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PubMed1992

Advancing social work practice in the health field: a collaborative research partnership.

This article describes and analyzes the development of a collaborative research model by one university faculty of social work and 10 health care settings. Established working relationships for educating students were the foundation of a research partnership formed to study questions of mutual interest. This article discusses the developmental stage of the research consortium, including needs assessment, workshop, identification of a common theme and research topic, preliminary funding, and literature review. This stage resulted in the decision to develop and test an instrument to screen for high social risk that would be capable of identifying the need for social work involvement with families to provide effective and efficient management of patients. The Delphi methodology was chosen in the first phase of the research design, and reasons for the choice of this methodology, the results from the two Delphi rounds, and a preliminary screening instrument are presented. Finally, issues in collaboration, such as institutional factors, dynamics of the working group, and leadership roles, are analyzed to identify facilitating features and problematic issues in such partnerships.

Academies and Institutes↗
PubMed1994

Expectations of general practice: gateways and bridges.

Looks at the role of the GP in today's Service and examines some of the organizational and motivational problems which have to be overcome before general practice can be confident of delivering to the strategic expectations of the NHS. They are designed to raise the level of debate for more long-term, practical support for general practice organizations. The issues involved have been researched both qualitatively and quantitatively and are grounded in a context of change. Includes excerpts from general practice profiles developed during research projects, consultancy projects and case study development work--large and small partnerships, single-handed practices, established and "bidding" fundholders, and significantly different practice populations. These are supported by the results of questionnaires circulated to over 2,500 doctors and practice managers and the views and work of others researching and practising in primary care.

Administrative Personnel↗
PubMed2006

Family physician/nurse practitioner: stories of collaboration.

AIMS: This paper presents the experiences of nurse practitioners and family physicians working in collaborative practice at four Canadian rural primary care agencies. It focuses on the qualitative segment of a larger study examining the impact of an educational intervention on interprofessional practice. BACKGROUND: Growing awareness of the importance of health promotion and disease prevention, the increased complexity of community-based care, and the need to use scarce human healthcare resources, especially family physicians, far more efficiently and effectively, have resulted in increased emphasis on primary healthcare renewal in Canada. Key to primary healthcare renewal is care delivery through interdisciplinary teams that include nurse practitioners. METHODS: Narrative analysis, a form of interpretive analysis that respects the integrity of the stories told by participants, was chosen as the strategy to examine the narrative data gathered in two sets of interviews with the nurse practitioners and family physicians. The study was undertaken during 2000. RESULTS: Thirteen family physicians and five nurse practitioners with diverse educational backgrounds and varied experience with collaboration participated in the qualitative component of the study. A number of issues related to working in a shared practice were identified in nurse practitioner and family physician interviews across the research sites. The themes identified in participants' stories included issues related to the scope of practice, emphasizing the importance of role clarity and trust, the ideological difference regarding disease prevention and health promotion, differences in perceptions about the operation of collaborative practice, and the understanding that collaborative relationships evolve. CONCLUSIONS: The placement of nurse practitioners and family physicians in a common clinical practice without some form of orientation process does not produce collaborative practice. Educational strategies related to role expectations are necessary to facilitate the development of care delivery partnerships characterized by interdependent practice.

Adult↗
PubMed2005

Is a physiological perspective relevant in a 'genocentric' age?

Currently, the major thrust of plant physiology research is to identify and understand the regulation of genes that might be relevant in plant development and growth. The dominance of a genocentric view of plant behaviour has, unfortunately, resulted in the development of major disconnects in the classical view of plant physiology as a partnership between fundamental and practical research contributing to improved plant production. One disconnect is that much of the genocentric research appears to be organized and executed without regard to the practical needs of enhancing plant performance under applied conditions. Although practical benefits from genocentric research are often claimed, basic assumptions guiding much research and the experimental protocols used are commonly not relevant for real-world plant production. A second disconnect is a failure fully to appreciate the lessons learned in 40 years of classical plant physiology research concerning the role of physiological processes in altering whole plant performance. Regulation of plant systems has proved to be complex and redundant. Alteration of a single physiological process is compensated or dampened so that commonly very little change in plant growth and yield results from modification of a single physiological process. Based on a few successful projects employing classical plant physiology to achieve crop yield increase, key characteristics for research projects that truly seek to increase plant performance in production systems are identified. Basically, the partnership between the fundamental and practical research long espoused for plant physiology needs to be re-established in an intimate and meaningful way.

