Exploring the Perceived Impact of Postgraduate Urology Education on the Workforce

The changing face of clinical genetics service delivery in the era of genomics: a framework for monitoring service delivery and data from a comprehensive metropolitan general genetics service

Although sexual health programming and clinical sexually transmitted infections (STIs) services have traditionally been developed through 'top-down' approaches, there is emerging evidence that participatory approaches benefit the development and implementation of such services. Although other studies have already highlighted the benefits of participation in research and implementation of clinical STIs services delivery, this narrative review focuses on how community participation in clinical STIs services delivery has been operationalised and on the various aspects of clinical STIs services delivery in which participatory processes have been implemented. A PubMed search was conducted in January 2022 using the search terms that reflected the topic of participatory processes in clinical STIs services delivery to identify relevant papers. Only peer-reviewed papers published in English were reviewed, and no timeframe was selected. After reviewing existing studies, we identified how community participation has been incorporated across stages of clinical STIs service delivery, including planning, developing, delivering, evaluating, and scaling up, as well as gaps and challenges faced in implementing such approaches. This review highlighted how a wide range of participatory processes characterised by varying depths of participation have been used in the above processes. Challenges such as funding, socio-cultural barriers, technical barriers and the digital divide, issues of quality assurance, and standardising the measurement of participation remain, which may impede the uptake of participatory processes in clinical STIs services.

Advances in technology have led to development of new vaccines for adolescents, but these vaccines will be added to a crowded schedule of recommended adolescent clinical preventive services. We reviewed adolescent clinical preventive health care guidelines and patterns of adolescent clinical preventive service delivery and assessed how new adolescent vaccines might affect health care visits and the delivery of other clinical preventive services. Our analysis suggests that new adolescent immunization recommendations are likely to improve adolescent health, both as a "needle" and a "hook." As a needle, the immunization will enhance an adolescent's health by preventing vaccine-preventable diseases during adolescence and adulthood. It also will likely be a hook to bring adolescents (and their parents) into the clinic for adolescent health care visits, during which other clinical preventive services can be provided. We also speculate that new adolescent immunization recommendations might increase the proportion and quality of other clinical preventive services delivered during health care visits. The factor most likely to diminish the positive influence of immunizations on delivery of other clinical preventive services is the additional visit time required for vaccine counseling and administration. Immunizations may "crowd out" delivery of other clinical preventive services during visits or reduce the quality of the clinical preventive service delivery. Complementary strategies to mitigate these effects might include prioritizing clinical preventive services with a strong evidence base for effectiveness, spreading clinical preventive services out over several visits, and withholding selected clinical preventive services during a visit if the prevention activity is effectively covered at the community level. Studies are needed to evaluate the effect of new immunizations on adolescent preventive health care visits, delivery of clinical preventive services, and health outcomes.

BackgroundThe integration of public health services into primary health care has been advocated and practiced worldwide for better management of preventable diseases. Health policy makers in China have started the reforms to better integrate public health services and clinical services, but public health services in China still remained neglected in primary health system. This study aimed to explore the input of Chinese primary health workers on delivering public health services and its association with their intrinsic working motivation in China.MethodsData were collected from a cross-sectional survey conducted in 2019. Participants in this survey included 803 primary health workers in 75 primary health institutions in China. Questions about the input on clinical and public health services delivery and intrinsic working motivation were asked. A multiple linear regression model was adopted to investigate the correlation between intrinsic working motivation and the time input on public health service. The robustness of this model was checked with a generalized linear model.ResultsIntrinsic motivation was found to have negative association with health workers’ input on public health (β: -1.01, p < 0.05), with the robustness checked with a generalized linear model. The significance of this association differed in the group of urban community health centers and rural township health center. Other factors that had significant relationship with the input on public health services include the being nurses instead of doctors (p < 0.01), being a member of family doctor team (p < 0.01), recognition on relative importance of clinical services (p < 0.01), and perception on better exterior support (p < 0.01).ConclusionWith higher intrinsic working motivation, primary health workers tended to spend less time on public health services. It reflected that doctors and nurses in primary healthcare institutions still perceived clinical treatment services as their main work responsibility and source of career recognition. Organizational level supports and system level policies should guide the primary health workers to increase their awareness on the importance of public health services and to cultivate their internal interests on public health services, in order to ensure sustainable input and performance improvement on public health services in primary health system in China.

