Non-physician Healthcare Professionals Research Articles

Effect of involving certified healthcare assistants in primary care in Germany: a cross-sectional study

ObjectivesGrowing prevalence of chronic diseases and limited resources are the key challenges for future healthcare. As a promising approach to maintain high-quality primary care, non-physician healthcare professionals have been trained...

Does task delegation to non-physician health professionals improve quality of diabetes care? Results of a scoping review.

ObjectiveAs a result of unhealthy lifestyles, reduced numbers of healthcare providers are having to deal with an increasing number of diabetes patients. In light of this shortage of physicians and nursing staff, new concepts of care are needed. The aim of this scoping review is to review the literature and examine the effects of task delegation to non-physician health professionals, with a further emphasis on inter-professional care.Research design and methodsSystematic searches were performed using the PubMed, Embase and Google Scholar databases to retrieve papers published between January 1994 and December 2017. Randomised/non-randomised controlled trials and studies with a before/after design that described the delegation of tasks from physicians to non-physicians in diabetes care were included in the search. This review is a subgroup analysis that further assesses all the studies conducted using a team-based approach.ResultsA total of 45 studies with 12,092 patients met the inclusion criteria. Most of the interventions were performed in an outpatient setting with type-2 diabetes mellitus patients. The non-physician healthcare professionals involved in the team were nurses, pharmacists, community health workers and dietitians. Most studies showed significant improvements in glycaemic control and high patient satisfaction, while there were no indications that the task delegation affected quality of life scores.ConclusionsThe findings of the review suggest that task delegation can provide equivalent glycaemic control and potentially lead to an improvement in the quality of care. However, this review revealed a lack of clinical endpoints, as well as an inconsistency between the biochemical outcome parameters and the patient-centred outcome parameters. Given the vast differences between the individual healthcare systems used around the world, further high-quality research with an emphasis on long-term outcome effects and the expertise of non-physicians is needed.

Community Characteristics and Regional Variations in Diabetes Prevalence in Texas Counties.

Diabetes has become a critical population health issue in the United States. Although researchers have focused on diabetes prevalence at the individual level, few studies address community contexts of diabetes prevalence at the county level. The objective of this study is to explore the association between community characteristics and diabetes prevalence in 254 counties in Texas. Using 3 countywide data sets in 2012, the authors measured county-level community characteristics, including social, environmental, and health behavior factors, and examined how these county-level factors are associated with diabetes prevalence. Multivariate ordinary least squares models weighted with population of county were used for estimation. Rurality, physical inactivity prevalence, and obesity prevalence were positively associated with diabetes prevalence, while the percentage of nonphysician health care professionals was negatively associated with diabetes prevalence. The findings indicate that environmental and health behaviors are significantly associated with a high prevalence of diabetes, but more nonphysician health care professionals, including nurse practitioners, may mitigate diabetes prevalence. This study highlights the significance of community factors in diabetes prevalence and provides insights for diabetes prevention programs with nonphysician health care professionals.

The Role of Non-Physician Health Care Professionals in the Education of Medical Students at Satellite Campuses

Phenomenon: Satellite campuses of medical schools in Canada introduce smaller communities to new medical learners. Non-physician health care professionals (NPHCPs) in regional hospitals may have had little prior exposure to learners. Lack of clarity regarding the role of the medical student is a barrier that hinders interprofessional collaboration. The purpose of this project was to examine the educational relationship between students and NPHCPs in regional hospitals.
 Approach: Surveys were distributed to NPHCPs of various disciplines at two community hospitals in Waterloo Region. A second survey was distributed to medical students attending a satellite medical campus of McMaster University. 
 Findings: Surveys completed by 141 NPHCPs identified the following themes: frequent student interaction, no orientation to students, uncertainty of roles, willingness to teach, and barriers to teaching. Student surveys demonstrated frequent interactions, lack of familiarity of their role by NPHCPs at regional hospitals, desire to learn from NPHCPs, and specific teachable procedures. 
 Insights: NPHCPs and medical students agree that interprofessional medical education can improve patient care, communication and the quality of education. While there is interest in involving NPHCPs in teaching, orienting NPHCPs to the roles of students in regional hospitals may improve relationships and allow informal teaching opportunities.
 
