Allied Health Care Providers Research Articles

Integrated Care Systems and the Aortovascular Hub.

Aortovascular medicine and surgery in relation to vascular health of the population requires input from a broad range of specialists and institutions throughout a patient life as well as integration with allied health care providers. This paper presents the essence of the novel clinical concept of the 'Aortovascular Hub' .

Advance care planning conversations in primary care: a quality improvement project using the Serious Illness Care Program

BackgroundAdvance care planning (ACP) conversations are associated with improved end-of-life healthcare outcomes and patients want to engage in ACP with their healthcare providers. Despite this, ACP conversations rarely occur in primary care settings. The objective of this study was to implement ACP through adapted Serious Illness Care Program (SICP) training sessions, and to understand primary care provider (PCP) perceptions of implementing ACP into practice.MethodsWe conducted a quality improvement project guided by the Normalization Process Theory (NPT), in an interprofessional academic family medicine group in Hamilton, Ontario, Canada. NPT is an explanatory model that delineates the processes by which organizations implement and integrate new work. PCPs (physicians, family medicine residents, and allied health care providers), completed pre- and post-SICP self-assessments evaluating training effectiveness, a survey evaluating program implementability and sustainability, and semi-structured qualitative interviews to elaborate on barriers, facilitators, and suggestions for successful implementation. Descriptive statistics and pre-post differences (Wilcoxon Sign-Rank test) were used to analyze surveys and thematic analysis was used to analyze qualitative interviews.Results30 PCPs participated in SICP training and completed self-assessments, 14 completed NoMAD surveys, and 7 were interviewed. There were reported improvements in ACP confidence and skills. NoMAD surveys reported mixed opinions towards ACP implementation, specifically concerning colleagues’ abilities to conduct ACP and patients’ abilities to participate in ACP. Physicians discussed busy clinical schedules, lack of patient preparedness, and continued discomfort or lack of confidence in having ACP conversations. Allied health professionals discussed difficulty sharing patient prognosis and identification of appropriate patients as barriers.ConclusionsTraining in ACP conversations improved PCPs’ individual perceived abilities, but discomfort and other barriers were identified. Future iterations will require a more systematic process to support the implementation of ACP into regular practice, in addition to addressing knowledge and skill gaps.

Choose your own adventure

Psychiatric advanced directives (PADs) are utilized by mental health patients to direct their psychiatric care including assigning surrogates for medical decision-making, listing preferred inpatient psychiatric/treating facilities, preferred medication regimens to stabilize acute psychiatric condition and to facilitate the patient's overall interaction with the mental health system. This article reviews the rationale behind PADs, how they can be utilized to reduce the need for de-escalation techniques, restraints and chemical anxiolysis by partnering with patients in the delivery of their care. This paper will also briefly address some of the practical limitations that Emergency Physicians and allied health care providers might face in attempting to honor PADs including the inability to admit to preferred facilities due to staff shortages or other issues associated with the global COVID-19 pandemic. The following core competencies are addressed in this article: Patient care, Interpersonal and communication skills, and Systems-based practice.

Typologies and Meanings of Prayer Among Patients.

Religion often aids patients, but critical questions arise concerning how patients approach issues regarding prayer. In-depth interviews suggest 12 key patient decisions and aspects of prayer-who prays, to whom (e.g., explicitly to "God" or not), for whom (forself or others), for what (e.g., for symptom reduction), when (regularly or only during crisis), where, what to say (pre-specified language or spontaneous), how consciously planned or not, with what expectations and outcomes, what to call it, and in what social contexts (e.g., how others view one's prayers). These data have implications for future research, clinicalpracticeof physicians, nurses, chaplains, and other allied healthcare providers, and patient education.

Hypertension management in 2030: a kaleidoscopic view.

The last decade has witnessed the healthcare system going paperless with increased use of electronic healthcare records. Artificial intelligence tools including smartphones and smart watches have changed the landscape of day-to-day lives. Digitisation, decentralisation of healthcare and empowerment of allied healthcare providers and patients themselves have made shared clinical decision-making a reality. The year 2020 quickly turned into an unprecedented time in our lives with the entry of COVID-19. Amidst a pandemic, healthcare systems rapidly adapted and transformed, and changes that otherwise would have taken a decade, took a mere few weeks (Webster, Lancet 395:1180–1, 2020). This essay reviews evidence of transformation in the realm of hypertension management, namely diagnosis, lifestyle changes, therapeutics and prevention of hypertension at both individual and population levels, and presents an extrapolation of how this transformation might shape the next decade.

