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Community partnership primary care case study: Abbottsford Community Health Center.

Welfare reform and the movement of Medicaid to managed care have set the stage for great risk and potential reward for low-income communities and their health care providers. Nurse practitioners are responding to current opportunities by opening up nurse practitioner-directed practices to offer a range of care to targeted high-risk patients and communities. Nursing practices and the communities they serve will be greatly strengthened by democratic collaboration and partnership. The beginnings of Abbottsford Community Health Center are described as an example of community partnership primary care.

Community Health Centers↗

Strengthening the HIV/AIDS service delivery system in Liberia: an international research capacity-building strategy.

Liberia's prolonged post-conflict transition has negatively impacted its health infrastructure, including the functioning of its health care delivery system. Considering the current national health crises, a study was conducted to identify research gaps and the need to propose changes for improving the health care delivery system in the country. The study results clearly demonstrated a lack of HIV/AIDS research infrastructure including organizational structure, linkages, leadership, champions, expertise, resources, and policies and procedures. Alignment of research needs and practice, and research use to support HIV/AIDS service delivery programmes in the country was also limited. An international research capacity-building partnership is proposed as an effective planned change strategy to strengthen HIV/AIDS-related research infrastructure and to inform management and practice within the Liberian HIV/AIDS service delivery system. A proposed capacity-building planning model can also strengthen research infrastructure and the production and use of research to positively impact the HIV/AIDS epidemic in Liberia and other developing countries.

Community Health Planning↗

Preventing the 'professional cleansing' of nurse educators.

The purpose of this paper is to argue that contrary to perceived wisdom nursing education ought to abandon the lecturer practitioner role on the grounds that it is a flawed concept predicated on a false assumption. In addition, and more seriously, it is in effect a significant hidden subsidy to service at the expense of education. It is suggested that by restructuring the nurse educator's role using the concepts of primary nursing as a method of organizing nurse educator's core activities, the perception and reality of teaching practice could be transformed. Calpin-Davies suggests that such a strategy enables nurse educators to be considered as practising nurses. It also has the added advantage that it is consistent with the form of organizing nursing expected of clinical colleagues. In addition it provides a basis for partnership with clinical nurses and with students, it responds to the imagined theory--practice gap, and affords nurse educators the means of becoming a credible role model.

Education, Nursing↗

Bridging town and gown: building research partnerships between community-based professional providers and academia.

Strategic research partnerships between community-based professionals and academic researchers are increasingly recognized as a means of evolving evidence-based practice and policy directions in health services delivery. Many barriers impede collaboration, however, and information on how to successfully implement collaborative partnerships is scattered, leaving much to trial and error. This article describes the process of achieving a successful research partnership among community-based home care professionals and academic researchers during a 6-year period of collaboration. The case illustration portrays how to identify and motivate the right research partners, how to mobilize resources, how to sustain an effective partnership process during the lengthy time commitments required to complete research, and how to ensure the experience of return on investment of time, energy, and resources in the partnership process. As measured by the outcomes of their collaborative research experience, the authors conclude that the benefits of bridging town and gown greatly outweigh the challenges of research partnerships.

Community Health Nursing↗

Utilizing research in professional practice.

A review of the rehabilitation, disability studies, and allied health literature suggests the presence of numerous factors that impede the utilization of research by practitioners. The purpose of this article is to describe these factors and offer potential solutions that could enable rehabilitation professionals to integrate research findings into their practice. Specifically, the authors recommend strategies to (a) contextualize research throughout pre-service curricula, (b) establish researcher-stakeholder partnerships, (c) increase the accessibility of research to practitioners, and (d) establish professional and peer support for implementing research in field practice.

Evidence-Based Medicine↗

[School health education: practices and representations of primary school teachers].

A better understanding of primary school teachers' practices and representations toward health education (HE), and identification of individual or structural resistance as well as the partnership and training needs all constitute important goals in HE research. A quantitative study was conducted between April and December 2001 on a representative sample of the population of primary school teachers (n = 673) in the Auvergne region. The results demonstrate that the majority of teachers declare practicing and implementing HE. The approach is primarily thematic, essentially limited to a few lessons since it is only integrated into a broader project 20% of the time. 30% of teachers work in partnership, mainly with partners in school health; however, parents are rarely involved in HE activities. Parameters which influence the teachers' practices and representations are: (1) prioritizing work within an educational network and an inter-communal pedagogical regrouping, with the advantage that there are a greater number of teachers to do HE in these schools than in others, and (2) receiving initial or in-service training. These results suggest that a policy aiming to generalize the inclusion of HE in French primary schools must develop teacher training as well as support and accompany the collective dynamics within schools.

Attitude↗

[Sickness, Healing, and Health Services: social representations, practices, and demands among the Baníwa].

