Different Groups Of Healthcare Professionals Research Articles

Inter-Rater Agreement on Cincinnati Prehospital Stroke Scale (CPSS) and Prehospital Acute Stroke Severity Scale (PASS) Between EMS Providers, Neurology Residents and Neurology Consultants.

To examine the agreement between emergency medical service (EMS) providers, neurology residents and neurology consultants, using the Cincinnati Prehospital Stroke Scale (CPSS) and the Prehospital Acute Stroke Severity Scale (PASS). Patients with stroke, transient ischemic attack (TIA) and stroke mimic were included upon primary stroke admission or during rehabilitation. Patients were included from June 2018 to September 2019. Video recordings were made of patients being assessed with CPSS and PASS. The recordings were later presented to the healthcare professionals. To determine relative and absolute interrater reliability in terms of inter-rater agreement (IRA), we used generalisability theory. Group-level agreement was determined against a gold standard and presented as an area under the curve (AUC). The gold standard was a consensus agreement between two neurology consultants. A total of 120 patient recordings were assessed by 30 EMS providers, two neurology residents and two neurology consultants. Using the CPSS and the PASS, a total of 1,800 assessments were completed by EMS providers, 240 by neurology residents and 240 by neurology consultants. The overall relative and absolute IRA for all items combined from the CPSS and PASS score was 0.84 (95% CI 0.80; 0.87) and 0.81 (95% CI 0.77; 0.85), respectively. Using the CPSS, the agreement on a group-level resulted in AUCs of 0.83 (95% CI 0.78; 0.88) for the EMS providers and 0.86 (95% CI 0.82; 0.90) for the neurology residents when compared with the gold standard. Using the PASS, the AUC was 0.82 (95% CI 0.77; 0.87) for the EMS providers and 0.88 (95% CI 0.84; 0.93) for the neurology residents. The high relative and absolute inter-rater agreement underpins a high robustness/generalisability of the two scales. A high agreement exists across individual raters and different groups of healthcare professionals supporting widespread applicability of the stroke scales.

Belgian Fertility Clinic Staff Value Healthy Lifestyle Promotion but Lack Access to a Structured Lifestyle Modification Programme: An Observational Study

Objectives: Guidelines advise promoting a healthy lifestyle among patients with fertility problems as the lifestyle of women and men proved to be associated with their fertility. Australian fertility nurses were shown to lack access to structured lifestyle modification programmes, although they value healthy lifestyle promotion. This study aimed to examine whether gynaecologists also value promoting a healthy lifestyle and whether structured lifestyle modification programmes are available in Belgian fertility clinics. Design: An observational study was conducted among health care professionals (HCPs) working in Belgian fertility clinics. Participants/Materials, Setting, Methods: An Australian questionnaire on attitudes and practices related to promoting a healthy lifestyle among patients with fertility problems was reciprocally back-to-back translated and three open-ended questions were added. All HCPs of Belgian fertility clinics, including gynaecologists, fertility nurses/midwives, psychologists, and embryologists, were invited by e-mail to complete the questionnaire online. Responses to closed and open-ended questions were analysed with, respectively, descriptive statistics and qualitative thematic analysis. Finally, differences in perspectives between different groups of HCPs were explored. Results: A total of 50 fertility nurses/midwives, 42 gynaecologists, and 19 other HCPs completed the survey (n = 111). Regarding attitudes, all respondents valued informing patients about the impact of lifestyle on fertility. The vast majority of HCPs (n = 96; 86%) stated that fertility clinics have the responsibility to address unhealthy lifestyles prior to offering fertility treatment. Fertility nurses/midwives were significantly more likely than gynaecologists to state that fertility clinics have this responsibility (p = 0.040). Regarding practices, the patient’s lifestyle was most commonly discussed by the gynaecologist (n = 107; 96%) during the first appointment (n = 105; 95%). The lifestyle factors that were being addressed, according to the vast majority of respondents, were smoking, weight, age, alcohol, and recreational drugs. Only three HCPs (from three different clinics) stated that their clinic offered a structured lifestyle modification programme. HCPs explained that they lacked the resources and expertise for offering a structured lifestyle modification programme. Limitations: Response rates were limited, but the responding Belgian gynaecologists and fertility nurses/midwives confirmed the findings of the previous study in Australian fertility nurses. Conclusions: HCPs working in Belgian fertility clinics value healthy lifestyle promotion but lack access to structured lifestyle modification programmes to implement in their daily clinical practice. Future studies should focus on developing and evaluating structured lifestyle modification programmes for patients with fertility problems.