An introduction: (comprising context and problem statement) The high prevalence of patients with complex needs is an increasingly worrying reality in health systems. The most characteristic features of the current healthcare model are the fragmentation of care levels, the lack of coordination, integration and continuity in patient care, leading to problems of inappropriate use of human and economic resources and health services. The problem requires a coordinated response comprising all stakeholders involved.Short description of practice change implemented: The European Carewell project http://www.carewell-project.eu/home.html aims the design and implementation of new organizational models of integrated cost-effective care, addressing multimorbid patients, in order to improve care and healthcare through: 1) the coordination and communication among health professionals, and 2) the patient-centered care based on empowerment of the patient (and their caregiver) and the monitoring of their health status. The project uses ICTs as enablers for the implementation of such interventions.Aim and theory of change: The main objective of Carewell is the design, implementation and evaluation of the impact of an integrated healthcare model for multimorbid patients, in terms of quality of care, efficiency and satisfaction of professionals and patientsTargeted population and stakeholders: The target population was elderly (≥ 65) patients having at least two of the chronic diseases included in the Charlson comorbidity index and being one of them CHF, EPOC or diabetes mellitus. In the Basque Country a population of around 6200 patients have benefited from the new integrated care pathway whereas only 200 patients (104 intervention and 100 controls) have been included in the evaluation. These patients have been followed up for a minimum of 9 months.There are 13 integrated care organizations (ICOs, primary and secondary care) in the Basque Country. 6 out of the existing 13 have been involved in the project. A multi-disciplinary, collaborative and inter-organizational team, which consisted in 130 health professionals and 58 social workers from distinct ICOs, was created to define and deploy the new care pathway.Timeline: The project started in February 2014 and phases completed are:- Definition of the new integrated care pathway: February-December 2014- Preparation of the piloting (professional engagement and training): January-April 2015- Piloting: May 2015-September 2016- Evaluation: October-December 2016Highlights: (innovation, Impact and outcomes)Innovation: A new organization model for the care of multimorbid patients has been defined,developed and deployed. Several elements have been identified as key factors: integrated care pathways agreed by all stakeholders, decision support tools, ICT services, training of professionals, development of an structured empowerment program for patients and caregivers (Kronik-ON) and a new mathematical model to predic sue of resources in mid-long term ("Predictive Modeling").Impact: In the Basque Country the new organizational model has had an impact on the provision of services to multimorbid patients. Through the prevention and promotion of health, as well as the empowerment of patients, it has promoted a transition from specialized and hospital care to primary care.Outcomes: Clinical effectiveness, economic analysis and the patient's and professionals´ perspectives have been assessed by quantitative and qualitative approaches. Satisfaction of both professionals and patients/caregivers has been demonstrated, whereas the profile of the use of services has moved from secondary care to primary. In fact, then number of hospitalizations and ED visits has decreased and the GP contacts have augmented.Comments on sustainability: The intervention in the Basque Country has used the human and technological resources currently available in Osakidetza (Basque Health Public System), which favors and facilitates any subsequent deployment. Predictive analysis has confirmed that intervention is cost effective.Comments on transferability: The results of the evaluation of the new organizational model have been positive, which has led to its imminent extension to other ICOs of Osakidetza.Conclusions (comprising key findings) and lessons learned:-A detailed methodology for the design of the intervention is crucial-Multidisciplinary teams should represent all stakeholders in order to consider their perspective in the definition of new care pathways. -New pathways must be integrated into the daily practice.-the service must be flexible to be adopted in new contexts-New roles are necessary which requires reorganization of tasks-Training of professionals is crucial to promote the development of new skills-Technology is essential for facilitating coordination among health professionals-Involvement of top managers of the organizations enhances the engagement of healthcare professionals, favoring the implementation of new procedures-Primary Care is responsible for proactive control of the patients-Nursing role is essential in the empowerment of the patient/caregiverDiscussions: It is fundamental to align the project objectives with the strategic plan of the central organization to ensure that the deployment of the intervention is a priority. However, top-down support is not enough, meso-level managers and front-line professionals have to believe in the project, so both interests converge. Continuous improvement methodologies are of great relevance identify weaknesses in a regular basis and apply new solutions. To do so, it is mandatory to establish a consolidate monitoring and assessment procedures.

