Number Of Full-time Equivalents Research Articles

EHealth profile and care coordination of primary care physicians

Abstract Background Digital health or eHealth is a vast field encompassing mobile health (mHealth), health information technology, wearable devices, telehealth, and telemedicine, and is changing the practice of medicine. While it holds promise for enhancing care coordination, its adoption is hindered by various barriers, including at the healthcare professional level. We assessed the eHealth profile of primary care physicians and its relationship with care coordination. Methods As part of the Commonwealth Fund 2022 IHP survey of primary care physicians, 1114 physicians in Switzerland completed a questionnaire on their digital health use, and care coordination practices. Based on their responses, we built a digital health score, summarizing physicians’ use of digital health tools, and a care coordination score. Associations between both scores were assessed using stratified analyses and multiple linear regression. Results Among 1114 participants (46% women, mean age 52), 83% used electronic patient records, 96% used teleconsultations for less than 5% of consultations, and 63% never used connected health tools for the monitoring of patients with chronic diseases. A total of 16% allowed for online appointments, 20% for online medical prescriptions, 52% for communicating electronically lists of medications with other healthcare professionals, and 89% the possibility of e-mail or web communications with the patient. The eHealth score was positively associated with the number of weekly working hours, being an internal medicine specialist or practicing physician, the number of full-time equivalents in the practice, and with being in a group practice setting. The higher the eHealth profile score, the higher was the care coordination score. Conclusions Physicians’ use of digital health tools was positively associated with care coordination. This could underscore the potential benefits of digital health in enhancing collaborative and interprofessional care practices. Key messages • In a large survey of primary care physicians, the use of digital health tools and care coordination were correlated. • Digital health could enhance collaborative and interprofessional care practices.

Primary care physician eHealth profile and care coordination: a cross-sectional study.

Digital health holds promise for enhancing care coordination and supporting patient self-management. However, various barriers, including at the healthcare professional level, hinder its adoption. This cross-sectional study explored the eHealth profile of primary care physicians and its relationship with care coordination. As part of "The Commonwealth Fund's 2022 International Health Policy Survey of Primary Care Physicians in 10 Countries", 1114 physicians in Switzerland completed a questionnaire on their sociodemographic and workplace characteristics, digital health use and care coordination practices. Based on their responses concerning the modality, frequency and application of digital health tools, we created a digital health score. Based on responses describing the collaboration with specialists and paramedical health professionals, we created a care coordination score. The associations between both scores were assessed using stratified analyses and multiple linear regression. Among the 1114 participants (46% women, mean age 52 years), 83% used electronic patient records, 96% used teleconsultations for less than 5% of consultations, and 63% never used connected health tools to monitor patients with chronic diseases. Further, 16% allowed online appointments, 20% online medical prescriptions, 52% the possibility of electronically communicating lists of medications with other healthcare professionals, and 89% the possibility of email or web communications with the patient. The eHealth score was positively associated with the number of weekly working hours, being an internal medicine specialist or practising physician, the number of full-time equivalents in the practice and being in a group practice setting. The higher the eHealth profile score, the higher the care coordination score. Digital health and care coordination were positively associated. This could underscore the potential benefits of digital health in enhancing collaborative and interprofessional care practices.

Developing a systems-focused tool for modeling lung cancer screening resource needs

