Non-clinical Work Research Articles

Cost-Effective Care Coordination for People With Dementia at Home.

Background and ObjectivesPeople with dementia (PWD) represent some of the highest-need and highest-cost individuals living in the community. Maximizing Independence (MIND) at Home is a potentially cost-effective and scalable home-based dementia care coordination program that uses trained, nonclinical community workers as the primary contact between the PWD and their care partner, supported by a multidisciplinary clinical team with expertise in dementia care.Research Design and MethodsCost of care management services based on actual time spent by care management personnel over first 12 months of MIND at Home intervention was calculated for 342 MIND at Home recipients from Baltimore, Maryland and surrounding areas participating in a Centers for Medicare and Medicaid Services (CMS) funded Health Care Innovation Award demonstration project. Difference-in-differences analysis of claims-based Medicaid spending of 120 dually-eligible MIND at Home participants with their propensity score matched comparison group (n = 360).ResultsThe average cost per enrollee per month was $110, or $1,320 per annum. Medicaid expenditures of dually-eligible participants grew 1.12 percentage points per quarter more slowly than that of the matched comparison group. Most savings came from slower growth in inpatient and long-term nursing home use. Net of the cost of the 5-year MIND at Home intervention, 5-year Medicaid savings are estimated at $7,052 per beneficiary, a 1.12-fold return on investment.Discussion and ImplicationsManaged care plans with the flexibility to engage community health workers could benefit from a low-cost, high-touch intervention to meet the needs of enrollees with dementia. Limitations for using and reimbursing community health workers exist in Medicare fee-for-service, which CMS should address to maximize benefit for PWD.

COVID-19 and SARS-CoV-2 Seropositivity in Children of Healthcare Workers in London

Background: The COVID-19 pandemic in the UK began in late January 2020 and peaked in mid-April before declining. Children typically develop only very mild symptoms and it remains unclear what role children play in the spread of COVID-19. The aim of this study was to report the prevalence of SARS-CoV-2 antibodies in healthy children of healthcare workers. Methods: Healthy children of healthcare workers, were recruited in London during May 2020. Participants had nose and throat swabs tested for SARS-CoV-2 infection via RT-qPCR and blood serums samples for SARS-CoV-2 immunoglobulin G (IgG) antibodies. Findings: A total of 215 children from 126 families took part and 25(12%) were seropositive for SARS-CoV-2. Children of clinical healthcare workers were significantly more likely to be seropositive 23/133(17%) than those of non-clinical healthcare workers 2/83(2%); p=0.001.In children of parents with confirmed COVID-19, seropositivity was 19/47(40%) compared to 3/44(7%) in children of parents with suspected COVID-19 and 3/124(2%) in children of asymptomatic parents (pInterpretation: The secondary attack rate in children of healthcare workers with confirmed COVID-19 was 40% compared to 2% of children in families with no reported symptoms. One in three seropositive children were asymptomatic.Trial Registration: NCT0434740Funding Statement: This study was funded by the Public Health Agency [COM/5596/20].Declaration of Interests: None disclosed.Ethics Approval Statement: The London (Chelsea) research ethics committee reviewed the study protocol and provided a favourable outcome (Project ID 282617, OREC ID 20/HRA/1731).

Levels and correlates of job satisfaction and quality of life among clinical and non-clinical staff in a teaching hospital in Nigeria

The objective of the paper is to assess the levels and correlates of JS and QoL of clinical and non-clinical health workers in University of Port Harcourt Teaching Hospital. Comparative, cross-sectional study of 440 staff selected by stratified sampling and administered Minnesota job satisfaction (MSQ) and WHO quality of life (WHO-BREF-QoL) questionnaires were used. Response rate was 80.5% and Cronbach's alphas were 0.91 and 0.84 for the MSQ and WHO-BREF-QoL, respectively. The low level of JS and moderate QoL showed significant differences in the intrinsic JS, social and general health domains of QoL. Age, marital status, education and working years showed associations with JS while education and working years with QoL. A moderate but significant association was observed between JS and QoL. JS and QoL among HCWs were low and mitigating remediable factors of poor JS and QoL can improve quality, safety, and efficiency of healthcare delivery.

Dental Students' Non-Clinical Learning During Community-Based Experiences: A Survey of U.S. Dental Schools.