Prevalence of Work-Related Musculoskeletal Disorders among Health Care Professionals at Federal Medical Centre Asaba, Delta State, Nigeria

Background: Musculoskeletal disorders (MSDs) are painful anatomical defects that are characterized by inflammatory and degenerative conditions in muscles, tendons, ligaments, joints, peripheral nerves, and supporting blood vessels. Work-related musculoskeletal disorders (WRMSDs) are associated with absenteeism, lost productivity, increased health care, disability, and worker’s compensation costs. Healthcare professionals are known to be at high risk for WRMSDs. Though several studies on WRMSDs among healthcare professionals have been conducted, the majority of these studies have been limited to certain professional groups such as physicians, nurses, physical therapists, and others. Therefore, this study aims to determine the prevalence and distribution of WRMSDs among seven different groups of healthcare professionals and to evaluate the multiple risk factors that contribute to the development of WRMSDs. Methodology: It was a cross-sectional study conducted among physicians, dentists, physiotherapists, nurses, pharmacists, medical laboratory scientists, and radiographers of various clinical departments in the Federal Medical Centre Asaba. Different combinations of validated and standardized questionnaires were used for collecting data on the pattern of WRMSDs and the multiple job risk factors among healthcare professionals. Descriptive (frequency, mean, standard deviation, and percentages) and inferential (Chi-square test) statistics were used to analyze data. Alpha level was set at P < 0.05. Results: A total of 278 questionnaires were completed, returned, and used for data analysis. The patterns of WRMSDs showed higher occurrence among nurses (100%), dentists (100%), and medical laboratory scientists (100%). Low back pain was the most complaint (79.8%) among health care professionals followed by shoulder (45.4%) and then neck (41.2%). The elbow (5.3%) and the ankle/feet (10.7%) were the least affected. Work-relatedness of musculoskeletal disorders was highest among nurses. Performing the same task over and over again, working with a large number of patients, and working overtime was the most commonly reported job risk factors for the development of WRMSDs. Conclusion: As shown by the study, a large percentage of healthcare professionals have WRMSDs. As a result, a hospital workplace safety, continuous education, and skill development system that is based on the best available evidence of quality and safety best practices, as well as communication of behaviour change, is recommended.

Risk of COVID-19 in different groups of healthcare professionals between February 2020 and June 2021 in Finland: a register-based cohort study

During the Coronavirus Disease 2019 (COVID-19) pandemic, healthcare workers (HCWs) have been a risk group for COVID-19. To assess the cumulative incidence in different groups of HCWs and the risk factors and outcomes of COVID-19 in HCWs between February 2020 and June 2021 in Finland. We linked two national registers, National Infectious Diseases Register (NIDR) and Register of Social Welfare and Healthcare Professionals (Terhikki), using national identity codes. COVID-19 cases were identified from NIDR notifications made by laboratories and physicians, and their healthcare professions from Terhikki. We categorized healthcare professions into seven groups and calculated cumulative incidences using Kaplan-Meier estimate during three periods (1/2/2020-30/6/2020, 1/7/2020-31/12/2020, 1/1/2021-30/6/2021). We identified risk factors in a multivariable model using Cox's regression. We identified 8,009 COVID-19-cases among HCWs, with cumulative incidence of 1.79%; 83% were female, median age was 40.9 years (interquartile range, 31.2-51.6). Most COVID-19-cases occurred in nursing assistants (53%) and nurses (17%), with the highest cumulative incidences 2.07% (95%CI, 2.01-2.13%) and 1.82% (95%CI, 1.73-1.91%), respectively. Risk factors were male sex (hazard ratio (HR) 1.2; 95%CI, 1.1-1.3), foreign native language (HR 2.5; 95%CI, 2.2-2.9) and foreign country of birth (HR 1.2; 95%CI, 1.1-1.4). Physician notification data was available for 6,113/8,009 cases (76.3%); 244/6,113 (4.0%) were hospitalized and 37/6,113 (0.6%) in intensive care. Nurses and nursing assistant, especially men and professionals with foreign background, were at higher risk of COVID-19. This should be specifically addressed during training and implementing infection control measures to protect themselves and patients.