Moderating influence of enculturation on the relations between minority stressors and physical health via anxiety in Latinx immigrants.

The Latinx population in the United States has grown rapidly, now standing at over 56 million people. Discrimination and acculturative stress have been found to affect the mental and physical health of Latinx immigrants, yet enculturation has been identified as an important cultural strength for this population. The purpose of this study was to examine the relations among minority stressors, anxiety, and physical health in a sample of Latinx immigrants living in the United States. A secondary aim was to examine whether the direct and indirect effects among these variables were moderated by enculturation (i.e., moderated mediation). A community sample of 202 Latinx immigrants completed questionnaires measuring these constructs. Both acculturative stress (b = -1.68, p < .001) and discrimination (b = -1.69, p < .001) yielded direct effects on physical health, as well as indirect effects (b = -.10, 95% confidence interval [-.23, -.01]; b = -.21, 95% confidence interval [-.40, -.08], respectively) through anxiety. Psychologists and allied health care providers are recommended to assess for the impact of minority stressors on anxiety and physical health when providing care to Latinx immigrants. Future intervention research targeting Latinx mental and physical health can consider ways to include innate cultural strengths like enculturation and partner with Latinx cultural centers, churches, and local communities to make enculturation more salient. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Communication in surgical decision-making while managing metastatic bone disease: matching patient expectations with surgical goals.

There is a paucity of research examining how surgical decision-making for metastatic bone disease (MBD) can be optimized to improve quality of life (QOL) and functional outcomes, while accurately aligning with patient goals and expectations. The objective of this study was to survey and interview patients with MBD and support persons (PS), physicians, and allied health care providers (HCP) with the goal of identifying (1) important surgical issues related to MBD management, (2) discordance in perioperative expectations, and (3) perceived measures of success in the surgical management of MBD. Utilizing a custom survey developed by HCP and patients with MBD, participants were asked to (1) identify important issues related to MBD management, (2) rank perceived measures of success, and (3) answer open-ended questions pertaining to the management of MBD. From the survey, increased life expectancy, minimizing disease progression, removal of local tumour, timely surgery after diagnosis, increased length of hospitalization, and physiotherapy access were all identified as significant discordant goals between PS and physicians/HCP. Conversely, there was an agreement between physicians and HCP who considered improved QOL and functional outcomes as most important goals. Structured homogenous-group workshops identified the need for (1) improved discussions of prognosis, surgical options, expectations, timelines, and resources, (2) the use of a care team "quarterback", and (3) an increased use of multi-disciplinary treatment planning. We feel this data highlights the importance of improved communication and coordination in treating patients with MBD. Further research evaluating how surgical techniques influence survival and disease progression in MBD is highly relevant and important to patients.

Allied Health Care Providers Participating in Medical Assistance in Dying: Perceptions of Support.

This study explored the experience of pharmacists, social workers, and nurses who participated in Medical Assistance in Dying (MAiD) in a tertiary care Canadian hospital. Consenting staff participated in qualitative semistructured interviews, which were then analyzed for thematic content. This article reports on the broad theme of "support" from the perspective of the 3 professions, focusing on the diversity in perceptions of support, how MAiD was discussed within health care teams, feelings of gratuitous or excessive gestures of support, ambivalence over debriefs, and the importance of informal support. While pharmacists and social workers generally felt part of a community that supported MAiD, nurses more often expressed opinions as highly divergent. The key finding across all themes was the central importance of the culture on any unit with respect to MAiD and specifically the role of the unit manager in creating either a positive open space for communication or a more silent or closed space. Nursing noted that in the latter setting many gestures of support were experienced as insincere and counterproductive, as were debriefs. We outline several recommendations for managers based on the study results with the intent of tailoring support for all professionals involved in MAiD.

