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PubMed2002

[Shared care--integrated cooperation across the sector boundaries about patient's course. Modern health care system cooperates].

Shared care programmes have been introduced in Denmark for areas, such as diabetes, asthma, and dementia. Over a three-year period, the communication and co-operation between the health sectors have improved. Specific demands on hospital referral and discharge letters have resulted in improved quality of contents and structure. This review shows that there is limited ongoing research on shared care and that the end points including formulations like "improved co-operation" have been too broad. Almost no research is available on specific improvements obtained by shared care. The study shows that implementation of shared care research programmes with specific end points is very extensive. Only 10 per cent of the present studies have specific end points, and 75 per cent of these show positive effects of shared care programmes. The GP Consulting System in Denmark has proved most useful in the progress of shared care. Future research in shared care should focus on specific end points, in which analyses of patient's course are fundamental in an effort to obtain improvements.

Community Health Services↗
PubMed2006

Development pathways in learning to be a physiotherapist.

BACKGROUND AND PURPOSE: Few studies have examined the experiences of students' professional socialization in physiotherapy. This international longitudinal study aimed to study experiences of situated learning and change in a student cohort during a physiotherapy education programme. METHOD: A phenomenographic design with semi-structured interviews was carried out with a cohort of physiotherapy students from two sites, strategically selected for variation in gender, age, educational background, work experience and academic level. Interviews were carried out after each of the first five semesters in the programme by a team of researchers. Seventy-six interviews explored students' learning experiences. Analysis identified the variation in experiences seen as important to becoming a physiotherapist. RESULTS: Distinct perceptions of professional growth and progression are identified in four pathways of development: 'Reflecting on Practice'; 'Communicating with Others'; 'Performing Skills'; and 'Searching Evidence'. These pathways demonstrate qualitative differences in the focus of learning experiences and preferred learning context, and include learning in a context which supports reflection, learning as agreed by others in a context with patients and other professionals, learning physiotherapy skills in a practice context and learning formal knowledge in a context where theory can be linked with practice. CONCLUSIONS: In a cohort of students professional growth can be seen in a variety of development pathways. Each shows progress of professional growth in the 'what' as changes in experiences and the 'how' as ways of learning from them. In addition, the pattern of pathways in a cohort may change from one semester to another suggesting individuals may adopt different learning pathways throughout their education. Teaching staff are challenged to consider how they recognize a variation in development pathways in their student cohorts and how they purposefully ensure experiences to guide students through different learning pathways in socialization to become a physiotherapist.

Clinical Competence↗
PubMedDate not supplied

Clinical nursing rounds, part 4: Teaching rounds for nurses.

Clinical rounds are being introduced in the Dudley Group of Hospitals to improve patient care, involve patients and improve communication. There are four types of rounds, Matrons rounds, Nurse Management Rounds, Patient Comfort rounds and Teaching rounds. This article describes Teaching rounds and is the final article in the series of four. Nurses and midwives learn in a variety of ways: through courses and accredited programmes, seminars, conferences, self-directed study and so on. One of the most effective ways, however, is to participate in special clinical teaching rounds. These are aimed at all learners, whether pre-registration students or qualified staff. Their aim is to learn from direct patient contact with facilitation from an experienced nurse teacher. In this article an account is given of how a Professor of Nursing linked to a hospital Trust uses this approach to teach and evaluate nursing care and is the last in the series of four on clinical nursing rounds. It is felt the rounds are particularly useful in developing clinical practice, evidence-based care, understanding patients and the conditions they experience, while linking theory and practice.

Clinical Competence↗
PubMedDate not supplied

An analysis of paramedic verbal reports to physicians in the emergency department trauma room.

