The Writing Series Project: a model for supporting social work clinicians in health settings to disseminate practice knowledge

Social work clinicians across health care settings are uniquely positioned to disseminate valuable practice experience, thereby contributing to knowledge development within their field of practice and across disciplines. Unfortunately, practitioners tend to shy away from writing and research, and are often reluctant to publicly disseminate their expertise through peer-reviewed journals and conference presentations. To better support health social workers in scholarly endeavors, we developed and implemented The Writing Series Project in southeast Queensland, Australia. This article reports on the development, programmatic challenges and practitioner feedback that offer insight into the benefits and pitfalls that we encountered.     

Influences on Practitioner Treatment Selection: Best Research Evidence and Other Considerations

The recent movement toward evidence-based practice in mental health services has highlighted the importance of research evidence in treatment decisions. However, the fact that many treatments with strong research support are not widely used in clinical settings suggests that practitioners’ decisions are not based on research alone but rather are influenced by other considerations. This study examines the relative importance of various considerations on practitioner treatment selection using a national survey of mental health practitioners including doctoral-level psychologists, master’s-level psychologists, and master’s-level clinical social workers (N = 206). Results indicate that practitioners are influenced by a range of considerations including empirical evidence from applied field studies, the perceived flexibility of a treatment, and the appeal of a treatment to colleagues and clients. These findings are discussed within the context of efforts to design, evaluate, and disseminate treatments with research support into clinical settings.     

Why “What Data Are Necessary for This Project?” and Other Basic Questions are Important to Address in Public Health Informatics Practice and Research

Despite the likelihood of poor quality data flowing from clinical information systems to public health information systems, current policies and practices are pushing for the adoption and use of even greater numbers of electronic data feeds. However, using poor data can lead to poor decision-making outcomes in public health. Therefore public health informatics professionals need to assess, and periodically re-evaluate, the quality of electronic data and their sources. Unfortunately there is currently a paucity of tools and strategies in use across public health agencies. Our Center of Excellence in Public Health Informatics is working to develop and disseminate tools and strategies for supporting on-going assessment of data quality and solutions for overcoming data quality challenges. In this article, we outline the need for better data quality assessment and our approach to the development of new tools and strategies. In other words, public health informatics professionals need to ask questions about the electronic data received by public health agencies, and we hope to create tools and strategies to help informaticians ask questions that will lead to improved population health outcomes.     

Revealing the wood and the trees: reporting qualitative research

Qualitative research methodologies, which are oriented to better understanding of the context, meaning and experiences of people's lives, have much to contribute to health promotion. For researchers trained in quantitative methods, writing up qualitative research for a peer‐reviewed journal can be a challenge, especially keeping within the prescribed word limits. How well you explain and disseminate your research will influence how others evaluate its quality; this has implications not only for what you write and the terminology you use but for how you structure your article. This paper provides a general guide to presenting qualitative research for publication in a way that has meaning for authors and readers, is acceptable to editors and reviewers, and meets criteria for high standards of qualitative research reporting across the board. We discuss the writing of all sections of an article, placing particular emphasis on how you might best present your findings, illustrating our points with examples drawn from previous issues of this Journal. Overall, we emphasise that reporting qualitative research involves sharing both the process and the findings, that is, revealing both the wood and the trees.     

安徽省全科医学培训现状、问题及建议

发展社区卫生服务,加快培养全科医师和社区护士是现阶段全科医学教育工作的重点,针时全科医学岗位培训,我省采取了一系列有力措施,正在逐步建立一支专业化、高素质的社区卫生服务人才队伍,极大推动了我省社区卫生服务工作的发展.本文从全科医学组织、网络、基地和师资建设以及培训开展情况等方面进行了介绍,并提出存在的问题和几点建议.     

广东省城市社区全科医师培训模式探讨

目的：为了提高社区卫生技术人员的业务水平，建立起一支高素质的社区医师队伍，结合广东省的实际情况，探讨全科医师的培训模式。方法：以分层抽样的方法，从广东省抽取9个城市，按“有关全科医学教育问卷”进行调查，召开座谈会和现场实地考察。结果：根据基层卫生技术人员的职称和学历情况，采取岗位培训，在职学历教育，本科学历教育等多层次和多种形式并举的培训模式，并提出设置“助理全科医师”职称的建议。结论：结合实际，讲求实效，做好全科医师的培训工作，保证城市社区卫生服务健康持续发展。     

Health professionals' views of the effectiveness of nutrition care in general practice setting

Aim: The current qualitative study aimed to explore the perceptions of key health professionals relating to the effectiveness of nutrition care provided in the general practice setting. Methods: Twenty‐eight health professionals across a range of disciplines (general practitioners (n = 11), practice nurses (n = 3), dieticians (n = 5), naturopaths (n = 5) and exercise physiologists (n = 4)) individually participated in a semistructured telephone interview, guided by an inquiry logic informed by the literature. Interviews were transcribed verbatim and analysed thematically using a constant comparison approach. Results: Health professionals, including general practitioners, perceived that nutrition care provided in the general practice setting was mostly ineffective at improving patient nutrition behaviour. This was reported to be due to nutrition care competency deficits among general practitioners, a general practice reimbursement system that encourages practices inconsistent with quality nutrition care, and a low prioritisation of nutrition care in general practice. Tensions were apparent between health professional groups, which may be hindering the successful implementation of interdisciplinary nutrition care for patients with chronic disease in this setting. Conclusion: Without systematic changes to Australian primary health care model, the demand on general practitioners as primary providers of nutrition care will continue, therefore mandating support for general practitioners providing care in this context. Further research is required to identify strategies to improve nutrition care and opportunities to facilitate integrated health care provided to the general public within the general practice setting.     