BackgroundEarly detection through screening dramatically improves lung cancer survival rates, including among war Veterans, who are at heightened risk. The effectiveness of low dose computed tomography scans in lung cancer screening (LCS) prompted the Veteran’s Affairs Lung Precision Oncology Program (VA LPOP) to increase screening rates. We aimed to develop an adaptive population health tool to determine adequate resource allocation for the program, with a specific focus on primary care providers, nurse navigators, and radiologists.MethodsWe developed a tool using C + + that uses inputs that represents the process of the VA LCS program in Ann Arbor, Michigan to calculate FTEs of human resource needs to screen a given population. Further, we performed a sensitivity analysis to understand how resource needs are impacted by changes in population, screening eligibility, and time allocated for the nurse navigators’ tasks.ResultsUsing estimates from the VA LCS Program as demonstrative inputs, we determined that the greatest number of full-time equivalents required were for radiologists, followed by nurse navigators and then primary care providers, for a target population of 75,000. An increase in the population resulted in a linear increase of resource needs, with radiologists experiencing the greatest rate of increase, followed by nurse navigators and primary care providers. These resource requirements changed with primary care providers, nurse navigators and radiologists demonstrating the greatest increase when 1–20, 20–40 and > 40% of Veterans accepted to be screened respectively. Finally, when increasing the time allocated to check eligibility by the nurse navigator from zero to three minutes, there was a linear increase in the full-time equivalents required for the nurse navigator.ConclusionVariation of resource utilization demonstrated by our user facing tool emphasizes the importance of tailored strategies to accommodate specific population demographics and downstream work. We will continue to refine this tool by incorporating additional variability in system parameters, resource requirements following an abnormal test result, and resource distribution over time to reach steady state. While our tool is designed for a specific program in one center, it has wider applicability to other cancer screening programs.

Socio-medical assessment: an inventory of the Medical Service of the Federal Employment Agency

The Medical Service of the Federal Employment Agency is responsible for socio-medical assessments of clients whose ability to work in the labor market is in question. Data about the Medical Service, its structure, and its performance were previously only available within the Federal Employment Agency. In October 2023, data from the Medical Service containing information on the employee structure, clients, and orders were extracted from three data systems, processed, and analyzed. The number of full-time equivalents (FTEs) in the Medical Service decreased significantly from 2016 (n = 859.1 FTEs) to 2021 (n = 799.0 FTEs). This holds true for the professional groups of physicians, specialist assistants, medical assistants, and externally contracted physicians. The number of female employee FTEs rose significantly during this period from 85.6% (2016) to 87.0% (2021). The part-time ratio also increased significantly from 41.4% (2016) to 50.6% (2021). The number of assignments to the Medical Service was stable in 2017-2019 at around 630,000 but showed areduction in 2020 (n = 518,538) and 2021 (n = 545,289); in particular, the number of assessments with client contact decreased significantly from 2019 (n = 166,980) to 2020 (n = 52,484). Most of the assignments came from the field of job placement (n = 349,346). The size of the Medical Service was in line with the total number of orders, which can certainly be seen as COVID-19-related in 2020 and 2021 and is likely due to the overall shortage of skilled personnel. The proportion of women and part-time employees increased significantly, with anationwide part-time trend emerging not only among women. In order to enable all clients who may be unable to perform in the labor market to receive aquick assessment, it is necessary that the number of employees in the Medical Service does not decrease in the future.

Palliative care need in the Eastern Mediterranean Region and human resource requirements for effective response.

Integration of palliative care into health care systems is considered an ethical responsibility, yet no country in the Eastern Mediterranean Region (EaMReg) has achieved integration. Data on palliative care need and cost are crucial forEaMReg health care planners and implementers in the region. Using data from the Lancet Commission on Palliative Care and Pain Relief, we estimated the number of people in each EaMReg country who needed palliative care in 2015 and their degree of access. In three countries, we estimated the number of days during which an encounter for palliative care was needed at each level of the health care system. This enabled calculation of the number of full-time equivalents (FTEs) of clinical and non-clinical staff members needed at each level to administer the essential package of palliative care recommended by WHO. In 2015, 3.2 million people in the EaMReg needed palliative care, yet most lacked access to it. The most common types of suffering were pain, fatigue, weakness, anxiety or worry, and depressed mood. To provide safe, effective palliative care at all levels of health care systems, between 5.4 and 11.1 FTEs of trained and supervised community health workers per 100,000 population would be needed in addition to 1.0-1.9 FTEs of doctors, 2.2-4.3 FTEs of nurses, and 1.4-2.9 FTEs of social workers. Data from our study enables design of palliative care services to meet the specific needs of each EaMReg country and to calculate the cost or cost savings.

