Responsibility For Patient Care Research Articles

Personal and work-related factors associated with post-traumatic growth in nurses: A mixed studies systematic review.

Nurses, assuming a wide range of clinical and patient care responsibilities in a healthcare team, are highly susceptible to direct and indirect exposure to traumatic experiences. However, literature has shown that nurses with certain traits developed a new sense of personal strength in the face of adversity, known as post-traumatic growth (PTG). This review aimed to synthesize the best available evidence to evaluate personal and work-related factors associated with PTG among nurses. Mixed studies systematic review. Studies examining factors influencing PTG on certified nurses from all healthcare facilities were included. Published and unpublished studies were identified by searching 12 databases from their inception until 4th February 2023. Two reviewers independently screened, appraised, piloted a data collection form, and extracted relevant data. Meta-summary, meta-synthesis, meta-analysis, as well as subgroup and sensitivity analyses were performed. Integration of results followed result-based convergent design. A total of 98 studies with 29,706 nurses from 18 countries were included. These included 49 quantitative, 42 qualitative, and seven mixed-methods studies. Forty-six influencing factors were meta-analyzed, whereas nine facilitating factors were meta-summarized. A PTG conceptual map was created. Four constructs emerged from the integration synthesis: (a) personal system, (b) work-related system, (c) event-related factors, and (d) cognitive transformation. The review findings highlighted areas healthcare organizations could do to facilitate PTG in nurses. Practical implications include developing intervention programs based on PTG facilitators. Further research should examine the trend of PTG and its dynamic response to different nursing factors. Research on trauma-focused therapies targeting nurses' mental health is lacking. Therefore, findings from this review could inform healthcare organizations on the PTG phenomenon and developing support measures for nurses through healthcare policies and clinical practice.

Pharmacist-prescriber collaborative models of care for opioid use disorder: an overview of recent research.

Collaborative models of care where pharmacists work alongside physicians have been developed for a range of physical health conditions, with benefits including improved patient outcomes and increased access to ongoing care. Opioid agonist treatment (methadone and buprenorphine) is a clinically effective and cost-effective treatment for opioid use disorder that is under-utilized in many countries due to a shortage of prescribers. In recent years, there has been increased interest in the development of collaborative models that utilize pharmacists to overcome barriers to treatment. In this article, we present a narrative review to synthesise recent work in this rapidly developing area. Two key aspects of opioid agonist treatment were identified: Collaborative models have utilized pharmacists to facilitate buprenorphine induction, and collaborative models provide increased capacity for delivering ongoing care in a variety of settings and patient groups where prescriber access is limited. Pharmacists have undertaken direct patient care responsibilities with varying degrees of autonomy, with benefits including a reduction in prescriber workload, and improvements in treatment retention and continuity of care. Collaborative models in which pharmacists are responsible for buprenorphine induction and ongoing management with methadone and buprenorphine have been shown to reduce demands on prescribers while improving or maintaining patient outcomes, and appear feasible and acceptable in a wide range of outpatient settings.

Effects of Telemedicine on Informal Caregivers of Patients in Palliative Care: Systematic Review and Meta-Analysis.

