Lack Of Financial Compensation Research Articles

Deprescribing NSAIDs: The Potential Role of Community Pharmacists.

Non-steroidal anti-inflammatory drugs (NSAIDs) are largely used for controlling various pain conditions and are widely available in community pharmacies, with and without prescription. Despite their effectiveness, NSAIDs can pose significant risks due to potential side effects and drug interactions, particularly in polypharmacy and comorbidity contexts and for vulnerable users. This study investigated whether and how NSAIDs deprescribing can be conducted at the community pharmacy level by assessing pharmacists' confidence, attitudes, and potential barriers and facilitators. Additionally, we aimed to identify any deprescribing guidelines that pharmacists could use. A literature search and a cross-sectional digital questionnaire targeting community pharmacists in Norway were conducted. Results showed that study participants (N = 73) feel confident in identifying needs for deprescribing NSAIDs but barriers such as time constraints, lack of financial compensation, and communication challenges were noted. Participants reported positive attitudes toward deprescribing but highlighted a need for better guidelines and training. This study highlights a gap in specific guidelines for deprescribing NSAIDs and a potential for enhancing pharmacists' roles in the deprescribing process, for example, through training and improved financial incentives. Further research is encouraged to develop concrete strategies for an effective implementation where community pharmacists can be involved in the deprescribing of NSAIDs.

Simulation-based medical education in Canadian anesthesiology academic institutions: a national survey.

Simulation-based medical education (SBME) is provided by all anesthesiology residency programs in Canada. The purpose of this study was to characterize SBME in Canadian anesthesiology residency training programs. We administered a 21-question survey to the simulation director/coordinator for all 17 Canadian academic departments of anesthesiology from October 2019 to January 2020. The survey consisted of questions pertaining to the characteristics of the simulation centres, their faculty, learners, curriculum, and assessment processes. All 17 residency training programs participated in the survey and reported large variability in the number and formal training of simulation faculty and in content delivery. Five programs (29%) did not provide faculty recognition for curriculum design and running simulation sessions. Most programs offered one to four simulation sessions per academic year for each year of residency. All programs offered mannequin-based and part-task trainers for teaching technical and nontechnical skills. Fourteen programs (82%) offered interprofessional and interdisciplinary simulation sessions, and ten programs (59%) did not include in situ simulation training. Commonly reported barriers to faculty involvement were lack of protected time (12 programs, 71%), lack of financial compensation (ten programs, 59%), and lack of appreciation for SBME (seven programs, 41%). Large variability exists in the delivery of SBME in Canadian anesthesiology residency simulation programs, in part because of differences in financial/human resources and educational content. Future studies should explore whether training and patient outcomes differ between SBME programs and, if so, whether additional standardization is warranted.

Perspectives on the Use of Digital Health Technologies in Cardiology Among Specialists from an ESC Member Country: Results from a Survey.

In this study, we aimed to identify the reasons for and perceived challenges associated with the use of digital health technologies (DHT) in cardiology. We distributed an online survey to Turkish Society of Cardiology member cardiologists (n = 2789) between January 10 and March 3, 2022. A total of 308 subjects responded (27.6% females, 62.0% aged 30-44 years). Of these, 42.5% worked at university hospitals, and 44.8% at state hospitals. Smart devices were used by 44.2% (136/308) for personal health monitoring. Additionally, 40.3% (117/290) used social media to provide medical information to patients, while 64.6% (193/299) did so for communication with other physicians. The self-reported recommendation frequencies of wearables, cardiac implantable electronic device telemonitorization, mobile health applications, and teleconsultation/televisit technologies were lower than the proportion of respondents who found DHT beneficial for both patients and physicians. The most frequently mentioned barriers for physicians were increased work burden and responsibilities (78.8%, 193/245), lack of financial compensation (66.9%, 164/245), and lack of relevant training (66.5%, 163/245). For patients, low technological adaptability (81.6%, 200/245), low health literacy (80.4%, 197/245), and low affordability (79.6%, 195/245) were the most frequently mentioned barriers. Additionally, the cost of technologies (69.4%, 170/245), concerns regarding data privacy and security (57.6%, 141/245), and data storage challenges (48.2%, 118/245) were the most significant technical impediments. The findings suggest that although the majority of physicians believe DHT to be beneficial for both themselves and their patients, the frequency of recommendations to patients remains low. A large-scale joint effort is required to address these issues and facilitate the integration of DHT into clinical practice.

