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PubMed2006

Decision-making in community-based paediatric physiotherapy: a qualitative study of children, parents and practitioners.

Approaches to practice based on partnership and shared decision-making with patients are now widely recommended in health and social care settings, but less attention has been given to these recommendations in children's services, and to the decision-making experiences of non-medical practitioners and their patients or clients. This study explored children's, parents' and practitioners' accounts of shared decision-making in the context of community-based physiotherapy services for children with cerebral palsy. Semi-structured interviews were conducted with 11 children with cerebral palsy living in an inner city area of northern England, and with 12 of their parents. Two focus groups were conducted with 10 physiotherapy practitioners. Data were analysed using the constant comparative method. When asked explicitly about decision-making, parents, children and practitioners reported little or no involvement, and each party saw the other as having responsibility for decisions. However, when talking in more concrete terms about their experiences, each party did report some involvement in decision-making. Practitioners' accounts focused on their responsibility for making decisions about resource allocation, and thereby, about the usefulness and intensity of interventions. Parents indicated that these practitioner-led decisions were sometimes in conflict with their aspirations for their child. Parents and children appeared to have most involvement in decisions about the acceptability and implementation of interventions. Children's involvement was more limited than parents'. While parents could legitimately curtail unacceptable interventions, children were mostly restricted to negotiating about how interventions were implemented. In these accounts the involvement of each party varied with the type of issue being decided and decision-making appeared more unilateral than shared. In advocating shared decision-making, greater understanding of its weaknesses as well as its strengths, and greater clarity about the domains that are suitable for a shared decision-making approach and the roles of different parties, would seem a helpful step.

Cerebral Palsy↗

PubMed1999

The virtual theory-practice gap.

The theory-practice gap receives much attention in the press and in discussions--what does it mean? There are differences and similarities between the service and education sectors--is it a gap? The theory-practice gap cannot be closed readily--should it? Efforts should be put into understanding the theory-practice relationship and partnership working.

Clinical Competence↗

PubMed2005

Walking forward: the South Dakota Native American project.

BACKGROUND: The "Walking Forward" program is a scientific collaborative program between Rapid City Regional Hospital, the University of Wisconsin, the Mayo Clinic, and partnerships with the American Indian community in western South Dakota-3 reservations and 1 urban population. The purpose is to increase participation of health disparities populations on National Cancer Institute clinical trials as part of the Cancer Disparities Research Partnership program. Clinical practice suggests that Native American cancer patients present with more advanced stages of cancer and hence have lower cure rates and higher treatment-related morbidities. It is hypothesized that a conventional course of cancer treatment lasting 6 to 8 weeks may be a barrier. METHODS: Innovative clinical trials have been developed to shorten the course of treatment. A molecular predisposition to treatment side effects is also explored. These clinical endeavors will be performed in conjunction with a patient navigator research program. RESULTS AND CONCLUSIONS: Research metrics include analysis of process, clinical trials participation, treatment outcome, and assessment of access to cancer care at an early stage of disease.

Breast Neoplasms↗

PubMedDate not supplied

Implementation of a patient medication assistance program in a community pharmacy setting.

OBJECTIVE: To describe the establishment of a community pharmacy-based patient medication assistance program to improve access to medications by indigent patients, lessen the burden placed on physicians in obtaining such medications, reduce the amount of money spent on such medications by area charitable organizations, and improve therapeutic outcomes by improving patient adherence with therapy. SETTING: Supermarket-based pharmacy in Ashland, Ohio. PRACTICE DESCRIPTION: Community pharmacy. PRACTICE INNOVATION: A partnership was developed among Buehler's Pharmacy #3, United Way of Ashland County, and United Way Affiliates to establish a community pharmacy-based medication assistance program to help indigent patients obtain needed medications through manufacturer assistance programs and discount card programs. INTERVENTIONS: Following initial screening by a United Way affiliate agency, patients are seen by appointment by a Certified Pharmacy Technician at the pharmacy. An electronic application is completed, printed, and sent to the patient's physician for signatures and medication orders. The paperwork is returned to the pharmacy, where it is completed, signed by the patient, and filed. The patient pays the United Way agency $10 and the pharmacy $15 for these services. MAIN OUTCOME MEASURES: Number of prescriptions dispensed cumulatively from April 1, 2003, to July 31, 2003, within the program, patients' cumulative savings, and community response. RESULTS: Between April 1, 2003, and July 31, 2003, a total of 123 patients and 47 physicians were served, and 512 medications valued at $112,139.00 were applied for and/or procured. The time lapse between filing of paperwork and receipt of medications varies from 1 to 6 weeks. While some manufacturers ship product to physicians or directly to patients, the process works better when the product is sent to the pharmacy, where it can be added to the patient's profile, screened for drug interactions and allergies, and dispensed with proper labels and counseling. CONCLUSION: Establishing a community pharmacy-based medication assistance program is an innovative spin on the traditional physician office, advocacy, or health-system setting and was found to be beneficial to the patients, physicians and other health care providers, and the community it served.

