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At least 1,171 records · Page 65Linked to original sources
PubMed2004

Joint working in community mental health teams: implementation of an integrated care pathway.

Abstract Integration of community mental health services is a key policy objective that aims to increase quality and efficiency of care. Integrated care pathways (ICPs) are a mechanism designed to formalise multi-agency working at an operational level and are currently being applied to mental health services. Evidence regarding the impact of this tool to support joint working is mixed, and there is limited evidence regarding the suitability of ICPs for complex, community-based services. The present study was set in one primary care trust (PCT) in Scotland that is currently implementing an ICP for community mental health teams (CMHTs) across the region. The aim of the study was to investigate professionals' experiences and views on the implementation of an ICP within adult CMHTs in order to generate learning points for other organisations which are considering developing and implementing such systems. The study used qualitative methods which comprised of individual interviews with three CMHT leaders and two service development managers, as well as group interviews with members of four adult CMHTs. Data was analysed using the constant comparison method. Participants reported positive views regarding joint working and the role of an ICP in theory. However, in practice, teams were not implementing the ICP. Lack of integration at higher organisational levels was found to create conflicts within the teams which became explicit in response to the ICP. Implementation was also hindered by lack of resources for ongoing support, team development and change management. In conclusion, the study suggests that operational systems such as ICPs do not address and cannot overcome wider organisational barriers to integration of mental health services. Integrated care pathways need to be developed with strategic input as well as practitioner involvement and ownership. Team development, education about integration and change management are essential if ICPs are to foster and support joint working in integrated teams.

Community Mental Health Services↗
PubMed1999

QUALIDIAB: implementation of the Diabcare project in the French-speaking environment: regional, national and international issues. Qualidiab Group.

Diabcare is an international Project devoted to the evaluation of the Quality of Care [1] in the population of diabetic patients. As Diabetes is one of the most frequent chronic illnesses, the management of its treatment has a strong impact on the public health policy both regional and national [2]. Funded by the European Commission, initiated by WHO and the International Diabetes Federation (IDF), this Project is now recognised as a Pilot Project throughout the world as an example of a large international collaboration for the surveillance of quality of care in a typical chronic disease.

Computer Security↗
PubMed2001

Implementing guidelines for smoking cessation advice in Australian general practice: opinions, current practices, readiness to change and perceived barriers.

OBJECTIVE: The aim of this study was to ascertain opinions, current practices, likely readiness to change and perceived barriers to change among Australian GPs in order to develop a plan to implement national guidelines for smoking cessation advice. METHOD: A postal survey of randomly selected GPs in New South Wales, Australia was carried out. RESULTS: We received 311 returned questionnaires (73% response rate). Only 34% of respondents reported providing cessation advice during every routine consultation with a smoker, in accordance with national guidelines. Specific evidence-based approaches recommended in guidelines were under-utilized, with only 54% 'always' or 'frequently' arranging follow-up, 32% providing written materials and 28% setting a 'quit date'. Respondents were no more likely to advise quitting completely than the less effective method of nicotine fading. More than one in four respondents (28%) indicated readiness to change their behaviour. Respondents rated their patients' lack of motivation and uninterest as the most important barriers to smoking cessation advice in general practice. Neither uncertainty about effective smoking cessation strategies nor lack of reimbursement for smoking cessation advice were identified as barriers. CONCLUSIONS: A multicomponent intervention to address suboptimal behaviour and barriers as revealed by this survey holds considerable potential to plan effective implementation of smoking cessation guidelines in general practice. The use of readiness to change as a tool to 'individualize' strategies for guideline implementation should be explored.

Adult↗
PubMed2003

Developing and implementing a statewide breast cancer action plan.

BACKGROUND: This article describes a model used by the Kentucky Breast Cancer Task Force to develop and implement a statewide breast cancer action plan. METHODS: The authors examine the challenges encountered during different phases of plan development and the ways in which these challenges were addressed. CONCLUSIONS: To successfully move from planning to implementation, task forces must have broad-based participation, a "lead organization" to coordinate the planning process, focused work agendas, and firm commitments from cancer-related organizations and groups to spearhead activities in specific implementation areas.

