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PubMedDate not supplied

The limited use of digital ink in the private-sector primary care physician's office.

Two of the greatest obstacles to the implementation of the standardized electronic medical record are physician and staff acceptance and the development of a complete standardized medical vocabulary. Physicians have found the familiar desktop computer environment cumbersome in the examination room and the coding and hierarchic structure of existing vocabulary inadequate. The author recommends the use of digital ink, the graphic form of the pen computer, in telephone messaging and as a supplement in the examination room encounter note. A key concept in this paper is that the development of a standard electronic medical record cannot occur without the thorough evaluation of the office environment and physicians' concerns. This approach reveals a role for digital ink in telephone messaging and as a supplement to the encounter note. It is hoped that the utilization of digital ink will foster greater physician participation in the development of the electronic medical record.

Attitude of Health Personnel↗
PubMed2000

Clinician satisfaction with a preventive services implementation trial. The IMPROVE project.

OBJECT: To discover how attempts to increase the delivery of preventive services affect clinician satisfaction. METHODS: The IMPROVE project was a randomized clinical trial conducted in 44 clinics in and around Minneapolis-St. Paul, Minnesota. Personnel were trained in continuous quality improvement techniques to organize preventive services delivery systems. Satisfaction with delivery of these services and with the sponsoring organizations was measured before the intervention (Time 1), at the end of the intervention (Time 2), and 1 year post-intervention (Time 3). RESULTS: At no time was the intervention associated with a change in the respondents satisfaction with their places of work or with their job roles. Satisfaction with preventive services delivery increased from Time 1 to Time 3 among intervention-clinic respondents. Satisfaction with the IMPROVE project and the efforts of the two managed care organizations to help the clinics deliver preventive services peaked at Time 2 and declined toward baseline at Time 3. Satisfaction with preventive services delivery tended to increase more in the 13 intervention clinics that implemented a preventive services delivery system than in the nine intervention clinics that did not implement a preventive services delivery system (p = 0.15). CONCLUSIONS: Planned organizational change to create systems for preventive services delivery can be associated with increased clinician satisfaction with the way these services are delivered. However, increased satisfaction with preventive services does not necessarily indicate that service delivery rates have increased.

Adult↗
PubMed2004

Implementing integrated treatment for co-existing substance use and severe mental health problems in assertive outreach teams: training issues.

This study sought to evaluate systematically training and implementation of a specific integrated treatment approach for co-occurring problem substance use and mental health within existing assertive outreach (AO) teams. The AO team was treated as a whole unit rather than as individual clinicians. They were provided with training and supervision to deliver a cognitive--behavioural integrated treatment approach. In a quasi-experimental time-lag design three teams were trained immediately and two others after an 18-month delay. There was evidence that teams acquired confidence and skills relevant to working with combined problems and that these gains were maintained over time. These results were replicated in the two teams trained after the delay. This study suggests that training mental health staff to use an integrated treatment approach is well received and produces lasting changes in confidence and skills. However, there are a number of issues related to staff training, shifting attitudes and implementation of integrated approaches into routine mental health practice. These issues are considered and suggestions made for staff training.

Attitude of Health Personnel↗
PubMed2003

Implementation of proficiency testing in conjunction with a rechecking system for external quality assurance in tuberculosis laboratories in Mexico.

SETTING: In developing countries, tuberculosis is diagnosed by identification of acid-fast bacilli (AFB) on sputum smears. OBJECTIVE: To evaluate the quality of AFB microscopy, the Mexican Secretary of Health National Reference Laboratory implemented proficiency testing for its network of 637 laboratories. DESIGN: A total of 586 (92%) laboratories were inspected and 430 technicians evaluated by proficiency testing consisting of 10 slides with known numbers of AFB. Results were compared with those of slide rechecking and with proficiency testing performed 2 years later. RESULTS: Of the 430 technicians evaluated by proficiency testing in 1998, 196 (46%) scored less than 80% and received intensive training in 1999. From a previous mean score of 65% their results increased to 90% (P < 0.0001). In 2001, they again underwent proficiency testing, and the mean score was 83%. The main factors affecting proficiency testing results were the type of laboratory in which the microscopists worked and the number of low-positive slides (1-9/100) in the test. Laboratories whose work was rechecked had better scores (P = 0.002). Proficiency testing scores and the estimated sensitivity of the microscopist's laboratory were associated (P = 0.01). CONCLUSION: External quality assessment and training improve diagnostic performance. Rechecking and proficiency testing are both viable measures of laboratory performance.

Clinical Competence↗
PubMed2005

An in-house course for first assistants (advanced scrub practitioners) in theatres.