Assessment of Basic and Advanced Knowledge in Biostatistics and Clinical Research among Health care Professionals at King Fahad Medical City, Riyadh, KSA: A cross-Sectional Survey

Background: Adequate biostatistics knowledge among healthcare professionals is imperative for understanding medical literature and practicing evidence-based medicine. This study assessed the basic and advanced knowledge in biostatistics and clinical research among healthcare workers at the King Fahad Medical City (KFMC), Riyadh, Saudi Arabia. Methods: In this cross-sectional survey, data was collected from healthcare providers using a self-administered questionnaire, having questions related to demographics, biostatistics and clinical research. Data analysis was performed using statistical package SPSS 22. Results: Of 194 participants (63 [32.5%] consultants, 52 [26.8%] residents, and 79 [40.7%] allied healthcare providers), 45.4% had positive attitude towards learning biostatistics. Only 35.1% correctly answered biostatistics and clinical research instrument-related questions. Half participants had low score, 33% had good score, and 18-19% had excellent score of basic and advanced knowledge of biostatistics and clinical research. The highest degree and number of years of experience in biostatistics after medical school graduation were significantly (χ2 (2)=16.589, p<0.001) associated with basic and advanced biostatistics knowledge scores. Conclusion: Timely and painstaking training courses in biostatistics and clinical research are needed to improve the research standards in Saudi Arabia. Interested candidates should collaborated with statisticians to improve quality of their work and enhance their statistical skills.

Heart failure management insights from primary care physicians and allied health care providers in Southwestern Ontario

BackgroundIt remains to be determined whether collaborative strategies to improve and sustain overall health in patients with heart failure (HF) are currently being adopted by health care professionals. We surveyed primary care physicians, nurses and allied health care professionals in Southwestern Ontario regarding how they currently manage HF patients and how they perceive limitations, barriers and challenges in achieving optimal management in these patients.MethodsWe developed an online survey based on field expertise and a review of pertinent literature in HF management. We analyzed quantitative data collected via an online questionnaire powered by Qualtrics®. The survey included 87 items, including multiple choice and free text questions. We collected participant demographic and educational background, and information relating to general clinical practice and specific to HF management. The survey was 25 min long and was administered in October and November of 2018.ResultsWe included 118 health care professionals from network lists of affiliated physicians and clinics of the department of Family Medicine at Western University; 88.1% (n = 104) were physicians while 11.9% (n = 14) were identified as other health care professionals. Two-thirds of our respondents were females (n = 72) and nearly one-third were males (n = 38). The survey included mostly family physicians (n = 74) and family medicine residents (n = 25). Most respondents indicated co-managing their HF patients with other health care professionals, including cardiologists and internists. The vast majority of respondents reported preferring to manage their HF patients as part of a team rather than alone. As well, the majority respondents (n = 47) indicated being satisfied with the way they currently manage their HF patients; however, some indicated that practice set up and communication resources, followed by experience and education relating to HF guidelines, current drug therapy and medical management were important barriers to optimal management of HF patients.ConclusionsMost respondents indicated HF management was satisfactory, however, a minority did identify some areas for improvement (communication systems, work more collaborative as a team, education resources and access to specialists). Future research should consider these factors in developing strategies to enhance primary care involvement in co-management of HF patients, within collaborative and multidisciplinary systems of care.

Outcomes of the V-Healthy Awareness Campaign That Empowers High-School Students to Understand and Diagnose Vascular Disease Risk Factors

