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PubMed2000

Preparing currently employed public health nurses for changes in the health system.

OBJECTIVES: This article describes a core public health nursing curriculum, part of a larger project designed to identify the skills needed by practicing public health workers if they are to successfully fill roles in the current and emerging public health system. METHODS: Two focus groups of key informants, representing state and local public health nursing practice, public health nursing education, organizations interested in public health and nursing education, federal agencies, and academia, synthesized material from multiple sources and outlined the key content for a continuing education curriculum appropriate to the current public health nursing workforce. RESULTS: The skills identified as most needed were those required for analyzing data, practicing epidemiology, measuring health status and organizational change, connecting people to organizations, bringing about change in organizations, building strength in diversity, conducting population-based intervention, building coalitions, strengthening environmental health, developing interdisciplinary teams, developing and advocating policy, evaluating programs, and devising approaches to quality improvement. CONCLUSIONS: Collaboration between public health nursing practice and education and partnerships with other public health agencies will be essential for public health nurses to achieve the required skills to enhance public health infrastructure.

Clinical Competence↗
PubMed2002

Use of the mediplus patient database in healthcare research.

OBJECTIVE: Public health systems require fast and precise analyses of physicians' day-to-day diagnoses and therapy behavior regarding qualitative, safety or economical aspects. A partnership between physicians in practices and a database organization (IMS Health, Frankfurt, Germany) which has been in existence for more than 10 years has developed a procedure for documenting various types of studies with regard to diagnosis and therapy behavior. This endeavor has facilitated scientific progress by providing precise analytical information and guidelines. METHODS: The database used has the name mediplus. It is a longitudinal patient database with anonymous access to a representative and valid panel of physicians and patients in Germany. A total of more than 1,000 medical practices and over 75 million prescriptions have been documented in a cross and/or longitudinal section. The longest time period per patient is more than 10 years starting in 1989, with monthly updates. RESULTS: Analyses have been obtained detailing prescription behavior of doctors regarding diabetes therapy and enable recommendations to be made regarding the therapy of migraine and the eradication of Helicobacter pylori infections. Information is also retrievable on drug safety studies in general and the extent to which hospitals influence the prescription behavior of doctors treating patients after discharge. DISCUSSION: The mediplus patient database combines all decision relevant information on physicians, patients, diagnoses and course of therapies and thus makes possible the investigation of the courses of diseases and therapy patterns. The monthly update enables trends to be identified at an early stage. The mediplus database is an ideal instrument for the enforcement of quantitative and qualitative analyses of patient histories because it directly links the individual diagnoses with the corresponding therapies. The database is currently undergoing extension with additional specialist groups such as pediatricians, neurologists, orthopedists, urologists, ENT specialists, surgeons and pulmonologists.

Databases, Factual↗
PubMedDate not supplied

Disease-modifying drugs in multiple sclerosis.

This article is a description of practice and a comment on the evolution of a disease-modifying drug (DMD) treatment service for multiple sclerosis (MS) in a tertiary referral centre. It is hoped it will help other MS nurses who are involved in the establishment of DMD clinics in their area. It aims to offer an update on practical management of DMDs that may prove useful for any nurse involved in caring for people with MS. It describes lessons learnt in the establishment and growth of the service and protocols put in place to ensure best practice. The importance of partnership in care with patients and multidisciplinary collaboration is highlighted, while the pivotal role of the MS nurse in the delivery of an effective service is emphasised.

Adjuvants, Immunologic↗
PubMedDate not supplied

Impact of the Leading an Empowered Organisation programme.

AIM: To evaluate the impact of the Leading an Empowered Organisation (LEO) programme on the role of grade G nurses and their multidisciplinary colleagues in one NHS trust. The LEO programme encourages and promotes leadership skills among NHS staff. METHOD: A purposive sample of four grade G nurses, one from each of the hospital's four clinical divisions, was included. Each grade G nurse, and his or her matron, nominated eight colleagues for interview. The final sample comprised four grade G nurses and 32 of their colleagues. Data were analysed using the principles of thematic analysis described by Attride-Stirling (2001). FINDINGS: The LEO programme improved the grade G nurses' approach to their work in relation to competence, communication strategies, problem solving, risk taking, leadership and management style. Factors that affected the grade G nurses' implementation of the LEO principles included: relationships, personality, experience, work context, staffing levels, autonomy and authority. CONCLUSION: This study provided insight into how the grade G nurses applied the principles of the LEO programme in their daily work. Their ability to apply the LEO principles was both restricted and assisted by the culture in which they worked. A partnership between theory and practice is needed. This finding has implications for the LEO programme and the need for it to be implicit in the local working philosophy, that is, the context in which its principles are to be used. This is so that the working context and people within it are intimately engaged with the individual undertaking the course.

Attitude of Health Personnel↗
PubMed2002

[Study of the motivation of physicians participating in public health research].