Crops, Agricultural↗
PubMedDate not supplied

Best practice using Excellence in Practice Accreditation Scheme.

This article describes how the University of Teesside School of Health and Social Care practice development team, in partnership with local professional colleagues and organizations, have addressed the issue of providing continuous quality evidence-based practice within the context of clinical governance. The newly devised Excellence in Practice Accreditation Scheme (EPAS) measures the standard of practice for a given health and social care setting by providing objective data indicating the level of clinical excellence obtained for the team or organization. The EPAS differs from other organizational accreditation schemes by facilitating excellence based upon a comprehensive set of measurable core standards: working in organizations, collaborative working, user-focused care, continuous quality improvements, performance management, and measuring efficiency and effectiveness. The standards are derived from a professional peer review of best practices. The uniqueness of EPAS is in consolidating the various organizational standards to elicit the core themes related to best practice where individuals, teams and organizations can be benchmarked and accredited for a level of excellence.

Accreditation↗
PubMed2005

The practice community meets the ivory tower: a health department/academic partnership to improve public health preparedness.

When the local health department of Montgomery County, Maryland, was chosen to participate in Project Public Health Ready and was charged with the daunting task of providing a comprehensive emergency preparedness plan, training all 600 employees to carry out that plan, and conducting exercises to demonstrate the department's competency, it realized it couldn't do it alone. The department sought the assistance of the Johns Hopkins Bloomberg School of Public Health. The first challenge for these unlikely partners, one a bastion of research and the other firmly immersed in the practice world of public health, was to figure out how to work together. This article describes the development of their partnership; outlines the preparedness plan, training, and exercises that resulted from the partnership; summarizes the challenges and benefits for each entity; and enumerates lessons learned that could be useful to other public health entities planning to undertake similar partnerships.

Disaster Planning↗
PubMed1999

Dental insurance, managed care and traditional practice.

BACKGROUND AND OVERVIEW: The author examined the impact of trends in commercial insurance plans and their managed care products on the traditional fee-for-service solo or partnership model of dental practice. CONCLUSION: In response to rising dental expenditures, employers are passing on more costs of dental insurance to employees, dropping dental benefits altogether and moving from indemnity to managed care plans, mainly preferred provider organizations. These trends are likely to continue, resulting in fewer people with employer-based dental insurance coverage. PRACTICE IMPLICATIONS: These changes in dental insurance coverage are unlikely to challenge the traditional model of dental practice within the next five years, largely because of the growing decline in the supply of dental services and a lack of local market concentration of dental managed care companies.

Dentists↗
PubMed1986

Family practitioner committee records--a neglected resource. 3. Three inner city areas compared.

Data from the family practitioner committees of three inner city areas - Kensington, Chelsea and Westminster; Lambeth, Lewisham and Southwark; and Manchester - were compared. The information about general practitioners over one year included number of principals, distribution by partnership size and numbers working from health centre premises. Data about practices covered the five years 1979-83, with figures for mean list size, registrations and removals, temporary residents and claims for various items of service. Comparisons between the three areas showed great differences for which no convincing explanation could be found. The possibility that people living in these areas have different primary care health services suggests that comparisons should be made nationally; this requires family practitioner committees to be fully computerized and to collect their data in the same way.

Age Factors↗
PubMedDate not supplied

Beyond cause and effect: some thoughts on research and practice in child psychiatric nursing.