 Funding: This work was supported by the Michael G. DeGroote School of Medicine, McMaster University.

Physicians as well as nonphysician health care professionals in Taiwan have higher risk for lumbar herniated intervertebral disc than general population.

Physicians in Taiwan have long working hours and are at risk for inappropriate posture when handling patients, which may contribute to lumbar herniated intervertebral disc (L-HIVD). This study was conducted to delineate this issue, which is still unknown. This nationwide population-based cohort study was based on Taiwan National Health Insurance Research Database. We identified 25,428 physicians, 32,316 nonphysician health care professionals (HCPs), and an identical number of age- and sex-matched individuals from the general population. All individuals who had L-HIVD before 2007 were excluded. We compared the L-HIVD risk between physicians and general population, nonphysician HCPs and general population, and physicians and nonphysician HCPs by tracing their medical histories between 2007 and 2011. A comparison among physician specialties was also performed. Physicians and nonphysician HCPs had higher L-HIVD risk than the general population [odds ratio (OR): 1.149; 95% confidence interval (CI): 1.011–1.307 and OR: 1.220; 95% CI: 1.080–1.378, respectively]. Physicians did not have higher L-HIVD risk than nonphysician HCPs [adjusted OR (AOR): 0.912; 95% CI: 0.795–1.046]. Physician specialties of orthopedics and obstetrics and gynecology had a trend of higher L-HIVD risk than other specialties (AOR: 1.538; 95% CI: 0.805–2.939, and AOR: 1.306; 95% CI: 0.967–1.764, respectively). Physicians as well as nonphysician health care professionals in Taiwan have higher L-HIVD risk than the general population, which could be attributed to a probable role of long working hours. This result provides an important reference for the government to promote occupational health in health care professionals; however, further studies are warranted for the underlying mechanisms.

The irritable bowel syndrome (IBS) in emergency healthcare professionals

The aim of the present study was to determine the frequency of irritable bowel syndrome (IBS) in emergency healthcare professionals in a public hospital and characteristics of healthcare professionals diagnosed with IBS. The population of this descriptive study consisted of a total of 67 people including 8 physicians and 59 non-physician healthcare professionals working at Emergency Service of Bingol Public Hospital. A questionnaire with two sections was used to collect data. While the first section of the questionnaire which was prepared and administered by the researchers based on the literature had questions about demographic characteristics, working conditions, daily habits, dietary information; the second section included questions about IBS condition. The Rome III criteria were employed for diagnosis of IBS. When some characteristics were examined in terms of the presence of IBS, 65.9% of the males and 69.2% of the females have IBS. Upon examination of the individuals with IBS it was observed that the distribution of IBS was more in those who were male (60%); were younger than 40 years of age; were in overweight BMI group, were non- smokers, had poor or sedentary physical activity level, were drinking 3 or more cups of tea a day, were drinking 1-2 cups of coffee, had 3 meals a day, did not skip the meal and sometimes had snacks; however the differences were not statistically significant (p

Interprofessional Collaboration: A Qualitative Study of Non-Physician Perspectives on Resident Competency.

The Association of American Medical Colleges (AAMC) includes the ability to collaborate in an interprofessional team as a core professional activity that trainees should be able to complete on day 1 of residency (Med Sci Educ. 26:797-800, 2016). The training that medical students require in order to achieve this competency, however, is not well established (Med Sci Educ. 26:457-61, 2016), and few studies have examined non-physician healthcare professionals' perspectives regarding resident physicians' interprofessional skills. This study aims to describe non-physicians' views on barriers to collaboration with physicians, as well as factors that contribute to good collaborative relationships. Nurses, social workers, case managers, dietitians, rehabilitation therapists, and pharmacists at one academic medical center, largely working in the inpatient setting. A qualitative study design was employed. Data were collected from individual interviews and focus groups comprising non-physician healthcare professionals. Knowledge gaps identified as impeding interprofessional collaboration included inadequate understanding of current roles, potential roles, and processes for non-physician healthcare professionals. Specific physician behaviors that were identified as contributing to good collaborative relationships included mutual support such as backing up other team members and prioritizing multidisciplinary rounds, and communication including keeping team members informed, asking for their input, physicians explaining their rationale, and practicing joint problem-solving with non-physicians. Discussion of how physician trainees can best learn to collaborate as members of an interprofessional team must include non-physician perspectives. Training designed to provide medical students and residents with a better understanding of non-physician roles and to enhance mutual support and communication skills may be critical in achieving the AAMC's goals of making physicians effective members of interprofessional teams, and thus improving patient-centered care. We hope that medical educators will include these areas identified as important by non-physicians in targeted team training for their learners.

