clinical Competence↗
PubMed1997

Predicting prescribing costs in general practice using practice demography.

Prescription and dispensing costs form a large part (c. 56%) of primary care expenditure in the NHS and concern has been expressed at its ever increasing total. Previous predictive models have either failed to account for a high proportion of costs or else have not been able to explain adequately the role practice list demography plays upon costs. Using prescription data and the practice demography, our model accounts for 91.4% of the variation in primary health care prescribing costs in Northern Ireland thus explaining them to a much greater extent than previous models and, in addition, explains a large part of the variation in total monthly consultations and numbers of prescriptions. In addition to comprehensiveness it has a high degree of parsimony, needing only three independent variables for each practice, namely, the number of children aged 0-4 years, the number of persons aged 60+ years and the number of partners in the practice, all of which are immediately comprehensible by GPs and their negotiators. Thus, it could form a valuable addition to the 'evaluation kit' of prescribing advisers and others concerned with auditing and containing costs. Previous studies have shown the importance of the age-sex structure of practice lists in relation to prescribing costs but none has been able to develop such a powerful, simple and comprehensible predictive model.

Journal Article↗
PubMedDate not supplied

National agenda for advanced practice nursing: the practice doctorate.

The purpose of this article was to provide the background and rationale for the practice doctorate in nursing. The American Association of Colleges of Nursing's Position Statement on the Practice Doctorate in Nursing, approved in October 2004, will be discussed. Outlined are some of the changes that will be needed in education, regulation, and advanced practice. Common questions and concerns that advanced practice nurses have, including titling, salary, and transitioning to the doctor of nursing practice degree, will be addressed.

Accreditation↗
PubMed2003

Higher level practice: degree of specialist practice?

Higher level practice (HLP) is the determinant characteristic of any maturing profession. Nursing should make a quantum leap with the development of HLP if the patient, the nurse, the context of caring and the acquisition of expertise are at the forefront of such growth. This study shows the matching of nursing concepts with nursing context is at the heart of HLP. It also shows that nurses are developing their own understanding of HLP which is different from the UKCC functional criteria. The intention here is to contribute to the development and understanding of HLP. Seven key concepts emerge in the definition of HLP. These concepts are unpacked to reflect the possible criteria, which could be used in the practice, teaching, assessment, and further refinement of HLP. A series of thought provoking recommendations are made for the Nursing and Midwifery Council to consider.A learning module entitled "Higher Level Practice" anchored in the epistemology of practice has been developed and successfully implemented by the author within the MSc Nursing Practice course attended by senior and consultant nurses.

Community Health Nursing↗
PubMed1998

Keeping a reflective practice diary: a practical guide.

Reflective practice aims to enhance client care via the professional development and growing expertise of practitioners. This paper offers practical guidelines for writing diaries that may form the basis for reflective practice, while acknowledging the skills that practitioners already use to examine their nursing actions and interactions. There is an emphasis on the outcomes of reflection as well as the reflections themselves, as this is seen as important if professional development is to be recognized and clients benefit. Time constraints that may make frequent formal reflection difficult are recognized by the format that allows deeper reflection where time permits and as skills develop. While ideas presented have been influenced by the literature on reflection, the paper owes as much to the continuing education students of the Homerton School of Health Studies who studied the reflective practice module during 1996. Without listening to their discussions, becoming aware of their difficulties and sharing their growing ability to reflect on practice, this article would not have been possible.

Clinical Competence↗
PubMed1998

Design and methodology in a community, practice-based research network: a study of nurse-midwifery home-birth practice.

OBJECTIVE: To assess the feasibility, probable success, and inherent problems of conducting a multi-site, multi-year cohort study of planned home birth in the USA. DESIGN: A prospective cohort study. SETTING: 14 states across the USA, representing a variety of regions and settings. PARTICIPANTS: 29 home-birth midwifery practices, representing 44 individual midwives in both large and small, solo and group practices. DATA COLLECTION: Birth outcomes for all women initially enrolled in these home-birth practices. KEY CONCLUSION: Multi-site studies of evaluating outcomes in small community-based practices are possible if several requirements are met. IMPLICATIONS FOR PRACTICE: Understudied birth alternatives can be formally researched within a co-operative network of participating practitioners.

Data Collection↗
PubMed2003

Evidence-based practice: justifying changes in clinical practice based upon the appraisal of evidence.

Patients with diabetes are known to be at higher risk of foot ulceration that can often lead to limb amputation. Anecdotal evidence suggested that the provision of a multidisciplinary foot clinic for patients with diabetes could improve outcomes. Although this approach appears common sense the author required evidence to support a bid for a change in practice. This paper begins by describing some of the origins and principles of evidence based practice and how they can be applied in practice. The search for evidence and critical appraisal of two papers is explained. The tools used to assist implementation of the change in practice are included. The paper concludes with recommendation for changes in practice based upon the evidence found.

Amputation, Surgical↗
PubMed2000

A brief history of advanced practice nursing and its implications for WOC advanced nursing practice.

Although the evolution of clinical nurse specialists and nurse practitioners during the previous several decades has led to a sense of novelty regarding advanced practice, it is important to remember that nurses have engaged in such roles for nearly 100 years. This article will review the history of advanced nursing practice, summarize current definitions of specialty and advanced practice, discuss the evolution of advanced practice and its impact on contemporary nursing, and provide a background for advanced practice considerations for the WOC nurse, which are discussed in detail in subsequent articles by Janice Beitz (pp 55-64) and Dorothy Doughty (pp 65-8) in this issue.