Telemedicine technology is a rapidly developing field that shows immense potential for improving medical services. In palliative care, informal caregivers assume the primary responsibility in patient care and often face challenges such as increased physical and mental stress and declining health. In such cases, telemedicine interventions can provide support and improve their health outcomes. However, research findings regarding the use of telemedicine among informal caregivers are controversial, and the efficacy of telemedicine remains unclear. This study aimed to evaluate the impacts of telemedicine on the burden, anxiety, depression, and quality of life of informal caregivers of patients in palliative care. A systematic literature search was conducted using the PubMed, Embase, Web of Science, CENTRAL, PsycINFO, CINAHL Plus with Full Text, CBM, CNKI, WanFang, and VIP databases to identify relevant randomized controlled trials published from inception to March 2023. Two authors independently screened the studies and extracted the relevant information. The methodological quality of the included studies was assessed using the Cochrane risk-of-bias tool. Intervention effects were estimated and sensitivity analysis was conducted using Review Manager 5.4, whereas 95% prediction intervals (PIs) were calculated using R (version 4.3.2) and RStudio. A total of 9 randomized controlled trials were included in this study. The meta-analysis indicated that telemedicine has reduced the caregiving burden (standardized mean differences [SMD] -0.49, 95% CI -0.72 to -0.27; P<.001; 95% PI -0.86 to -0.13) and anxiety (SMD -0.23, 95% CI -0.40 to -0.06; P=.009; 95% PI -0.98 to 0.39) of informal caregivers; however, it did not affect depression (SMD -0.21, 95% CI -0.47 to 0.05; P=.11; 95% PI -0.94 to 0.51) or quality of life (SMD 0.35, 95% CI -0.20 to 0.89; P=.21; 95% PI -2.15 to 2.85). Although telemedicine can alleviate the caregiving burden and anxiety of informal caregivers, it does not significantly reduce depression or improve their quality of life. Further high-quality, large-sample studies are needed to validate the effects of telemedicine. Furthermore, personalized intervention programs based on theoretical foundations are required to support caregivers.

Roles, Responsibilities, and Expectations of Medical Students on Surgical Subinternships: A Modified Delphi Consensus Study.

Surgical subinternships are important rotations for students preparing for a career in general surgery; however, these rotations often vary by institution and service. This modified Delphi study was conducted to reach a consensus set of roles, responsibilities, and expectations of fourth-year medical students on their surgical subinternships. Candidate statements on roles, responsibilities, and expectations of subinterns were categorized into 7 domains: rotation structure, rounding and patient care, operating room conduct, technical skills, knowledge base, clinic, and professionalism. Expert panels were assembled of key stakeholders: program directors, clerkship directors, other education faculty, trainees, and recent subinterns. Three Delphi rounds were conducted from January to April 2023 to reach consensus defined a priori as a Cronbach α ≥ 0.8 and 80% or greater panel agreement. Forty-six expert panelists were recruited to participate in Delphi rounds, with 100%, 95.7%, and 97.8% response rates in the first, second, and third rounds, respectively. By the third round, 67 statements reached consensus as essential roles, responsibilities, and expectations of surgical subinterns. Key themes from these 67 statements included subinterns approximating the role of an intern with respect to work hours, patient care responsibilities, basic technical skills, and knowledge base. Panelists rated rounding and patient care as the most important domain, followed closely by professionalism. Additional key domains for evaluation in descending order were knowledge base, operating room conduct, clinic, and technical skills. By the third round, notable disagreements in the Delphi process included technical skills and rounding and patient care (93.3% and 88.9% agreement, respectively). This study provides a national consensus on core roles, responsibilities, and expectations for medical students completing surgical subinternships. Students can use these recommendations to prepare for subinternships, whereas faculty as well as residents and fellows can use them to evaluate applicants for general surgery residency positions.

Enhancing availability of services to control hypertension through a team-based care approach that includes pharmacists

BackgroundPrimary care physician (PCP) shortages are expected to increase. The Michigan Medicine Hypertension Pharmacists’ Program uses a team-based care (TBC) approach to redistribute some patient care responsibilities from PCPs to pharmacists for patients with diagnosed hypertension. ObjectiveThis evaluation analyzed whether the Michigan Medicine Hypertension Pharmacists’ Program increased the availability of hypertension management services and described facilitators that addressed barriers to program sustainability and replicability. MethodsWe conducted a retrospective observational study that used a mixed methods approach. We examined the availability of hypertension management services using the number of pharmacists’ referrals of patients to other services and the number of PCP appointments. We analyzed qualitative interviews with program staff and site-level quantitative data to examine the program’s impact on the availability of services, the impact of TBC that engaged pharmacists, and program barriers and facilitators. ResultsPatients who visited a pharmacist had fewer PCP visits over 3- and 6-month periods compared to a matched comparison group that did not see a pharmacist and were 1.35 times more likely to receive a referral to a specialist within a 3-month period. Support from leaders and physicians, shared electronic health record access, and financial backing emerged as leading factors for program sustainability and replicability. ConclusionAdding pharmacists to the care team reduced the number of PCP appointments per patient while increasing the availability of hypertension management services; this may in turn improve PCPs’ availability. Similar models may be sustainable and replicable by relying on organizational buy-in, accessible infrastructure, and financing.