ASHP National Survey of Pharmacy Practice in Hospital Settings: Workforce - 2022.

Results of the 2022 ASHP National Survey of Pharmacy Practice in Hospital Settings are presented. Pharmacy directors at 1,498 general and children's medical/surgical hospitals in the United States were surveyed using a mixed-mode method of contact by email and mail. Survey completion was online. IQVIA supplied data on hospital characteristics; the survey sample was drawn from IQVIA's hospital database. The response rate was 23.7%. Inpatient pharmacists independently prescribe in 27.1% of hospitals. Advanced analytics are used in 8.7% of hospitals. Pharmacists work in ambulatory or primary care clinics in 51.6% of hospitals operating outpatient clinics. Some level of pharmacy service integration is reported in 53.6% of hospitals. More advanced pharmacy technician roles are emerging. For health systems offering hospital at home services, 65.9% of pharmacy departments are involved. Shortages of pharmacists and technicians were reported but are more acute for pharmacy technicians. Aspects of burnout are being measured in 34.0% of hospitals, and 83.7% are attempting to prevent and mitigate burnout. The average number of full-time equivalents per 100 occupied beds is 16.9 for pharmacists and 16.1 for pharmacy technicians. Health-system pharmacies are experiencing workforce shortages; however, these shortages have had limited impact on budgeted positions. Workforce challenges are influencing the work of pharmacists and pharmacy technicians. Adoption of practice advancement initiatives has continued the positive trend from past years despite workforce issues.

The School Librarian Equity Gap: Inequities Associated with Race and Ethnicity Compounded by Poverty, Locale, and Enrollment

ABSTRACT The School Librarian Investigation—Decline or Evolution? (SLIDE) project is a federally funded study of the almost 20% national decline in the number of full-time equivalents (FTEs) of school librarians between 2015 and 2019, according to the National Center for Education Statistics. In this update to the project’s original research, school librarian employment data for the 2020-2021 school year were examined for 12,537 school districts and associated with district characteristics (poverty, locale, and district enrollment) and student demographics (race and ethnicity). Data supported previous findings that access to school librarians is strongly related to race and ethnicity and further exacerbated for students living in extreme poverty, in more-isolated locales, and in the smallest districts—locales where students are less likely to have access to the educational resources available in large urban areas. In school year 2021, 3 million students in majority nonwhite districts were without any librarians; they were 54% of the 5.6 million students in all districts without any librarians during the COVID-19 pandemic. The gap between students in districts with a “library privilege” and those without librarians continues to widen.

Staffing Up and Sustaining the Public Health Workforce.

Estimate the number of full-time equivalents (FTEs) needed to fully implement Foundational Public Health Services (FPHS) at the state and local levels in the United States. Current and full implementation cost estimation data from 168 local health departments (LHDs), as well as data from the Association of State and Territorial Health Officials and the National Association of County and City Health Officials, were utilized to estimate current and "full implementation" staffing modes to estimate the workforce gap. The US state and local governmental public health workforce needs at least 80 000 additional FTEs to deliver core FPHS in a post-COVID-19 landscape. LHDs require approximately 54 000 more FTEs, and states health agency central offices require approximately 26 000 more. Governmental public health needs tens of thousands of more FTEs, on top of replacements for those leaving or retiring, to fully implement core FPHS. Transitioning a COVID-related surge in staffing to a permanent workforce requires substantial and sustained investment from federal and state governments to deliver even the bare minimum of public health services.