Osteopathic Physicians on Editorial Boards of Neurosurgical Journals: A Quantitative Analysis

Objective: The Accreditation Council for Graduate Medical Education and the American Osteopathic Association reached an agreement to form a single accreditation system for graduate medical education by 2020. As a result of this merger, new criteria may be established for academic endeavors within medical school as well as post-graduate curricula. In the present study, we analyze the number of osteopathic physicians serving on editorial boards of neurosurgical journals. Methods: Editorial members of 50 neurosurgical journals were included in the analyses. The number of allopathic and osteopathic physicians as well as other healthcare professionals serving as editor-in-chief, associate editor, editor emeritus, other editor, and editorial board members were analyzed. Results: Our data showed that of the 2826 editorial positions available, 2645 (93.6%) were held by allopathic physicians, 177 (6.3%) were held by non-physician healthcare professionals, and 4 (0.14%) were held by osteopathic physicians. Statistical significance was observed upon comparing the number of osteopathic physicians against the number of allopathic physicians serving editorial roles (p<0.00001). Osteopathic physicians held 1 (1.7%) of the 59 editor-in-chief positions and 3 (0.11%) of the 2114 editorial board member positions. Conclusion: These data establish a significant disparity in representation of allopathic physicians and osteopathic physicians on editorial boards of neurosurgical journals. Future investigation should identify causative factors for the disparity of osteopathic physicians on these editorial boards.

Primary Health Care Providers' Perspectives: Facilitating Older Patients' Access to Community Support Services.

The purpose of the study examined in this article was to understand how non-physician health care professionals working in Canadian primary health care settings facilitate older persons' access to community support services (CSSs). The use of CSSs has positive impacts for clients, yet they are underused from lack of awareness. Using a qualitative description approach, we interviewed 20 health care professionals from various disciplines and primary health care models about the processes they use to link older patients to CSSs. Participants collaborated extensively with interprofessional colleagues within and outside their organizations to find relevant CSSs. They actively engaged patients and families in making these linkages and ensured follow-up. It was troubling to find that they relied on out-of-date resources and inefficient search strategies to find CSSs. Our findings can be used to develop resources and approaches to better support primary health care providers in linking older adults to relevant CSSs.

Medical Abortion Provided by Nurse-Midwives or Physicians in a High Resource Setting: A Cost-Effectiveness Analysis.

ObjectiveThe objective of the present study is to calculate the cost-effectiveness of early medical abortion performed by nurse-midwifes in comparison to physicians in a high resource setting where ultrasound dating is part of the protocol. Non-physician health care professionals have previously been shown to provide medical abortion as effectively and safely as physicians, but the cost-effectiveness of such task shifting remains to be established.Study designA cost effectiveness analysis was conducted based on data from a previously published randomized-controlled equivalence study including 1180 healthy women randomized to the standard procedure, early medical abortion provided by physicians, or the intervention, provision by nurse-midwifes. A 1.6% risk difference for efficacy defined as complete abortion without surgical interventions in favor of midwife provision was established which means that for every 100 procedures, the intervention treatment resulted in 1.6 fewer incomplete abortions needing surgical intervention than the standard treatment. The average direct and indirect costs and the incremental cost-effectiveness ratio (ICER) were calculated. The study was conducted at a university hospital in Stockholm, Sweden.ResultsThe average direct costs per procedure were EUR 45 for the intervention compared to EUR 58.3 for the standard procedure. Both the cost and the efficacy of the intervention were superior to the standard treatment resulting in a negative ICER at EUR -831 based on direct costs and EUR -1769 considering total costs per surgical intervention avoided.ConclusionEarly medical abortion provided by nurse-midwives is more cost-effective than provision by physicians. This evidence provides clinicians and decision makers with an important tool that may influence policy and clinical practice and eventually increase numbers of abortion providers and reduce one barrier to women’s access to safe abortion.