Opportunities for advance practice nurses in the nursing facility

Advance practice nurses (APNs) have emerged as valuable members of the nursing facility interdisciplinary team. They function in a variety of roles, including clinical care, administration, nursing consultation, and education. Positive outcomes in key indicators of care and reduction in costs to the healthcare systems have been attributed to their practice. Barriers to implementation of the role include regulatory issues, facility resistance, and difficulty adapting to the environment. Facilitation of the role is enhanced by collegial relationships and role negotiation. There is strength in the APN-physician collaborative model. The APN is likely to concentrate on prevention, restoration, maintenance, and palliative care, allowing the physician to concentrate on complex medical problems. There is a need for APN practices to identify APN-sensitive outcomes, collect and analyze data, and disseminate findings.     

Translating a Research Intervention into Community Practice: The Nurse Family Partnership

Public policy initiatives have begun to recommend that interventions have strong evidence of effectiveness before there is expenditure of restrained public funds. The Nurse Family Partnership (NFP), a home visiting program for low-income parents expecting their first child, has been identified as a preventive intervention program that meets high evidentiary standards based on results from three randomized trials. Strategies used to promote successful translation of the research intervention into clinical practice, findings from the evaluation of the replication of the NFP in 22 states, and challenges experienced in moving a research program to practice are discussed.Editors’ Strategic Implications: Policymakers, community public health officials, and researchers planning to disseminate their prevention programs will find many lessons in this example of bringing a model program (i.e., a prevention strategy that works) up to scale. Although results at replication sites are somewhat weaker than at model sites, the consistent positive outcomes are a testimony to the strength of the NFP model and the fidelity of its implementation across sites.     

Improving the roles of rural women in health and environmental issues

Safe water supply, sanitation facilities and safe environments are the priorities of the communities in the villages of Upper Egypt. However, personal hygienic behaviors need improvement for substantial promotion of family health. This cannot be met without the full participation of women in their various roles in their communities. Accordingly, 375 females belonging to rural villages of Egypt (VHVs) volunteered to have a role in health and sanitation aspects and disseminate hygienic messages to their communities. The objective of this study was to assess and upgrade the levels of awareness, attitude and practice of VHVs towards environmental sanitation, sanitary housing, personal hygiene, safe water, food safety, sanitary sewage and refuse disposals. Implementation of environmental health education courses resulted in significant improvement of VHVs' awareness, attitude and practice towards the majority of the environmental topics that were addressed. Similar extensive courses are recommended for the promotion of environmental sanitation in other communities.     

Scholarship of Practice in the Care of People with Dementia: Creating the Future Through Collaborative Efforts

ABSTRACT

A scholarship of practice approach sets the stage for collaborative partnerships across academic and clinical practice settings that result in positive gains for all stakeholders. These gains include an enhanced ability to generate and apply relevant evidence in practice, disseminate knowledge and innovation, and ensure best practice is relevant to and effective for, people receiving services and their caregivers.

?This paper discusses national and international examples of collaborative, research-based practice initiatives that have implemented a scholarship of practice approach. The exemplars described here are framed within the Model of Human Occupation, which addresses the importance of volition, habits, roles, environment, and performance capacities in facilitating engagement in occupation for people with dementia. Research that focuses on how therapists adopt and use evidence in practice, as well as the opportunities and challenges for supporting therapists and their use of theory and evidence are discussed.     

Academic-Practice Partnerships in Practice Research

Summary

Academic-practice partnerships in practice research support health social workers in engaging in research that is embedded within their practice. This shift in culture enables social workers to join in a health service discourse that is increasingly data-driven and focused on effective practice and demonstrated quality of care for patients. The mentoring model is described as enabling practitioners to superimpose research skills onto existing practice skills. An academic-practice research collaboration can reduce the distance between research and practice, contribute to a body of knowledge for health social work and promote health social workers as “research focused practitioners.”     

Learning issues for nurses in renal satellite centres

ABSTRACT: The introduction of 'satellite' dialysis centres has increased local access to renal services for patients living in rural and remote areas across Australia and is, therefore, consistent with rural health policies. Rural health strategies also aim to maintain and improve the skills of health professionals through regular review of the scope of their practice and evaluation of the education required. Yet, the results of the present national study of nurses working in satellite dialysis centres indicate that, for many, the context of practice influences their ability to access ongoing professional education to support and extend their nursing practice. The present study showed that there was a range of educational backgrounds among nurses working in rural 'satellite' centres with reportedly limited access to specific dialysis-related professional development. In the present paper we report on factors that influence the ability of nurses working in satellite dialysis centres to access ongoing professional education.     