Costs, consequences and value for money in non-medical prescribing: a scoping review

ObjectivesNon-medical prescribing (NMP) is a key feature of the UK healthcare system that refers to the legal prescribing rights granted to nurses, pharmacists and other non-medical healthcare professionals who have...

Analysis of headache management in Andalusia

Introduction and objectiveHeadache is a frequent reason for consultation between primary care physicians, emergency services physicians, and neurology specialists; however, it is not always well managed. The Andalusian Society of Neurology’s Headache Study Group (SANCE) aimed to analyse headache management at different levels of care. Material and methodsWe conducted a descriptive cross-sectional study with data gathered through a retrospective survey in July 2019. Participants completed a series of structured questionnaires on different social and work-related variables from 4 different groups of healthcare professionals (primary care [PC], emergency departments, neurology departments, headache units). ResultsA total of 204 healthcare professionals completed the survey: 35 emergency department physicians, 113 PC physicians, 37 general neurologists, and 19 neurologists specialising in headache. Eighty-five percent of PC physicians reported prescribing preventive drugs, which were maintained for at least 6 months (59%), with flunarizine and amitriptyline being the most commonly used. Most patients attended at neurology consultations (65%) are referred by PC physicians, with changes in the headache pattern being the main reason for referral (74%). Healthcare professionals across all levels of care showed great interest in headache and in receiving training in headache management (97% of PC physicians, 100% of emergency services physicians, 100% of general neurologists). ConclusionsMigraine sparks great interest among healthcare professionals from different levels of care. Our results also reveal a lack of resources for headache management, which is reflected in the long waiting times. Other means of bilateral communication between different levels of care should be explored (eg, e-mail).

Health care professionals' knowledge and attitudes toward telemedicine.

The utilization of modern communication technology in the healthcare field is known as telemedicine, and it represents an advancement in the healthcare industry. For effective implementation of these technologies, healthcare professionals must possess the appropriate knowledge and hold a positive perspective toward the implementation of telemedicine. The current study aims to evaluate the knowledge and perspective of healthcare professionals in King Fahad Medical City, Saudi Arabia toward telemedicine. This study was carried out in a diverse hospital, King Fahad Medical City, Saudi Arabia and it was a cross-sectional study. The study took place from June 2019 until February 2020, during which 370 healthcare professionals, including physicians, nurses, and other healthcare professionals participated. The data was gathered by using a structured self-administered questionnaire. The analysis of the data revealed that the majority of the healthcare professionals who participated in the study, 237 (63.7%), had limited knowledge of telemedicine. About 41 (11%) participants had a good understanding of the technology, and 94 participants (25.3%) had extensive knowledge. The overall attitude of the participants toward telemedicine was positive, with a mean score of 3.26. The mean attitude scores varied significantly (P < 0.001) among the different professions, with physicians scoring 3.69, allied healthcare professionals scoring 3.31, and nurses scoring 3.07. The coefficient of determination (R2) was used to evaluate the variation in attitude toward telemedicine and it was found that education (12.4%) and nationality (4.7%) had the least impact on the attitude toward telemedicine. Healthcare professionals are crucial to the successful implementation and continuity of telemedicine. However, despite their positive attitude toward telemedicine, most of the healthcare professionals who participated in the study had limited knowledge of it. There were differences in attitude among different groups of healthcare professionals. As a result, it is necessary to create specialized educational programs for healthcare professionals to guarantee the proper implementation and continuation of telemedicine.

Low inter-rater reliability between nurses and researchers for the NRS-2002 screening tool for malnutrition in a hematological hospital ward

NRS-2002 is one of the recommended tools to screen hospitalized patients for malnutrition. NRS-2002 is considered as valid and reliable, but little is known about the inter-rater reliability between different groups of healthcare professionals. The aim of this study was to test the inter-rater reliability of the NRS-2002 tool between department nurses and researchers. Inter-rater reliability was measured between the NRS-2002 scores given by department nurses and researchers, using data from a randomized controlled trial (RCT) at a hematological department in a Norwegian hospital. The mean NRS-2002 score was significantly higher when using researchers' scores compared to the department nurses' scores. The total agreement between the two groups of raters was 59%, kappa=0.27. The inter-rater reliability of the NRS-2002 scores given by nurses and researchers was low. More research is needed to study if this is applicable also to other patient groups and in other wards.