Delegation of Medical Treatment to Non-physician Health Care Professionals: The Medical Care Structure agneszwei in Brandenburg - A Qualitative Acceptance Analysis

Backround: To address the increasing shortage of primary care physicians in rural regions, pilot model projects were tested, where general practitioners delegate certain physician tasks including house calls to qualified physician assistants. Evaluations show a high level of acceptance among participating physicians, medical assistants and patients. This study aims to measure the quality of cooperation among professionals participating in an outpatient health care delegation structure agneszwei with a focus on case management in Brandenburg. Methods: We conducted 10 qualitative semi-structured expert interviews among 6 physicians and 4 physician's assistants. Results: Physicians and physicians' assistants reported the cooperative action to be successful and as an advantage for patients. The precondition for successful cooperation is that non-physician health care professionals strictly respect the governance of the General Practitioners. Physicians report that the delegation of certain medical tasks reduces their everyday workload. Physician assistants derive professional satisfaction from the confidential relationship they have with the patients. All physician assistants are in favor of medical tasks being delegated to them in regular medical outpatient care, while most physicians are skeptical or reluctant despite their reported positive experience. Conclusion: Despite the high level of acceptance of delegating some medical tasks to physician assistants, the negotiation process of introducing cooperative working structures in the outpatient health care system is still at the beginning.

Delegation hausärztlicher Tätigkeiten an qualifiziertes medizinisches Fachpersonal in Deutschland – eine Übersicht

To assure nationwide provision of family medical care, a greater involvement of non-physician healthcare professionals has been discussed in Germany for some time. Currently, there are various delegation models. The aim of this study is to provide an overview of existing delegation models in a German family practice setting and to investigate to what extent they are implemented in practice. Internet search was made for delegation models for non-physician healthcare staff, and various experts were contacted in April 2014. Models that explicitly addressed family practice, involved continuing education of more than 80 h, and for which health insurance funds bore the costs, were taken into consideration. The models were judged in accordance with the PDCA implementation cycle (Plan-Do-Check-Act). 6 delegation models used in family practice were identified for which only 4 qualifications were still available in 2014. The duration, content and aims of the training courses differed markedly. Since 2015, training to become a NäPA non-physician practice assistant (or a VERAH healthcare assistant in the family practice if the necessary supplementary qualification is achieved) is the basic qualification for which costs are reimbursed. However, one important quality criterion for its broad implementation, namely evaluation, is missing in NäPA training. Only the VERAH qualification fulfills all quality criteria. In order to fully implement the delegation models and to strengthen and promote the healthcare assistant profession, the delegation models for which training costs are generally reimbursable should satisfy all quality criteria and also be subject to continual evaluation.

Collaboration and communication in colorectal cancer care: a qualitative study of the challenges experienced by patients and health care professionals.

Background.Colorectal cancer is becoming a chronic condition. This has significant implications for the delivery of health care and implies the involvement of a range of health care professionals (HCPs) from different settings to ensure the needed quality and continuity of care.Objectives.To explore the challenges that patients and HCPs experience in the course of colorectal cancer care and the perceived consequences caused by these challenges.Methods.Ten semi-structured focus groups were conducted including patients receiving treatment for colorectal cancer, representatives of patient support groups, physicians and other non-physician HCPs from different health care settings. Participants were asked to share their experiences regarding colorectal cancer care. All data were audio- and videotaped, transcribed verbatim and thematically analysed using qualitative content analysis.Results.Patients and HCPs (total N = 47) experienced collaboration and communication as well as exchange of information between HCPs as challenging. Particularly communication and information exchange with GPs appeared to be lacking. The difficulties identified restricted a well-working coordination of care and seemed to cause inappropriate health care.Conclusion.Colorectal cancer care seems to require an effective, well-working collaboration and communication between the different HCPs involved ensuring the best possible care to suit patients’ individual needs. However, the perceived challenges and consequences of our participants seem to restrict the delivery of the needed quality of care. Therefore, it seems crucial (i) to include all HCPs involved, especially the GP, (ii) to support an efficient and standardized exchange of health-related information and (iii) to focus on the patients’ entire pathway of care.