TOPIC: A comprehensive conceptual framework that informs about the complexity of childhood psychopathology. PURPOSE: To discuss the importance of a unifying conceptual framework and multiple partnerships in research and practice that can inform critical events and effects of interventions at various system levels in the treatment of children. SOURCES: Literature review. CONCLUSIONS: The most informative research and intervention will occur by using multiple measures and sources of information. As understanding of children and their problems in development and in context grows, intervention research that will be both useful, timely, and cost-effective must include cross-discipline teams of researchers and practitioners who will speak to these complexities.

Child↗
PubMed2003

Women-centred care and caseload models of midwifery.

OBJECTIVE: A partnership caseload model of midwifery-led practice was developed and introduced as an option of maternity care for low risk women at our local health service. To assess the benefits of this new practice model, aspects of continuity, choice, control and satisfaction were examined in women receiving Primary Health Midwifery Care (PHMC) and standard hospital care (SHC). DESIGN AND SETTING: A descriptive comparative design was used and survey data were collected using a modified version of the Mason Survey of Womens' Experience of Maternity Care from a convenience sample of women receiving PHMC (n = 357) and SHC (n = 202) from a large metropolitan health service. FINDINGS: Overall, more women receiving PHMC experienced key aspects of women-centered care-choice, control and continuity than women receiving SHC. KEY CONCLUSIONS: This study, within the limitations of its design and sample size, confirms that low risk women have positively responded to partnership caseload midwifery practice, and the practice model has supported women-centred care with special benefits for primipara women.

Adult↗
PubMed1998

The impact of true partnership between a university Level I trauma center and a community Level II trauma center on patient transfer practices.

OBJECTIVE: To examine the effect of a clinical and administrative partnership with an academic urban Level I trauma center on the patient transfer practices at a suburban/rural Level II center. METHODS: Data for 2 years before affiliation (PRE) abstracted from inpatient charts and the trauma registry were compared with that for 2 years after (POST). The following data were collected: number of, reason for, and destination and demographics of transfers. Chi(2) test and t test analyses were used; p < 0.05 defined significance; data are mean +/- SEM. RESULTS: Transfer rate increased from 4% PRE to 6.9% (p = 0.001) POST with no significant difference in age, Glasgow Coma Scale score, Injury Severity Score, or Revised Trauma Score. Repatriation occurred in 12.8% POST (none PRE). The current Level I facility accepted 1.8% of all transfers PRE and 36.4% POST (p = 0.0001). PRE/POST rates by reason are as follows: pediatric, 14.6%/9.0% (p = 0.04); intensive care unit, 0.4%/1.7% (p = 0.13); complex orthopedic, 100%/0% (p = 0.005); vascular, 50%/0% (p = 0.008); spinal cord injury, 100%/100%; and ophthalmologic, 0%/100% (p = 0.005). CONCLUSIONS: In this experience of Level I/II partnership (1) transfer patterns were altered, (2) select patient cohort transfers decreased (pediatric, complex orthopedic, vascular), whereas others increased (aortic work-up), and (3) repatriation rates were low.

Hospitals, Community↗
PubMed2000

Situational trust and co-operative partnerships between physicians and their patients: a theoretical explanation transferable from business practice.

A model to explain interpersonal trust development, and its consequences for co-operative behaviour in doctor/patient partnerships derived from the context of business relationships is applied to patient/physician relationships. Threshold barriers exist against all human behaviours or actions and trust is the process by which barriers to co-operation and compliance are overcome. Dispositional trust (a psychological trait to be trusting) is dominant in the early stages of a relationship and contributes to the weight of subsequent trust development. Co-operative behaviour or compliance ultimately requires a secure situational trust emerging from consultations, which is carried forward as learnt trust and modified in each subsequent consultation. The model comprises three types of situational trust (calculus-based, knowledge-based, and identification trust) and five co-operation criteria from which to determine an individual's tendency for co- operative behaviour. These model components can be identified and mapped from a range of qualitative data, with the aim of enhancing co-operative behaviour and efficiently achieving optimal patient compliance.

Clinical Competence↗
PubMed1996

Influences of practice characteristics on prescribing in fundholding and non-fundholding general practices: an observational study.