Dental schools use community-based dental education (CBDE) to ensure students gain experience in treating diverse and underserved patient populations. However, it is unclear to what extent schools utilize CBDE experiences to increase students' knowledge of structural factors impacting access to care. The aim of this study was to determine the level and types of non- clinical learning included in CBDE experiences and how that learning is being assessed across U.S. dental schools. This cross- sectional analysis used an 18-item questionnaire distributed to associate deans and CBDE directors at all 66 U.S. dental schools. The questions focused on rotation structure, CBDE objectives, and didactic content for CBDE programs. Representatives from 31 schools-public (71%) and private (29%)-responded, for a 44% response rate. The primary objectives for the community-based rotations were reported to be demonstrating cultural competence in diverse clinical settings (93.1%), addressing access to care (86.2%), and diagnosing and treating oral diseases (75.9%). Of the respondents, 73% reported that their schools supported clinical experiences with non-clinical didactic course work, which addressed access to care (95%), professional responsibility (91%), social determinants of health (86%), the U.S. health care system (77%), health policy (73%), practice management (73%), motivational interviewing (50%), and public presentation training (32%). The results suggest that U.S. dental schools are using CBDE rotations to provide didactic content and assessing students on their knowledge of access to care, social determinants of health, interprofessional practice, and oral health policy. These important aspects of students' education provide additional evidence of the value of CBDE in dental education.

The “All of Us” study – Non-clinical staff members’ experience of performing cardiopulmonary resuscitation in acute care settings

BackgroundA multitude of Australian hospitals use non-clinical staff to assist with chest compressions and ancillary duties during cardiopulmonary resuscitation. Whilst few studies have focused on psychological implications for non-clinical staff, research into other groups indicates that a lack of attention to psychological support may adversely impact individual wellbeing, team functioning and clinical performance.The aim of this study was to explore how non-clinical workers were psychologically affected during cardiopulmonary resuscitation and factors that might mitigate adverse psychological effects. MethodsThis study utilised a qualitative descriptive methodology involving semi-structured, face to face interviews to investigate the experiences of non-clinical staff involved in cardiopulmonary resuscitation. Data was collected using semi-structured interviews and a validated Post Traumatic Stress rating scale. ResultsThe study found that all 12 participants had experienced critical incident stress symptoms following their involvement in resuscitation attempts, though only one had ongoing evidence of Post Traumatic Stress Disorder.Participants felt that they needed more psychological preparation and that post-incident debriefs had been helpful but inconsistently provided and facilitated. Peer support was seen as the most significant factor in mitigating the psychological impact of critical incidents. ConclusionThis study shows that the development and formalisation of peer support networks for non-clinical health staff warrants serious consideration. The study also indicates that non-clinical members of resuscitation teams may benefit from more psychological preparation and support with self-care.

Clinical capacity of Australian and New Zealand psychiatrists who work with people with intellectual and developmental disabilities

To describe the characteristics and clinical capacity of Australian and New Zealand psychiatrists working in intellectual and developmental disability mental health (IDDMH). Consultant psychiatrists (n=71) with an interest or expertise in IDDMH completed an online survey about their roles, experience and time spent in intellectual developmental disability (IDD)-related activities. Psychiatrists had worked in IDDMH for a median of 11.34 years and half (53.5%) reported expertise in the area. One-fifth of psychiatrists reported IDDMH as their main area of practice. The majority of respondents (85.1%) reported that they were working clinically with people with IDD. Respondents practicing clinically worked a median of 8 hours in clinical and 3 hours in non-clinical IDD-related work per week. Surveyed psychiatrists had considerable experience in IDDMH. However, their work in IDDMH represented a relatively small proportion of their overall work hours, and a minority of respondents were responsible for a large proportion of clinical work. Exploring ways to broaden capacity is crucial to ensuring the mental health needs of people with IDD are met.