Just imagine the impact of empowering young high-school students to become the Sherlock Holmes of vascular health and disease. V-Healthy is a grassroots vascular education and awareness campaign that educates high-school students of the importance of vascular disease risks they face today and its impact decades later. Since 2016, >300 volunteer educators including vascular surgeons, primary care physicians, allied health care providers, and teachers have participated in the V-Healthy campaign that educated >12,000 students in 40 high schools on the implications of vascular disease risks. Students participated in didactics and hands-on workshops focused on the impact of vascular disease risk factors on peripheral artery disease, venous disease, aortic aneurysms and dissections, and stroke. In 3 years, 1210 students have participated in a Diagnosing Hypertension (HTN) study, which included monitoring daily blood pressures in their parents for a week, and participated in creating a public service announcement focused on vascular health education and awareness in their communities. An additional 2950 students participated in a survey questionnaire on the impact of the V-Healthy campaign. Of the previously undiagnosed 1210 parents who participated in the Diagnosing HTN study, >50% were hypertensive; 10% had pre-HTN (120-129/<80 mm Hg), 31% had stage 1 HTN (130-139/80-89 mm Hg), and an additional 20% had stage 2 HTN (≥140/≥90 mm Hg). Of the 2950 students who participated in the V-Healthy survey, 99% reported that they had a better understanding of vascular health; 90% recognized HTN, diabetes, smoking, obesity, and family history as risk factors; 84% would discuss vascular health with their families; and 76% were interested in learning more about their vascular health. V-Healthy is a grassroots campaign that allows vascular surgeons to lead community vascular health education and awareness and to have an impact on change. HTN is prevalent and an under-recognized vascular disease risk factor that can be used as a focal point for public vascular health education and awareness. The V-Healthy project identifies a process that can be used to develop outreach programs that empower high-school students to understand the implications of vascular disease risks and promote vascular health in our communities.

AORN Position Statement on Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing an Operative or Other Invasive Procedure

<scp>AORN</scp> Position Statement on Perioperative Registered Nurse Circulator Dedicated to Every Patient Undergoing an Operative or Other Invasive Procedure

Stakeholder Groups' Unique Perspectives About the Attending Physician Preceptor Role: A Qualitative Study.

Attending physician preceptors are accountable to many stakeholder groups, yet stakeholders' views about what the preceptor role entails have not been sufficiently considered. To explore stakeholder groups' unique perspectives of the preceptor role. Qualitative study with a constructivist orientation. Semi-structured interviews were conducted with 73 participants from two university teaching hospitals between October 2012 and March 2014. Participants included representatives from seven stakeholder groups: patients and their families, allied healthcare providers, bedside nurses, nurse managers, medical students, internal medicine residents, and preceptors. An inductive thematic analysis was conducted where researchers coded transcripts, abstracted codes into themes, and then mapped themes onto six focus areas: role dimensions, role performance, stressors and rewards, mastery, fulfillment, and impact on others. Two authors then identified "recurrent themes" (emerging in two or more focus areas) and compared them across groups to identify "unique themes" (emerging from a maximum of two stakeholder groups). "Unique thematic emphases" (unique themes that would not have emerged if a stakeholder group was not interviewed) are described. Patients and their families emphasized preceptors' ultimate authority. Allied healthcare providers described preceptors as engaged collaborators involved in discharge planning and requiring a sense of humor. Bedside nurses highlighted the need for role standardization. Nurse managers stressed preceptors' need for humanism. Medical students highlighted preceptors' emotional labor and their influence on learners' emotional well-being. Residents emphasized preceptors' responsibilities to multiple stakeholders. Preceptors described lifelong learning and exercising control over one's environment. Various stakeholder groups hold unique and nuanced views of the attending physician preceptor role. These views could broaden formal role guidance for medical education and patient care. This study generated real-world, practical examples of what stakeholders feel are important preceptor skills. These skills should be practiced, taught, and role modeled in this clinical setting.

Continence Promotion and Successful Aging: The Role of the Multidisciplinary Continence Clinic.

Incontinence is a common yet under-recognized issue that impacts quality of life, especially for older adults in whom there is often a multifactorial etiology. A retrospective chart review was performed on a representative sample of patients seen at our multidisciplinary continence clinic in Vancouver, Canada from January to December 2017 inclusive. Initial assessment was performed by the nurse continence advisor (NCA) or geriatrician depending on the source of referral. The pelvic floor physiotherapist (PFP) could then be consulted based on perceived need. The average age at assessment was 76 years old (range 29–102), with 82% of patients ≥65 years and 27% ≥85 years old. The majority of patients were referred for bladder incontinence (72%), with the remaining patients referred for bowel incontinence (28%) or pessary care (7%). Referrals came from a variety of sources including physicians (62%), nurses (22%), allied health care providers (12%) and self-referral (5%). Multimorbidity was common, with 40% of patients having a Charlson Comorbidity Index ≥6. The same proportion of patients (40%) were on ≥5 prescription medications. Many patients were functionally dependent for either instrumental activities of daily living (52%) or activities of daily living (25%). Non-pharmacologic treatments were commonly recommended, with the majority of patients counselled on lifestyle changes (88%) and taught Kegel exercises (70%). For patients seen by the geriatrician, modifications were made to non-continence medications in 50% of cases and medical comorbidities were optimized in 39% of cases. In terms of pharmacologic therapy, over-the-counter (OTC) medications were initiated in 45% of patients whereas continence-specific prescription medications were started in 17% of patients. A multidisciplinary continence clinic can play an important role in promoting successful aging by assessing and treating medical causes of incontinence in medically complex older adults.