Umbrella Review: Stress Levels, Sources of Stress, and Coping Mechanisms among Student Nurses.

Prelicensure nursing students face significant stress from their education and clinical placements, highlighting the crucial need for the development of effective coping mechanisms with which to manage both academic and clinical responsibilities, ultimately enhancing the wellbeing and academic performance of these students. This umbrella review aims to evaluate and synthesize existing review articles that examine stress levels and coping mechanisms among student nurses during their education and training. Five databases (PsycINFO, PubMed, CINAHL, Scopus and Web of Science) were searched for review articles published from 2010 onwards. This review includes twelve articles, encompassing 189 studies. The review findings demonstrate that student nurses experience moderate-to-high levels of stress during their nurse education. Major sources of stress include academic demands, patient care responsibilities, and interactions with nursing staff and faculty. Commonly utilized coping skills involve problem-solving behaviors, transference, and maintaining an optimistic outlook. Given the adverse consequences of stress, nurse educators play a critical role in the development of strategies with which to reduce stress and enhance coping skills among student nurses. This study was not registered.

Peer support-based online education, burden of care and quality of life among family caregivers of patients with leukaemia: non-randomised clinical trial

ObjectiveThe responsibility of caring for patients with leukaemia places a heavy burden on family caregivers (FCs) and negatively impacts their quality of life (QoL). This study aimed to investigate the...

Factors Associated with Burnout Syndrome among Clinical Medical Students at Chonburi Hospital, Thailand

Objective: Burnout syndrome causes chronic fatigue, loss of motivation, despair, decreased work performance, and depression. Clinical medical students risk developing burnout syndrome due to long-term learning pressure, responsibilities for patient care and night shifts. This study aimed to examine the factors associated with burnout syndrome among clinical medical students at Chonburi Hospital.Material and Methods: A cross-sectional study was conducted from July 2022 and January 2023. Data were collected using the Maslach Burnout Inventory General Survey among 106 medical students. Descriptive statistics, chi-square, ANOVA, and the independent t-test were used to investigate the association among variables.Results: Severe burnout syndrome was not found among clinical medical students. High emotional exhaustion was the most common burnout symptom among these medical students (53.8%). While 27.3% had high depersonalization, no medical students had low personal accomplishment. The factor related to high emotional exhaustion was 4th-year medical students. At the same time, the factors associated with high depersonalization were fourth-year medical students, males, and low accumulated grade point averages (GPAX).Conclusion: The prevalence of severe burnout was not found among clinical medical students at Chonburi Hospital. However, males, fourth-year medical students, and low GPAX were risk factors for burnout symptoms. Therefore, screening, monitoring, and providing help to these at-risk medical students to reduce their chances of severe burnout should be encouraged.

Alone yet accountable, the unseen buffers: A qualitative study of nurses' experiences working in home care during the COVID-19 pandemic.

