Numbers and distribution of general practitioners in Victoria.
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The National Diabetes Prevention Center (NDPC) is an emerging model for public health practice and partnership. It is rooted in a "promising practices" framework, one that looks at what works for community diabetes prevention, care, and treatment practices. Working with national and local partners to explore new approaches to diabetes prevention invites us to move beyond traditional models of community public health partnerships. Traditional community partnership models emphasized the technical assistance in research, surveillance, and program development that can be provided by partners from outside the community. While not diminishing the importance of these activities, the NDPC seeks to provide an environment for meaningful language and discourse that adequately honors the innovative and culturally rich approaches to diabetes prevention already being developed within many American Indian and Alaska Native communities, which have some of the highest rates of diabetes in the world. The NDPC strives to provide common ground for the emergent discussions around the power and practice of solid evaluation frameworks, new information technologies, capacity-building philosophies, health systems, and collaborative approaches.
BACKGROUND: The objective of this study was to quantify the rate of partnership change among general practitioners (GPs) in the National Health Service (NHS) in England from 1990 to 1994. METHODS: Time series data on English GPs were analysed on 1 October for the years 1990-1994. The main outcome measures include: (1) proportion of GPs practising in an unchanged partnership from 1 October 1990 to 1 October 1994; (2) proportion of partnerships that were unchanged over the study period; (3) the average yearly rate of partnership changes for England and per Family Health Service Authority (FHSA), calculated using both the individual GP and the practice as the unit of analysis. RESULTS: A total of 6532 (27.1 per cent) of the 24,107 unrestricted GPs practising full time on 1 October 1990 were still practising in the identical partnership on 1 October 1994; 3539 (35.7 per cent) of the 9918 practices in England were unchanged over the same period. The average yearly partnership change rate for all England was 23.1 per cent when calculated using the individual GP as the unit of analysis, and 23.4 per cent when calculated using the practice as the unit of analysis. There is threefold variation found in the average yearly partnership change rate by FHSA, with similar rank ordering of health authorities when using either the individual GP or practice as unit of analysis. CONCLUSIONS: Changes in partnerships are commonplace. The possible influence of such changes on primary care in the NHS should be further investigated.
The second paper in this series of two on partnership examines the effects of family partnership (parent adviser) training which builds on health visitors' skills to facilitate partnership working with parents. This study was utilised as a pilot to identify a suitable method, to explore the interaction processes of health visitors who had undergone the training. The study draws together both quantitative and qualitative methods to seek to understand processes in depth. Three health visitors, who were part of a training group of 12, took part in the qualitative research using stimulated recall methodology. The quantitative data was collected from the whole training group using the Constructions of Helping questionnaire and the course evaluation form. The findings suggest that the family partnership training may be effective in enhancing partnership working in health visiting and that the stimulated recall methodology is an effective method of identifying the processes of interaction. The triangulation of methods led to an understanding that change in practice is dependent on the insight of the practitioner and that this may be able to be measured to some extent by the use of different methods.
Public policy initiatives have begun to recommend that interventions have strong evidence of effectiveness before there is expenditure of restrained public funds. The Nurse Family Partnership (NFP), a home visiting program for low-income parents expecting their first child, has been identified as a preventive intervention program that meets high evidentiary standards based on results from three randomized trials. Strategies used to promote successful translation of the research intervention into clinical practice, findings from the evaluation of the replication of the NFP in 22 states, and challenges experienced in moving a research program to practice are discussed. EDITORS' STRATEGIC IMPLICATIONS: Policymakers, community public health officials, and researchers planning to disseminate their prevention programs will find many lessons in this example of bringing a model program (i.e., a prevention strategy that works) up to scale. Although results at replication sites are somewhat weaker than at model sites, the consistent positive outcomes are a testimony to the strength of the NFP model and the fidelity of its implementation across sites.
Despite the growing literature that collaboration is a 'good' thing, there are calls emphasising the need for evidence of its effectiveness. However, the nature of the evidence to assess effectiveness is less clear. This paper examines the components that contribute to the challenges that confront evidence on collaboration. It considers the differing interpretations that have been placed on evaluation and explores how ways of determining the outcomes of collaboration and the levels of outcome measurement to assess collaborative effectiveness are influenced by the multifactorial nature of the concept. Evidence on the impact of collaboration is influenced by the diversity of perspectives and conceptual facets, and difficulty in measurement of the notions involved. Other factors discussed are the choice of macro or micro evaluation, of proximal or distal indicators, of short and long-term effects, or of individual-level or collective community-level outcomes. The suitability of randomised controlled trials for the measurement of collaborative outcomes as well as the requirement of mixed methods evaluations are highlighted. An evaluation of five community partnerships in South Africa is employed as an example to link the evaluation concepts that are discussed to a real enquiry. If collaboration is to be successful in making a difference in the lives of people, then increasing the precision and context of appraising its effectiveness will reduce the nature of inconclusive evidence and is likely to improve the practice of partnerships, coalitions and joint working in health and social care.