Prevalence of burnout among healthcare professionals in Singapore

The aim was to study the prevalence of burnout among various groups of healthcare professionals in Singapore. An anonymous online survey questionnaire was conducted using the Maslach Burnout Inventory - Human Services to measure three categories of burnout: emotional exhaustion (EE), depersonalisation (DP) and personal accomplishment (PA) from July 2019 to January 2020 in a healthcare cluster in Singapore. The survey was completed by 6,048 healthcare professionals out of a target survey population of 15,000 (response rate 40.3%). The study revealed 37.8% of respondents had high EE score ≥27, 29.7% of respondents had high DP score ≥10, and 55.3% of respondents had low PA score ≤33. Respondents with either high EE score or high DP score constituted 43.9% (n=2,654). The Allied Health group had the highest mean EE score, which was significantly higher than those of Medical, Nursing and Non-clinical groups (P<0.05). The Medical group had the highest mean DP score and this was significantly higher than the Nursing, Allied Health and Non-clinical groups (P<0.05). The Non-clinical group had the lowest PA, which was significantly lower than the Medical, Nursing and Allied Health groups (P<0.005). There was high prevalence of burnout among healthcare professionals in Singapore, especially the allied health professionals. There were significant differences in the 3 categories of burnout (EE, DP and PA) among the different groups of healthcare professionals. There is an urgent need to address the high burnout rate.

Análisis de la situación actual de la cefalea en Andalucía

Introduction and objectiveHeadache is a frequent reason for consultation between primary care physicians, emergency services physicians, and neurology specialists; however, it is not always well managed. The Andalusian Society of Neurology's Headache Study Group (SANCE) aimed to analyse headache management at different levels of care. Material and methodsWe conducted a descriptive cross-sectional study with data gathered through a retrospective survey in July 2019. Participants completed a series of structured questionnaires on different social and work-related variables from 4 different groups of healthcare professionals (primary care [PC], emergency departments, neurology departments, headache units). ResultsA total of 204 healthcare professionals completed the survey: 35 emergency department physicians, 113 PC physicians, 37 general neurologists, and 19 neurologists specialising in headache. Eighty-five percent of PC physicians reported prescribing preventive drugs, which were maintained for at least 6 months (59%), with flunarizine and amitriptyline being the most commonly used. Most patients attended at neurology consultations (65%) are referred by PC physicians, with changes in the headache pattern being the main reason for referral (74%). Healthcare professionals across all levels of care showed great interest in headache and in receiving training in headache management (97% of PC physicians, 100% of emergency services physicians, 100% of general neurologists). ConclusionsMigraine sparks great interest among healthcare professionals from different levels of care. Our results also reveal a lack of resources for headache management, which is reflected in the long waiting times. Other means of bilateral communication between different levels of care should be explored (e.g., e-mail).

Abstract P5-15-02: The risk for locoregional breast cancer recurrences: Significant differences in perceptions among health care professionals (HCPs)