Modeling Health Workforce Planning in Specialties and Subspecialties: A Need-Adjusted Demand Model

Background: Need and demand modeling is one of the conceptual approaches of health workforce planning. In many models of this field, “need” is not considered. Each country should model according to its context. Objectives: The present study aimed to design a need adjusted with demand model of the health workforce in the fields of specialties and subspecialties. Methods: Walker and Avant’s synthesis theory method was used for modeling in this study. The concepts of need and demand were chosen as the focal concepts. In addition, to find the components related to the concepts and the relationships between these components, the result of a previous systematic review and a supplementary study of viewpoints of research teams were used. In the last step, the graphic form of the model was presented. Results: The need-adjusted demand model was presented in this study. In this model, the types of flows were headcounts. Actual need, willingness, and ability to use health services were considered. Finally, the number of full-time equivalents of physicians was estimated. Conclusions: In this model, a series of main components that are headcounts and a series of influential factors that affect the main factors through rates were considered.

Establishing an Advanced Practice Provider Resource Team: An Agile Staffing Model

Advanced practice provider (APP) vacancy rates contribute to staffing shortfalls impacting many health care systems. These vacancies are caused by turnover, absenteeism, and medical leaves, and can result in medical errors, employee stress, provider burnout, patient and provider dissatisfaction, and lost revenue. This paper summarizes the experience of the development and implementation of the APP resource team within a single organization to address APP staffing shortages. Challenges and lessons learned will be described. The decade success of this novel program has led to an increase in the number of full-time equivalents employed on the resource team.

The Challenge of Employee Retention in Medical Practices across the United States: An Exploratory Investigation Into the Relationship between Operational Succession Planning and Employee Turnover.

Employee turnover is a growing challenge for health-care providers delivering patient care today. US population demographics are shifting as the population ages, which leaves the field of health care poised to lose key leaders and employees to retirement at a time when patient care has grown more complex. This means health care will lose its core of key employees at a time when skilled leadership and specialized knowledge is most needed and directly impacts health care's ability to deliver quality care. Operational succession planning (OSP) may be one solution to manage this looming challenge in health care, as the process identifies and develops the next generation of leadership. Thus, this exploratory national study used a quantitative and cross-sectional design to examine the relationship between OSP and employee turnover. Demographic and 10-point Likert scale data were collected from n = 66 medical practices, using an online survey instrument. Data were analyzed using various descriptive and inferential statistical methods. Distribution (frequency and chi-square) analyses of the study sample, one-way analysis of variance (ANOVA), and regression analyses were performed across seven demographic characteristics of the medical practices: Specialty, Ownership Structure, Number of full-time equivalent (FTE) Physicians, Number of FTE Clinical Employees, Number of FTE Nonclinical Employees, Number of FTE Employees Left Position, and Region. Study results provided statistically significant evidence to support the relationship between OSP and employee turnover, highlighting that OSP was associated with lower employee turnover. The finding suggests that OSP can serve as an effective mechanism for increasing employee retention.

Association of the Frequency of In-Home Care Services Utilization and the Probability of In-Home Death

The provision of end-of-life care is an important policy issue associated with population aging around the world. Yet it is unclear whether the provision of in-home care services can allow patients the option of in-home death at end of life. To assess whether the frequent use of in-home care services can assist recipients to stay at home at the end of life. This cohort study of older adults in Japan's long-term care insurance system used national claims data. Participants were long-term care insurance beneficiaries aged 65 years or over who died in 2015, excluding those who died due to external causes such as accidents. Data analyses were conducted from October to December 2020. Mean days of in-home care service used per week from the first day of the month before the month of death to the date of death. Primary outcome was whether the older person died at home (or not). To address lack of information on individual preference for place of death, we used an instrumental variable estimation with the full-time equivalent number of care workers providing in-home care services per older population at the municipality level in 2014. Of the 572 059 decedents included in the study, 314 743 (55.0%) were women (median [IQR] age, 87 [81-91] years). The proportion of in-home deaths was 10.5% (60 175 decedents), and 81 675 decedents (14.3%) used in-home care services at least once prior to their death. Ordinary least squares and 2-stage least squares analyses both indicated that more frequent use of in-home care was associated with a higher probability of in-home deaths (ordinary least squares estimate, 5.0 percentage points; 95% CI, 4.9-5.1 points vs 2-stage least squares estimate, 3.6 percentage points; 95% CI, 2.3-4.9 points). This retrospective cohort study using an instrumental variable approach demonstrated that more frequent use of in-home care services at the end of life was associated with a higher probability of in-home death. One policy implication of these results is that in order to meet the end-of-life preferences of patients, it is not only necessary to promote the provision of medical services at home but also to ensure an adequate supply of care workers.