Is the Australian primary healthcare system ready for the Rheumatic Heart Disease Endgame strategy? Data synthesis and recommendations

IntroductionRadiographers and radiation therapists are key patient‐facing health practitioners supporting the delivery of optimal patient care during the COVID‐19 pandemic. The aim of this research was to investigate the impact of COVID‐19 on clinical service delivery and well‐being of these healthcare professionals in Australia.MethodsA cross‐sectional online survey of Australian radiographers and radiation therapists was conducted in June–July 2020. The survey collected data on demographic characteristics, and the impact of COVID‐19 on professional practice, infection control and workplace‐related stress.ResultsA total of 218 responses were received. Changes in work hours (P < 0.001) and workload (P = 0.022) were experienced due to COVID‐19. Diagnostic radiographers reported increased procedural pressure on mobile radiography, computed tomography and general radiography. For radiation therapists, most pressure included areas of simulation and linear accelerator. PPE was in short supply at the start of the pandemic, and at the time of the study, shortages were identified for all PPE items. There was no difference in PPE supply reported by diagnostic radiographers and radiation therapists except for hand sanitiser (P = 0.003). Respondents experienced increased personal stress (61.4%) and anxiety (58.2%) at work due to COVID‐19. In addition, their work caused increased stress to their family, partners or friends (57.4%).ConclusionsCOVID‐19 has resulted in changes to clinical working patterns and service delivery. PPE shortages, as well as increased workplace‐related stress, were identified. Workplaces should seek to mitigate the pandemic impact through the provision of adequate PPE for safe practice as well as implement strategies to support and enhance staff well‐being.

An electronic questionnaire was sent to 239 public hospital pharmacy services in Australia to update and expand on a survey undertaken in 2001. The key findings from the 109 respondents (46%) showed that: 1. the average proportion of time pharmacists spent on clinical activities was 47%; 2. the average proportion of time spent on distribution activities was 37% and management activities was 16%; 3. in Victoria, the State with considerable uptake of the Pharmaceutical Benefits Scheme, the proportion of time spent on distribution services by pharmacists had increased slightly in the last 2 years. There had also been a change in the use of pharmacy technicians: 24% of their time was devoted to supporting clinical services and management activities; 4. the role of pharmacy technicians is changing; more than 30 full‐time equivalent positions were involved in supporting clinical pharmacy activities; 5. the vast majority of hospital pharmacy services (94%) offered some form of clinical service to some or all of their overnight patients; however, only 75% offered clinical services to some or all of their same‐day patients; 6. the clinical service delivery model used ranged considerably across and within States and Hospital Peer Groups; 55% of hospital pharmacy services had a mixed clinical service model in their hospital; 7. 7 hospitals offered a 7‐day‐a‐week clinical pharmacy service; 8. 19 hospitals had clinical pharmacy services available in emergency departments and 10 in pre‐admission clinics; 9. 32 hospital pharmacy services offered non‐admitted or discharge patients access to medicines through the Pharmaceutical Benefits Scheme; 10. 32% of hospital pharmacy services offered a comprehensive distribution service to non‐admitted patients and 28% offered a comprehensive service to discharge patients; 11. access to the Pharmaceutical Benefits Scheme was not the only factor driving the level of service delivered; 66% of hospitals with access to the Pharmaceutical Benefits Scheme offered a comprehensive service to non‐admitted patients and 75% a comprehensive service to discharge patients; and 12. the distribution service delivery model used for inpatients ranged considerably across and within States and Hospital Peer Groups. Australian public hospitals generally use a hybrid distribution model for inpatients where a ward‐based system is supported by an individual patient‐based system.