In order to explore practitioners' motivations to participate in epidemiological research, a study was conducted among doctors who had been requested to provide clinical information on their patients included in the group study DESIR in the Inde and Loire regions of France. Six semi-structured individual interviews were carried out by two sociologists, and were then followed-up by 216 questionnaires, 80 of which were completed and analysed. Finally, 18 telephone interviews were conducted to complete the data collected. Reasons given for participating in epidemiological studies are mainly the perceived scientific interest, relevance for public health and the feeling of being a partner in the research. The obstacles seem to be the vague image of the promoter, ignorance of the DESIR study's objectives, lack of direct contact for communicating information, and the mixture and confusion between filling out the study's questionnaire and handling administrative constraints in general. Therefore, better communication, centred on the concept of partnership between research and practical medicine, informing on the usefulness of knowledge from epidemiological studies for the practice of medicine, and clarifying the promoter's role, could improve the level of participation from general practitioners.

Communication↗
PubMed1997

Primary care for children with spina bifida.

Primary care providers are recognizing the need to be able to establish protocols for children with complex conditions, such as spina bifida. Best practices are to form partnerships with families to address the complex health care needs for their children who require comprehensive care, coordination of community services and resources, regular communication with interdisciplinary and specialty teams, and preparation for transition into young adulthood. Health status and quality of life for children with spina bifida depends in part on preventing complications or further disability and maximizing functional independence and inclusion in society. The content in this article presents special considerations through guidelines for medical and psychosocial aspects of primary health care for children with spina bifida.

Adolescent↗
PubMed1998

Managerial partnerships. The wave of the future?

Although managerial partnerships are becoming more common in healthcare organizations, very little is available in the literature regarding a practical, concrete methodology for ensuring success of the relationship. The authors explore the nature of managerial partnerships and the perils and pitfalls of forming these relationships. Experiences from successful and failing partnerships will be used to identify the essential elements of healthy partnerships. Key steps and principles for creating a successful partnership are identified.

Attitude of Health Personnel↗
PubMed1986

Family practitioner committee records--a neglected resource. 2. Drawing the profile of an area.

Capitation and item of service fees paid by a family practitioner committee can be analysed to produce a profile of the area which covers list sizes, age structure and mobility of the population and the extent of various practice activities. Such an analysis was made for Kensington, Chelsea and Westminster, an area for which it was particularly appropriate to consider these variables in terms of partnership size and doctor's age. Practices with one or two principals had lower rates of claiming for items of service than the larger partnerships, and within these smaller groupings it was the practices with elderly doctors that had the lowest rates. The findings indicate a problem associated with elderly doctors but wider conclusions are not necessarily justified. Profiles produced in the way described should be available for local planning but must be interpreted with caution.

Age Factors↗
PubMed1996

The business of partnership.

The movement to the continuum of care and the emergence of an array of partnerships requires a different set of insights for leadership. The advanced practice nurse will be a part of forming newer configurations for practice and must be aware of the business implications of these new arrangements.

Commerce↗
PubMedDate not supplied

Towards anti-oppressive practice in mental health nursing.

Working in Partnership, the Department of Health's report on the 1994 review of mental health nursing, implies that mental health nurses should develop anti-oppressive approaches to nursing practice. There is a notable absence of articles within the nursing literature which specifically address this issue. This is possibly because the historical and ideological issues which have informed the development of mental health nursing are complex and difficult to unravel. However, an integration of the theories of David Cooper and Frantz Fanon may provide an appropriate starting point for the development of a theory of anti-oppressive practice which addresses some of the issues specific to mental health nursing.

Attitude of Health Personnel↗
PubMed2005

Community-level child health: a decade of progress.

In the late 1980s, the leadership of the South Carolina Chapter of the American Academy of Pediatrics (AAP) developed a growing awareness that there was a population of children in the state who frequented emergency departments and public health clinics but were not considered patients in any medical professional's office. Coincidentally, the commissioner of the South Carolina Department of Health and Environmental Control was struggling to expand resources needed to care for these children, who were crowding his facilities in search of primary care. Department of Health and Environmental Control clinic staff increasingly were unable to provide core public health services because of the need to treat illnesses and conduct well-child visits. Concurrently, with mounting concerns over the inadequacy and/or unavailability of quality health care for all children, the AAP embarked on the Access to Care campaign, a multiyear effort to improve access to care. The South Carolina Chapter of the AAP and Department of Health and Environmental Control subsequently launched an initiative, the Partnerships for Children program, to ensure that South Carolina children who were medically disenfranchised could have a medical home and all other services necessary for health and well-being. Although structured somewhat differently in various communities and practices, each of the >75 partnerships statewide focused on using public health professionals for specific care coordination and support that complemented physician office visits and encounters. These partnerships have gained substantial leverage through the expanding resources of the AAP Access to Care campaign. In reviewing claims for children <3 years old who were enrolled in Medicaid before the establishment of the Partnerships for Children program, <45% had evidence of a well-child visit. Data in the fourth year of the program indicate that 84% of children in this age group have had at least 1 well-child visit. Other data suggesting improved access to care are equally reassuring. In this report, I describe the evolution of the Partnerships for Children program, identify key ingredients for its success, and provide examples of effective strategies that bring community resources into pediatric practices to allow for more efficient and productive delivery of primary care. I also indicate the important role of the AAP Community Access to Child Health infrastructure in the maintenance and further development of this initiative.