Cost evaluation of integrating local HIV and housing data to facilitate service coordination in four demonstration sites

ABSTRACT As part of the evaluation of a federal initiative to integrate HIV medical and housing data at four local jurisdictions in the U.S., we estimated the financial costs of implementing data integration occurring from June 2016 to August 2018. We collected data on labor, non-labor, and overhead expenses based on invoices and surveys of staff time, staff compensation, and non-labor expenses. Non-labor expenses were directly charged or allocated to the project using the number of full-time equivalents as the allocation basis. Reported indirect cost rates were used to estimate overhead expenses. Demonstration sites spent an average of $273,656 over the full 27-month period, with an average monthly spending of $10,010 in 2018 U.S. dollars. There was sizable variation in the data integration costs across sites, implementation phases, and data integration models. Findings may help policymakers and potential adopters of similar data integration efforts customize parameters for local conditions and estimate resources required.

Does Publishing During the Doctorate Influence Completion Time? A Quantitative Study of Doctoral Candidates in Australia

Aim/Purpose: This paper investigates the association between publishing during doctoral candidature and completion time. The effects of discipline and of gaining additional support through a doctoral cohort program are also explored. Background: Candidates recognize the value of building a publication track record to improve their career prospects yet are cognizant of the time it takes to publish peer-reviewed articles. In some institutions or disciplines, there is a policy or the expectation that doctoral students will publish during their candidature. However, doctoral candidates are also under increasing pressure to complete their studies within a designated timeframe. Thus, some candidates and faculty perceive the two requirements – to publish and to complete on time – as mutually exclusive. Furthermore, where candidates have a choice in the format that the PhD submission will take, be it by monograph, PhD-by-publication, or a hybrid thesis, there is little empirical evidence available to guide the decision. This paper provides a quantitative analysis of the association between publishing during candidature and time-to-degree and investigates other variables associated with doctoral candidate research productivity and efficiency. Methodology: Multivariate logistic regression analyses were used to examine the predictors (discipline [field of research], gender, age group, domestic or international student status, and belonging to a cohort program) of doctoral candidate research productivity and efficacy. Research productivity was quantified by the number of peer-reviewed journal articles that a candidate published as a primary author during and up to 24 months after thesis submission. Efficacy (time-to-degree) was quantified by the number of Full-Time Equivalent (FTE) years of candidature. Data on 1,143 doctoral graduates were obtained from a single Australian university for the period extending from 2000 to 2020. Complete publication data were available on 707 graduates, and time-to-degree data on 664 graduates. Data were drawn from eight fields of research, which were grouped into the disciplines of health, biological sciences, agricultural and environmental sciences, and chemical, earth, and physical sciences. Contribution: This paper addresses a gap in empirical literature by providing evidence of the association between publishing during doctoral candidature and time-to-degree in the disciplines of health, biological sciences, agricultural and environmental sciences, and chemical, earth, and physical sciences. The paper also adds to the body of evidence that demonstrates the value of belonging to a cohort program for doctoral student outcomes. Findings: There is a significant association between the number of articles published and median time-to-degree. Graduates with the highest research productivity (four or more articles) exhibited the shortest time-to-degree. There was also a significant association between discipline and the number of publications published during candidature. Gaining additional peer and research-focused support and training through a cohort program was also associated with higher research productivity and efficiency compared to candidates in the same discipline but not in receipt of the additional support. Recommendations for Practitioners: While the encouragement of candidates to both publish and complete within the recommended doctorate timeframe is recommended, even within disciplines characterized by high levels of research productivity, i.e., where publishing during candidature is the “norm,” the desired levels of student research productivity and efficiency are only likely to be achieved where candidates are provided with consistent writing and publication-focused training, together with peer or mentor support. Recommendation for Researchers: Publishing peer-reviewed articles during doctoral candidature is shown not to adversely affect candidates’ completion time. Researchers should seek writing and publication-focused support to enhance their research productivity and efficiency. Impact on Society: Researchers have an obligation to disseminate their findings for the benefit of society, industry, or practice. Thus, doctoral candidates need to be encouraged and supported to publish as they progress through their candidature. Future Research: The quantitative findings need to be followed up with a mixed-methods study aimed at identifying which elements of publication and research-focused support are most effective in raising doctoral candidate productivity and efficacy.