History, 20th Century↗
PubMed2000

Specialty practice, advanced practice, and WOC nursing: current professional issues and future opportunities.

Interest in clarification of the role of the WOC nurse as a specialized or advanced practice practitioner is increasing. Although much has occurred to delineate practice parameters, lack of expectations for specialty versus advanced nursing practice still exists. This article will differentiate advanced, specialty, and WOC nursing practice by examining their legal definitions, educational requirements, licensure, certifications, and practice milieus. Implications for the future of WOC nursing are posed within the context of the evolving American health care system.

Fecal Incontinence↗
PubMed1998

The theory-practice gap in nursing: from research-based practice to practitioner-based research.

The aim of nursing research is generally agreed to be the generation of knowledge, and whilst this is a relevant aim in theory-based disciplines such as sociology, the primary concern of nursing is with practice. Using examples drawn mainly from the field of mental health, it will be argued in this paper that the application of generalizable, research-based knowledge to individual, unique, person-centred practice, the so-called 'research-based practice' advocated by the Department of Health, is one of the main causes of the theory-practice gap. It will be further suggested that nursing requires a paradigm of clinical research which focuses on the individual therapeutic encounter in order to complement the existing sociological paradigm of theoretical research which is best suited to the generation of generalizable knowledge and theory. The paper will conclude by suggesting that such a clinically based research paradigm must not only focus on the individual nurse-patient relationship, but that it must be carried out by the nurse herself. Clinical research, if it is to make a difference to practice, must therefore be practitioner-based research.

Humans↗
PubMed2001

Teaching advanced practice nursing students how to use the Internet to support an evidence-based clinical practice.

In the past decade, clinicians have dramatically increased their use of the Internet as an information resource to guide clinical practice. The amount of evidence-based information on the World Wide Web (WWW) is growing at an explosive rate. Although the term "Internet" actually refers to the wires that link computers, and the term "World Wide Web" refers to the linked information, these terms will be used interchangeably in this article. Advanced practice nurses (APNs) need to learn how to locate evidence-based information efficiently on the Internet, how to evaluate the validity and relevance of the information, and how to use the information to support their practice decisions. This article describes a research course that the author teaches to APN students at the University of San Francisco School of Nursing. The course was designed to improve students' skills in using the Internet to support an evidence-based clinical practice (EBCP). The information in this article can assist nurse educators in teaching their APN students how to locate and evaluate evidence-based information on the Internet. It also can assist practicing APNs in using the Internet to facilitate an EBCP.

Evidence-Based Medicine↗
PubMed2005

Practical clinical trials for translating research to practice: design and measurement recommendations.

RATIONALE: There is a pressing need for practical clinical trials (PCTs) that are more relevant to clinicians and decision-makers, but many are unaware of these trials. Furthermore, such trials can be challenging to conduct and to report. OBJECTIVE: The objective of this study was to build on the seminal paper by Tunis et al (Practical clinical trials. Increasing the value of clinical research for decision making in clinical and health policy. JAMA. 2003;290:1624-1632.) and to provide recommendations and examples of how practical clinical trials can be conducted and the results reported to enhance external validity without sacrificing internal validity. KEY ISSUES: We discuss evaluating practical intervention options, alternative research designs, representativeness of samples participating at both the patient and the setting/clinician level, and the need for multiple outcomes to address clinical and policy implications. CONCLUSIONS: We provide a set of specific recommendations for issues to be reported in PCTs to increase their relevance to clinicians and policymakers, and to help reduce the gap between research and practice.

Clinical Trials as Topic↗
PubMed1996

From research to practice: one organizational model for promoting research-based practice.

This paper describes a framework used by the National Institute for Nursing in Oxford to integrate research, development and practice. With the increasing attention given to the topic of how research findings are implemented into clinical practice, it was felt important to share the challenges that have arisen in attempting to combine traditional research activities with more practice-based development work. The emerging conceptual framework, structures and functions are described, highlighting the variety of partnerships to be established in order to achieve the goal of integrating research into practice. While the underpinning principles of the framework-generating knowledge, implementing research into practice and evaluating the effectiveness of programmes-are not new, it is the way they have been combined within an organizational structure that could be helpful to others considering such a strategy. Both the strengths and weaknesses of the framework are discussed, a number of conclusions drawn as to its robustness and consideration given to its replication.

Diffusion of Innovation↗
PubMed2004

University Health Network framework for advanced nursing practice: development of a comprehensive conceptual framework describing the multidimensional contributions of advanced practice nurses.

BACKGROUND: The global paradigm shift resulting from radical transformations in knowledge and technology is significantly changing the context of healthcare delivery. In this changing environment, the contributions of health professions are vital in ensuring that the healthcare system adapts to meet the needs of today's patient. Advanced practice nurses (APNs) are clinical scholars and leaders in creating innovative approaches to patient care and organizational and professional leadership. AIMS: To develop a comprehensive conceptual framework for advanced nursing practice at University Health Network that will enhance role clarity by describing the complexity of these nursing roles and the significant contributions they make to patients and the healthcare system. METHODS: A critical review of the literature and a consultative process were undertaken to build consensus and develop a comprehensive framework for advanced nursing practice. RESULTS: The development of the University Health Network Framework for Advanced Nursing Practice (UHN-FANP), which clearly articulates all dimensions of advanced nursing practice roles. CONCLUSION: As clinical leadership roles in nursing continue to evolve, utilization of a conceptual framework facilitates role clarity, role implementation and role evaluation.

Clinical Competence↗