Charities↗

PubMed1998

Achieving business growth through minority equity partnerships.

Healthcare organizations can become more accessible to patients and managed care organizations and can expand their patient base by forming minority equity partnerships with physician practices. By investing in practices, healthcare organizations provide capital and guidance to help the practices grow. Such an arrangement fosters goodwill as the physicians retain ownership interests, which preserves their entrepreneurial spirit.

Capital Financing↗

PubMed1999

Roll Back Malaria.

Roll Back Malaria is an initiative intended to halve the suffering caused by this disease by 2010. The initiative is being developed as a social movement. Action is directed by national authorities backed by a global partnership which consists of development agencies, banks, private sector groups and researchers. The World Health Organization, the World Bank, UNICEF and UNDP founded the partnership in October 1998. The WHO has established a new Cabinet Project, and a WHO-wide strategy and workplan, to support the partnership. High quality, practical, consistent and relevant technical advice is made available through networks of experts based in research, academic, and disease control institutions, particularly those in endemic countries. The initiative also supports research and development of new products and tools to control malaria. Implementation of Roll Back Malaria began with a series of in-country consultations in 1998, followed by sub-regional consensus building and inception meetings. The current period is one of momentum building at country level during which national authorities are developing their own strategies with the global partners. It is anticipated that, during the year 2000, RBM movements will become active in at least 30 countries.

Health Services Accessibility↗

PubMed1999

Enhancing the quality of home health care.

A strong partnership between clinical practice and nursing education is essential to innovative home health care services. Nevertheless, these two components have not always worked in close association for mutual benefit--bringing the two together has been a continuing challenge. Recently, such an alliance was achieved in Edmonton, Alberta, brought on by necessity and triggered by rapid and substantial changes in both home health care and nursing educational environments.

Alberta↗

PubMed2002

[Consequences of domestic violence on women's health and their management in primary health care].

Because of its frequency and impact on women's health, domestic violence is an important public health issue. Psychological and psychosomatic disorders, pathological pregnancies as well as traumatic and gynaecological conditions are the main consequences of such violence, which may arise at a distant term after the events that constitute it. Health professionals, particularly general practitioners, emergency doctors, gynaecologists, obstetricians and midwives are on the frontline in identifying the victims and providing care to them. Therefore, there is a need to make a wide range of specific and relevant information readily available to these professionals and a call to renew their practices and increase partnerships.

Domestic Violence↗

PubMed1992

A historical review of the Kaiser Permanente Medical Care Program.

The Kaiser Permanente Medical Care Program evolved from a series of major construction projects in the 1930s and from the World War II shipyards in the early 1940s. In the late 1940s, it became a community-based medical care program, and later in the 1970s, the prototype Health Maintenance Organization (HMO). Over the past five decades, Kaiser Permanente has developed its basic principles of prepaid, group practice for comprehensive-care services where physicians control their medical practice in a partnership of responsibility for the Health Plan, the Hospitals, and the Medical Groups. All of this is carried out with autonomy of its 13 regions in the United States.

California↗

PubMed1999

Effects of viral respiratory disease education and surveillance on antibiotic prescribing.

BACKGROUND AND OBJECTIVES: We describe a partnership between family practice residency clinics and a state public health virology laboratory that has produced comprehensive viral respiratory disease education and surveillance. Family practice residents have been provided with education on respiratory viruses and the results of ongoing viral surveillance. The preliminary effects of this program on antibiotic prescribing by senior residents are evaluated in this paper. METHODS: We used a questionnaire to assess the acceptance by family practice residents of the educational component and the utility of ongoing viral surveillance. We used chart review to evaluate rates of antibiotic prescribing and the number of patients diagnosed per year with acute upper respiratory infection and acute bronchitis by senior residents in 1992 (preexposure) and 1996 (postexposure). RESULTS: By the third year of training, most residents (79%) reported receiving adequate training regarding common viral respiratory diseases. Moreover, residents reported that they were less likely to prescribe antibiotics to patients presenting with respiratory infections when provided with specific information on circulating viral pathogens. Antibiotic prescribing in the postexposure group was 68% lower for upper respiratory infection (URI) and 45% lower for a composite of URI and bronchitis. CONCLUSIONS: Education and monitoring of circulating respiratory viruses can result in familiarity with common disorders in primary care and reduce unnecessary antibiotic use.