Abstract Introduction: Unlike the highly personalized breast cancer treatment, surveillance in the Netherlands is still ‘one-size-fits-all’: annual imaging and physical examination for at least five year after treatment. To identify patients with a low or high risk for locoregional recurrences (LRRs) who might benefit from less or more intensive surveillance, risk prediction models can be used. The INFLUENCE-nomogram is an example of this and is developed using on data of the Netherlands Cancer Registry. It remains unclear to which extent health care professionals (HCPs) are able to accurately estimate the patient individual risk for locoregional recurrences. Objective: To evaluate the current awareness, knowledge and ability to estimate patients individual risks for locoregional recurrences after breast cancer - without using any prediction tools - among HCPs in the Netherlands. Methods: In this study, a cross-sectional survey was performed among general practitioners (GPs) and HCPs working in breast cancer care in six teaching hospitals in the Netherlands. In total, 85 HCPs (25 GPs and 60 hospital HCPs) participated. HCPs received descriptions of eleven breast cancer cases with different patient-, tumor- and treatment characteristics for which they were asked to estimate the risk for LRRs. The estimations were compared among different groups of HCPs and with the estimation calculated using the INFLUENCE-nomogram. Results: HCPs structurally overestimated the risk for LRRs (ranging from an average overestimation from 4% on one case to 26% on another case). In nine out of eleven cases, significant differences in risk estimates were found between groups of HCPs. In five of the eleven cases, GPs had a significantly higher median estimate than medical oncologists (respectively 10 % vs. 2.5 %; 15 % vs. 5 %; 25 % vs. 6.5 %; 25% vs. 6.5 %; 8 % vs. 1 %; and 12 % vs. 2% on these five cases). Conclusion: The structural overestimation of the risks stresses the importance to create more awareness and knowledge of the risk for LRRs after breast cancer. Medical oncologists seem to estimates risks for recurrences more accurately then GPs. This might be due to the fact that medical oncologists have more experience with the use of risk prediction models (such as Predict) in clinical practice. More awareness and knowledge of the risk for LRRs can be generated using objective estimations by prediction models. This will support the implementation of personalized surveillance after breast cancer. Table: Descriptive statistics predicted five-year risks HCPs and risk estimation INFLUENCE-nomogramCaseNMin.Max.MedianMeanStd. DeviationVarianceRisk estimation INFLUENCE-nomogramAverage overestimation HCPs1a850305***5.805.3028.040.96 %4.84 %1b850708***10.6410.07101.312.29 %8.35 %28536015***17.6712.16147.847.17 %10.50 %3a850305***6.956.8046.231.18 %5.77 %3b850.17010***12.5310.70114.482.27 %10.26 %4a8515010***12.598.3769.980.74 %11.85 %4b850.58019***19.0612.86165.441.72 %17.34 %5a851.56020***20.5713.38179.041.57 %19.00 %5b842.59025***29.6818.70349.783.6 %26.08 %6a630305***7.216.1137.310.64 %6.57 %6b620.14010***11.909.1884.272.94 %8.96 %Results of Wilcoxon one-sample signed rank test *** Median is significantly greater than risk estimation INFLUENCE-nomogram at the 0.001 level. ** Median is significantly greater than risk estimation INFLUENCE-nomogram at the 0.01 level. * Median is significantly greater than risk estimation INFLUENCE-nomogram at the 0.05 level. Citation Format: Jet W. Ankersmid, Pauline E.R. Spronk, Anneke M. Zeillemaker, Sabine Siesling. The risk for locoregional breast cancer recurrences: Significant differences in perceptions among health care professionals (HCPs) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-15-02.

Co-designing a remote rehabilitation tool for Parkinson\u2019s disease: exploratory values and challenges

BackgroundImpaired motor function is one of the early symptoms shown in patients with Parkinson Disease (PD). For this reason, rehabilitative interventions have been used for many years to improve motor and non-motor symptoms. Among them, the use of music therapy has shown benefits in helping to overcome some of the most common motor dysfunction. Addressing the challenge of providing access to this type of therapy, this document presents the collaborative design process to develop a remote training support tool for PD based on music therapy.MethodsA qualitative study with creative co-design methods was used in which different groups of healthcare professionals, patients, and relatives participated in six iterative sessions. Workshops were designed and structured to incrementally discover requirements and needs and validate the proposed prototype ideas.ResultsThe study provided key aspects that were used for the development and validation of the proposed prototypes for the remote music-based training support tool for PD. Up to 20 factors that had a positive and/or negative influence on patient access to training were detected. These factors were classified into three common themes: daily activities and independence, participation in treatment and barriers to daily treatment, and self-management and personalization of information and telecommunication technologies (ICT).ConclusionsThis paper shows the results of a collaborative design process aimed at identifying the different factors, relevant to patients with PD, to improve their access to remote ICT-based training therapy and their expectations regarding alternative therapies, such as music. The participatory design methods and the iterative model used helped overcome many of the traditionally barriers that this type of technological support solutions usually have, facilitating the future participation.