Building an oncology community of practice to improve cancer care.

Communities of practice (cops) have been shown to be effective models for achieving quality outcomes in health care. Here, we describe the application of the cop model to the Canadian oncology context. We established an oncology cop at our urban community hospital and its networks. Goals were to decrease barriers to access, foster collaboration, and improve knowledge of guidelines in cancer care. We hosted 6 in-person multidisciplinary meetings, focusing on screening, diagnosis, and management of common solid tumours. Health care providers affiliated with our hospital were invited to attend and to complete post-meeting surveys. Likert scales assessed whether cop goals were realized. Meetings attracted a mean of 57 attendees (range: 48-65 attendees), with a mean of 84% completing the surveys and consenting to the analysis. Attendees included family physicians (mean: 41%), specialist physicians (mean: 24%), nurses (mean: 10%), and allied health care providers (mean: 22%). Repeat attendance increased during the series, with 85% of attendees at the final meeting having attended 1 or more prior meetings. Across the series, most participants agreed or strongly agreed that the cop reduced barriers (mean: 76.0% ± 7.9%) and improved access to cancer care services (mean: 82.4% ± 8.1%) and subject matter experts (mean: 91.7% ± 4.2%); fostered teamwork (mean: 84.5% ± 6.8%) and a culture of collaboration (mean: 94.8% ± 4.2%); improved knowledge of cancer care services (mean: 93.3% ± 4.8%), standards of practice (mean: 92.3% ± 3.1%), and quality indicators (mean: 77.5% ± 6.3%); and improved cancer-related practice (mean: 88.8% ± 4.6%) and satisfaction in caring for cancer patients (mean: 82.9% ± 6.8%). Participant feedback carried a potential for bias. We demonstrated the feasibility of oncology cops and found that participants perceived their value in reducing barriers to access, fostering collaboration, and improving knowledge of guidelines in cancer care.

Individual and organizational predictors of allied healthcare providers\u2019 job satisfaction in residential long-term care

BackgroundJob satisfaction is a predictor of intention to stay and turnover among allied healthcare providers. However, there is limited research examining job satisfaction among allied health professionals, specifically in residential long-term care (LTC) settings. The purpose of this study was to identify factors (demographic, individual, and organizational) that predict job satisfaction among allied healthcare providers in residential LTC.MethodsWe conducted a secondary analysis of data from Phase 2 of the Translating Research in Elder Care program. A total of 334 allied healthcare providers from 77 residential LTC in three Western Canadian provinces were included in the analysis. Generalized estimating equation modeling was used to assess demographics, individual, and organizational context predictors of allied healthcare providers’ job satisfaction. We measured job satisfaction using the Michigan Organizational Assessment Questionnaire Job Satisfaction Subscale.ResultsBoth individual and organizational context variables predicted job satisfaction among allied healthcare providers employed in LTC. Demographic variables did not predict job satisfaction. At the individual level, burnout (cynicism) (β = −.113, p = .001) and the competence subscale of psychological empowerment (β = −.224, p = < .001), were predictive of lower job satisfaction levels while higher scores on the meaning (β = .232, p = .001), self-determination (β = .128, p = .005), and impact (β = .10, p = .014) subscales of psychological empowerment predicted higher job satisfaction. Organizational context variables that predicted job satisfaction included: social capital (β = .158, p = .012), organizational slack-time (β = .096, p = .029), and adequate orientation (β = .088, p = .005).ConclusionsThis study suggests that individual allied healthcare provider and organizational context features are both predictive of allied healthcare provider job satisfaction in residential LTC settings. Unlike demographics and structural characteristics of LTC facilities, all variables identified as important to allied healthcare providers’ job satisfaction in this study are potentially modifiable, and therefore amenable to intervention.

