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PubMedDate not supplied

The scope of professional practice in specialist practice.

The Scope of Professional Practice (UKCC, 1994a) now offers nurses, midwives and health visitors new opportunities to develop their clinical role. Role expansion is at the centre of debate in the health service. In the spirit of Scope, trusts and regional health authorities have been experimenting with new roles that combine medical and nursing practice in order to promote a holistic approach to health care. Education, experience and the appropriate clinical competency are the foundations for role expansion and the development of professional practice. However, some of the new roles and innovative practices have also been targeted at reducing junior doctors' hours (Read and Graves, 1994). New roles must be evaluated before they are allowed to develop and there is an urgent need for national evaluation of the initiatives underpinning Scope. This article examines the changing role of practitioners in specialist practice. The ethical, professional and legal issues surrounding these changes will also be considered.

Clinical Competence↗
PubMed2004

Facilitating participation of students with severe disabilities: aligning school based occupational therapy practice with best practices in severe disabilities.

School-based occupational therapy is the largest employer of occupational therapists. School-based occupational therapists work extensively with students with severe disabilities. Over the past decade, one significant change in the field of severe disabilities has been the advocacy of best practices. This paper discusses the implications of best practices for school-based occupational therapy practice and examines strategies that occupational therapists use to tackle such challenges. Focuses of the discussions are centered on the issues relative to curriculum, educational setting and instructional strategies. The theme of Activity and Participation proposed in International Classification of Functioning (WHO, 2001) guides our discussions. Specific strategies in aligning school-based occupational therapy practice with best practices in severe disabilities are proposed and highlighted.

Adolescent↗
PubMed2004

The impact of pharmaceutical care practice on the practitioner and the patient in the ambulatory practice setting: twenty-five years of experience.

This manuscript reviews 25 years of experience that include developing the practice of pharmaceutical care and initiating new practices. The impact this practice has on practitioners in the ambulatory setting is described as well as data that reflect its clinical and economic impact. There is a great need to prepare new practitioners to provide pharmaceutical care. A focused training program was developed and delivered to over 300 practitioners. The practitioners were prepared by providing direct patient care. They learned the philosophy of pharmaceutical care practice, to identify, resolve and prevent drug therapy problems, to document care using a specially designed software program called the Assurance Pharmaceutical Care program. The practitioners who participated in the training program reported that the average amount of time spent with patients increased three-fold, they now see four times more patients than prior to training, and the number of new patients referred by physicians increased nine-fold as a result of the program. These practitioners have now provided care to more than 25,000 patients in their practices. These data have now been consolidated and analyzed, and a portion of these results is reported here. The clinical and economic outcomes from 2,985 adult patients, who received pharmaceutical care between January, 2000 and December, 2003, are presented. At the first assessment by the pharmaceutical care practitioner, 61% of the patients had one or more drug therapy problems identified and resolved. This resulted in an improvement in the clinical status or maintaining a stable status in 83% of the patients. The health care savings realized from pharmaceutical care were $1,134,162. This represented a benefit to cost ratio of 2:1. Physicians who collaborate with pharmaceutical care practitioners have validated the work of the practitioners, and patients are recognizing the benefits of pharmaceutical care.

Adult↗
PubMedDate not supplied

Practice facilitators and practice-based research networks.

Practice facilitators (PFs) are health care professionals, who assist primary care practices in research and quality improvement activities. Their work goes beyond data collection and feedback and includes practice enhancement methods to facilitate system-level changes. PFs provide a framework for translating research into practice by building relationships, improving communication, facilitating change, and sharing resources in practice-based research networks (PBRNs). The work of PFs is funded from a variety of sources, including academic grants and renewable contracts with national, state, and local health care agencies. Limited information is available on cost-effectiveness of PF interventions. This article provides examples of how the PF model was implemented in 4 PBRNs in the United States.

Health Personnel↗
PubMed2001

[Clinical practice improvement--clinical practice quality improvement of local health care processes].