Speech intelligibility of Parkinson’s disease patients evaluated by different groups of healthcare professionals and naïve listeners

Introduction Speech intelligibility, how well a listener comprehends the speaker’s message, is related to the listener’ expertise and type of the message conveyed. There is no evidence about speech intelligibility in different groups of healthcare professionals and naïve listeners. Objectives This study is the first to understand if there were differences in the speech intelligibility of Parkinson’s Disease (PD) patients by different experienced and naïve listeners, according to the speech stimuli and dysarthria severity. Materials and methods Randomly digitised audio-files (50 words and 50 sentences) of 10 PD patients, one without dysarthria and 9 with different dysarthria severities (3 each: mild, moderate and severe dysarthria), were collected from a database of 60 PD patients’ audio-files. A jury panel was formed by five different listeners groups including 10 speech and language therapists, 10 neurologists, 10 PD relatives, 12 PD patients, and 10 people from the general population. The jury panel transcribed single words and sentences from the audio recordings, the percentage correctly understood was calculated and the results were compared between the groups. Results Multiple comparisons showed significant speech intelligibility differences between healthcare professionals and naïve listerners in words (highest effect size, η2 = 0.7) and sentences (the highest effect size: η2 = 0.6). Pairwise comparisons revealed that those significant differences were specifically in words with moderate and severe dysarthria and sentences with all severity levels of dysarthria. Conclusion The groups of healthcare professionals who work with dysarthria are more likely to understand the PD patients’ speech than the groups of naïve listeners.

"… Above All, It's a Matter of This Person's Quality of Life": Health Care Professionals' Perspectives on Deprescribing in Older Patients With Limited Life Expectancy.

Deprescribing may be particularly relevant in older people with limited life expectancy. In order to effectively carry out deprescribing in this population, it is important to understand the perspectives of the full spectrum of health care professionals (HCPs) involved in the management of these patients' medication. Thus, we aimed to explore different HCPs' perspectives on deprescribing in older patients with limited life expectancy. Six qualitative focus group interviews were conducted using a semistructured approach. The groups comprised HCPs from both primary and secondary care, including family physicians (FPs), geriatricians, clinical pharmacologists, clinical pharmacists, nurses, and health care assistants. Interviews were audio recorded and transcribed verbatim. Results were analyzed using systematic text condensation. A total of 32 HCPs participated in the study (median age of 40.5 years; 22% male). The analysis elicited three main themes related to HCPs' perspectives on deprescribing in older patients with limited life expectancy: (a) Approaching deprescribing, (b) Taking responsibility, and (c) Collaboration across professions. Within themes, subthemes were identified and analyzed. Our results imply that different groups of HCPs consider deprescribing an essential aspect of providing good care for older people with limited life expectancy and find that all HCPs play a crucial role in the deprescribing process, with FPs having the primary responsibility. In order to facilitate deprescribing among this population, however, the collaboration between different HCPs should be improved.

Are healthcare professionals being left in the lurch? The role of structural barriers and information resources to promote physical activity to cancer patients.

Although many cancer patients benefit from physical activity (PA), healthcare professionals (HCP) still do not promote it routinely. Including different groups of HCP, this study aimed to examine how structural barriers are perceived as impeding by HCP for promoting PA to cancer patients, how the perceptions of structural barriers are associated with promoting PA, and how HCP react to information resources. A total of 287 physicians in outpatient care, 242 physicians in inpatient care, and 388 oncology nurses completed our questionnaire (paper-pencil or online). Participants assessed nine different structural barriers (on a 4-point Likert Scale) and reported their PA promotion frequency. Further, they could request three different kinds of information resources about PA in oncological settings. Across professional groups, more than 70% of HCP indicated that they promoted PA to their cancer patients often or routinely. Oncology nurses indicated that they were more impeded in promoting PA by six structural barriers than physicians (all p < .01). "Not enough time per patient" and "lack of an expert contact person" were associated with a reduced PA promotion in two professional groups (all p < .05). Information resources were requested by 69.5% of the participants: mostly physicians working in outpatient care and especially by those perceiving structural barriers. Although a big proportion of HCP reported that they frequently promoted PA, our findings suggest that HCP still perceive structural barriers. The perception and influence of structural barriers differed between professional groups, pointing to the importance of profession specific guidance.