Performance accuracy, advantages and limitations of a store-and-forward teledermatology platform developed for general practitioners: A retrospective study of 298 cases

BackgroundStore-and-forward (SAF) tele-dermatology (TD) platforms could help promote coordination between hospital and general practitioners (GPs). However, very little data exists on the performance accuracy and opinions of GPs participating in this type of project in France. MethodsWe report on the diagnostic and management plan accuracy of an SAF-TD platform developed for neighbouring GPs around our hospital compared with routine face-to-face (FTF) dermatological consultation in our department. We also compared the accuracy of SAF-TD with that of the participating GPs. Lastly, we collected feedback from GPs after their participation in this project. ResultsOverall, 298 patients were included by 58 GPs between November 2016 and January 2020, of whom 169 (57%) were female, and with a median age of 44.5 years (range 0–96). The diagnostic accuracy of TD was 62% (n=184/298) for the initial hypothesis and 80% (n=239/298) for aggregated diagnostic accuracy. Management plan accuracy for TD was 81% (n=225/277). At least 43% of consultations (n=127/298) met the criteria for preventable consultation. Diagnostic accuracy for the initial hypothesis was significantly lower for GPs than for TD (Odd Ratio [OR]=0.34; 95% Confidence Interval [95% CI]: 0.20–0.56; p<0.0001), as was management plan accuracy (OR=0.23; 95% CI: 0.10–0.46; p<0.0001). Among the responding GPs, 78% (n=29) reported very high satisfaction and 97% would consider integrating this type of programme in their long-term practice, but they highlighted the time-consuming nature of the platform (46%) and the lack of financial compensation (44%). ConclusionSAF-TD in coordination with GPs seems safe and efficient in the management of outpatients, and enjoys a high satisfaction rate among GPs, despite its time-consuming nature and the lack of financial compensation. Healthcare policy should promote financial participation to help the expansion of TD.

Barriers and facilitators to program directors\u2019 use of the medical education literature: a qualitative study

BackgroundIt is unclear how often frontline clinical teachers are using this literature and its evidence base in teaching and assessment. Our study purpose was to examine postgraduate program director perspectives on the utilization and integration of evidence-based medical education literature in their teaching and assessment practices.MethodsThe authors conducted semi-structured telephone interviews with a convenience sample of current and former program directors from across Canada. Interviews were transcribed and analyzed inductively to distil pertinent themes.ResultsIn 2017, 11 former and current program directors participated in interviews. Major themes uncovered included the desire for time-efficient and easily adaptable teaching and assessment tools. Participants reported insufficient time to examine the medical education literature, and preferred that it be ‘synthesized for them’. (i.e., Best evidence guidelines). Participants recognised continuing professional development and peer to peer sharing as useful means of education about evidence-based tools. Barriers to the integration of the literature in practice included inadequate time, lack of financial compensation for teaching and assessment, and the perception that teaching and assessment of trainees was not valued in academic promotion.DiscussionFaculty development offices should consider the time constraints of clinical teachers when planning programming on teaching and assessment. To enhance uptake, medical education publications need to consider approaches that best meet the needs of a targeted audiences, including frontline clinical teachers. This may involve novel methods and formats that render evidence and findings from their studies more easily ‘digestible’ by clinical teachers to narrow the knowledge to practice gap.

Perspectives of primary care physicians and pharmacists on interprofessional collaboration in Kuwait: A quantitative study.

Collaborative practice between physicians and pharmacists has a positive effect on healthcare outcomes. Understanding the local data related to this collaboration is vital in establishing efficient collaboration. Therefore, this study was designed to assess the collaborative relationships between physicians and pharmacists working in the primary healthcare centres regarding their attitudes and experiences, preferred methods of communication, perceptions related to the role of pharmacists, areas of potential further collaboration, and perceived barriers. A cross-sectional study was conducted using two parallel pretested self-administered questionnaires on a sample of 518 randomly selected physicians and pharmacists. Descriptive and comparative analyses were used in data analysis. The overall response rate was 86.3%. Although over 98% of respondents agreed that physician-pharmacist collaboration improves patient outcomes, more than half of the physicians (52.1%) and pharmacists (55.7%) had never practised collaboratively. Both groups preferred to communicate face-to-face (76.7%) or via telephone (76.5%). Both professions showed good agreement on pharmacists’ roles related to managing side effects, improving adherence, assisting in dosage adjustment, providing advice regarding drug interactions, and providing drug information to physicians. They indicated disagreements on the importance of dispensing of prescriptions and providing advice to physicians regarding modification of drug therapy. Both groups expressed overall positive perceptions of the potential for further collaboration in areas related to the clinical roles of pharmacists, which were significantly higher among those with practice experience of < 10 years and those aged < 40 years (p<0.05). The top four perceived barriers to collaborative practice were lack of time (84.1%), lack of financial compensation (76.3%), lack of face-to-face communication (68.9%), and the possible fragmentation of patient care by the involvement of multiple healthcare professionals (68.9%). The present findings provide valuable input that could be a catalyst to enhance or establish physician-pharmacist collaboration in primary healthcare settings in Kuwait.