Clinical Practice Improvement (CPI) is a methodological approach to develop analytically-based protocols to achieve desirable outcomes at the lowest essential cost over the continuum of local care processes. Several elements of the CPI approach make it attractive to clinicians: First, it is a scientific bottom-up approach that places accountability for practice improvement and outcomes with local clinicians. Clinicians are not told to blindly follow a guideline or protocol developed by others, but instead collect data on outcomes, on treatments, and on patient signs and symptoms that support practice change. CPI supports caregivers in making their own decisions about optimal care on the basis of objective statistical evidence gathered in the routine, everyday practice of medicine. Second, CPI measurement encompasses a comprehensive view of the care management process: patient characteristics, process steps, and outcomes. All three classes of data are considered simultaneously. This comprehensive measurement framework provides a basis for meaningful analyses of significant associations, as well as relationships between process and outcome. Third, the CPI methodology focuses on deployment and application. There is a continual emphasis on factors that can be implemented to improve outcomes and the process to achieve these results. This focus on implementation guides who is involved in the design, what data are collected, what questions are answered during analyses, and who designs the protocols or improvements in practice.

Delivery of Health Care↗
PubMed1992

Single-subject experimental designs: a practical research alternative for practicing physicians.

Single-subject research designs offer a viable alternative to the more customary group-comparison designs. The flexibility and practicality of these designs make them particularly well suited for practicing family physicians interested in testing their clinical hunches. Three designs are described that are feasible in a practice setting: ABAB (reversal), multiple-baseline, and the alternating treatment design. Either visual inspection or statistical approaches can be used to evaluate these designs. By being aware of their limitations and by following simple practical steps, the practicing physician can use these designs to improve care of individual patients while simultaneously contributing to our general knowledge.

Clinical Trials as Topic↗
PubMed2005

A study of occupational stress, scope of practice, and collaboration in nurse anesthetists practicing in anesthesia care team settings.

This study examined occupational stress in Certified Registered Nurse Anesthetists (CRNAs) practicing with anesthesiologists in anesthesia care team (ACT) settings. The focus was to examine the relationships among CRNA scope of practice (SOP) in ACTs, collaboration, and role-related occupational stress. A survey questionnaire was mailed to CRNAs from the 6 New England states, with a return rate of 30.87% (n = 347). Data analysis included practice characteristics and demographics of the sample, and the research questions were examined applying correlational analysis, t test, and analysis of variance addressing relationships among the study measures. Data analyses revealed that limited, restricted CRNA practice scope was particularly evident in respondents employed by anesthesiology groups, compared with hospital-employed CRNAs. Few CRNA respondents perceived their practice as collaborative, and many used compromise as a conflict-resolution style. Respondents with a broader SOP reported higher collaboration than those with restrictions. Respondents reporting a broader SOP also experienced increased job stress in relation to role overload but used coping resources effectively. Implications for future studies include exploring strategies that achieve consensus between CRNAs and anesthesiologists in ACTs, emphasizing clearly defined roles and optimizing productivity.

Adult↗
PubMed2004

Information technology in the interventional pain practice: electronic medical records, practice management software, and document management.

Electronic medical records (EMR) can both replace the paper clinical chart and perform scheduling and billing tasks. EMRs are currently used in only a small proportion of medical practices; however, EMR adoption is expected to soar in a few years. Governmental and industry concerns about safety and quality, along with medical practice needs for increased productivity, are fueling this transition. Medical practices are likely to consider transitioning to EMRs. At this point, the marketplace is fragmented in terms of suppliers, and refinement of the software is continuing. Transitioning to an EMR is a step that offers enormous benefits to interventional pain management physicians, in terms of compliance, the ability to maintain quality, and the ability to manage practices, including larger and more complex practices. Transitioning to an EMR is also a major effort in terms of time and expense: the goal is to settle on a specific EMR and continue to use it. This review focuses on (1) why physicians are or are not transitioning to EMRs; (2) the benefits of a transition; and (3) factors to consider in evaluating the various competing software products. Although EMR technology continues to develop, the review also considers areas in which future development is necessary. The most important areas are seen in document management, data input, and outcomes analysis and decision support capability. The EMR market is evolving rapidly. However, this review should in no way serve as an endorsement of any particular system, vendor, or technology.

Journal Article↗
PubMed1989

Should performance indicators in general practice relate to whole practices or to individual doctors?