Anti-Bacterial Agents↗

PubMed1990

A student health HMO as a partnership model within an academic medical center.

The Department of Family Practice, College of Medicine, in partnership with the University of Illinois at Chicago, was responsible for the reorganization of the Student Health Service into a health maintenance organization (HMO), Campus Care. Historically, the two campuses of the University of Illinois at Chicago operated student health as an infirmary model. Reorganization of student health into the Campus Care HMO provided expanded health care services to students, preserved more health care dollars in the university system, and provided a nonincremental increase in the size and responsibility of the Department of Family Practice. One year's experience showed that while the capitation was low compared with standard HMOs, the variable and less frequent use of services by the student population resulted in a fiscally viable operation. Numerous transition difficulties were encountered, including the need for rapid systems conversion within a complex university system, reeducation of students as well as traditional university-based practitioners for operation in a managed care system, and the rapid expansion of a small family practice department. The positive experience of the University of Illinois at Chicago supports the notion that family practice is better suited to providing student health care than other primary care disciplines. Three issues are paramount to success: (1) approval, support, and protection by higher level administration from university territorialism, (2) a core family practice faculty with strong leadership and experience in high-volume clinical activity, and (3) a close examination of financial resources in light of expected utilization.

Academic Medical Centers↗

PubMedDate not supplied

Community pharmacists and Colleges of Pharmacy: the Ohio partnership.

OBJECTIVE: To develop pharmacist practice standards, pharmacy preceptor standards, and objectives for students completing advanced practice community pharmacy rotations. SETTING: Ohio. PRACTICE DESCRIPTION: Pharmacy schools and community pharmacies that serve as advanced practice rotation sites. PRACTICE INNOVATION: Developed standards for preceptors and objectives for student experiences. INTERVENTIONS: Focus groups that included both community pharmacists and pharmacy faculty collaborated on defining key standards for advanced community pharmacy rotations. MAIN OUTCOME MEASURE: Not applicable. RESULTS: Three main documents were produced in this initiative, and these are provided as appendices to this article. Professional and patient care guidelines for preceptors define minimum standards for these role models. Expectations of pharmacists as preceptors provide insights for managing this student-teacher relationship, which is fundamentally different from the more common employer-employee and coworker relationships found in pharmacies of all types. Objectives for student experiences during advanced practice community pharmacy rotations present core expectations in clinical, dispensing, patient education, wellness, and drug information areas. CONCLUSION: Through this collaboration, Ohio colleges of pharmacy developed a partnership with practitioners in community settings that should enhance the Ohio experiential educational program for student pharmacists. Use of the established guidelines will help educators and practitioners achieve their shared vision for advanced practice community pharmacy rotations and promote high-quality patient care.

Community Pharmacy Services↗

PubMedDate not supplied

Resident partnerships: a tool for enhancing ambulatory training.

BACKGROUND AND OBJECTIVES: This study examined resident partnerships and their effect on graduates' practice patterns. METHODS: The study authors surveyed graduates from a residency program that used resident partnerships. We also surveyed the graduates' current practice partners, and they served as a comparison group. RESULTS: The graduates' response rate was 86%, and their current practice partners' response rate was 61%. Graduates from a partnership program rated themselves better trained for outpatient medicine and more comfortable communicating with other physicians and working within a patient care team; they were also slightly less likely to practice inpatient medicine. Reported benefits during residency included enhanced availability for continuity clinics, more emotional and intellectual support, and more flexible work schedules. CONCLUSIONS: Graduates valued partnerships during their training and reported being better prepared to work with other physicians in ambulatory settings.

Adult↗

PubMedDate not supplied

MAPP and the evolution of planning in public health practice.

Mobilizing for Action through Planning and Partnerships, the most recent planning tool in public health practice, is built upon a long history of planning by local public health agencies (LPHAs). Planning by LPHAs has evolved over half a century from the earliest problem/program-focused planning, through more comprehensive approaches like the Planned Approach to Community Health (PATCH) and the Assessment Protocol for Excellence in Public Health (APEXPH) to strategic planning of today. While LPHAs were not notably participants in the federally sponsored health planning of the 1960s and 1970s, this planning left a legacy in public health. Mobilizing for Action through Planning and Partnerships introduces strategic thinking and a systems orientation into public health planning that builds upon this legacy.