Advisory Committees↗
PubMed2006

A survey of the clinical acceptability of screening for postnatal depression in depressed and non-depressed women.

BACKGROUND: Information on clinical acceptability is needed when making cost-utility decisions about health screening implementation. Despite being in use for two decades, most data on the clinical acceptability of the Edinburgh Postnatal Depression Scale (EPDS) come from qualitative reports, or include relatively small samples of depressed women. This study aimed to measure acceptability in a survey of a relatively large, community sample with a high representation of clinically depressed women. METHODS: Using mail, telephone and face-to-face interview, 920 postnatal women were approached to take part in a survey on the acceptability of the EPDS, including 601 women who had screened positive for depression and 245 who had received DSM-IV diagnoses of depression. Acceptability was measured on a 5-point Likert scale of comfort ranging from "Not Comfortable", through "Comfortable" to "Very Comfortable". RESULTS: The response rate was just over half for postal surveys (52%) and was 100% for telephone and face-to-face surveys (432, 21 and 26 respondents for postal, telephone and face-to-face surveys respectively) making 479 respondents in total. Of these, 81.2% indicated that screening with the EPDS had been in the range of "Comfortable" to "Very Comfortable". The other 18.8 % rated screening below the "Comfortable" point, including a small fraction (4.3%) who rated answering questions on the EPDS as "Not Comfortable" at the extreme end of the scale. Comfort was inversely related to EPDS score, but the absolute size of this effect was small. Almost all respondents (97%) felt that screening was desirable. CONCLUSION: The EPDS had good acceptability in this study for depressed and non-depressed women. Women's views on the desirability of postnatal depression screening appear to be largely independent of personal level of comfort with screening. These results should be useful to policy-makers and are broadly supportive of the Edinburgh Postnatal Depression Scale as a suitable tool for universal perinatal depression screening.

Adult↗
PubMed2002

The construction and implementation of a psychosocial interventions care pathway within a low secure environment: a pilot study.

This paper builds on previous articles that explore the use of psychosocial interventions within inpatient settings. There are obvious difficulties in the implementation of psychosocial interventions in practice. The authors suggest that one method of developing psychosocial interventions within services is to provide organizational support to clinicians. This paper explores the development and initial implementation of a psychosocial care pathway within an inpatient setting to provide such support. It concludes with a summary of the immediate effect of the pathway on care.

Critical Pathways↗
PubMed2006

Initial steps taken by nine primary care practices to implement alcohol screening guidelines with hypertensive patients: the AA-TRIP project.

Many medical conditions are caused or exacerbated by heavy drinking, necessitating alcohol screening and discussion in primary care practices. This is particularly true of hypertension, the most common primary diagnosis in the United States, which has been linked to the regular consumption of 3 or more standard alcoholic beverages a day. The Accelerating Alcohol Screening-Translating Research into Practice (AA-TRIP) project was designed to improve detection and management of alcohol problems in primary care patients with hypertension. Medical providers are being trained using the Practice Partner Research Network's- Translating Research into Practice (PPRNet-TRIP) quality improvement model. This includes a multi-method intervention (electronic medical records, on-site academic detailing, practice feedback reports and annual network meetings) to help practices increase adherence to clinical guidelines. Qualitative analyses of initial steps taken by nine primary care practices toward the routine implementation of alcohol screening guidelines are presented. Organizational factors and provider and patient characteristics all influenced the method and consistency of alcohol screening and intervention. Perceived time constraints, patient sensitivity to questions about alcohol, and possible stigma associated with a diagnosis of alcoholism were also relevant barriers requiring problem solving.

Alcohol-Related Disorders↗
PubMed2001

[Methods of process analysis, instruments of quality management. Successful implementation of quality projects].

Meaningful experience and knowledge--the prerequisite for the successful implementation of quality projects--are described in terms of their practical importance on the basis of the experience gained with quality management in the municipal hospital at München-Schwabing (HMS). Against the background of the process of quality assurance or PDCA (Plan Do Check Act), the approach to the selection of suitable themes (problem selection), the prioritization of projects, the appropriate composition of the project group, the description of the problem, and the organization of the project, are discussed. The authors describe the implementation of methods of process analysis such as flow diagrams and cause-and-effect diagrams. The importance of evaluation is justified, and pragmatic approaches are presented. The importance of project documentation and essential contents are discussed.