Negotiating the boundaries between clinical and non-clinical work within a supported housing program

Many contemporary mental health care programs rely on cross-agency models of service delivery. In these models, staff from different organizations provide care for the same clients, and this requires negotiation around role boundaries. In Australia, cross-agency programs have been developed to promote collaboration between government and not-for-profit community groups to meet the needs of those with serious mental health problems. Policy makers need to be aware of how staff in these roles conceptualize the boundaries and interconnection of their work with others to ensure that program goals are achieved. This study examined the division of labor that emerged between support workers (employed by the not-for-profit sector) and government health workers within a cross agency supported housing program for people with serious mental illness at risk of homelessness and self-neglect. Interviews were conducted with 40 government health workers and 37 staff from non-government agencies that shared clients in a supported housing program. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. While the division between clinical and non-clinical work was accepted and co-produced, tensions arose in defining the boundaries between them. These tensions resulted from poor communication on the part of both groups, perceived lack of clinical intervention by case managers, high caseloads of case managers, role ambiguity, and support workers feeling their input and feedback were not valued by government health workers. Divisions of labor in cross-agency programs need to be critically evaluated to assess whether they serve program goals. Tensions are inevitable when dividing the tasks involved in care of a single client between different organizations. Co-location of multidisciplinary teams that include health professionals, support workers and peer workers may lead to more effective recovery oriented care. The findings have implications for the future development of recovery oriented mental health services.

Stress, burnout, depression and work satisfaction among UK anaesthetic trainees: a qualitative analysis of in-depth participant interviews in the Satisfaction and Wellbeing in Anaesthetic Training study.

Anaesthetists experience unique stressors, and recent evidence suggests a high prevalence of stress and burnout in trainee anaesthetists. There has been no in-depth qualitative analysis to explore this further. We conducted semi-structured interviews to explore contributory and potentially protective factors in the development of perceived stress, burnout, depression and low work satisfaction. We sampled purposively among participants in the Satisfaction and Wellbeing in Anaesthetic Training study, reaching data saturation at 12 interviews. Thematic analysis identified three overarching themes: factors enabling work satisfaction; stressors of being an anaesthetic trainee; and suggestions for improving working conditions. Factors enabling work satisfaction were patient contact; the privilege of enabling good patient outcomes; and strong support at home and work. Stressors were demanding non-clinical work-loads; exhaustion from multiple commitments; a 'love/hate' relationship, as trainees value clinical work but find the training burden immense; feeling 'on edge', even unsafe at work; and the changing way society sees doctors. Nearly all trainees discussed feeling some levels of burnout (which were high and distressing for some) and also high levels of perceived stress. However, trainees also experienced distinct elements of work satisfaction and support. Suggested recommendations for improvement included: allowing contracted hours for non-clinical work; individuals taking responsibility for self-care in and out of work; cultural acceptance that doctors can struggle; and embedding wellbeing support more deeply in organisations and the specialty. Our study provides a foundation for further work to inform organisational and cultural changes, to help translate anaesthetic trainees' passion for their work into a manageable and satisfactory career.

Stress, burnout, depression and work satisfaction among UK anaesthetic trainees; a quantitative analysis of the Satisfaction and Wellbeing in Anaesthetic Training study.

There is growing evidence that anaesthetic trainees experience, and may be particularly susceptible to, high levels of work stress, burnout and depression. This is concern for the safety and wellbeing of these doctors and for the patients they treat. To date, there has been no in-depth evaluation of these issues among UK anaesthetic trainees to examine which groups may be most affected, and to identify the professional and personal factors with which they are associated. We conducted an anonymous electronic survey to determine the prevalence of perceived stress, risk of burnout/depression and work satisfaction among anaesthetic trainees within South-West England and Wales, and explored in detail the influence of key baseline characteristics, lifestyle and anaesthetic training variables. We identified a denominator of 619 eligible participants and received 397 responses, a response rate of 64%. We observed a high prevalence of perceived stress; 37% (95%CI 32-42%), burnout risk 25% (21-29%) and depression risk 18% (15-23%), and found that these issues frequently co-exist. Having no children, >3days sickness absence in the previous year, ≤1h.week-1 of exercise and >7.5h.week-1 of additional non-clinical work were independant predictors of negative psychological outcomes. Although female respondents reported higher stress, burnout risk was more likely in male respondents. This information could help in the identification of at-risk groups as well as informing ways to support these groups and to influence resource and intervention design. Targeted interventions, such as modification of exercise behaviour and methods of reducing stressors relating to non-clinical workloads, warrant further research.

Overview of the Components of Cardiac Metabolism.