OBJECTIVE: To investigate the variation in prescribing among general practices by examining the contribution to this variation of fundholding, training status, partnership status, and the level of deprivation in the practice population and to investigate the extent to which fundholding has been responsible for any changes in prescribing. DESIGN: Analysis of prescribing data (PACT) for the years 1990-1 (before fundholding) and 1993-4 (after fundholding), Use of multiple linear regressions to investigate the variation among practices in total prescribing costs (net ingredient cost per prescribing units), and mean cost per item in each of the two years and also the change in these variables between years. SETTING: Former Mersey region. SUBJECTS: 384 practices. RESULTS: The models developed explained the variation in cost per item (43% of variation explained for 1990-1, 38% for 1993-4) and prescribing volume (34% for 1990-1, 38% for 1993-4) better than the variation in total prescribing costs (3% for 1990-1, 7% for 1993-4). The models developed to explain the change in these variables between years did not explain more than 10% of the variation. Most of the explained variation in the change in total prescribing costs was accounted for by fundholding. Of the pounds 3.71 saved by first wave fundholders compared with non-fundholders pounds 3.57 was attributable to fundholding alone. CONCLUSION: In neither year did fundholding make a major contribution to the variation in prescribing behaviour among practices, which was better explained by deprivation, training status, and partnership status, but it did seem largely responsible for differences in the rise of total prescribing costs between fundholders and non fundholders.

Drug Prescriptions↗
PubMed1986

A look by medical students at medical practice in the future.

Ninety-six first- and second-year students (97 percent) at the University of Minnesota, Duluth, School of Medicine responded to a questionnaire on their career choices and their perceptions of changes in the organization and financing of medical care. Their responses indicated a great deal of student concern regarding the future of medical practice. Overall, the students were the most concerned about a perceived loss of practice autonomy and inadequate financial rewards. In the face of these perceptions, the students reported changes in career preferences: from smaller to larger communities, from solo or partnership arrangements to group practice settings, and from generalist to specialist practices. A student's anticipated debt level was the most important predictor of whether the student changed career goals.

Career Choice↗
PubMed2003

Building the minority faculty development pipeline.

The shortage of faculty in dental education is well documented, but the data also show a shortage of minorities in postgraduate programs, which develop future faculty. In the last ten years, ADEA's effort to address minority issues in dental education has made some progress. In addition, examples of pipelines for minority faculty development that have shown some success include: a partnership between Harlem Hospital and Columbia University School of Dentistry and Oral Surgery in which the school dedicates one position in its postgraduate training programs to an individual participating in the Harlem Hospital General Practice Residency program; a partnership between the National Dental Association Foundation and Colgate-Palmolive Company, which provides scholarships for advanced dental education study; and the Bronx Lebanon Hospital Center Department of Dentistry, which enrolls underrepresented minorities in its General Practice Residency Program, a new Pediatric Dentistry Residency Program, and a unique program providing hands-on experience in HIV/AIDS health care policy and AIDS development management. Critical elements in the relative success of these programs are environment, selection criteria, mentoring, networking, and finance. The true measure of the outcomes is still to be seen.

Black or African American↗
PubMed2002

Nursing care and collaborative practice.

This article argues that the time is right for nurses in the UK to become the case managers in all healthcare settings. The re-launch of family health nursing, as a model for the organization and delivery of nursing care in the community, and the advent of the GP practice-based self-managed integrated nursing teams, offer the means by which to take up the opportunities presented by recent legislation and the national strategies for promoting partnership working and collaborative practice. Nurses could approach this by combining their current involvement with developing the single assessment process for older people with the overall development of interprofessional collaborative practice across all boundaries in health and social services. Despite the new opportunities, this will not be straightforward because of the still existing problems associated with the health and social care divide. In order to generate high quality care, it is imperative for nurses and their patients that the profession gains control and ownership of its own policy, remit and practice. Nursing care should be defined according to the patient's condition, so that their dependency level, diagnostic picture and potential for rehabilitation govern the eligibility criteria for health or social care and not the level of technicality in the task itself.

Case Management↗