The research for this paper was conducted in São Gabriel da Cachoeira, in the northwestern Amazon, with the Baníwa indigenous people, in partnership with indigenous organizations, seeking to understand the relations among the group's cosmology, their system of representations of sickness and healing practices, and their transformation through inter-ethnic contact. The recording of myths showed the origin of the diseases and demonstrated the existence of several traditional categories of sickness, guiding traditional healing practices and the incorporation of biomedical knowledge. The Baníwa's cosmology operates like a reception system for biomedical information, which the people grasp according to the logic of mythical thought. Similar cognitive strategies are used to generate the demands that indigenous leaders submit to the Health Councils and Health Services.

Brazil↗

[Integrated quality assurance].

The definition of terms and connotation of "Quality", "Quality Assurance" and "Integration" lead to an analysis and understanding of inhibiting and fostering factors of the "Health Triad" of people, animals and environment. Although "Quality" is largely or ultimately determined by the consumer, there are considerable differences as this term is applied by (a) the individual consumer, (b) the dynamic producer defending or gaining markets, (c) those engaged in traditional product manufacturing, or (d) governments setting (minimum) requirements for the sake of free trade. "Quality Assurance" offers cooperation of partners all along the food chain from "pasture to table". The managerial process turned into a continuum of responsibility and agreement on processes and product characteristics. This overcomes the disadvantages of strategies stressing distinct defense barriers. In practice this philosophy of a predominant role of defence barriers proved largely partnership destructive, in that it permitted to shift responsibilities for failures and to claim administrative competence according to momentary situations and interests. "Integrated Quality Assurance" means mutual agreement of two or more partners along the food chain (e. g. feed producers, farmers, animal health industry, veterinarians and food processors) on product characteristics and production methods. It involves essential system elements including facilities, materials, manpower, information, transport, management etc. Different principles and procedures of quality assurance have been introduced in practice, including agriculture and food processing. These different approaches are not mutually exclusive but largely of complementary nature.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

Nursing and midwifery research in Scotland: from partnership to collaboration.

Nurses and midwives form the workforce that provides the greatest proportion of direct care to service users. They have the ability to make a significant impact not only on the quality and outcomes of patient care, but also on service users' and carers' perceptions of the care experience. It is therefore vital that nursing and midwifery practice has a robust knowledge and evidence base. The Scottish Executive Health Department, in partnership with other key stakeholders, launched in 2004 an 8 million pounds funding package for research and development capacity and capability initiatives for nursing, midwifery and the allied health professions. This article seeks to describe the process of engagement and partnership building that enabled this scheme to be developed. It will attempt to illustrate how the convergence of political, policy and professional agendas has provided the opportunity for nurses and midwives to set a direction of travel for research and development that will enable them to become key players within multidisciplinary research at United Kingdom and international levels.

Cooperative Behavior↗

Public- and private-sector partnerships in contraceptive research and development: guiding principles.

The objective was to review and analyze practices of preferential pricing and royalties for products resulting from collaboration between the public and private sectors. A wide variety of practices and experience exist, and collaboration depends on the product being developed and its potential markets. Guiding principles in preferential pricing, royalty provisions, and long-term collaboration are presented that can be mutually beneficial to both the public and private sector.

Contraceptive Agents↗

Changing nursing practice through continuing education: a tool for evaluation.

In light of the current cost-orientated, rapidly changing health service, continuing education providers are challenged to achieve the greatest benefits for the service. Given this culture it is argued that it is essential for nurses to acquire the skills to continually learn, and that for managers there is seen to be a measurable change in a recommended practice or behaviour. To meet these challenges it is essential that continuing educators plan, implement and evaluate programmes in partnership with clinicians and managers. A literature review revealed that most evaluations did not address whether continuing education has resulted in a change in practice. This paper describes a study on the use of goal attainment scaling as an evaluation tool to measure changes in learner behaviour and as a means of promoting self-determination among the participants. It is proposed that goal attainment scaling can be used to measure changes in participant behaviour following an educational programme. In addition, this analysis of participant interviews indicates the tool's usefulness as a self-reporting instrument and this appears to foster the skills of self-assessment and appraisal of performance.

Clinical Competence↗

A rapid-cycle collaborative model to promote guidelines for acute myocardial infarction.

BACKGROUND: This American College of Cardiology (ACC) Acute Myocardial Infarction (AMI) Guidelines Applied in Practice (GAP) collaborative in Michigan represented ACC's third initiative, in partnership with local health care coalitions and the Michigan Peer Review Organization. The GAP Pilot Project formed the basis for this project, which supported caregivers' efforts to improve their processes and consistently apply the evidence-based guidelines for AMI care. THE SOUTHEAST MICHIGAN EXPANSION PROJECT: The Institute for Healthcare Improvement (IHI) Breakthrough Series model of improvement was modified to merge the GAP Pilot Project's design with a rapid-cycle quality improvement model. The collaborative included learning sessions that focused on five phases--planning, tool implementation, monitoring tool use, remeasurement, and results--and on increasing tool use rates in each phase. CONCLUSIONS: Building on the work of two previous efforts, the ACC AMI GAP projects yielded substantial collective knowledge. Developing and fostering a collaborative culture allowed hospital teams to avoid barriers or overcome them successfully based on others' experiences and collectively solve problems, and it shortened the learning curve and accelerated QI.