Metabolism in organs other than the liver and kidneys may play a significant role in how a specific organ responds to chemicals. The heart has metabolic capability for energy production and homeostasis. This homeostatic machinery can also process xenobiotics. Cardiac metabolism includes the expression of numerous organic anion transporters, organic cation transporters, organic carnitine (zwitterion) transporters, and ATP-binding cassette transporters. Expression and distribution of the transporters within the heart may vary, depending on the patient’s age, disease, endocrine status, and various other factors. Several cytochrome P450 (P450) enzyme classes have been identified within the heart. The P450 hydroxylases and epoxygenases within the heart produce hydroxyeicosatetraneoic acids and epoxyeicosatrienoic acids, metabolites of arachidonic acid, which are critical in regulating homeostatic processes of the heart. The susceptibility of the cardiac P450 system to induction and inhibition from exogenous materials is an area of expanding knowledge, as are the metabolic processes of glucuronidation and sulfation in the heart. The susceptibility of various transcription factors and signaling pathways of the heart to disruption by xenobiotics is not fully characterized but is an area with implications for disruption of normal postnatal development, as well as modulation of adult cardiac health. There are knowledge gaps in the timelines of physiologic maturation and deterioration of cardiac metabolism. Cross-species characterization of cardiac-specific metabolism is needed for nonclinical work of optimum translational value to predict possible adverse effects, identify sensitive developmental windows for the design and conduct of informative nonclinical and clinical studies, and explore the possibilities of organ-specific therapeutics.

Employee variables influencing ‘Run Hide Fight’ policy knowledge retention and perceptions of preparedness in the hospital setting

Nationally, there has been a large increase in the number of active shooter events within healthcare facilities such as hospitals. Due to this upturn, government organizations have recently released documents to guide healthcare facilities on implementing active shooter policies and updating emergency operation plans. Currently, recommendations from government entities, such as the Federal Bureau of Investigation and the Department of Homeland Security, suggest the ‘Run, Hide, Fight’ approach during an active shooter incident. The current study uses data collected from hospital employees via a survey to determine and assesses variables that influence whether hospital employees retain knowledge related to the ‘Run Hide Fight’ policy, as well as employee perception of whether the training was adequate. Results reveal that level of education, clinical versus non-clinical work role, and work schedule are significant variables in determining successful program implementation.

Editor's Spotlight/Take 5: The Growing Executive-Physician Wage Gap and Burden of Nonclinical Workers on the U.S. Healthcare System.

Editor's Spotlight/Take 5: The Growing Executive-Physician Wage Gap and Burden of Nonclinical Workers on the U.S. Healthcare System.

Conversations With Nonclinical Worker Bring Patient Satisfaction, Lower Costs

Conversations With Nonclinical Worker Bring Patient Satisfaction, Lower Costs

Risky business

PurposeThe purpose of this paper is to describe the experiences of non-clinical staff working in psychiatric settings, particularly in relation to exposure to context-specific hazards, and perceived safety.Design/methodology/approachQualitative interviews with 23 administrative and operational staff were analysed using a framework approach.FindingsAnalysis demonstrated extensive exposure to occupational violence, including assault and verbal abuse within and/or beyond the workplace and concern about infectious disease. Impact of exposure was wide ranging, dependent on type and circumstances of violence and personal resources, with several participants experiencing ongoing psychological distress. Participants employed a range of problem- and emotion-focused strategies, typically seeking support from peers, to manage work-related stress but felt neglected by the organisation. They sought inclusion in or access to processes, such as supervision and debrief, routinely available to clinicians and to information about risk associated with patients.Research limitations/implicationsGeneralisability is constrained by conduct of this study in a particular setting with non-random sample.Practical implicationsThe findings of this paper indicate a pressing need for administrators to ensure efforts to address safety encompass all staff, and the need for further research. Particular attention should be given to enabling non-clinical staff to examine ethical questions, ensuring access to support mechanisms and development of an inclusive culture.Originality/valueWhile exposure to, and impact of workplace violence on clinical staff have been extensively studied, this paper is the first to qualitatively examine the safety of a commonly forgotten workforce.