Norwegian society's resilience during the COVID-19 pandemic resulted in low mortality rates and moderate economic decline. The accessible primary healthcare system played a vital role in this, especially in the care of elderly and chronically ill patients. However, nurses in home care experienced emotional burdens, ethical dilemmas and limited access to protective equipment. These challenges were overshadowed by media coverage of hospital struggles, and municipal home care services were oddly absent from post-pandemic reports. This research therefore aimed to explore and describe how nurses experienced working in home care during the pandemic. We designed a qualitative study and conducted semi-structured interviews with nine home care nurses from different municipalities in Southeast Norway. Systematic text condensation inspired by Malterud was employed for data analysis. Nurses' experiences were described through two categories: 'adapting approaches' and 'adapting work practices'. The results showed how nurses often felt alone while simultaneously shouldering a significant responsibility for patients facing a novel and unfamiliar illness. The pandemic necessitated treating patients in their own homes to minimise infection risks, intensifying the nurses' treatment responsibilities. Furthermore, limited access to medical expertise and physical separation from management due to remote work accentuated feelings of isolation and amplified the nurses' responsibility for patient care. Additionally, the nurses encountered frequent changes in work routines, demanding adaptability. This study underscores the significant role of home care nurses, who, despite feeling professionally isolated and unsupported, demonstrated impressive adaptability. They served as a crucial buffer in the healthcare system, ensuring vulnerable individuals received essential care. This highlights the importance of a robust primary healthcare system with a skilled nursing workforce that can work autonomously, shoulder responsibility, and make clinical decisions, even when medical expertise is less readily available. It also reminds us that healthcare preparedness depends on collaborative efforts across all sectors.

Re-conceptualizing medical education in the post-COVID era

Purpose The COVID-19 pandemic has forced changes in the delivery of medical education. We aimed to explore these changes and determine whether they will impact the future of medical education in any way. Methods We invited leaders in medical education from all accessible US-based medical schools to participate in an online individual semi-structured interview. Results Representatives of 16 medical schools participated. They commented on the adequacy of online education for knowledge transfer, and the logistical advantages it offered, but decried its negative influence on social learning, interpersonal relationships and professional development of students, and its ineffectiveness for clinical education. Most participants indicated that they would maintain online learning for didactic purposes in the context of flipped classrooms but that a return to in-person education was essential for most other educational goals. Novel content will be introduced, especially in telemedicine and social medicine, and the students’ roles and responsibilities in patient care and in curricular development may evolve in the future. Conclusions This study is the first to document the practical steps that will be adopted by US medical schools in delivering medical education, which were prompted and reinforced by their experience during the COVID-19 pandemic.

P178: Scope of post-diagnostic dementia care by Japanese primary care clinics using team-based care models

Objective:Primary care clinics (PCCs) in Japan have acquired the capacity for screening and diagnosing dementia in its early stage. They face challenges in accommodating the complex care needs of people with early-stage dementia in collaboration with other healthcare providers in the community. The study aims were; 1) to classify team-based care models of PCCs for post-diagnostic care for people with early-stage dementia in Japan’s Community-based Integrative Care System and 2) to compare the scope of care in each model.Methods:We conducted a cross-sectional postal survey to certified Dementia Support Doctors working in PCCs in Tokyo. To classify team-based care models, the questionnaire asked about the members, roles, and collaboration of the community-wide care team for early-stage dementia in which participants’ PCCs were involved. We gathered information on care provision across seven domains that PCCs offered for people with early-stage dementia. Three-step latent class analysis was performed to classify models and analyze differences in the proportions of care provision in each domain. The Tokyo Metropolitan Institute for Geriatrics and Gerontology institutional review board approved the study.Results:From the 188 responses, PCCs’ team practices were categorized into three classes, which we named “co-managed,” carved-out,” and “stand-alone” models. While the first two ran an extended care team through in-person communication across facilities in the community, the last applied a minimal team approach with limited and indirect external interaction. The “co-managed” and “carved-out” models were distinguished by how team members shared decision-making responsibilities for patient care. Maximum likelihood estimation grouped 46.6%, 32.8%, and 20.6% of the PCCs into each model in the above order. The three models significantly differed in the proportions of care provision in five of seven domains. The proportions in each domain were the highest for the “co-managed” model (60.7-100%), followed by the “carved-out” (46.2- 98.2%) and “stand-alone” (25.7-88.6%) models.Conclusion:PCCs in Japan’s Community-based Integrative Care System formed three models of post- diagnostic support for people with early-stage dementia. Considering the application of the team approach and the breadth of care provision, either “co-managed” or “carved-out” models are recommended with available community resources in mind.