How to Implement Evidence-Based Healthcare

How to Implement Evidence-Based Healthcare

Utilization of Kaizen Methodology to Promote Safe Care Paradigms in Neonatal ICUs

Keywords: Kaizen, Staffing Models, Care Paradigms Institutions: 1. Huntsville Hospital, Huntsville, AL, United States 2. Joe DiMaggio Children’s Hospital, Hollywood, FL, United States 3. Banner Thunderbird Medical Center, Phoenix, AZ, United States 4. Baptist South Medical Center, Montgomery, AL, United States Background: Allied Health Personnel are being utilized to enhance the care teams in Neonatal Intensive Care Units. Staffing models for Neonatologist and Allied Health Care Providers varies depending on the type, size, location, and acuity of the NICU. State …

Can chiropractors contribute to work disability prevention through sickness absence management for musculoskeletal disorders? - a comparative qualitative case study in the Scandinavian context

BackgroundDespite extensive publication of clinical guidelines on how to manage musculoskeletal pain and back pain in particular, these efforts have not significantly translated into decreases in work disability due to musculoskeletal pain. Previous studies have indicated a potential for better outcomes by formalized, early referral to allied healthcare providers familiar with occupational health issues. Instances where allied healthcare providers of comparable professional characteristics, but with differing practice parameters, can highlight important social and organisational strategies useful for informing policy and practice. Currently, Norwegian chiropractors have legislated sickness certification rights, whereas their Danish and Swedish counterparts do not. Against the backdrop of legislative variation, we described, compared and contrasted the views and experiences of Scandinavian chiropractors engaging in work disability prevention and sickness absence management.MethodsThis study was embedded in a two-phased, sequential exploratory mixed-methods design. In a comparative qualitative case study design, we explored the experience of chiropractors regarding sickness absence management drawn from face-to-face, semi-structured interviews. We subsequently coded and thematically restructured their experiences and perceptions.ResultsTwelve interviews were conducted. Thematically, chiropractors’ capacity to support patients in sickness absence management revolved around four key issues: issues of legislation and politics; the rationale for being a sickness absence management partner; whether an integrated sickness absence management pathway existed/could be created; and finally, the barriers to service provision for sickness absence management.ConclusionAllied health providers, in this instance chiropractors, with patient management expertise can fulfil a key role in sickness absence management and by extension work disability prevention when these practices are legislatively supported. In cases where these practices occur informally, however, practitioners face systemic-related issues and professional self-image challenges that tend to hamper them in fulfilling a more integrated role as providers of work disability prevention practices.

Impact of Pharmacist Participation on Chemotherapy Administration Outcomes in a Low-Resource Setting

Abstract 50 Purpose Implementation of specialty oncology pharmacy services is associated with improved patient care and reduced medical errors. Pharmacy capacity is limited in many low-resource countries, with chemotherapy preparation and administration often being performed by other allied health care providers. At Bugando Medical Center in Tanzania, both nurses and pharmacists are responsible for mixing and administering chemotherapy; however, most nurses do not have specialized oncology training, which increases the risk for medication errors. The purpose of the current study was to assess the effects of pharmacist participation on therapeutic outcomes, including verified dosage calculations, chemotherapy administration adherence, and dose documentation. Methods Chemotherapy encounters were observed over a 1-month period. Recorded observations included adherence to prescribed chemotherapy administration times; errors, including spills and extravasation; and administrative adherence, including dose verification and documentation. Results There were 53 observed encounters—32 with a pharmacist and 21 without; 15 were for pediatric patients. Pharmacist participation increased adherence to prescribed administration time (54% v 19%; P = .009) and decreased errors (zero v two extravasations; zero v one spill). Pharmacist participation improved chemotherapy administration documentation (96.8% v 76.2%; P = .049); however, patient safety measures, including intravenous catheter placement verification, secondary dose check, and toxicity monitoring during administration, were not done with or without pharmacist participation. Conclusion Pharmacist participation increased adherence to prescribed chemotherapy administration and documentation, and reduced extravasation; however, additional patient safety training is needed. A larger study can further evaluate the impact of the participation of a specialty pharmacist on patient-related outcomes. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the authors.