OBJECTIVE: To measure the verbal communication between emergency medical technician-paramedics (EMT-Ps) and physicians in an emergency department trauma room (EDTR) before and after an educational intervention. METHODS: Using a before-after design, we audio-recorded paramedic verbal trauma reports in a large EDTR over a 12-week period. Trained research assistants subsequently queried physicians about information from the paramedic report in a separate interview. Physician recall was quantified. Midway through the study, a web-based, educational intervention designed to enhance paramedic communication skills was administered to the three participating emergency medical services (EMS) systems. Physician recall of more severely injured trauma cases (red triage) was compared with their recall of less severely injured cases (yellow triage). Further comparisons were made between pre- and post-intervention physician recalls, and the extent to which physicians recalled three distinct categories of paramedic verbal information was measured. RESULTS: Overall, physicians accurately recalled 36% of the paramedic verbal report. Information from less severe "yellow" trauma reports was recalled more accurately than that from more severe "red" traumas (40% vs. 34% p = 0.02). Pre- and post-intervention recalls were not significantly different (33% vs. 38% p = 0.16). Physicians' recall of information about the crash scene (46%) was significantly greater than their recall of information about the patient's health status (34%) or information about prehospital patient care (30%) (p = 0.0012). CONCLUSION: Physicians appear to recall paramedic verbal reports about trauma patients poorly. Recall is probably multifactorial and will require further work to design appropriate interventions.

Emergency Medical Technicians↗
PubMed2005

Quality of communication between dental practitioners and dental technicians for fixed prosthodontics in Ireland.

The aim of this investigation was to examine the quality of communication between dental practitioners and dental technicians for fixed prosthodontics in Ireland. A pre-piloted questionnaire was distributed to large commercial laboratories in Ireland. Information was sought relating to the quality of written instructions and use of impression trays and materials for two forms of fixed prosthodontics--full veneer porcelain-fused-to-metal crowns (PFMs), and conventional fixed partial dentures (FPDs). Information was received relating to 241 items (145 PFMs, 96 FPDs). All items were funded privately. Using pre-determined grading criteria, poor or no written instructions were provided in 55% of cases examined (n=128). Fifty-four per cent of master impressions were (n=129) made using a plastic stock tray. Three-quarters of written instructions for FPDs (n=73) did not specify the number of pontics to be included in its design. Despite the existence of various legal and ethical guidelines relating to the prescription and fabrication of fixed prostheses, more than one-half of the written instructions and master impressions examined in this study were inadequate.

Crowns↗
PubMedDate not supplied

Communication between psychosomatic C-L consultants and general practitioners in a German health care system.

A randomized and prospective study examined the effects of intensive communication between treatment providers on physician behavior and patient care using a representative sample of patients referred to a German psychosomatic consultation-liaison (C-L) service (1998-1999). Sixty-seven patients were grouped (ICD-10) and randomized into intervention (n=33) and control groups (n=34). In the control group (CG), only the inpatient referring physicians were informed of consultation findings, as is standard practice in Germany. In the IG, the consultant directly reported the consultation findings to the general practitioner (GP). Patients were examined at 6-month (T2) and 3.5-year (T3) follow-up. Physician feedback and requests regarding the nature of communication were also assessed at T2. A significant reduction in symptoms was revealed at both follow-ups for the IG and CG. No significant group differences were found for acceptance of psychotherapy (59.1% IG and 42.3% CG at T3). The utilization of medical services remained stable across time. Patients who began psychotherapy were shown to have greater baseline symptom levels and "openness for new experiences" (NEO Five-Factor Inventory, NEO-FFi). Regular GP integration of psychosocial aspects into primary care differed between IG (44.0%) and CG (25.0%). Ninety-one percent of the GPs requested the option for a telephone conversation with the consultant or a case conference involving the patient at either their practice (37.7%) or the clinic (24.5%). We conclude that GPs are interested in a differentiated and more intensive cooperation concerning the integration of psychosocial aspects in their outpatient treatment. The patient's acceptance to follow a recommendation for psychotherapy, however, is related to the level of symptom severity and openness for new experiences.

Adult↗
PubMed2005

Interprofessional education in undergraduate healthcare programmes: the reaction of student dietitians.