Stereotype Threat and Gender Bias in Internal Medicine Residency: It is Still Hard to be in Charge

BackgroundDespite similar numbers of women and men in internal medicine (IM) residency, women face unique challenges. Stereotype threat is hypothesized to contribute to underrepresentation of women in academic leadership, and exploring how it manifests in residency may provide insight into forces that perpetuate gender disparities.ObjectiveTo quantify the prevalence of stereotype threat in IM residency and explore experiences contributing to that stereotype threat.DesignWe used a mixed methods study design. First, we surveyed IM residents using the Stereotype Vulnerability Scale (SVS) to screen for stereotype threat. Second, we conducted focus groups with women who scored high on the SVS to understand experiences that led to stereotype threat.ParticipantsThe survey was sent to all IM residents at University of California, San Francisco (UCSF), in September–November 2019. Focus groups were conducted at UCSF in Spring 2020.ApproachThe survey included an adapted version of the SVS. For focus groups, we developed a focus group guide informed by literature on stereotype threat. We used a thematic approach to data analysis. The mixed methods design enabled us to draw metainferences by integrating the two data sources.Key ResultsSurvey response rate was 61% (110/181). Women were significantly more likely than men to have a score indicating stereotype threat vulnerability (77% vs 0%, p < 0.001). Four themes from focus groups characterized women’s experiences of gender bias and stereotype threat: gender norm tension, microaggressions and sexual harassment, authority questioned, and support and allyship.ConclusionsGender-based stereotype threat is highly prevalent among women IM residents. This phenomenon poses a threat to confidence and ability to execute patient care responsibilities, detracting from well-being and professional development. These findings indicate that, despite robust representation of women in IM training, further attention is needed to address gendered experiences and contributors to women’s vulnerability to stereotype threat.

Cardiology professionals' views of social robots in augmenting heart failure patient care.

Social robots are arriving to the modern healthcare system. Whether patients with heart failure, a prevalent chronic disease with high health and human costs would derive benefit from a social robot intervention has not been investigated empirically. Diverse healthcare provider's perspectives are needed to develop an acceptable and feasible social robot intervention to be adopted for the clinical benefit of patients with heart failure. Using a qualitative research design, this study investigated healthcare providers' perspectives of social robot use in heart failure patient care. Interdisciplinary healthcare providers from a tertiary care cardiac hospital completed a structured individual interview and a supplemental questionnaire. The framework method was used to analyse the qualitative data. Respondents (n = 22; saturation was reached with this sample; 77% female; 52% physicians) were open to using social robots to augment their practice, particularly with collecting pertinent data and providing patient and family education and self-management prompts, but with limited responsibility for direct patient care. Prior to implementation, providers required robust evidence of: value-added beyond current remote patient monitoring devices, patient and healthcare provider partnerships, streamlined integration into existing practice, and capability of supporting precision medicine goals. Respondents were concerned that social robots did not address and masked broader systemic issues of healthcare access and equity. The adoption of social robots is a viable option to assist in the care of patients with heart failure, albeit in a restricted capacity. The results inform the development of a social robotic intervention for patients with heart failure, including improving social robot efficiencies and increasing their uptake, while protecting patients' and providers' best interest.

ASSESSMENT OF TIME MANAGEMENT SKILLS AMONG NURSES WORKING IN THE EMERGENCY DEPARTMENT

Nursing is a noble profession; time management is paramount to ensure the best patient care, effective management, quality education, and personal responsibilities. This study aimed to assess the time management skills of nurses working in the emergency department. A quantitative cross-sectional descriptive study design was used to assess the time management skills of nurses in the emergency department. The study was conducted at Lahore General Hospital (LGH) and Sir Ganga Ram Hospital Lahore, using purposive sampling techniques. Nurses aged over 25, working in emergency departments, having clinical experience of 3-5 years, and being registered by the Pakistan Nursing Council were included. Non-cooperative nurses and those working in departments other than emergencies were excluded. Data was collected through questionnaires that had two parts. Part I included biographic data, and Part II comprised 15 questions about time management skills. The results showed that over 50% of the nurses working in the emergency department, considered a hectic hospital unit, possessed time management skills. These skills included confidence, competence, prioritizing tasks, command and control, planning tasks or daily activities, learning from mistakes, feeling confident and competent, and writing appointments, following schedules, and rewarding themselves for their good job. The study concluded that most nurses working in the emergency department possess time management skills necessary for effective patient care. It is recommended that hospitals should provide training and resources to enhance these skills and that further research should be conducted to explore other factors that may affect time management in this setting. Overall, improving time management skills can lead to better patient outcomes, increased job satisfaction, and reduced stress for nursing staff.