MIND at Home-Streamlined: Study protocol for a randomized trial of home-based care coordination for persons with dementia and their caregivers

BackgroundDementia is associated with high health care costs, premature long-term care (LTC) placement, medical complications, reduced quality of life, and caregiver burden. Most health care providers and systems are not yet organized or equipped to provide comprehensive long-term care management for dementia, although a range of effective symptoms and supportive care approaches exist. The Maximizing Independence at Home-Streamlined (MIND-S) is a promising model of home-based dementia care coordination designed to efficiently improve person-centered outcomes, while reducing care costs. This report describes the rationale and design of an NIA-funded randomized controlled trial to test the impact of MIND-S on time to LTC placement, person with dementia outcomes (unmet needs, behavior, quality of life), family caregiver outcomes (unmet needs, burden), and cost offset at 18 (primary end point) and 24 months, compared to an augmented usual care group. MethodsThis is a 24-month, parallel group, randomized trial evaluating MIND-S in a cohort of 304 community-living persons with dementia and their family caregivers in Maryland. MIND-S dyads receive 18 months of care coordination by an interdisciplinary team comprised of trained non-clinical community workers (e.g. Memory Care Coordinators), a registered nurse, and a geriatric psychiatrist. Intervention components include in-home dementia-related needs assessments; individualized care planning; implementation of standardized evidence-based care strategy protocols; and ongoing monitoring and reassessment. Outcomes are assessed by blinded evaluators at baseline, 4.5, 9, 13.5, 18, and 24 months. DiscussionTrial results will provide rigorous data to inform innovations in effective system-level approaches to dementia care.

From Classroom to Community: the Impact of a Non-Clinical Clerkship on Fourth-Year Medical Students’ Ability to Address Social Determinants of Health

The AAMC has called for research exploring causes of health disparities and the value of educating health care providers about population health. Research on best practices for educating medical students about social determinants of health is limited. During academic year 2015–2016, we implemented a required 4-week community health clerkship for all fourth-year medical students at Tulane University not concurrently seeking an MPH. The 15-h classroom component of the course included discussion of reading materials and didactic instruction on social determinants of health, principles of prevention, health disparities, racism, cultural humility, and community health workers’ (CHWs) roles in improving population health. Students also spent 80 h at a community agency doing non-clinical work. In addition to course evaluations, students completed pre-and post-course surveys that included 15 items measuring knowledge and attitudes about patient care and community health on a 4-point Likert scale. Post-course surveys also contained ten open-ended questions. Students were highly satisfied with the course. There were significant changes in 11 of 15 items related to knowledge and attitudes about patient care and community health. Students reported better understanding of chronic disease causes, physicians’ roles in health promotion, and the roles of CHWs. Students expressed intent to improve their communication skills, address health literacy, contextualize care based on social circumstances, and respond to patients’ cultural health beliefs. This required 4-week course resulted in significant changes in fourth-year students’ attitudes and knowledge of community health principles. This course may be a model for other institutions.

Job Satisfaction and Burnout Among Nonclinical Workers in a Medical Education Center.

Research into the rates of burnout among nonclinical workers is nonexistent at medical education centers (MECs). The first goal of this study was to explore the prevalence of burnout among nonclinical faculty and staff working at a local MEC. The second goal was to identify predictors of burnout using job satisfaction dimensions-supervision, coworkers, contingency rewards, and nature of work. The study included a convenience sample of 95 nonclinical faculty and staff working at a local MEC. Data from these workers were collected between December 2016 and January 2017. The Abbreviated Maslach Burnout Inventory (AMBI) was used to measure burnout while a modified Spector's Job Satisfaction Survey (JSS) was used to measure participants' job satisfaction. The authors correlated the dimensions of the AMBI and JSS. They also conducted multiple regression analysis using the four dimensions of JSS to determine predictors of participant burnout. The data showed that 1% of the 95 respondents reported high burnout and 35% reported medium burnout on the scale. Correlation coefficient showed that job satisfaction and burnout strongly and negatively correlated (r[93]=-.66; P<.001). Multiple regression analysis showed that nature of work (β=-.49) and coworkers (β=-.30) were significant predictors of burnout (R=0.74; F[4, 90]=26.81; P<.001). Nonclinical workers at a local MEC were generally satisfied with their job and showed a moderate degree of burnout. Compared to the general population, our sample reported less burnout.