BACKGROUND: Interprofessional education (IPE) is a novel teaching and learning initiative where students of more than one health profession learn interactively together. However, despite its potential for improving interprofessional relationships, there is little information regarding the participation of student dietitians in IPE. The aim of this paper was to consider the reaction of student dietitians to an IPE course in order to stimulate debate between dietitians regarding the issues relating to IPE. METHODS: Student dietitians participated in an IPE course consisting of seven sessions on communication and ethics in health care together with students of medicine and nursing. Student dietitians completed an evaluation questionnaire following each session that surveyed their reaction to the session using both a Likert scale and free-text comments. RESULTS: Twenty-six student dietitians completed the IPE course. All sessions were rated positively for interest value (P < or = 0.14), learning experience (P < or = 0.036) and value for clinical practice (P < or = 0.05). The limited number of free-text comments indicated some positive experiences regarding interprofessional learning, teaching content and teaching strategy. CONCLUSIONS: This is one of very few evaluations to describe the reaction of student dietitians to IPE. Student dietitians had largely positive reactions to the IPE course. Further research is required to evaluate whether these positive reactions were a direct consequence of the inclusion of students from other health professions and whether these translate into positive effects on learning, behaviour and results. The opportunities for the dietetic profession posed by students' involvement in IPE are discussed.

Adult↗
PubMed2005

A unified web-based query and notification system (QNS) for subject management, adverse events, regulatory, and IRB components of clinical trials.

Even after intensive review, interpretative questions, ambiguities, contradictions, or errors, will arise once the protocol is scrutinized by site IRBs and implemented at sites. This will occur despite preparation and implementation of site protocol training, and provision of well crafted case report forms for the reporting of clinical and laboratory evaluations and adverse events. Since many staff are involved in each protocol, site investigators or study coordinators might direct protocol queries, participant management, or IRB queries to different network participants, resulting in inconsistent responses. It is important to establish a response mechanism that ensures consistent responses and their systematic documentation. For reporting of adverse events, and the submission of or documentation of completion of regulatory requirements, an easily accessible and structured communications system is also required. This paper describes the development and implementation of a user-friendly web-based query and notification system (QNS) for subject management, adverse events, regulatory, and IRB components. This system was created in the Adolescent Trials Network for HIV/AIDS Interventions (ATN), using existing web based tools with minor modifications and minimal cost. The query and notification system is interactive and allows for free flow of information among the site coordinators and both the protocol teams and the regulatory group. The process of the system is transparent to users at the sites, although its use and maintenance is controlled by Data Operations Center staff, to assure that ATN requirements for review and approval are met. This results in consistency of and timeliness of responses to queries, timeliness and accuracy of adverse event reporting and the ability for the data operations center regulatory staff to provide notification of pending or delinquent regulatory submissions.

Adolescent↗
PubMed2004

Specialist drug misuse nurse's motivation, clinical decision-making and professional communication: an exploratory study.

UK guidelines advocate a multidisciplinary shared care approach to manage drug-related problems. While general practitioners (GPs), consultants and pharmacists have been researched, there has been little research into the role of nurses in this field. This study examined nurses specialized in the field of substance misuse. It specifically explored their motivation for entering this area, interaction with other health professionals and their role in clinical decision-making. Seventeen face-to-face interviews were undertaken with nurses from the study population of the 21 nursing staff currently employed in one service. Responses were tape-recorded, transcribed and analysed using qualitative methods. The majority of nurses entered this field because of a specific interest in its patients and their problems. Various professionals interacted with nurses: specialist medical staff, who served as an expert resource and pharmacists through the dispensing of substitute drugs. GP participation in services was inconsistent forcing some nurses to take undue responsibility for clinical decision-making. It is essential that nurses entering this field have an interest in this field and positive attitudes towards drug users, and greater emphasis should be placed on this attribute when selecting new employees. If a shared care model is to be successful, it is important that all GPs accept their responsibilities and relieve pressure currently placed on specialist services. Alternatively, it may be necessary to adopt a new model of care.

Decision Making↗
PubMed2003

Initial experiences of interprofessional problem-based learning: a comparison of male and female students' views.

Few studies have considered the contribution of problem-based learning (PBL) to interprofessional education, and even fewer have examined whether women and men evaluate PBL differently. This paper examines first year occupational therapy and physiotherapy students' evaluations of their initial participation in PBL, during an interprofessional module focusing on communication skills and patient-focused approaches to care. Questionnaire data included attitude ratings and qualitative evaluations of PBL. A total of 133 females and 24 males responded (comprising 83% of the total cohort). Most students were positive that PBL contributed to both personal learning and team-working skills. Both female and male students felt able to express their opinions within the seminar groups and were positive that their understanding of therapists' roles within the multidisciplinary team had increased. However, women expressed rather more trust in the information provided by other students, confirmed greater enjoyment in taking responsibility for their own learning and had more positive views about working with students from another course. In their qualitative comments, more women made reference to enjoying the social aspects of PBL (such as group work, support and collaboration). The gender differences were not substantial but those that were observed support previous researchers' arguments that women are more inclined to be 'connected learners' who value the social aspects of learning contexts. The findings overall suggested that PBL made a positive, well-received contribution to learning during an interprofessional module.