Barriers to and facilitators of the implementation of multi-disciplinary care pathways in primary care: a systematic review

BackgroundCare pathways (CPWs) are complex interventions that have the potential to reduce treatment errors and optimize patient outcomes by translating evidence into local practice. To design an optimal implementation strategy, potential barriers to and facilitators of implementation must be considered.The objective of this systematic review is to identify barriers to and facilitators of the implementation of CPWs in primary care (PC).MethodsA systematic search via Cochrane Library, CINAHL, and MEDLINE via PubMed supplemented by hand searches and citation tracing was carried out. We considered articles reporting on CPWs targeting patients at least 65 years of age in outpatient settings that were written in the English or German language and were published between 2007 and 2019. We considered (non-)randomized controlled trials, controlled before-after studies, interrupted time series studies (main project reports) as well as associated process evaluation reports of either methodology. Two independent researchers performed the study selection; the data extraction and critical appraisal were duplicated until the point of perfect agreement between the two reviewers. Due to the heterogeneity of the included studies, a narrative synthesis was performed.ResultsFourteen studies (seven main project reports and seven process evaluation reports) of the identified 8154 records in the search update were included in the synthesis. The structure and content of the interventions as well as the quality of evidence of the studies varied.The identified barriers and facilitators were classified using the Context and Implementation of Complex Interventions framework. The identified barriers were inadequate staffing, insufficient education, lack of financial compensation, low motivation and lack of time. Adequate skills and knowledge through training activities for health professionals, good multi-disciplinary communication and individual tailored interventions were identified as facilitators.ConclusionsIn the implementation of CPWs in PC, a multitude of barriers and facilitators must be considered, and most of them can be modified through the careful design of intervention and implementation strategies. Furthermore, process evaluations must become a standard component of implementing CPWs to enable other projects to build upon previous experience.Trial registrationPROSPERO 2018 CRD42018087689.

Determinants of Hospital-based Physician Participation in Quality Improvement: A Survey of Hospitalists in British Columbia, Canada

Abstract Objective: We aimed to understand the extent of hospitalist involvement in system improvement efforts across the province of British Columbia in Canada and provide insights into determinants of such participation. Materials and Methods: We designed a web-based survey and asked about individual, programmatic, and institutional characteristics that may facilitate or impair hospitalist involvement in quality improvement (QI) activities. The survey was sent to all individuals who participated in “hospitalist care” from January 2014 to February 2015, in the province of British Columbia, Canada. We conducted both quantitative and qualitative analysis of responses. Results: We received 57 complete responses to the survey of 322 invited individuals (17.7% response rate). Of these, 15 individuals (26.3%) indicated that they had participated in QI initiatives. Respondents highlighted high clinical workload and lack of time, lack of QI skills and training, lack of access to performance data, poor support from hospital/health authority administration, and lack of financial compensation as main barriers to QI involvement. These themes were also supported in logistic regression, where QI training and the number of weeks worked as a hospitalist showed significant predictive properties for involvement in QI initiatives. Conclusion: Our study attempts to understand the various individual or organizational attributes that could facilitate involvement by hospital-based generalist physicians in QI activities. Our findings show lack of formal QI training is an important barrier for hospitalist involvement in QI, and highlight the need for formal training, dedicated time, support from physician leadership, and financial incentive as important facilitators for participation in systemic improvement efforts.

Pharmacists’ and patients’ views and feedback on Italian Medicines Use Review (I-MUR)