Child↗
PubMed1987

Organizational aspects of physician joint ventures.

This article describes organizational forms of physician joint ventures. Four models are described that typify physician involvement in health care joint ventures: limited partnership syndication, venture capital company, provider network, and alternative delivery system. Important practical issues are discussed.

Health Maintenance Organizations↗
PubMed2005

Reflection as a means to foster client-centred practice.

BACKGROUND: Client-centred practice embraces important concepts about partnership and justice that promote client participation in meaningful occupations. It is important to understand how occupational therapists can engage in and continue to develop client-centred practice within the constraints of everyday settings. PURPOSE AND METHODS: An action research study was undertaken by a group of four occupational therapists to describe insights gained, and to show the effectiveness of participation in reflective education to help foster client-centred practice. RESULTS: The six main insights generated by the group involve: congruence, understanding the potential, environmental factors, personal factors, expectations, and lifelong learning. PRACTICE IMPLICATIONS: Although actual change to daily practice was limited, group members felt the reflective group discussion provided them with a launch pad to start a journey toward more client-centred practice. This may be the key to moving beyond simply changing the face and language of occupational therapy practice toward a deeper understanding and implementation of client-centred practice to improve client outcomes. Suggestions are provided for implementing reflection to help continue to develop your own practice.

Biomedical Research↗
PubMed1995

Community partnership primary care: a new paradigm for primary care.

Primary care has become the focal point of health care reform. For too long primary care has been narrowly conceptualized as office-based care for common problems of individuals. In this article, a nurse practitioner describes a new model for primary care, community partnership primary care (CPPC), which moves beyond typical primary care practice to create what may be a new paradigm for primary care. This proposed new paradigm moves beyond older models of primary care into new dimensions of practice. The CPPC model emphasizes new roles for clinicians and a unique goal to foster the empowerment of individuals, families, and community. Innovative features of the CPPC model include blending a clinical role with a new area of practice called community practice. CPPC emphasizes new, innovative roles for nurse practitioners and nurses in community development and community empowerment activities. A 4-year funded project permitted the development and implementation of the CPPC model in an urban Hispanic community. This article provides an overview of the CPPC model and the initial steps of model implementation.

Community Health Services↗
PubMed1994

Researching self help drug treatment: collaboration and conflict in the age of harm reduction.

While there is evidence supporting the effectiveness of drug treatment in self help groups there are many points of divergence between the philosophies traditionally espoused by these groups and those advocated within harm reduction policies. In this paper we examine some of the differences between self help and harm reduction approaches. We argue that (in common with other treatment modalities) self help groups have altered and developed in response to changing community expectations and that this process should be expected to continue. We report on our ongoing exploration of research partnerships with self help group members focusing particularly upon research conducted in collaboration with self help groups in Victoria. We argue that research partnerships have advantages for both parties. These partnerships have the potential to better inform researchers of developments in the self help community (including the practices of active drug users). Research partnerships also encourage better understanding among self help group members of some of the potential problems that, as research has indicated, may be associated with certain self help group practices. We advocate such understanding as a potentially effective means of encouraging the appropriate development and refinement of self help group practices in line with harm reduction principals.

Alcoholics Anonymous↗
PubMed2005

Mental health research in general practice.

OBJECTIVE: To explore problems in carrying out a mental health research project in the general practice setting. METHOD: Open-ended interviews were conducted with general practice stakeholders, focusing on impediments to the conduct of mental health research in general practice and possible means for improving the participation of general practitioners in such research. Participants in the consultations were members of five divisions of general practice, senior staff within an academic department of general practice, four general practitioners and a research group engaged with general practice research. The discussions were recorded in detailed interview notes, and key issues and themes emerging from consultations were derived by the researchers. RESULTS: Three main themes summarized most of the issues reported through the consultations, including structural issues (e.g. disruption of practice, time limitations and lack of remuneration), process issues (e.g. researcher-general practice communication, researcher-imposed issues and need for partnerships) and content issues (e.g. study design, study procedures and methods). CONCLUSIONS: The consultations revealed similar findings to previously published reports concerning general practice research, with an emphasis on the need for partnerships between researchers and general practice organizations in the conduct of such research.

Family Practice↗
PubMed1991

The power of health care value-adding partnerships: meeting competition through cooperation.

Given the hypercompetitive health care industry, proposing cooperation as a means to survive and prosper appears radical. This article develops a case for the formation of a health care value-adding partnership as a viable, if not preferred, alternative to the integrated health care system owned and controlled by a single entity. The conceptual and the practical aspects of obtaining voluntary cooperation are addressed, and examples of successful value-adding partnerships are presented.

Continuity of Patient Care↗