In a study of referrals to East Anglian hospitals 737 referrals in six specialties from three general practices were examined to see how accurately the hospital computer master index had identified the referring practice, the referring general practitioner and the doctor with whom the patient was registered. Although the practice was accurately identified by the hospital computer in 97% of referrals, the identification of the referring doctor and the patient's registered general practitioner were less reliable (72% and 49% respectively). It is concluded that at present the practice rather than the individual doctor may be the appropriate unit of analysis for studies of general practitioners' referral rates. This may be true for other performance indicators where information on a doctor's case mix and workload is not available. The results of this study emphasize that problems may arise if data relating to individual general practitioners are interpreted out of context of the practice and the way in which it is organized.

England↗
PubMedDate not supplied

Family practice physicians' beliefs, attitudes, and practices regarding obesity.

This study examined 318 family practice physicians' beliefs, attitudes, and practices regarding obese patients. Most physicians surveyed were aware of the health effects of obesity and that normal weight is important to the health of their patients. Beliefs, attitudes, and practices differed significantly based on the physicians' sex, weight, years in practice, and belief that counseling patients on weight loss is professionally gratifying and that most obese patients can lose significant amounts of weight. A notable number of respondents held negative or stereotypical attitudes toward obese patients (i.e., obese patients lack self-control, are lazy and sad). The most commonly recommended weight loss techniques were decreasing caloric consumption (92 percent), participating in Weight Watchers (84 percent), consulting a dietitian/nutritionist (76 percent), and aerobic exercise (75 percent). The two sources of weight control information most frequently cited were past experience (73 percent) and medical journals (71 percent). The results of this survey indicate that there is considerable room for improvement in the beliefs, attitudes, and practices of family physicians regarding obese patients.

Adult↗
PubMed1987

Twenty-four-hour recall, knowledge-attitude-practice questionnaires, and direct observations of sanitary practices: a comparative study.

Although responses to 24-hour recall and knowledge-attitude-practice questionnaires are commonly used in water-sanitation studies as surrogates for direct observation of behaviour, the validity of this approach is questionable. We therefore compared questionnaire data with those obtained by direct observation of practices related to water storage, handwashing, and defecation among 247 families in urban Dhaka, Bangladesh. Analysis of the results indicates that accord between the replies to the questionnaires and the data collected by direct observation was poor and that the responses to the two questionnaires were often contradictory. Significant disagreements between the results of questionnaires and observations arose usually because desirable practices were over-reported by the respondents. The results of the study suggest that in urban Bangladesh 24-hour recall and knowledge-attitude-practice questionnaires should not be used as proxies for direct observation of hygiene practices.

Bangladesh↗
PubMed1994

Practice parameters for the use of laser-assisted uvulopalatoplasty. Standards of Practice Committee of the American Sleep Disorders Association.

This paper, which has been reviewed and approved by the Board of Directors of the American Sleep Disorders Association, provides the background for the Standards of Practice Committee's practice parameters for the practice of sleep medicine in North America. An office-based surgical procedure, laser-assisted uvulopalatoplasty (LAUP), has recently been promoted as a treatment for snoring. The American Sleep Disorders Association's Standards of Practice Committee reviewed the medical literature and developed practice parameters for the use of this operation. Adequate controlled studies regarding LAUP were not found in peer-reviewed journals; therefore, patients should be informed that the risks, benefits, and complications of this procedure have not been established. Because inadequate validation studies exist, prudence dictates that patients who elect this procedure undergo appropriate preoperative evaluation and postoperative follow-up.

Humans↗
PubMedDate not supplied

From research to practice: one organisational 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 organisational structure that could be helpful to others considering such a strategy. Both the strengths and weaknesses of the model are discussed, a number of conclusions drawn as to its robustness and consideration given to its replication.

Diffusion of Innovation↗
PubMed1997

The curriculum of practice: a conceptual framework for speech-language therapy and audiology practice with a black African first language clientele.

This paper discusses the use of a conceptual framework (i.e., the curriculum of practice) to guide the transformation of professional practice toward equitable service provision, rooted in a research finding that South African Speech-Language Therapy & Audiology has a favourable service bias toward White English/Afrikaans first language speakers (Pillay, 1997b). Three perspectives of practice are discussed, i.e., the official, espoused and actual perspectives. Also, the various elements of practice are reviewed, and include clinical practice activities, resources and their utilization, professional education curricular and professional policies. It is asserted that re-constructing the profession's knowledge base in a presently (1996-) transforming South Africa, mostly requires the use of a critical (versus, for e.g., a scientific) paradigm.