Baseline Survey of the Neuroradiology Work Environment in the United States with Reported Trends in Clinical Work, Nonclinical Work, Perceptions of Trainees, and Burnout Metrics.

Neuroradiologists have faced continuously increasing clinical workloads. Our aim was to establish and report a baseline survey of the current neuroradiology work environment in the United States and of experiential changes in recent years. A voluntary survey was sent to practicing and out-of-training members of the American Society of Neuroradiology in the United States. Selected measures included workday volume and length, burnout symptoms, participation in academic and practice-building duties; effects on perceived interpretation quality, communication of abnormal results, and consideration of early retirement or career changes, among others. Four hundred thirty-two respondents across a broad range of experience reported the following: 52.8% (224/424) with teaching responsibilities; 93% (399/430) with workdays extending at least 1 hour past expected, in 45% (193/430) frequently or always; 71.9% (309/430) reading more cases per hour compared to previous years; 79.5% (341/429) sometimes-to-always interpreting cases faster than comfortable for optimal interpretation; and 67.8% (292/431) sometimes or more often with inadequate time to discuss abnormal results. Burnout symptoms ranged between 49% and 75% (211/428 to 322/428) across 4 indices. For academic activities of teaching, mentoring, and research/publications, a mean of 94.3% reported cut-backs during the past few years. For practice-building activities, 92% reported cut-backs, 51.6% (222/429) considered early retirement, and 38.8% (167/429) considered changing careers. Increasing clinical demands have coincided with destructive effects in the work environment and the ability and desire of neuroradiologists in the United States to perform academic or practice-building duties with a substantial incidence of burnout symptoms. While this survey does not prove causation, the trends and the correlations should be concerning to the leaders of radiology and warrant further monitoring.

Serological survey of hepatitis B immunity in healthcare workers in Catalonia (Spain)

ABSTRACTHealthcare workers (HCW) are exposed to preventable infectious diseases, notably hepatitis B (HB). The aim of this study was to determine the immunity of HCW against hepatitis B. We made a seroprevalence study using a self-administered survey and obtained blood samples. Antibodies against the HB surface antigen (anti-HBs) and against the HB core antigen (anti-HBc) were studied. The odds ratio (OR) and 95% confidence intervals (CI) were calculated. The adjusted OR were calculated using logistic regression.Of the 644 HCW who participated (29.7% physicians, 38.7% nurses, 13.4% other clinical workers and 18.3% non-clinical workers), 46.4% were primary care workers and 53.6% hospital workers. The overall prevalence of anti-HBs was 64.4%. HCW aged <25 y had a significantly higher prevalence (86.7%) than those aged 35–44 y (adjusted OR 3.40; 95% CI 1.06–10.90). The prevalence of anti-HBc was 4.1%, and increased with age. Significant differences were found for HCW aged >44 y with respect to those aged 25–34 y. 75.6% of HCW stated they were vaccinated, but only 39.3% had a vaccination card. In HCW who stated they were unvaccinated, 10.8% had a vaccinated serological pattern (anti-HBc-negative and anti-HBs -positive). Written, updated vaccination records are essential to reliably determine the vaccination status.

Clinical Practice in Portuguese Sexology

Few studies explore the clinicians' knowledge, attitudes, and practices regarding sexuality, despite their role in the sexual-health socialization process. This study focuses on Portuguese sexologists engaged in clinical practice. It aims to characterize sexologists' sex education and training and their clinical practices, including diagnostic and therapeutic approaches. This research followed the methodology of an European survey on sexology as a profession (Euro-Sexo). From the 91 respondents who completed questionnaires, 51 (56%) were active in clinical practice. Results indicate that the Portuguese clinical sexologist is significantly older, predominantly male, has had training in sexology, performs more scientific research, and is more engaged in teaching activities when compared to nonclinical working sexologists. This article describes the main sexual problems presented by patients to Portuguese clinical sexologists and highlights differences in the professional groups and approaches toward treating these problems by medical doctors and nonmedical professionals. Results reinforce the idea that there are intra-European differences in the educational background of sexologists and reveal important variations in Portuguese sexologists' education, training, and clinical practice. The representations and practices of the sexologists in Portugal, as in other European countries, are embedded in cultural scenarios and sexual cultures, with implications for the clinical practice.