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PubMedDate not supplied

Community-based senior health promotion program using a collaborative practice model: the Escalante Health Partnerships.

Recent research demonstrates that, although the risk of disease and disability clearly increases with age, poor health need not be an inevitable consequence of aging. A healthy lifestyle is more influential than genetic factors in assisting older adults avoid the decline and deterioration traditionally associated with aging. Many effective strategies for reducing disease and disability are widely underused. The Escalante Health Partnerships is a community-based, nurse-managed health promotion and chronic disease care management program for community-residing older adults. The program base supports a multidisciplinary, collaborative practice model, which has responded to the health needs of members of a community at high risk of having or developing chronic conditions. Preliminary comparisons of the health status of program participants with national norms demonstrate that these seniors report better general health, performance of roles, and social functioning, with the strongest correlations occurring between general health and vitality and between general health and role-physical. In addition, these participants have 4.2 doctor visits per year, in comparison with 7.1 office visits for a national comparison group and 1.6 hospital days per year, in comparison with 2.1 hospital days in the same referenced population. This collaborative partnership is a model that can be replicated cost-effectively in other communities.

Aged↗
PubMed1997

Changing preventive practice: a controlled trial on the effects of outreach visits to organise prevention of cardiovascular disease.

OBJECTIVES: To assess the effects of outreach visits by trained nurse facilitators on the organisation of services used to prevent cardiovascular disease. To identify the characteristics of general practices that determined success. DESIGN: A non-randomised controlled trial of two methods of implementing guidelines to organise prevention of cardiovascular disease: an innovative outreach visit method compared with a feedback method. The results in both groups were compared with data from a control group. SETTING AND SUBJECTS: 95 general practices in two regions in The Netherlands. INTERVENTIONS: Trained nurse facilitators visited practices, focusing on solving problems in the organisation of prevention. They applied a four step model in each practice. The number of visits depended on the needs of the practice team. The feedback method consisted of the provision of a feedback report with advice specific to each practice and standardised instructions. MAIN OUTCOME MEASURES: The proportion of practices adhering to 10 different guidelines. Guidelines were on the detection of patients at risk, their follow up, the registration of preventive activities, and teamwork within the practice. RESULTS: Outreach visits were more effective than feedback in implementing guidelines to organise prevention. Within the group with outreach visits, the increase in the number of practices adhering to the guidelines was significant for six out of 10 guidelines. Within the feedback group, a comparison of data before and after intervention showed no significant differences. Partnerships and practices with a computer changed more. CONCLUSION: Outreach visits by trained nurse facilitators proved to be effective in implementing guidelines within general practices, probably because their help was practical and designed for the individual practice, guided by the wishes and capabilities of the practice team.

Cardiovascular Diseases↗
PubMed1988

Dissatisfaction in general practice: what do patients really want?

In 31 general practices in Adelaide, approximately 100 consecutive adult patients aged 15-64 years completed a 21-item questionnaire that related to their dissatisfaction with aspects of the care that was provided in the practice. Fourteen of the practices were "solo" practices, five practices were two-person partnerships and 12 practices involved three or more partners. The 21 items divided naturally into five groups: "architecture", "receptionists", "accessibility", "quality" and "communication". Factor analysis of the responses provided support for the idea that "receptionists", "accessibility" and "communication" were independent issues for the respondents and that "quality" was less discrete and was embedded in a factor which we have labelled "mechanics". For nearly all items, the mean dissatisfaction values for the practices were greatest in the larger practices and least in the two-person practices, with solo practices occupying an intermediate position. The main dissatisfaction related to accessibility and communication. These issues are explored in the light of current trends in the organization of primary medical care.

Adolescent↗
PubMed2001

Cross-infection control in dental practice in the Republic of Ireland.