It has become commonplace to see theatre practitioners undertaking the role of the first assistant to the surgeon in the absence of medical staff in the operating room (Martin 2004). At Kettering General Hospital we have devised, implemented and are in the process of evaluating a first assistant training package to facilitate a solution to the increasing problems arising from the challenges of the European Working Time Directive.

Health Plan Implementation↗
PubMed2002

Implementation and evaluation of guidelines for preoperative testing in a tertiary hospital.

The aim of this study was to determine the extent of unnecessary investigation performed as part of the preoperative preparation of elective surgical patients in a teaching hospital and to audit the effect of guidelines and education designed to reduce unnecessary investigation. Guidelines were developed for preoperative anaesthetic investigation for elective surgical procedures in patients over one year of age according to internationally accepted criteria, with some adjustment for local differences in patient morbidity. Forrms outlining these criteria were placed in all operating theatres and anaesthetists were asked to determine whether tests performed were indicated or not, according to these criteria, over a two-week period, in each patient undergoing elective surgery. Tests indicated for surgical reasons were excluded. These same guidelines were then issued to all surgical departments along with explanatory lectures. The audit was repeated six months later and results compared. The incidence of over-investigation decreased from 13.8% to 11.6% (P = 0.03) without a significant increase in under-investigation (0.7 v 1.0%; P = 0.2). This study highlights the incidence of unwarranted screening tests in patients presenting for elective surgery and the role of protocols and ongoing education in reducing this incidence.

Anesthesia↗
PubMed1995

Implementation of quality assurance and medical audit: general practitioners' perceived obstacles and requirements.

BACKGROUND: The introduction of quality assurance and medical audit has been an important development in general practice. However, the introduction of such programmes does not necessarily mean they are implemented by general practitioners. AIM: A study was undertaken to describe the problems and requirements perceived by general practitioners in relation to the implementation of quality assurance and medical audit in general practice. METHOD: Interviews were carried out with a stratified sample of 120 Dutch general practitioners. Knowledge, acceptance and application of quality assurance and medical audit activities were investigated, and perceived problems and requirements in implementing quality assurance and audit activities were explored. RESULTS: General practitioners in the Netherlands were generally positive towards quality assurance activities, but had little experience of carrying out such activities. The most frequently mentioned obstacles to implementing quality assurance activities concerned lack of time, colleagues' negative attitudes and fear of assessment and criticism by colleagues. Requirements for implementing quality assurance included having regular meetings with colleagues about quality assurance, having information on the aims and methods of quality assurance, having data from other practices with which to compare performance, having support in data collection, in audit in the practice and in setting up local peer review, and having financial support. The most important factor predicting the actual application of quality assurance activities was found to be knowledge of specific quality assurance activities. CONCLUSION: Well-designed programmes for the implementation of quality assurance and medical audit, using a variety of different interventions, have to be developed. Such programmes should include the training of professionals in the concepts and methods of quality assurance as well as the provision of financial support for quality assurance activities.

Family Practice↗
PubMed2002

[New avenues to quality assurance--a model project for recording bedsore incidence].

Bedsores can usually be avoided by adequate care and preventive measures. In the context of the local agenda process a local district office (Landratsamt) and inspection units initiated a variety of activities to promote sensitisation in health institutions and contribute to an increase in life quality of the persons concerned. Nearly all nursing care homes, domiciliary services and hospitals participated in a pilot study which was accompanied by the Fraunhofer IAO in Stuttgart. Objectives of the pilot study were to implement internal quality assurance to sensitise for persons the topic and to collect comparable data to achieve benchmarking. Software-tool institutions recorded data on care days, days spent with bedsores according to care level from July till September 01. Major result was that - although institutions had already a decreasing incidence in bedsores since the start of discussing the project - bedsore quotas could be further decreased from 2.15 to 1.84 %.

Aged↗
PubMed2004

Psychiatric occupational therapy service--quality assurance.

During the last few decades, quality assurance has been a central issue in the societies, both in, for example the industrial area and in healthcare. It is a tool to measure the outcomes of product or service provided. A review of the literature during the last 17 years with respect to quality assurance work in psychiatric occupational therapy indicates that few articles have been published in the area and that their scientific quality is questionable. The studies show many methodological shortcomings, which result in difficulty drawing any conclusion from the studies. The number of publications is also decreasing. Furthermore, a survey to investigate quality assurance work in psychiatric occupational therapy service shows that the occupational therapists do not work with quality assurance methods to a great extent. The methods they use most are interviews with patients and patient questionnaire. Both these methods require documentation in order to offer the patient a suitable service. Quality assurance work will be difficult to implement if no documentation is available. Documentation is central to communicating with other professions and with the client. This study points out that occupational therapists need to improve practice as well as research concerning quality assurance in order to ensure that they offer the patient a high-quality service.