The wrong tool for the job: diabetes public health programs and practice guidelines

We surveyed state diabetes programs to determine whether they develop and disseminate diabetes guidelines. We found they largely disseminate clinical practice guidelines developed from subspecialty organizations, do not prioritize among the many recommendations contained in diabetes guidelines, and have not adapted guidelines to focus on population rather than individual health. An opportunity exists for state diabetes control programs to better align guidelines with public health goals.     

英国全科医生流失现状、应对措施与借鉴

英国全科医生是国家卫生服务体系的基石,被誉为居民的"健康守门人"。在人口持续增长、老龄化程度不断加剧、医疗需求多样化的多重挑战下,全科医疗体系面临巨大压力。本文通过查阅文献,对英国目前全科医生流失现状、原因及国家卫生服务体系的应对措施进行了探讨。其做法包括拓宽投入渠道、发展劳动力、合理化工作量、提升工作环境与改善服务五大措施值得我国借鉴学习。在此基础上,本文提出了引入全科医生助理,加强团队分工协作、借助信息化手段,精简行政任务、完善制度建设、发展基层医疗体系等建议。     

Vertical and horizontal aspects of socio-economic inequity in general practitioner contacts in Scotland

Health status varies across socio-economic groups and health status is generally assumed to predict health care needs. Therefore the need for health care varies across socio-economic groups, and studies of equity in the distribution of health care between socio-economic groups must compare levels of utilisation with levels of need. Economic studies of equity in health care generally assume that health care needs can be derived from the current health-health care relationship. They therefore do not consider whether the current health-health care relationship is (vertically) equitable and the focus is restricted to horizontal inequity. This paper proposes a framework for incorporating the implications of vertical inequity for the socio-economic distribution of health care. An alternative to the current health-health care relationship is proposed using a restriction on the health-elasticity of health care. The health-elasticity of general practitioner contacts in Scotland is found to be generally negative, but positive at low levels of health status. Pro-rich estimates of horizontal inequity and vertical inequity are obtained but neither is statistically significant. Further analysis demonstrates that the magnitude of vertical inequity in health care may be larger than horizontal inequity.     

社区卫生服务机构签约服务模式分析

目的:分析典型地区社区卫生服务机构签约服务模式进展,为社区首诊、有序转诊等分级诊疗体系的建立提供实践依据。方法:采取目的抽样,选取全科医生制度探索较早且具有代表性的北京市、上海市、郑州市、成都市共12家社区卫生服务中心进行现场调查。采用主题框架法,围绕签约服务的关键要素展开描述性分析。结果:调研地区签约服务的开展主体是以全科医生为核心的服务团队;以慢性病患者等重点人群为签约对象,并辐射至其家庭成员,签约人数控制在1 500~2 000人;以提供防治结合的基本公共卫生和基本医疗服务为主要内容,多为免费服务;以家庭医生工作室为服务平台,主动服务意识凸显;建立物质激励、精神激励、医保政策优惠、绿色转诊等机制保障签约服务的有效落实。结论:以信息平台为基础,调研地区签约服务的开展对预约服务、转诊服务、居民自我健康管理起到促进作用,有助于稳固医患关系,改善患者体验,形成有序就医格局。     

The occupational health field in the cochrane collaboration

It is the aim of the Cochrane Collaboration to gather, summarise and disseminate evidence of health care interventions. Recently, the Occupational Health Field has started to do so for occupational health interventions. In this article we would like to describe the organisation and the methods used by the Field. First, the use of research information to improve the quality of occupational health practice is explained. Next, the process and contents of Cochrane Reviews are described. The pros and cons of Cochrane Reviews are listed and what occupational health practitioners can learn from it. There is a great variety of occupational health interventions that requires flexibility in which research design to use. The Occupational Health Field will enhance our understanding of the effectiveness of occupational health interventions in the coming years.     

Assessing guidelines for use in family practice.

With more than 1000 new guidelines produced annually over the past decade, it is impossible for the practicing family physician to determine which ones should be adapted into their clinical practice. The Ontario Ministry of Health and Long-Term Care and the Ontario Medical Association formed the Guideline Advisory Committee (GAC) in 1997 to assess and disseminate guidelines that would improve the quality and utilization of health care services in the province. Over the past 3 years the GAC has developed a strategy to identify important topics, to rank order guidelines published on these topics based on the quality of their development, and to reformat guidelines as necessary to make them user-friendly for implementation in clinical practice. The GAC is currently assessing a number of strategies to enhance the dissemination of selected guidelines to improve the quality of care delivered in the province.     

国内外全科医学发展比较与探讨

全科医学是我国深化医药卫生体制改革、构建分级诊疗体系的重要桥梁.通过梳理全科医学发展的国际经验,结合我国国情,剖析我国全科医学发展的现状和目前存在的问题,在此基础上寻求促进我国全科医学发展、深化医疗卫生事业改革的方向和途径.