Rationale, aims and objectives: Although medicine review services are offered by community pharmacists in many countries, they are non-existent in Italy. A novel intervention, I-MUR, was developed for patients with asthma aiming to improve medicines use. The aim of this study was to obtain pharmacists’ and patients’ views on the acceptability of the I-MUR service provided by community pharmacists to asthma patients in 4 Italian regions. Methods: Pharmacists’ expectations, experiences and attitudes to delivering the I-MUR were obtained through questionnaires distributed before and after delivering the I-MUR, plus focus groups. Patients’ views were obtained via questionnaires, distributed by the pharmacists and returned anonymously.Results: Seventy-four pharmacists provided the I-MUR service to 895 asthma patients; 49 pharmacists completed both questionnaires, 53 participated in focus groups and 246 patients returned questionnaires. Barriers anticipated most frequently by pharmacists before the I-MUR were lack of time (53%) and lack of co-ordination with other health professionals (61%), while lack of financial compensation was identified by 37%. Lack of co-ordination proved the most common actual barrier (88%), with lack of financial compensation being cited less frequently after providing the intervention (8%). Ninety-six percent of pharmacists anticipated providing both education on inhaler technique and medication counselling, but in practice slightly fewer had provided these (90% and 86% respectively). Focus groups highlighted a lack of relevant undergraduate education to support medication review and structural barriers within some pharmacies, but described positive patient feedback and a desire to extend the I-MUR. Patient respondents were positive; 62% indicated the reason for having an I-MUR as making sure that they were using medication correctly, 75% considered they benefited from it and 86% would recommend it to others.Conclusions: The I-MUR service was perceived positively by both pharmacists and patients, supporting the extension of medicine review services to community pharmacists in Italy in an enhancement of the person-centeredness of care.

Understanding the factors affecting the attraction and retention of health professionals in rural and remote areas: a mixed-method study in Niger

BackgroundThe critical shortage of human resources in health is a critical public health problem affecting most low- and middle-income countries, particularly in sub-Saharan Africa. In addition to the shortage of health professionals, attracting and retaining them in rural areas is a challenge. The objective of the study was to understand the factors that influence the attraction and retention of health professionals working in rural areas in Niger.MethodsA mixed-method study was conducted in Tillabery region, Niger. A conceptual framework was used that included five dimensions. Three data collection methods were employed: in-depth interviews, documentary analysis, and concept mapping. In-depth interviews were conducted with three main actor groups: policy-makers and Ministry of Health officials (n = 15), health professionals (n = 102), and local health managers (n = 46). Concept mapping was conducted with midwifery students (n = 29). Multidimensional scaling and cluster analysis were performed to analyse the data from the concept mapping method. A content analysis was conducted for the qualitative data.ResultsThe results of the study showed that the local environment, which includes living conditions (no electricity, lack of availability of schools), social factors (isolation, national and local insecurity), working conditions (workload), the lack of financial compensation, and individual factors (marital status, gender), influences the attraction and retention of health professionals to work in rural areas. Human resources policies do not adequately take into account the factors influencing the retention of rural health professionals.ConclusionIntersectoral policies are needed to improve living conditions and public services in rural areas. The government should also take into account the feminization of the medical profession and the social and cultural norms related to marital status and population mobility when formulating human resources management policies.

Factors influencing decisions about a career in hepatology: A survey of gastroenterology fellows.

Despite an unmet need for hepatologists in the United States, every year transplant hepatology (TH) fellowship positions remain unfilled. To address this, we investigated factors that influence trainee decisions about pursuing a career in hepatology. We invited current gastroenterology (GI) and TH fellows from all Accreditation Council for Graduate Medical Education‐accredited programs for the academic year 2014‐2015 to participate in an online survey about factors influencing decisions to train in hepatology. The same paper‐based survey was distributed at a nationally recognized GI board review course. The survey was completed by 180 participants of which 91% were current GI or TH fellows and 24% were not aware of the pilot 3‐year combined GI and TH training program. A majority of respondents (57%) reported that a shorter time (3 versus 4 years) to become board certification eligible would influence their decisions to pursue TH. The most common reasons for not pursuing hepatology were less endoscopy time (67%), additional length of training (64%), and lack of financial compensation (44%). Personal satisfaction (66%), management of complex multisystem disease (60%), and long‐term relationships with patients (57%) were the most attractive factors. Sixty‐one percent of participants reported having a mentor, and 94% of those with mentors reported that their mentors influenced their career decisions. Conclusion: We have identified several factors that affect fellows' decision to pursue TH. Shorter training, increased financial compensation, and increased endoscopy time are potentially modifiable factors that may increase the number of trainees seeking careers in hepatology and help alleviate the deficit of hepatologists. (Hepatology Communications 2017;1:347–353)

Dropping Out or Dropping In? A Connectivist Approach to Understanding Participants’ Strategies in an e-Learning MOOC Pilot