Adolescent↗
PubMed2004

Improving team structure and communication: a key to hospital efficiency.

HYPOTHESIS: Improving team structure and heightening communication will help provide cost-effective and high-quality patient care for general surgery patients. DESIGN: This study surveys teamwork initiatives and their effects on specific variables related to patient care. PATIENTS: The study population comprised all patients admitted to the hospital's general surgery teams during 5 years 3 months. SETTING: Tertiary care hospital. INTERVENTIONS: A complete restructuring of the patient care team for general surgery patients admitted to the hospital. The intervention occurred midway through the study period. MAIN OUTCOME MEASURES: Mean length of stay for general surgery patients as a marker of team efficiency and a standardized patient satisfaction survey. RESULTS: The mean length of stay after initiation of the restructured care team was significantly shorter than before initiation. The significance was present despite a consistent patient acuity measure and was associated with a high patient satisfaction level. CONCLUSIONS: Restructuring the patient care team yielded a decreased mean length of stay while maintaining a high level of patient satisfaction. This analysis helps validate a hospital-wide initiative to maintain a high level of patient care while increasing patient volume.

Cost-Benefit Analysis↗
PubMed2003

Randomised controlled trial of a shared care programme for newly referred cancer patients: bridging the gap between general practice and hospital.

OBJECTIVE: To determine the effect of a shared care programme on the attitudes of newly referred cancer patients towards the healthcare system and their health related quality of life and performance status, and to assess patients' reports on contacts with their general practitioner (GP). SETTING: Department of Oncology at Aarhus University Hospital and general practices. DESIGN: Randomised controlled trial in which patients completed questionnaires at three time points. The shared care programme included transfer of knowledge from the oncologist to the GP, improved communication between the parties, and active patient involvement. PARTICIPANTS: 248 consecutive cancer patients recently referred to the department. MAIN OUTCOME MEASURES: Patients' attitudes towards the healthcare services, their health related quality of life, performance status, and reports on contacts with their GPs. RESULTS: The shared care programme had a positive effect on patient evaluation of cooperation between the primary and secondary healthcare sectors. The effect was particularly significant in men and in younger patients (18-49 years) who felt they received more care from the GP and were left less in limbo. Young patients in the intervention group rated the GP's knowledge of disease and treatment significantly higher than young patients in the control group. The number of contacts with the GP was significantly higher in the intervention group. The EORTC quality of life questionnaire and performance status showed no significant differences between the two groups. CONCLUSIONS: An intersectoral shared care programme in which GPs and patients are actively involved has a positive influence on patients' attitudes towards the healthcare system. Young patients and men particularly benefit from the programme.

Adolescent↗
PubMed2006

Governing the surgical count through communication interactions: implications for patient safety.

BACKGROUND: Intermittently, the incidence of retained surgical items after surgery is reported in the healthcare literature, usually in the form of case studies. It is commonly recognised that poor communication practices influence surgical outcomes. AIM: To explore the power relationships in the communication between nurses and surgeons that affect the conduct of the surgical count. METHODS: A qualitative, ethnographic study was undertaken. Data were collected in three operating room departments in metropolitan Melbourne, Australia. 11 operating room nurses who worked as anaesthetic, instrument and circulating nurses were individually observed during their interactions with surgeons, anaesthetists, other nurses and patients. Data were generated through 230 h of participant observation, 11 individual and 4 group interviews, and the keeping of a diary by the first author. A deconstructive analysis was undertaken. RESULTS: Results are discussed in terms of the discursive practices in which clinicians engaged to govern and control the surgical count. The three major issues presented in this paper are judging, coping with normalisation and establishing priorities. CONCLUSIONS: The findings highlight the power relationships between members of the surgical team and the complexity of striking a balance between organisational policy and professional judgement. Increasing professional accountability may help to deal with the issues of normalisation, whereas greater attention needs to be paid to issues of time management. More sophisticated technological solutions need to be considered to support manual counting techniques.