BackgroundVirtual healthcare services are usually provided from urban centres to outpatient clinics or underserved rural areas. This study utilises virtual pharmacy as an innovative model to provide services to a metropolitan hospital from a rural area.AimThis study assesses the feasibility, and patient and staff acceptability of a Virtual Clinical Pharmacy Service (VCPS) in a tertiary metropolitan hospital ward with limited on‐site clinical pharmacy services.MethodPharmacists from a rural health district provided telepharmacy services for nine weeks. Data on service provision and detection of medication‐related issues were captured in the electronic health record. Service acceptability was assessed through a staff focus group and patient acceptability by a patient‐reported experience measures (PREM) survey. Ethical approval was granted by the Greater Western Human Research Ethics Committee (Reference no: 2021/ETH00097).ResultsThe VCPS demonstrated high utilisation, with 535 clinical and medication reviews provided for 225 patients. Virtual medication reviews identified 151 medication‐related issues or recommendations. PREM surveys (n = 22) were supportive of the VCPS model. Staff valued the service and reported ease of access to specialist medication advice and confidence that patient medications were correct. Staff raised patient confidentiality in open wards and lack of experience using virtual healthcare as barriers to the implementation.ConclusionFeasibility was demonstrated by high service utilisation, detection of medication‐related issues, and measures of acceptability from patients and staff. The VCPS offers a solution to enhance sustainability and service agility by delivery of clinical services when face‐to‐face is not practicable or available. Further research is required to demonstrate efficacy and to confirm patient acceptability.

Challenges in the development of pediatric health services research

IntroductionTelehealth offers a promising opportunity for the delivery of clinical pharmacy services by increasing the accessibility of health care, extending the reach of clinical services, and allowing pharmacists to engage with patients who might otherwise be overlooked. The objectives of the project were to discover effective strategies for the delivery of clinical pharmacy services via telehealth and to identify core components of comprehensive medication management (CMM) that are deliverable via telehealth.MethodsA systematic literature review was performed by searching four databases (Cumulative Index to Nursing and Allied Health Literature [CINAHL], PubMed, Scopus, and Web of Science) for relevant citations using keywords and subject headings relating to telemedicine, clinical pharmacy services, and health conditions. Studies were eligible for inclusion in the review if the interventions they describe involved telehealth technologies and pharmacist care. Blind screening of abstracts and full‐text review was completed by six researchers divided into teams of two. Any discrepancies were resolved by the corresponding author.ResultsFifty‐nine studies met the inclusion criteria, most (n = 53) of which were conducted in the U.S. Five studies (8.5%) reported pharmacist training as an implementation strategy. The telehealth technologies most regularly utilized were telephone‐based interventions (n = 45), videoconferences (n = 13), and web‐based (n = 4) interventions, with five studies using a combination of technologies. Most studies focused on hypertension (n = 22), diabetes (n = 20), or lipid‐related (n = 14) disease state management. Eighteen studies qualified as CMM (n = 18), with most involving all five essential CMM functions.ConclusionThis systematic review study highlights opportunities for pharmacists to deliver clinical pharmacy services using telehealth. The majority of clinical pharmacy services described in the accessed literature was provided via telephone and focused on targeted monitoring of disease states. While studies reporting the use of CMM interventions were limited, there is an opportunity to increase the application of CMM principles as healthcare systems transition to providing more telehealth services.