Scaling the optimizing care model in community pharmacy using implementation mapping and COM-B theoretical frameworks

BackgroundThere has been increasing evidence that “task shifting,” when a provider entrusting specific responsibilities to another member of their team, can increase care access and may lead to better patient care outcomes. This has been particularly underscored in underserved communities throughout the world where task shifting has led to increased health care access in areas of provider shortages. Within the profession of pharmacy, pharmacy technicians are the primary pharmacist assistants and recipients of pharmacist-delegated tasks. Recently, such task delegation has placed the pharmacist in more direct patient care responsibilities beyond medication dispensing—and one such model with a growing evidence base is the optimizing care model. The optimizing care model is an novel approach to community pharmacy practice centered on expanded clinical service delivery by means of task delegation. Through task shifting, the optimizing care model has been shown to reduce medication errors and increase the quantity of patient care services offered by the pharmacist. However, means to spread and scale the model have yet to be reported in the literature. MethodsThis article describes the development of a package of implementation strategies designed to facilitate implementation of the optimizing care model in a single division of nationwide supermarket pharmacy chain. The implementation mapping approach was used to systematically develop strategies. In this approach, a protocol is prospectively developed to guide the implementation of a novel evidence-based interventions into a given setting, including the development of implementation strategies. ResultsThe application of the 5 steps of implementation mapping is described in detail. Implementation objectives, models, and strategies are outlined, as well as the final implementation protocol. There was an overall increase in weeks meeting the 10% optimizing care model threshold—33% at baseline to 83% after the intervention. ConclusionsThe implementation mapping process led to development of multifaceted implementation strategy for implementing the optimizing care model into community pharmacy practice. The strategy improved optimizing care model implementation. Further research is needed to understand which strategies were most impactful.

Knowledge and practice of handoff among doctors in a tertiary care hospital in Manipur: A cross-sectional study

ABSTRACT Context: The exchange of patient information and the transfer of responsibility for patient care between health-care providers constitute a vital aspect of health-care communication and maintain continuum of care and patient safety. There are limited data on knowledge and practice of handoff among resident doctors in Manipur. Aims: To assess the knowledge and practice of handoff among resident doctors of a tertiary care hospital, in Imphal, and to determine the association between sociodemographic characteristics and handoff practice. Subjects and Methods: A cross-sectional study among 279 resident doctors of a tertiary care hospital in Manipur was conducted. The data were collected using a pretested structured questionnaire. Statistical Analysis: The data were analyzed using IBM SPSS version 26.0. Descriptive statistics such as percentage, mean, and standard deviation were used to represent quantitative data. Chi-square test or Fisher’s exact test were used for categorical data. P &lt; 0.05 was considered statistically significant. Results: The mean age of participants was 29.65 ± 3.97 years. More than two-thirds of the participants were inadequately practicing handoff in patient care. There were significant associations between the knowledge pertaining to questions, “When does handoff occur in patient care?” (P = 0.013), “What is the purpose of handoff?” (P = 0.024), and “What are the characteristics of good handoff?”(P = 0.019) with the practice of handoff. Conclusion: Although more than 4/5th of the doctors had good knowledge, only a quarter of them had adequate handoff practice.

Nurses' Rest Breaks and Fatigue: The Roles of Psychological Detachment and Workload.