Adult↗
PubMed2004

[Information for the patient in hospitals: the implicit shared role among professionals].

OBJECTIVE: Perceived practices declared by physicians were assessed in order to determine the role of the different professionals in patient medical information, the communication methods and traceability practices used in patient files. Method Data were collected using an anonymous questionnaire sent by mail in April 2003 to the 794 physicians of the University Hospital of Nantes (France). RESULTS: The participation rate was of 38% (302 responses) and differed according to the medical categories: university professors (44%), young seniors (50%), hospital practitioners (43%) and practitioners under contract (21%). In outpatient departments, patient information was rarely shared between professionals: the senior practitioner only informed the patient in 80% of cases. In the case of hospitalisation, patient information concerned various health professionals: in general, senior practitioners, junior practitioners (50% of cases) and nursing staff (20 to 45%). Information for the patient was always oral, accompanied in 1/3 of cases by one or more documents. The traceability of the elements of information supplied to the patient was inadequate. CONCLUSION: This survey underlined the interest of the medical corps regarding information for the patient, and the important role played by junior practitioners and paramedical staff. Because they are all obviously implied in information supplied to the patient, quality improvement projects should target all the health professionals.

Adult↗
PubMedDate not supplied

Relationship-centered administration: transferring effective communication skills from the exam room to the conference room.

Medical researchers have shown that relationship-centered healthcare increases patient satisfaction and improves health outcomes. The components of relationship-centered healthcare--listening, sharing decision making, and respecting others--improve patient motivation and commitment to a plan of action. Currently, no data are available on the extent to which medical administrative settings adhere to relationship-centered principles. To begin to answer this question, we observed a convenience sample of 45 meetings in healthcare settings to assess the frequency and types of relationship-centered behaviors shown by group leaders. Our results provide preliminary data that leaders, especially female leaders, praised the value of group member efforts and encouraged members to provide input. Less frequently employed relationship-centered behaviors included providing a verbal summary of a discussion, responding to feelings expressed by members, and setting explicit agendas. Finally, we found some provocative associations. Female leaders received higher satisfaction ratings, and male leaders were more verbally dominant. Similar to physician-patient interaction, new topics for discussion are less likely to arise spontaneously late in a meeting if early agenda setting is utilized. To our knowledge, this is the first such study in a medical setting. Our findings encourage those who chair meetings to reflect on the extent to which they use a collaborative approach and offer specific content areas on which to focus. Further research on the concept and outcomes of relationship-centered administrative approach is warranted.

Colorado↗
PubMed2005

What do other local providers think of NHS walk-in centres? Results of a postal survey.

OBJECTIVES: To ascertain the views of other providers of primary and emergency healthcare services about their local walk-in centre. DESIGN: Postal survey. SETTING AND PARTICIPANTS: National Health Service healthcare providers (general practitioners (GPs), practice nurses, pharmacists, Accident and Emergency (A and E) consultants) working in close proximity to 20 English walk-in centres. RESULTS: The overall response rate to the survey was 79% (n = 1591). Nearly one-third of respondents felt that patient expectations had increased since their local walk-in centre opened, although this varied across the different sites. Some providers had noticed a reduction in their workload, but 15% claimed that workloads had increased since their local walk-in centre opened. There was broad agreement that these new centres did address issues of access and that they provided appropriate care of a reasonable quality. Communication between walk-in centres and other local healthcare providers was an area of considerable concern; GPs, in particular, were anxious about the impact of the service on continuity of care. There were clear differences of opinion between different types of health professional, with doctors tending to be more critical and practice nurses being more supportive. CONCLUSION: It has been suggested that healthcare professionals, notably GPs, are universally opposed to the concept of walk-in centres. This survey shows that opinions were divided, but overall, more local providers were in favour of this new service than were opposed to it. There was more support for centres co-located with A and E departments than "shop-front"-type facilities, but there were concerns that the service offered was too limited. The success or otherwise of the walk-in centre initiative will depend, in part, on building good relationships between the centres and other local providers. Understanding the views of local providers is important for those developing walk-in centres, and for those engaged in planning services in the wider health economies where these services are placed.