Integrated care in Switzerland: Results from the first nationwide survey

IntroductionDue to fragmentation of care delivery, health systems are under pressure and integrated care is advocated for. Compared to the numerous existing integrated care initiatives in Europe and elsewhere, Switzerland seems to lag behind. MethodsThe objective of the survey was to produce a comprehensive overview of integrated care initiatives in Switzerland. To be included, initiatives needed to meet four criteria: present some type of formalization, consider >2 different groups of healthcare professionals, integrate >2 healthcare levels, be ongoing. We systematically contacted major health system organizations at federal, cantonal and local level. Between 2015 and 2016, we identified 172 integrated care initiatives and sent them a questionnaire. We performed descriptive analyses. ResultsIntegrated care initiatives in Switzerland are frequent and increasing. The implementation of initiatives over time, their distribution between linguistic areas, the number of healthcare levels integrated, and the number of professionals involved vary according to the type of initiatives. DiscussionDespite Switzerland's federalist structure and organization of healthcare, and only recent incentives to develop integrated care, initiatives are frequent and diverse. Stakeholders should support existing initiatives and facilitate their development. They should also promote innovative avenues, experiment alternative payment models for integrated care, foster people-centeredness and incentivize interprofessional models. This will require systems thinking and contributions from all actors of the healthcare system.

Comprehensive overview of integrated care in Switzerland: Results of the 1st Swiss Survey on Integrated Care

Introduction: Because of the fragmentation of health care delivery, systems are under pressure and integrated care is advocated for. Compared to the numerous initiatives in this field in Europe and elsewhere, Switzerland seems to lag behind. Methods: The objective of the survey was to produce a comprehensive overview of integrated care initiatives in Switzerland. To be included, initiatives needed to meet the following four criteria: some type of formalization, > 2 different groups of healthcare professionals, integration of > 2 levels of care, currently ongoing. We systematically contacted major organizations of the Swiss health system (providers, regulators, financers, educational and research structures, as well as professional and community organizations) at the national, federal, cantonal and local levels. We also approached experts and used the “snow-ball effect” to increase our reach. Between July 2015 and 2016, 172 integrated care initiatives were identified. They were sent self-reported questionnaire in order to collect data on localisation, target groups, professionals involved, services offered, levels integrated, funding sources, etc. Initiatives were empirically divided into six categories: Health centres, Physicians’ networks, Programs focusing on medication, Projects in mental health & psychiatry, Initiatives targeting specific groups of patients, Programs focusing on transition & coordination. Descriptive analyses of the results were performed. Results: Results from the 162 completed questionnaires revealed important differences between the linguistic regions of Switzerland: there were more “Physicians’ networks” and “Health centres” in the German part of Switzerland, whereas “Specific target-groups”, “Medication” and “Transition & Coordination” initiatives were more frequent in the French and Italian regions. Among numerous differences across categories, “Health Centres” reported the broadest integration, while “Medication Programs” indicated the narrowest; “Transition & Coordination” initiatives were mostly funded by public health departments, while “Health centres” and “Physicians’ networks” reported being mostly financed by health insurances. Discussion: The 162 included initiatives presented unexpected high frequency, heterogeneity and diversity. Empirical categorization of initiatives revealed differences in the models available across linguistic regions of Switzerland, as well as differences across categories: in the number of levels of care integrated, and in the funding sources. Conclusion: This survey intended to produce a first comprehensive overview of integrated care initiatives in Switzerland. Despite this country’s federalist structure and limited incentives to develop integrated care, initiatives were shown to be frequent and diverse. The differentiated picture revealed by the empirical categorization of initiatives raises up questions about the potential impact of the context on the implementation of specific models. Such results should be of interest to stakeholders both in Switzerland and elsewhere. Limitations: The strength of this project was the systematic and comprehensive search of initiatives across a whole country. Accuracy and representativeness of the results was reinforced by the 94% response rate achieved. Weaknesses included the fact that initiatives might have been missed and that data remained self-reported and liable to bias. Suggestions for future research: Empirical categorization of Swiss results might be refined to further explore characteristics of contexts enabling the emergence of integrated care initiatives. Similar comprehensive surveys could be replicated to compare findings across various political and health systems.

Cross-sector user and provider perceptions on experiences of shared-care clozapine: a qualitative study

Objectives(1) To explore individual perceptions on experiences of people receiving and/or delivering a shared-care clozapine serviceand (2) to gain an understanding of effectiveness and acceptability of shared-care clozapine.DesignInterpretative phenomenological analysis...