Biased technical change in hospital care and the demand for physicians

BackgroundThe development of labour productivity is relevant for accurately planning future staffing requirements, especially in sectors where technological developments may drive labour substitution. The present study investigates how labour productivity has developed across Dutch medical specialists (2007–2017) and discusses its implications for workforce planning, also in relation to the existing literature.MethodsA regression model is developed in which the number of full-time equivalents is related to production (admissions), hospital characteristics and a trend parameter. The trend parameter captures the average annual change in the number of full-time equivalents per production output and is a measure for labour productivity. The model is applied to a micro-data set of Dutch hospitals in the period 2007–2017 across 24 different specialties using regression methods.ResultsThe results indicate an increase in the number of full-time equivalents per admission has increased for most specialisms and that labour productivity has thus decreased. However, there is considerable heterogeneity and uncertainty across different specialisms.ConclusionsThe results amplify the issue of medical personnel shortages driven by the growing demand for health care. The research outcomes are linked to the existing literature regarding physicians’ productivity. Changes in accountability such as using relative value units, incentive payments, use of staff and mid-level providers, and technology have been discussed, and some consensus has been reached.

Reducing CLABSI and CAUTI: Does the Infection Preventionist's Title Matter?

<h3>Background</h3> Central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) are associated with morbidity, mortality, expense and prolonged length of stay, yet these infections are largely preventable. We found that CLABSI/CAUTI reduction success varied widely within our 27-facility US acute care hospital system, and that infection prevention (IP) leadership roles were not standardized throughout. We conducted a 12-month study to examine differences in CLABSI and CAUTI standardized infection ratios (SIR) between director-led IP programs and manager-led programs. We also analyzed additional variables that may have influenced the outcomes between the two groups. <h3>Methods</h3> Nine of our facility IP programs are led by directors, while 18 are led by managers. CLABSI and CAUTI SIRs were calculated for each group via the National Healthcare Safety Network (NHSN). In addition, we examined IP years' experience, certification (CIC) status, and IP staffing ratios to account for differences in knowledge, experience, and full-time equivalents (FTE) available for the programs. An eight-question survey was sent to front-line nursing staff at each facility via Survey Monkey to assess nursing perceptions on the importance of the IP program. Analysis was completed on levels of influence using Fischer's Exact and Student's T Tests. <h3>Results</h3> Analysis revealed that programs led by IP directors had statistically significant lower CLABSI (p=0.00) and CAUTI (p=0.026) SIRs than manager-led programs. There was no significant difference in years of IP experience (p=0.31), CIC status (p=0.38) or the number of FTEs (p=0.24) between each group. Additionally, survey results on perceptions of IP program importance among front line nursing staff showed significantly higher scores for IP directors reporting to senior leadership (p=0.04). <h3>Conclusions</h3> Our study suggests that director-led IP programs may be more successful in CLABSI and CAUTI reductions due to the direct reporting structure and access to senior leadership that influences perception of the IP program.