Acute Disease↗

Role of community programs in controlling blood pressure.

Despite more than 30 years of intense activity to improve control--and more recently prevention--high blood pressure continues to be a major public health problem. Evidence-based reviews have identified best practices and quality improvement strategies to address prevention and control. Since the 1970s, community-based programs have been instrumental in raising awareness, increasing knowledge, and promoting changes in health behavior to improve blood pressure control. Most of these programs have emphasized the use of partnerships and involvement of community residents in conducting screening and referral activities, implementing clinical practice guidelines, and increasing healthy eating and physical activity. Many also have used health care team approaches, including the use of trained community health workers to deliver targeted, culturally sensitive heart health education, particularly related to the prevention of cardiovascular disease risk factors in general and high blood pressure in particular. Increased focus on implementation of evidence-based lifestyle and clinical management strategies coupled with community-based approaches may help increase blood pressure control rates within communities.

Blood Pressure↗

System looks outside its own walls to find innovative way to cut kids' asthma admissions.

Atlanta children's hospital system initiates outpatient pediatric asthma disease management program to reduce inpatient admissions and ER visits while reducing costs. Children's Healthcare of Atlanta turned to the primary care physician community for front-line support in keeping mild asthma cases out of the hospital. By offering evidence-based practice guidelines, training for staff, and educational materials for patients and their families, the Partnership to ACE Asthma program is off to a running start. Learn how to set up a similar program.

Ambulatory Care↗

Enhancing preventive practice.

Health professionals can play a major role in prevention. They are perceived as a reliable and credible source of health information and they have contact with a large percentage of the population every year. In Canada, a key development for the integration of prevention in clinical practice was the establishment of the Canadian Task Force on the Periodic Health Examination. The Task Force has provided guidance on effective preventive interventions in the clinical setting over the past 15 years. The challenge lies in the implementation of these guidelines. We need to find innovative ways to disseminate and promote them. In this context, the creation of a National Partnership for Quality in Health is an important avenue for the coordination of practice guideline development and implementation in this country. An emerging concern in the delivery of preventive services is the coordination of activities of health professionals within the public health sector, with those of clinical care. In Canada, such a comprehensive and coordinated approach has been put into practice through the Canadian Heart Health Initiative.

Canada↗

Partnership for excellence in asthma care: evidence-based disease management.

Our experience with developing and implementing the outpatient component of an evidence-based disease management initiative has been a positive one. Involvement of respected practicing physicians in the planning phase, recommendation of evidence-based guidelines, and the supportive relationship between the hospital and participating practices have been essential to the successful launching of an asthma disease management program by a children's healthcare system. As the implementation phase continues to progress, we are preparing for the 6 month data collection stage, including outcomes measurement and practice pattern feedback. After 1 year of implementation we will analyze the data and report on the effects of the Partnership. We expect that physicians will continue to use the guidelines, and therefore sustain the improved health status of children with asthma. We will continue to invite pediatricians' participation in the Partnership so that more children in our community can benefit from high-quality cost-effective care that results in superior health outcomes.

Ambulatory Care↗

Association between teenage pregnancy rates and the age and sex of general practitioners: cross sectional survey in Trent 1994-7.

OBJECTIVE: To examine variations in teenage pregnancy rates in Trent region and to determine possible associations with local general practice characteristics such as the age and sex of the doctors. DESIGN: Cross sectional survey. SETTING: All 826 general practices in Trent region in existence between 1994 and 1997. SUBJECTS: All pregnancies of teenagers aged 13 to 19 between 1994 and 1997 that resulted in an admission to an NHS hospital. MAIN OUTCOME MEASURES: Pregnancy rates for teenagers aged 13 to 19 and general practice characteristics: presence of a female or young doctor (under 36 years old), number of whole time equivalent practice nurses, Townsend score, vocational training status, list size per whole time equivalent doctor, fund-holding status, and partnership size. RESULTS: On multivariate analysis, lower teenage pregnancy rates were associated with the presence of a female or young doctor and more nurse time. Practices in deprived areas had higher teenage pregnancy rates. CONCLUSION: General practices with female doctors, young doctors, or more nurse time had lower teenage pregnancy rates. The findings may have implications for the mix of health professionals within primary care.

Abortion, Therapeutic↗