Germany↗
PubMedDate not supplied

A bi-state, metropolitan, school-based immunization campaign: lessons from the Kansas City experience.

INTRODUCTION: Through school-based immunization programs, large numbers of children can be vaccinated in a cost-effective manner. Information from successful programs can be valuable to communities, schools, or pediatric health care providers considering the implementation of a school-based immunization program. The purpose of this study was to identify factors considered key to the success of a large bi-state, metropolitan, multi-school district, school-based, hepatitis B immunization program. METHOD: Immunizations were offered to 14,865 sixth-grade students in 16 school districts at 123 public and private school buildings. Personnel from 6 health departments and numerous volunteers administered the vaccines. Twenty-two semistructured interviews were conducted with a representative sample of program participants from schools, health departments, and the coordinating immunization coalition. A qualitative, grounded theory analysis was performed using data from the interviews. RESULTS: The following categories emerged and were considered important issues in the success of a school-based program: organization, time, obtaining consent, educational opportunity, school support, and student tracking. DISCUSSION: School-based immunization programs can be successful, but they require a coordinated effort with school support to meet the challenges of obtaining consent and tracking students.

Child↗
PubMed2004

Implementation of the WHO Multicentre Growth Reference Study in India.

The World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) Asian site was New Delhi, India. Its sample was drawn from 58 affluent neighborhoods in South Delhi. This community was selected to facilitate the recruitment of children who had at least one parent with 17 or more years of education, a key factor associated with unconstrained child growth in this setting. A door-to-door survey was conducted to identify pregnant women whose newborns were subsequently screened for eligibility for the longitudinal study, and children aged 18 to 71 months for the cross-sectional component of the study. A total of 111,084 households were visited over an 18-month period. Newborns were screened at birth at 73 sites. The large number of birthing facilities used by this community, the geographically extensive study area, and difficulties in securing support of pediatricians and obstetricians for the feeding recommendations of the study were among the unique challenges faced by the implementation of the MGRS protocol at this site.

Child Development↗
PubMed2004

Implementation of the WHO Multicentre Growth Reference Study in the United States.

The World Health Organization (WHO) Multicentre Growth Reference Study (MRGS) North American site was Davis, California. For the longitudinal cohort (0-24 months), 208 infants were enrolled between January and December 1999 from five area hospitals at which nearly all Davis women give birth. The target sample size was lower in the United States than in the other sites, because recruitment in the United States was restricted to mothers who were willing to exclusively breastfeed for at least 4 months and continue breastfeeding for at least 12 months. For the cross-sectional component, a mixed-longitudinal design was used, which required approximately 500 subjects. The subjects were recruited by going door-to-door, with the sampling scheme based on the distribution of the subjects of the longitudinal study within the city. The cross-sectional sample was recruited between January and July 2001. Major challenges during implementation were maintaining daily communication with hospital personnel and scheduling home visits.

Child Development↗
PubMed2002

Is there a future for clinical laboratories? Experience in the Marche Region, Italy.

The government of the Marche Region has approved an Act called the "Regional Health Plan" establishing rules for the organization and development of healthcare. The main aim of the general plan is to rationalize the activities of medical laboratories first by making up an inventory of existing facilities and tests performed, and by classifying laboratories on the basis of their specialization and the complexity of tests that they perform.Moreover, the possible role of point-of-care testing and the need for clinical advice by laboratory professionals has also been debated.

Clinical Laboratory Techniques↗
PubMed1984

Family practice in the US Air Force.

The United States Air Force Medical Service is well suited for family practice because of its early identification with the small community hospital. A plan was originally developed in 1968 to bring family practice to every Air Force member. This paper traces the progress of the program, identifies problem areas, specifies the planning factors and implementation plan, and gives the final goal for full family practice in the USAF.

Family Practice↗