Attitude of Health Personnel↗
PubMed2006

Do we practice what we preach? A review of actual clinical practice with regards to preconception care guidelines.

OBJECTIVES: To review what past studies have found with regard to existing clinical practices and approaches to providing preconception care. METHODS: A literature review between 1966 and September 2005 was performed using Medline. Key words included preconception care, preconception counseling, preconception surveys, practice patterns, pregnancy outcomes, prepregnancy planning, and prepregnancy surveys. RESULTS: There are no current national recommendations that fully address preconception care; as a result, there is wide variability in what is provided clinically under the rubric of preconception care. CONCLUSIONS: In 2005, the Centers for Disease Control and Prevention sponsored a national summit regarding preconception care and efforts are underway to develop a uniform set of national recommendations and guidelines for preconception care. Understanding how preconception care is presently incorporated and manifested in current medical practices should help in the development of these national guidelines. Knowing where, how, and why some specific preconception recommendations have been successfully adopted and translated into clinical practice, as well as barriers to implementation of other recommendations or guidelines, is vitally important in developing an overarching set of national guidelines. Ultimately, the success of these recommendations rests on their ability to influence and shape women's health policy.

Female↗
PubMed2006

Preparing for professional practice: how well does professional training equip health and social care practitioners to engage in evidence-based practice?

This paper reports on the findings of a study that aimed to explore how relevant initial training is in relation to evidence-based practice, and explore the perceptions of recently qualified practitioners about their confidence to engage in evidence-based practice. A cross-sectional postal survey was used to ascertain the views of nurses, social workers, occupational therapists and physiotherapists who had been qualified no longer than two years prior to the survey, and had qualified at one of three London Universities. Fifty questionnaires were sent out to each professional group (a sample of 200 overall) and there was a 43% response rate achieved. The results show a clear discrepancy between what are generally positive attitudes towards evidence-based practice and the value of research evidence and the infrequency with which they actually do make use of research resources and engage in evidence-based practice. A number of constraints to engagement in accessing and utilising evidence were identified.

Attitude of Health Personnel↗
PubMed1996

A change in practice: current urologic practice in response to reports concerning vasectomy and prostate cancer.

OBJECTIVE: To examine the practice patterns of urologists performing vasectomy in response to studies reporting an increased risk of prostate cancer in vasectomized men. DESIGN: A mailed survey. SETTING: A university medical institution. PARTICIPANTS: One thousand five hundred randomly selected United States urologists under the age of 65 years. MAIN OUTCOME MEASURE: Urologists reported practice patterns of vasectomy in response to studies showing possible link between vasectomy and prostate cancer. RESULTS: A response rate of 51% (759/1,500) was obtained. Although > 90% state that these studies have had little or no effect upon their practice of vasectomy, 27% screen vasectomized men earlier for prostate cancer, and 20% would be reluctant to recommend a vasectomy to a man with a strong family history of prostate cancer. CONCLUSIONS: Over one fourth of urologists who screen for prostate cancer have altered their screening patterns even though they responded that the studies have not affected their practice patterns.

Health Knowledge, Attitudes, Practice↗
PubMed2004

VA practice patterns and practice guidelines for treating posttraumatic stress disorder.

Little is known about how recent ISTSS practice guidelines (E. B. Foa, T. M. Keane, & M. J. Friedman, 2000) compare with prevailing PTSD treatment practices for veterans. Prior to guideline dissemination, clinicians in 6 VA medical centers were surveyed in 1999 (n = 321) and in 2001 (n = 271) regarding their use of various assessment and treatment procedures. Practices most consistent with guideline recommendations included psychoeducation, coping skills training, attention to trust issues, depression and substance use screening, and prescribing of SSRIs, anticonvulsants, and trazodone. PTSD and trauma assessment, anger management, and sleep hygiene practices were provided less consistently. Exposure therapy was rarely used. Additional research is needed on training, clinical resources, and organizational factors that may influence VA implementation of guideline recommendations.

Depression↗