“How is it for you?” – residents’ and faculty experience with a new family medicine competency-based curriculum

Background/Purpose The University of Calgary Family Medicine (FM) residency program introduced a new “Triple-C”, competency based curriculum in 2012. This presented an opportunity to study in depth, the impact of such a major change on both Faculty and Residents. Methodology Semi-structured interviews were completed with 10 second-year FM residents and 16 Faculty involved in the introduction of the new curriculum. Study participants were selected using purposeful sampling method. Interviews were recorded and subsequently transcribed verbatim for thematic analysis. Results The analysis revealed a wide variation in residents’ and Faculty understanding of the elements of a “Triple-C”, competency-based curriculum. Study participants identified issues relating to the delivery of quality, consistent, and equitable learning experiences in a large residency Program. Scheduled learning experiences with non-physician health care professionals appeared to be less valued by residents than those with physicians, and significant challenges around providing experience of continuity of care were also identified, especially in larger academic teaching clinics. Conclusions For a new curriculum to be successful, an ongoing process of evaluation and monitoring of learning experiences is essential. Despite some deficiencies and implementation challenges identified by study participants, both residents and Faculty acknowledged that these were expected, and were willing to commit to and engage with the new curriculum. Understanding how the “Triple-C” curriculum impacted our learners and Faculty provided essential feedback to curriculum developers, and enhanced our ongoing processes of quality assurance and improvement within the Program.

Experts Predict: What's Ahead for PA/LTC in 2015?

Experts Predict: What's Ahead for PA/LTC in 2015?

Screening obstetric ultrasound training for a 5-country cluster randomized controlled trial.

With decreased equipment cost, provision of ultrasound is now feasible in some low resource settings. Screening obstetric ultrasound may identify potential pregnancy complications and, with this knowledge, allow women to plan to deliver at the appropriate level of care. In this article, we describe a 10-day course with quality assurance activities to train ultrasound-naïve, nonphysician healthcare professionals at midlevel health facilities to perform screening obstetric ultrasound. Those trained will participate in a cluster randomized controlled trial to assess the impact of screening obstetric ultrasound on maternal and newborn outcomes.

Development and validation of the primary care team dynamics survey.

To develop and validate a survey instrument designed to measure team dynamics in primary care. We studied 1,080 physician and nonphysician health care professionals working at 18 primary care practices participating in a learning collaborative aimed at improving team-based care. We developed a conceptual model and administered a cross-sectional survey addressing team dynamics, and we assessed reliability and discriminant validity of survey factors and the overall survey's goodness-of-fit using structural equation modeling. We administered the survey between September 2012 and March 2013. Overall response rate was 68 percent (732 respondents). Results support a seven-factor model of team dynamics, suggesting that conditions for team effectiveness, shared understanding, and three supportive processes are associated with acting and feeling like a team and, in turn, perceived team effectiveness. This model demonstrated adequate fit (goodness-of-fit index: 0.91), scale reliability (Cronbach's alphas: 0.71-0.91), and discriminant validity (average factor correlations: 0.49). It is possible to measure primary care team dynamics reliably using a 29-item survey. This survey may be used in ambulatory settings to study teamwork and explore the effect of efforts to improve team-based care. Future studies should demonstrate the importance of team dynamics for markers of team effectiveness (e.g., work satisfaction, care quality, clinical outcomes).