Ambulatory Care Facilities↗
PubMed2006

A taxonomy for disease management: a scientific statement from the American Heart Association Disease Management Taxonomy Writing Group.

BACKGROUND: Disease management has shown great promise as a means of reorganizing chronic care and optimizing patient outcomes. Nevertheless, disease management programs are widely heterogeneous and lack a shared definition of disease management, which limits our ability to compare and evaluate different programs. To address this problem, the American Heart Association's Disease Management Taxonomy Writing Group developed a system of classification that can be used both to categorize and compare disease management programs and to inform efforts to identify specific factors associated with effectiveness. METHODS: The AHA Writing Group began with a conceptual model of disease management and its components and subsequently validated this model over a wide range of disease management programs. A systematic MEDLINE search was performed on the terms heart failure, diabetes, and depression, together with disease management, case management, and care management. The search encompassed articles published in English between 1987 and 2005. We then selected studies that incorporated (1) interventions designed to improve outcomes and/or reduce medical resource utilization in patients with heart failure, diabetes, or depression and (2) clearly defined protocols with at least 2 prespecified components traditionally associated with disease management. We analyzed the study protocols and used qualitative research methods to develop a disease management taxonomy with our conceptual model as the organizing framework. RESULTS: The final taxonomy includes the following 8 domains: (1) Patient population is characterized by risk status, demographic profile, and level of comorbidity. (2) Intervention recipient describes the primary targets of disease management intervention and includes patients and caregivers, physicians and allied healthcare providers, and healthcare delivery systems. (3) Intervention content delineates individual components, such as patient education, medication management, peer support, or some form of postacute care, that are included in disease management. (4) Delivery personnel describes the network of healthcare providers involved in the delivery of disease management interventions, including nurses, case managers, physicians, pharmacists, case workers, dietitians, physical therapists, psychologists, and information systems specialists. (5) Method of communication identifies a broad range of disease management delivery systems that may include in-person visitation, audiovisual information packets, and some form of electronic or telecommunication technology. (6) Intensity and complexity distinguish between the frequency and duration of exposure, as well as the mix of program components, with respect to the target for disease management. (7) Environment defines the context in which disease management interventions are typically delivered and includes inpatient or hospital-affiliated outpatient programs, community or home-based programs, or some combination of these factors. (8) Clinical outcomes include traditional, frequently assessed primary and secondary outcomes, as well as patient-centered measures, such as adherence to medication, self-management, and caregiver burden. CONCLUSIONS: This statement presents a taxonomy for disease management that describes critical program attributes and allows for comparisons across interventions. Routine application of the taxonomy may facilitate better comparisons of structure, process, and outcome measures across a range of disease management programs and should promote uniformity in the design and conduct of studies that seek to validate disease management strategies.

Cardiology↗
PubMed2005

"Bridging the gap." Should the training of dental technicians be linked with that of the dental undergraduate?

OBJECTIVES: Improving communication and collaboration between members of the dental team is important to the long term aim of improving the quality of dental care for patients. For example, closer integration between trainee dental technicians and undergraduate dental students during their courses of training should both help to develop their own skills and foster an improved level of communication and understanding between these members of the dental team. The purpose of this study was to ascertain the number of dental teaching hospitals in Great Britain and Ireland currently involved with the training of dental technicians, and to find out how many of these bring trainee technician and undergraduate dental students together at some time during training as a matter of policy. METHODS: Action research was carried out in the form of a linking exercise in the Newcastle upon Tyne Dental Hospital. This involved second year trainee dental technicians and third year undergraduate dental students working together to provide complete dentures for a patient within the formal undergraduate course in complete denture construction. The trainee technicians also attended a series of lectures relevant to this course alongside undergraduate dental students. RESULTS: The main findings revealed that although a number of dental teaching hospitals were involved with the training of dental technicians and had encouraged links between undergraduate dental students and trainee technicians, few had formalised these links in any way. CONCLUSION: The outcomes of the linking exercise were evaluated by means of focus groups, observations and semi-structured interviews. Results indicated that both the trainee dental technician and the undergraduate dental student benefited to some extent from closer collaboration during training.

Dental Technicians↗