Documentation↗
PubMedDate not supplied

Difficulties in clinical supervision and lifelong learning.

Reflective and lifelong learning are integral components of professional practice. They have been introduced successfully in nursing as part of academic study programmes, but nurses have been less keen to embrace the facilitated reflection on practice known as clinical supervision, despite professional requirements to do so. This article explores the context in which clinical supervision resides, and the parallels of policy issues with post-compulsory education and training. The focus is on lifelong learning. The aim is to identify an implementation strategy by exploring the difficulties in implementing clinical supervision and lifelong learning through critical analysis. The objective is to determine how to remove these barriers. Derivative themes underpin recommendations for practice in the conclusion. The themes are: Careful planning of objectives and goals. Working more creatively through the use of technology. Using existing forums. Networking with other disciplines.

Health Plan Implementation↗
PubMed2004

Factors in care management affecting client outcomes in home care.

The purpose of the present study was to identify which factors in care management affect client outcomes. We performed path analysis using care management processes as independent variables, and client outcomes measures as dependent variables. Client outcomes were measured by improvement in care items and Functional Independence Measure (FIM) scores in 170 clients, and client satisfaction in 97 clients. Improvement in care items was significantly related to the amount of service. Deterioration of the functional independence level was significantly related to the amount of service and lower implementation of monitoring. Higher implementation of evaluation raised client satisfaction. It is important for care managers to develop a care plan based on the necessary amount of service and to perform monitoring. A sufficient amount of service in the care plan and higher implementation of monitoring and evaluation are the three factors in care management affecting client outcomes.

Activities of Daily Living↗
PubMed1998

Developing an integrated information system for specialized addiction treatment agencies.

This article outlines the development of an integrated information system for specialized alcohol and drug treatment agencies in Ontario, Canada. The system is being developed following a strategic planning process involving provincial funding ministries and coalitions of service providers. An overview of the system's development is provided and the implementation of one subcomponent, a client-tracking system, is described. Some challenges to the implementation of this component are identified.

Alcoholism↗
PubMed1997

Tried, true, and new: public health nursing in a county substance abuse treatment system.

The Milwaukee Target Cities (MTC) project was the only site within 19 federally funded Target Cities programs to feature a public health nursing model as its sole means of providing comprehensive health-related services to indigent substance abuse clients. We first describe MTC's implementation process, focusing on the public health nursing component, and then present a program evaluation section with selected findings from the ongoing qualitative evaluation. Initially, misunderstandings about the nurses' community-based, family-centered strategy of assuring access to health care through cross-system service linkage dogged the nurses' efforts to explain their roles and mission to federal funders, project management, coworkers, and treatment providers. In the end, after federal funding ended, public health nursing left an enduring legacy of partnerships in the county substance abuse treatment system: education about public health nursing, networking, referral processes, and resources to meet the complex health-related needs of indigent substance abusers. Despite the project's many changes, the nurses (a) became specialists in substance abuse, gaining expertise and recognition in a new community, particularly with isolated subpopulations; (b) assured substance abuse clients and their families access to health-related resources through core public health nursing skills; and (c) educated project staff, administrators, providers, and clients about public health nursing.

Child, Preschool↗
PubMed1999

Peer counselling in Saudi Arabia.

Peer counselling, an essentially Western innovation, was trialled in a boys' secondary school in Saudi Arabia over an academic year. Aims were to support individual pupils, improve the social environment and reduce loneliness. Impact was assessed using school records, interviews, questionnaires, standard psychological tests and focus groups. Although there was no change over the period in loneliness, there was significant positive change in two social provisions (guidance and reliable alliance), and a reduction in problems presented to the school counsellor. While teaching staff were unsupportive of the programme, clients valued the service and peer counsellors themselves profited through increased self-esteem.

Adolescent↗
PubMed2002

Social norms marketing: a prevention strategy to decrease high-risk drinking among college students.

We describe a social-norms marketing approach to moderating college student drinking behaviors and correcting student misperceptions about campus drinking. The intervention has the potential to be applied to other health behaviors where misperceptions abound, such as those related to cigarette smoking, eating disorders, sexual health, and sexual assault. Even though nurses are actively working on alcohol and other drug (AOD) prevention efforts on college campuses, little data based research have been published. Collaborative efforts between faculty from different disciplines, including nursing and nurse health educators, can be an effective combination for preventing alcohol abuse and for initiating sound research-based campus prevention programs.

Alcohol Drinking↗