O-199 Evaluation Of Home Health Care Services

<h3>Objective</h3> To evaluate the status and results of home health care services conducted for paediatric patients in our hospital and to identify the medical needs of patients for a better quality of service delivery. <h3>Materials and methods</h3> Paediatric patients recorded by our hospital’s Home Health Services Unit (HHSU) and followed-up regularly for one year were included. Demographic data like age, gender, diagnosis, number of doctor visits, non-physician health care visits and the reasons of requested visits were collected retrospectively between November 2012–December 2013. <h3>Results</h3> A total of 63 patients were included in the study. 54% of patients were male, 46% were female. The mean age of the patients was 8.87 ± 4.6. Diagnose of the patients was 58.7% of cerebral palsy (CP) and motor mental retardation (MMR) followed by subacute sclerosing panencephalitis (SSPE) in 11% of patients. Tracheostomy was present in 34.9% of patients, 13 patients (20.6%) with chronic respiratory failure had home ventilation and 14.2% of the patients was receiving oxygen from a tracheotomy. 28.6% of patients were not dependent on medical devices however, all of the patients were in need of physical therapy and rehabilitation. The mean number of doctor visits for a patient was 1.89 ± 1.23 (median: 2) times per year. The number of visits of non-physician health care professionals working in home health care services were 13.7 ± 14.8 (median: 10) times per year. In our study primary care was given by mother in 95.2% of the patients. <h3>Conclusion</h3> With home health care services, children with special health care needs can be followed at home and fascilitating hospital discharge. This condition reduces costs and brings many advantages in social aspects. Home health care service is very important in offering positive factors to patients and families. Identification of deficiencies in this service will improve quality in the future. The medical care of dental disease and eye disease in terms of home health care is necessary in the future for children with special health care needs. These services must include social services especially in children.

Disparity in perceptions of disease characteristics, treatment effectiveness, and factors influencing treatment adherence between physicians and patients with myelodysplastic syndromes

Previous studies have suggested that many patients with myelodysplastic syndromes (MDS) have an incomplete understanding of their disease, which may influence adherence to prescribed regimens and outcomes. To better understand physician and patient perceptions about MDS and MDS therapy, the authors conducted 2 surveys in February 2012: 1 for patients with MDS and 1 for health care professionals (HCPs) who cared for patients with MDS. Patient and HCP surveys consisted of 57 and 49 questions, respectively, assessing understanding of MDS, perceptions of specific treatments, barriers to treatment adherence, and treatment experience. In total, 477 complete patient responses and 120 complete HCP responses were received. Among patient responders, 63% were aged ≥60 years, and 42% had received at least 1 disease-modifying therapy. Of the 61 physician responders, 57% practiced in an academic setting, and 43% practiced in the community; 71% of the 59 nonphysician HCPs worked in the community setting. Only 10% of patients agreed that MDS represented "cancer" compared with 59% of physicians and 46% of nonphysician HCPs (P < .001). Only 29% of patients reported that MDS was ever "curable" compared with 52% of physicians (P < .001). Physicians viewed the potential benefits of active therapy as greater than patients, but patients perceived the actual treatment experience more positively than physicians and differed from physicians in perceived reasons for stopping therapy. Physicians, nonphysician HCPs, and patients with MDS have disparate views of MDS characteristics and the value and limitations of treatments for MDS. Improved communication and education may increase understanding and achieve better treatment adherence and patient outcomes.

Social Media Made Easy: Guiding Patients to Credible Online Health Information and Engagement Resources

W ithin the changing dynamic of health care, health care professionals (HCPs) are no longer the sole sources of health information. Recent estimates suggest that 83% of Internet users with chronic conditions such as diabetes go online to look for health information.1 People with diabetes seek online information about the condition, treatment options, practical strategies and tools for managing diabetes in their daily lives, scientific breakthroughs, and advocacy efforts.2 Yet, a Google search for “diabetes” returns 290 million results. A search for “diabetes online support” yields close to 36 million results. This can be overwhelming for anyone. Some HCPs assist with this information overload by filtering and narrowing down online resources and search results for their patients. SurroundHealth, an online learning community for nonphysician HCPs, recently surveyed its members about the use of educational technology in health care. Many respondents reported that they used time during patient interactions to refer patients to online resources. Eighty-two percent of HCPs in private practice reported having referred patients to specific online resources, compared to 60% of HCPs in outpatient clinics and 52% of HCPs in hospital settings. The HCPs who made referrals intended to help patients overcome common online obstacles such as difficulty distinguishing between high-quality information and material that is out of date, inaccurate, or overly promotional.3 Connecting patients to credible online health information during office visits can facilitate more appropriate use of health care resources, shorter clinical encounters, more patient-centered decision-making, and, in some cases, reduced barriers to treatment adherence.4,5 This article explains how online health information and engagement resources are integrated into patients' overall health care experiences. In addition, it addresses common HCP concerns about patients accessing online resources and will outline steps that busy professionals can take to help connect patients to appropriate …