The Implication of the HEQSF Act on Human and Financial Resources

Currently the fee structure at a University of Technology is based on subject and not credit base. Qualifications found in the same funding category within the University showed a large variability in costs. The research seeked to understand how the alignment of the fee structure of the Higher Education Qualifications Sub Framework (HEQSF) would affect class fees at UoTs. To propose a new fee structure in a sustainable way a model was developed. &#x0D; A University of Technology was used as a case study. A mixed method research design was followed in the realm of an epistemological paradigm that focusing on policy and needs analysis and on predicted future requirements. The model takes into consideration the qualification mix, funding groups, National Qualifications Framework (NQF) levels, NQF credits of the qualifications. &#x0D; Benchmarking between universities indicate significant discrepancies, based on qualifications of similar duration, funding category and resources required. It showed that the UoT was much lower than the country average.&#x0D; The novelty of the developed model was to calculate the total income of a qualification for each funding group. Based on classification of educational subject matter (CESM) categories, Department of Higher Education and Training (DHET) funding, Teaching Input Units (TIUs) , Teaching Output Units (TOUs), the Rand value of a Senior Lecturer Equivalent (SLE), the targeted number of Full Time Equivalents (FTEs) per SLE per CESM category, TUT financial targets, and benchmarked data. Variables of the model were dynamic, implying that it could easily be adapted for changes in (DHET) funding policy.&#x0D; The developed model showed the new class fee structure for all qualification types. Ring fencing of 25% between the lowest and the highest funding group was done, and the impact it has on income generated by class fees.

The Supply of Rheumatology Specialist Care in Real Life. Results of a Nationwide Survey and Analysis of Supply and Needs.

Objectives: To study the balance between the supply and need for rheumatology care in Austria. In addition, to investigate rheumatologists' work-hours, the amount of time rheumatologists dedicate to care for patients with rheumatic and musculoskeletal diseases (RMD), with non-RMD problems, and other professional activities such as research, teaching, and administration.Methods: A questionnaire covering aspects of professional activities was sent to all 215 rheumatologists registered with the Austrian Medical Association. The data collected was set in relation to the need calculated on the basis of recommendations put forward by the German society of rheumatology.Results: 149 of the 215 rheumatologists (69.0%) responded. Median weekly working time was 50 h (IQR 45–60). 47.4% of the working time was spent for care of patients with RMD. The remaining time was dedicated to patients with non-rheumatic diseases (19.6%), research and teaching (8.4%), and administration (24.5%). The number of full-time equivalents (FTE, based on a 40-h work-week) available for rheumatology care, thus, was calculated to be 178.5. Based on disease prevalence/incidence estimates and on the time allocation results of this survey, our study resulted in a need of 4.29 rheumatologists per 100.000 adult inhabitants (301.79 for an adult population of 7.03 × 106).Conclusion: The study demonstrated a substantial mismatch between the available supply and the need for rheumatology care. The results of our study are a conservative estimate, which should be taken into consideration for future healthcare workforce planning. In particular, the rising need for rheumatologists should be met by increasing the numbers of those specialists.

Improving the delivery of primary care for older people.

Improving the delivery of primary care for older people.

Developing an appropriate staff mix for anticoagulation clinics: functional job analysis approach

Anticoagulation clinics (ACCs) are specialty clinics that manage patients with blood clotting problems. Since labor costs usually account for a substantial portion of a healthcare organization’s budget, optimizing the number and types of staff required was often the focus, especially for ACCs, where labor-intensive staff-patient interactions occur. A significant portion of tasks performed by clinical pharmacists might be completed by clinical pharmacist technicians, which are less-expensive resources. While nurse staffing models for a hospital inpatient unit are well established, these models are not readily applicable to staffing ACCs. Therefore, the objective of this paper is to develop a framework for determining the right staff mix of clinical pharmacists and clinical pharmacy technicians that increases the efficiency of care delivery process and improves the productivity of ACC staff. A framework is developed and applied to build a semi-automated full-time equivalent (FTE) calculator and compare various staffing scenarios using a simulation model. The FTE calculator provides the right staff mix for a given staff utilization target. Data collected from the ACCs at VA Boston Healthcare System is used to illustrate the FTE calculator and the simulation model. The result of the simulation model can be used by ACC managers to easily determine the number of FTEs of clinical pharmacists and clinical pharmacy technicians required to reach the target utilization and the corresponding staffing cost.