A realist analysis of hospital patient safety in Wales: applied learning for alternative contexts from a multisite case study

BackgroundHospital patient safety is a major social problem. In the UK, policy responses focus on the introduction of improvement programmes that seek to implement evidence-based clinical practices using the Model for Improvement, Plan-Do-Study-Act cycle. Empirical evidence that the outcomes of such programmes vary across hospitals demonstrates that the context of their implementation matters. However, the relationships between features of context and the implementation of safety programmes are both undertheorised and poorly understood in empirical terms.ObjectivesThis study is designed to address gaps in conceptual, methodological and empirical knowledge about the influence of context on the local implementation of patient safety programmes.DesignWe used concepts from critical realism and institutional analysis to conduct a qualitative comparative-intensive case study involving 21 hospitals across all seven Welsh health boards. We focused on the local implementation of three focal interventions from the 1000 Lives+patient safety programme: Improving Leadership for Quality Improvement, Reducing Surgical Complications and Reducing Health-care Associated Infection. Our main sources of data were 160 semistructured interviews, observation and 1700 health policy and organisational documents. These data were analysed using the realist approaches of abstraction, abduction and retroduction.SettingWelsh Government and NHS Wales.ParticipantsInterviews were conducted with 160 participants including government policy leads, health managers and professionals, partner agencies with strategic oversight of patient safety, advocacy groups and academics with expertise in patient safety.Main outcome measuresIdentification of the contextual factors pertinent to the local implementation of the 1000 Lives+patient safety programme in Welsh NHS hospitals.ResultsAn innovative conceptual framework harnessing realist social theory and institutional theory was produced to address challenges identified within previous applications of realist inquiry in patient safety research. This involved the development and use of an explanatory intervention–context–mechanism–agency–outcome (I-CMAO) configuration to illustrate the processes behind implementation of a change programme. Our findings, illustrated by multiple nested I-CMAO configurations, show how local implementation of patient safety interventions are impacted and modified by particular aspects of context: specifically, isomorphism, by which an intervention becomes adapted to the environment in which it is implemented; institutional logics, the beliefs and values underpinning the intervention and its source, and their perceived legitimacy among different groups of health-care professionals; and the relational structure and power dynamics of the functional group, that is, those tasked with implementing the initiative. This dynamic interplay shapes and guides actions leading to the normalisation or the rejection of the patient safety programme.ConclusionsHeightened awareness of the influence of context on the local implementation of patient safety programmes is required to inform the design of such interventions and to ensure their effective implementation and operationalisation in the day-to-day practice of health-care teams. Future work is required to elaborate our conceptual model and findings in similar settings where different interventions are introduced, and in different settings where similar innovations are implemented.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

Health of the healthcare professionals: A risk assessment study on work-related musculoskeletal disorders in a tertiary hospital, Chennai, India

Background: Healthcare profession is known to be at high risk for work related musculoskeletal disorders (WMSDs). It is estimated that almost one-third of all cases of sick leave among healthcare workers are related to WMSDs. Many studies are conducted, which measured the variety of factors across a range of occupations at different levels of risk. However, relation of current exposure to the risk of developing WMSDs is indeed an area to be looked into. Hence, the current study evaluated current exposure and risk of developing WMSDs among different groups of healthcare professionals. Materials and Methods: This was a cross-sectional exposure-risk assessment study, conducted on 140 healthcare professionals, including dentists, laboratory technicians, nurses, physicians and physiotherapists of various clinical departments in a tertiary care hospital in Chennai, India from January to June 2013. Face-to-face interviews and observational analysis of various job tasks were employed. Different combinations of validated and standardized questionnaires were used for collecting different types of data. Results: The exposure and risk assessment on occurrence of WMSDs indicates that nurses are at the highest risk for developing WMSDs, followed by dentists and physiotherapists whereas laboratory technicians and physicians have the least. Among the participants who reported MSDs pain, more than half of the cases were related to work. Conclusion: Among all the healthcare professions, nurses were found to be the high risk group, whereas physicians were found to be the low risk group. We recommend that education, awareness, and training programs on prevention and coping strategies for MSDs be made mandatory for healthcare professionals.