Targeting faculties and external mentors in the teacher-training unit, The Norwegian University of Science and Technology in Trondheim, Norway opened up a Massive Open Online Course (MOOC) pilot on digital learning in the fall of 2014. A main objective was to encourage these to use digital media more actively and hence, also to become role models for their own students’ future digital practice. However, research has shown that a main concern with MOOC programs is attrition. In line with those findings, and according to the course platform data, none of the MOOC participants completed the course material. As the course progressed, less and less pages were opened and obligatory assignments were only rarely submitted. The participants may thus be described as dropouts. Five of these participants were then interviewed about their MOOC experiences and activities. The interviews were transcribed and analyzed according to Grounded theory procedures. A general finding was that the informants would in fact put some of the material and ideas from the MOOC to use. Even if they dropped out, this indicates a gain from the course. In fact, some of the material that was introduced significantly changed these informants’ digital practices when they tested out new ideas in their own teaching. Frame-factors, such as lack of financial compensation or a nonstop flow of competing tasks, however, led the informants to down-prioritize the formal demands in the MOOC pilot. The informants selectively picked the material that suited their own purpose and therefore qualified as “drop-ins” rather than “drop-outs”. Rather than quitters who could not keep up with the pace in the MOOC we met media literate participants who remixed and redefined the MOOC content into a Web 2.0 resource and a stepping stone for self-directed online learning.

Residents training in private practice : Conflicts between circumstances, willingness, and reality

The increasing average age of urologists in private practice and outpatient treatment needs means that there is an increased demand for young urologists to cover outpatient care. Due to the increasing range of treatments, residents lack the mediation of those treatment methods and medical conditions which are necessary to become competent in the complete field of urology. To assess the willingness, the requirements, and the current implementation of residents training in private practice. A14-item online survey was sent to 1326 urologists in private practice to measure the willingness, the requirements, and the current implementation of residents training. Of the 219 (17 %) respondents, 25 % have already trained residents, 41 % were authorized to provide training to residents, and 87 % have taken the appointment of atrainee into consideration. The main reason for employing atrainee was the enjoyment of the teaching experience. The main reason against employing atrainee was the lack of financial compensation. Urologists in private practice are willing and able to participate in residents' training. An extended integration of urological training into private practice can contribute to ensure the teaching of awide variety of diseases/procedures and influence structural changes in the field of urology. Residents, private practitioners, and clinicians should search for solutions together with those responsible in the health care system for better integration of private practice into urology residents training.

SHA 086. Risk predicators of coronary heart diseases (CHD) among females in Benghazi – Libya

Cardiac catheterization laboratory is a specialized cardiac unit utilizing the state-of-the art technology in providing high quality of care that is efficient, effective and affordable. Nurses working in the cardiac cath lab are performing a unique duty requires high level of training and proficiency in the skills and other interpersonal skills as they are working with cardiologists and cardiovascular technologists. The aim and purpose of this paper is to: Explore the basic and advanced entry requirements to be a ‘‘Cardiac Cath Lab Expert’’ including the qualifications/ degrees, credentials, competencies and training. Discuss the primary and secondary duties of the cardiac cath lab nurse ‘‘Scope of Practice’’. What is beyond the scope of practice? The educational structure of the National Guard Health Affair-Cardiac Cath Lab: review the training courses and residency programs. The major constraints to implement such programs and courses are: The availability of physician’s preferences instead of standards and guidelines. Staff Turnover. Lack of resources: time and equipments. Lack of participants. Lack of lack of support. Lack of financial compensation. The key factors to succeed in expanding the role of the nurse in the Cardiac cath lab are: Managerial and educational support. Availability of resources to enhance the knowledge and skills up to advanced biomedical technology. 196 Abstract for SHA22

Barriers to compliance with OBRA'90 regulations in community pharmacies.

To identify which barriers have been most significant to community pharmacists in their ability to comply with the Omnibus Budget Reconciliation Act of 1990 (OBRA'90) regulations during its first year of implementation. Mailing of a two-page survey in April 1994. Four hundred randomly selected community pharmacies in the Commonwealth of Massachusetts. Of 400 pharmacies surveyed, 156 surveys were completed and returned for analysis. Barriers that were considered most significant to pharmacies surveyed in their ability to implement OBRA'90 regulations were excessive workload, lack of financial compensation, and patients' attitudes. Of least significance were inadequate knowledge about drugs, inadequate references, and store layout. Almost half the responding pharmacists indicated that OBRA'90 regulations had not affected or changed their practice, one-quarter of the pharmacists believed their practice was less rewarding after OBRA'90, and about one-fifth believed it was more rewarding. Community pharmacists in Massachusetts are making an attempt to comply with OBRA'90, but there are specific barriers that are affecting their ability to do so. The OBRA'90 regulations appear to have had little impact on the practice of most community pharmacies. Community pharmacy management needs to examine (1) expanded roles of supportive personnel to give pharmacists more time to spend counseling patients, (2) reimbursement mechanisms for cognitive service, and (3) approaches to educating patients about these changes in the pharmacy profession.