OBJECTIVE: The purpose of this study was to examine the infection control procedures used in general dental practices in the Republic of Ireland. DESIGN: Postal survey. SETTING: The Republic of Ireland. PARTICIPANTS: 250 general dental practices. METHODS: Postal questionnaire. MAIN OUTCOME MEASURES: Use of infection control procedures; gloves, masks, sterilisation of instruments, staff training. RESULTS: A 74% response rate (n = 177), with 162 wearing gloves for all patients, 97% of whom used latex gloves. Routine glove use by 69% of dental nurses. Approximately one third of respondents complained of hand skin irritation attributed to the wearing of latex gloves. Routine mask wearing during treatment was reported by 68% of respondents. The method of choice for sterilising instruments was the steam autoclave for 97%. Time spent on surgery cleaning between patients was less than one minute in 12 per cent of practices. CONCLUSIONS: Cross-infection control procedures practiced by a high proportion of the respondents to the survey conform to guidelines suggested by various authorities. Further education may be appropriate in a number of areas such as mask wearing and the need to change gloves between patients.

Cross Infection↗
PubMed2002

Evaluating the design of a family practice healthcare clinic using discrete-event simulation.

With increased pressures from governmental and insurance agencies, today's physician devotes less time to patient care and more time to administration. To assist physician clinics in evaluating potential operating procedures that improve operating efficiencies and better satisfy patients, an object-oriented discrete-event simulation model has been constructed using the Visual Simulation Environment (VSE). The research presented herein describes a methodology for determining appropriate staffing and physical resources in a clinical environment using this simulation model. This methodology takes advantage of several simulation-based statistical techniques, including batch means: fractional factorial design: and simultaneous ranking, selection, and multiple comparisons. A clinic effectiveness measure is introduced that captures several objectives within a health care clinic, including profitability and patient satisfaction. An explanation of the experimental design is provided and results of the experimentation are presented. Based upon the experimental results, conclusions are drawn and recommendations are made for an appropriate staffing and facility size for a two physician family practice healthcare clinic.

Ambulatory Care Facilities↗
PubMed1978

Some variables affecting dentists' desire to use expanded duty dental auxiliaries.

A survey of all active practitioners in Rhode Island was conducted to determine which demographic or practice variables or knowledge or attitude variables, or both, might be associated with a desire to use EDDAs. A total of 355 (74.6%) dentists responded to the questionnaire. Of these, 33.4% indicated a desire to use EDDAs, 36.1% were undecided, and another 30.5% did not wish to use EDDAs. A desire to use EDDAs was associated with the following variables: demographic background, continuing education profile, indicators of how busy the practice is, number of hours auxiliaries were employed, practice efficiency indicators, and knowledge and attitude indicators.

Appointments and Schedules↗
PubMed2001

When is the best time to hire an associate?

Hiring an associate is a natural step in the growth of a dental practice. However, it is a choice not to be made lightly or based on vague perceptions and expectations. A dentist wishing to bring another dentist into the practice needs to consider concerns such as the business of the operative schedule, personal and professional wishes in regard to sharing the workload, and how future practice growth or retirement will impact the choice of an assistant.

Appointments and Schedules↗
PubMed1983

Goodwill--fact or fiction.

The validity of goodwill payments when partners enter or leave practice is doubtful. The present situation in veterinary private practice in the Republic is described and compared with other professions. This profession is urged to review its attitude.

Partnership Practice↗
PubMed1994

Associateships: a business wedding.

The high price of being competitive may make associateships an attractive option to solo practice. Advantages of hiring an associate, factors to consider in interviewing and determining compensation are discussed.

Female↗
PubMed1992

The next step.

Following on from three articles published in the BDJ earlier last year, Leonard D'Cruz has made the transition from vocational trainee to associate. He has chosen to remain in the same practice, and here discusses his reasons for doing so, whilst also indicating how his life metamorphosed.

Career Choice↗
PubMed2006

Pharmacological management of akathisia in combination with psychological interventions by a mental health nurse consultant.

The article describes the management of akathisia by a mental health nurse (MHN) prescriber, working in partnership with the patient. A single-case design was used to evaluate this. It highlights three features: first, MHN can safely prescribe psychiatric medication in combination with concordance therapy. Second, the value base underpinning prescribing practice is partnership, honesty and choice for the patient. Finally, the pharmacological mechanism of antipsychotic medication, which contributes towards akathisia, requires further analysis.

Akathisia, Drug-Induced↗