Community Health Planning↗

PubMed2003

Community-provider partnerships to reduce immunization disparities: field report from northern Manhattan.

In 1996 we launched a community-provider partnership to raise immunization coverage for children aged younger than 3 years in Northern Manhattan, New York City. The partnership was aimed at fostering provider knowledge and accountability, practice improvements, and community outreach. By 1999 the partnership included 26 practices and 20 community groups. Between 1996 and 1999, immunization coverage rates increased in Northern Manhattan 5 times faster than in New York City and 8 times faster than in the United States (respectively, 3.4% vs 0.4% [t = 6.05, p < 0.001] and vs 0.6% [t = 5.65, p < 0.001]). The coverage rate for Northern Manhattan stayed constant through 2000, although it declined during this period for the United States and New York City. We attribute the success at reducing the gap to the effectiveness of our partnership.

Child, Preschool↗

PubMed1997

Medical practice with nursing home residents: results from the National Physician Professional Activities Census.

OBJECTIVE: The study describes the prevalence of medical nursing home practice. Further, it examines the extent to which physician characteristics and local county health care resources predict nursing home involvement. This information is relevant to evaluating and devising strategies that address the future provision of medical care in institutionalized long-term care. DESIGN: A cross-sectional survey. SETTING: A national sample of all licensed practicing physicians was obtained from a special Professional Activities (PPA) survey conducted by the American Medical Association (AMA) in 1991. PARTICIPANTS: Respondents were 21,578 physicians involved in direct patient care. MEASURES: The typical number of hours spent weekly caring for nursing home patients was obtained from the PPA survey, and physician demographics were obtained from the AMA Masterfile. County health care resources were obtained from the National Institutes of Health Area Resources File. RESULTS: Most (77%) physicians reported spending no measurable time caring for nursing home patients. In all disciplines, a majority of physicians with a nursing home practice spent less than 2 hours per week with patients. Logistic regressions indicted that family practitioners and internists were most likely to have a nursing home practice, but general practitioners were most likely to spend more time in practice. Only 15% of specialists reported having a nursing home practice. Prevalence of practice was greatest among solo practitioners and physicians in partnerships and least among academic and hospital-based physicians and physicians in group practice or employed by the government. Most county of practice resources were not associated or were modestly associated with nursing home practice, but having a nursing home practice became much more likely as the number of nursing home residents increased and hospital beds decreased. A pattern was found for nursing home practice to be slightly less likely as the county's per capita income and the proportion of proprietary nursing facilities increased. CONCLUSIONS: With increasing numbers of older and frailer residents, nursing homes will continue to be integral components of the future healthcare system. However, physicians currently spend minimal time caring for nursing home patients, with physician characteristics best predicting involvement. Questions remain about the future of nursing home medical practice and how to best recruit, staff, and train future cadres of physicians to provide sufficient quality care for nursing home patients in an evolving health care system.

Aged↗

PubMedDate not supplied

HMO innovations. Video-enhanced medical advice; senior zoo walkers; Group Health Resource Line; enhancing health education programs through desktop publishing; home health beat; innovative school health partnership.

The editors of HMO PRACTICE asked clinicians and health educators in HMOs across the country to submit reports on their unique, successful patient education programs. The following HMO Innovations testify to the wide range of new technologies, enterprising partnerships, and creative ideas that are shaping health education in HMOs today.

Creativity↗

PubMed1973

B.M.A. deputizing service in Sheffield, 1970.

Seventy-four per cent. of Sheffield general practitioners and 78% of those in Nottingham used a deputizing service in 1970. In each city the deputizing service was used by about 80% of single-handed general practitioners, 90% of doctors in two-doctor practices, and 60% of those in partnerships of three or more.The Sheffield deputizing service handled 15,988 new calls in the year, an average of 106 per subscribing doctor, and in addition made 339 revisits. The median number of calls handled for single-handed doctors was 98, for those in two-doctor practices 95, and for those in partnerships of three or more 75. The growth of group practice has not eliminated the demand for deputizing services.Sixty-six per cent. of consultations were with deputies who were primarily hospital doctors, 20% with a full-time deputy, 11% with deputies who were primarily general practitioners, and 3% with the switchboard staff, who were also trained nurses. The deputies had been qualified, on average, for eight years. Seventy-two per cent. of patients attended were seen within one hour of receipt of the call.Calls handled by the deputizing service represented approximately 1% of all the subscribers' consultations, 5% of their home visits, and half their calls between midnight and 07.00 hours. At this level of activity the concept of "personal doctoring" was not threatened.

Adolescent↗