Rest breaks have been shown to reduce acute fatigue, yet not all nurses who take rest breaks report lower fatigue. Psychological detachment-letting go of work-related thoughts-during rest breaks and workload may be key factors in explaining this phenomenon. To examine the mediating role of psychological detachment during rest breaks and determine how workload moderated that pathway to lower acute fatigue among hospital nurses. In this cross-sectional study, data were collected from 1861 12-hour shift nurses who answered an online survey between July and September 2021. The survey included measures of occupational fatigue, psychological detachment from work, workload, and questions on breaks, work, health, and demographics. Structural equation modeling was used in Mplus 8.9 software to estimate the direct and indirect effects of rest breaks on acute fatigue at 3 levels of workload. Nurses, on average, reported high acute fatigue, rarely experienced psychological detachment during rest breaks, and reported heavy workloads. Around 60% were able to sit down for a break on their last shift but with patient-care responsibilities. The relationship between taking a rest break and acute fatigue was fully mediated by psychological detachment from work. However, this relationship only held in the context of manageable workloads. Our findings showed that within-shift recovery is possible when nurses can psychologically detach from work during rest breaks. However, this within-shift recovery mechanism was disrupted for nurses with heavy workloads.

Prioritizing ethical patient care responsibilities: A call to restructure student training practices in federally qualified health centers

Federally Qualified Health Centers (FQHCs) are federally funded clinics that often serve medically underserved groups. Many Colleges of Pharmacy have faculty and non-faculty pharmacist preceptors who provide clinical services such as drug therapy management to FQHCs. It is critical that Colleges of Pharmacy and pharmacist preceptors reinforce and uphold the standard of providing high quality and evidenced based care when students rotate at these sites. Learners may have implicit biases and variable levels of emotional intelligence prior to a clinical rotation at an FQHC, which can affect the quality-of-care patients receive. Colleges of Pharmacy who send learners onto rotations at FQHCs should collaborate with FQHC sites to ensure learner readiness in clinical and emotional levels and mediate for any concerns that may arise.

Pharmacists in general practice: what do they do? A qualitative case study

BackgroundPharmacists working in general practice are a relatively new phenomenon in many European countries. Providing insight into what pharmacists do in general practice may support further implementation of general practice-based pharmacist roles and enhance their contribution to health care.AimTo explore the tasks performed by pharmacists in general practice in Sweden.MethodA case study was conducted in 7 general practices in Uppsala County, Sweden, where pharmacists were employed. Activities performed by pharmacists were self-reported during March 2021. Participant observations and semi-structured interviews with pharmacists were conducted between October and November 2021. Self-reported activities were categorised and analysed using descriptive statistics. Qualitative data were analysed using conventional content analysis.ResultsIn total, 174 activities were self-reported by 8 pharmacists. Two pharmacists were observed for 2 days each, and 6 pharmacists were interviewed. Their main task was conducting medication reviews in older patients with polypharmacy. In addition, they handled a broad variety of drug-related questions and treatment follow-up. Pharmacists described working in a more efficient and needs-based manner over time. They stressed that working at the practice increased their accessibility to and their collaborative work with other healthcare professionals, and enabled them to meet patients face-to-face. Future challenges include defining tasks more clearly, assuming greater responsibility for patient care, and meeting the growing demand for pharmacists in general practice.ConclusionPharmacists in general practice in Sweden perform a broad variety of tasks related to identifying, resolving and preventing drug-related problems, mainly in older patients with polypharmacy.

An "Engage to Sustain" Intervention to Improve Process Performance Measures in Ambulatory Care.

In ambulatory care, monitoring process performance measures (PPMs) is essential to meet regulatory requirements, establish targets for care, seek reimbursement, and evaluate patient care responsibilities. We implemented a comprehensive program, "Engage to Sustain," for licensed practical nurses (LPNs) and certified medical assistants (CMAs) to practice at the top of their licensure/certification. Screening rates for 4 key PPMs (depression screening, fall risk screening, and tobacco use screening and counseling) markedly increased following this intervention across 18 ambulatory departments with more than 2 million patient visits. These results suggest that shifting responsibilities for patient screening from physicians and advanced practitioners to LPNs and CMAs may improve screening rates.