Transgender health: an opportunity for global health equity

Background:Currently, clinical pharmacists have in-depth therapeutic knowledge and scientific skills to act as drug therapy experts in healthcare settings.Objective:The aim of this study was to assess the opportunities and challenges of clinical pharmacy services from the health practitioners’ perspective in University of Gondar (UOG) hospital Ethiopia.Methods:A qualitative study was performed using face-to-face in-depth interviews with health practitioners who were directly involved in clinical pharmacy services (clinical pharmacists, physicians, and nurses) in UOG hospital.Results:A total of 15 health professionals from various specialties were interviewed to express their views towards clinical pharmacists’ competencies and identified challenges and opportunities regarding their clinical services. Based on interviewees report, the opportunities for clinical pharmacists includes acceptance of their clinical services among health specialties, new government policy and high patient load in hospital. However, inadequacy of service promotions, lack of continuity of clinical pharmacy services in wards, poor drug information services, lack of commitment, lack of confidence among clinical pharmacists, conflict of interest due to unclear scope of practice, and absence of cooperation with health workers were some of the challenges identified by the interviewees.Conclusion:We identified health professionals working in UOG hospital are receptive towards clinical pharmacy services, but identified some of the potential challenges that needed to be focused to strengthen and promote clinical pharmacy services. Further, the opportunities at hand also need to be utilized astutely to boost the services.

Clinical preventive services, such as screening tests, vaccinations, behavioral counseling, or preventive medication, are offered to most people on the basis of age, sex, health behaviors, or clinical risk factors, with goals of detecting early disease, preventing future disease, or mitigating the impact of unhealthy behaviors on future health. However, many people do not receive all the recommended services for which they are eligible. The Agency for Healthcare Research and Quality identified 4 topics for gathering stakeholder input on evidence and implementation for the equitable delivery of clinical preventive services. These included technology, innovative delivery models, public health linkages, and disparities. For each topic, the authors conducted an environmental scan to identify existing programs or interventions to promote the delivery of clinical preventive services, a technical expert panel meeting, and key informant interviews. The authors synthesized input from each topic's technical expert panel and key informant interviews and used inductive reasoning to identify themes. Within each overarching theme, the authors identified subthemes supported by specific statements, examples, and illustrative quotes. A total of 90 individuals participated on stakeholder panels, technical expert panels, or key informant interviews; some individuals participated in multiple roles. Across the topics, the authors identified 3 overarching themes from synthesis of the technical expert panel and key informant interview comments across topics: (1) transitioning to holistic healthcare delivery and financing models, (2) including community and patient voice in healthcare system design, and (3) leveraging technology to improve clinical preventive services delivery. Promoting the equitable delivery of clinical preventive services requires improving access to primary care but also expanding efforts beyond clinical settings to encompass public health and community infrastructure and engagement. Experts recommended that person-centered preventive care should empower patients to make informed decisions about clinical preventive services on the basis of their values, risks, and preferences. This more individualized approach tailored to needs and context may reduce barriers to receipt of clinical preventive services.

Purpose To evaluate comprehensiveness and acceptability of the patient-reported outcome instrument (PRO-LBP) and the clinician-reported outcome instrument (ClinRO-LBP) included in the low back pain (LBP) assessment tool. Second, to assess degree of implementation after three months. Methods Feasibility-testing, training of health professionals, field-testing, and a feedback meeting was undertaken. Field-testing provided data to evaluate comprehensiveness, acceptability, and degree of implementation. Results Feasibility-testing and training of health professionals revealed that the LBP assessment tool was usable and ready for field-testing. In total, 152 patients participated in the field-testing of whom 95% considered the PRO-LBP comprehensive and 59% found it acceptable. Health professionals found the ClinRO-LBP comprehensive and acceptable. The feedback meeting revealed that the LBP assessment tool broadened the health professionals’ approach to functioning and facilitated a consultation based on the patient perspective. The degree of implementation reached 79%. Conclusions The PRO-LBP and the ClinRO-LBP covered key concepts of LBP and were found acceptable by patients and health professionals. Despite the reduced degree of implementation after three months the LBP assessment tool allowed the health professionals to apply a biopsychosocial and patient-centred approach. Future research should investigate whether the LBP assessment can enhance patient-centred care. Implications for rehabilitation The low back pain (LBP) assessment tool is the first evidence-based tangible tool to cover biopsychosocial aspects related to LBP as defined by the International Classification of Functioning, Disability and Health (ICF). The LBP assessment tool allowed health professionals to apply a biopsychosocial and patients-centred approach and has the potential to be used in rehabilitation planning. Awareness to continuous facilitation and training of health professionals is important to facilitate and maintain implementation of new procedures into routine clinical practice.