A survey of recently graduated chiropractors in Australia

A survey was performed in Australia to study recently graduated chiropractors. Five general themes were investigated: a) personal and professional demographic profile, b) personal and professional attitudes, c) referral patterns, d) diagnostic procedures, and e) therapeutic procedures. Consideration is given to the possible development of the chiropractic profession in Australia.     

Nurse practitioners' use of clinical preventive services

Purpose: To examine the use of clinical preventive services (CPSs) by nurse practitioners (NPs) in practice.
Data sources: A total of 53 transcribed NP–patient encounters and 28 NP surveys.
Conclusions: Based on content analysis of the transcribed interviews, only a small majority of NPs (60.4%) used at least one CPS per visit. From the post-survey results, it appears that what NPs think they do varies greatly from what they actually do in clinical practice.
Implications for practice: The knowledge gained about the use of recommended CPSs may help promote better clinical practice among NPs and foster improvement in graduate school preparation of NP students.     

A survey of practice patterns and the health promotion and prevention attitudes of US chiropractors. Maintenance care: part I

OBJECTIVE: To investigate the primary care, health promotion activities associated with what has historically been called "maintenance care" (MC) as used in the practice of chiropractic in the United States. This includes issues such as investigating the purpose of MC, what conditions and patient populations it best serves, how frequently it is required, what therapeutic interventions constitute MC, how often it is recommended, and what percent of patient visits are for prevention and health promotion services. It also investigates the economic impact of these services. DESIGN: Postal survey of a randomized sample of practicing US chiropractors. The questionnaire was structured with a 5-point ordinal Likert scale (28 questions) and brief fill-in questionnaire (12 questions). The 40-question survey was mailed to 1500 chiropractors selected at random from a pool of chiropractors with active practices in the United States. The National Directory of Chiropractic database was the source of actively practicing chiropractors from which doctor selection was made. The sample was derived by using the last numbers composing the zip codes assigned by the US Postal Service. This sampling method assured potential inclusion of chiropractors from all 50 states, from rural areas and large cities, and assured a sample weighting based on population density that might not have been afforded by a simple random sample. RESULTS: Six hundred and fifty-eight (44%) of the questionnaires were completed and returned. US chiropractors agreed or strongly agreed that the purpose of MC was to optimize health (90%), prevent conditions from developing (88%), provide palliative care (86%), and minimize recurrence or exacerbations (95%). MC was viewed as helpful in preventing both musculoskeletal and visceral health problems. There was strong agreement that the therapeutic composition of MC placed virtually equal weight on exercise (96%) and adjustments/manipulation (97%) and that other interventions, including dietary recommendations (93%) and patient education about lifestyle changes (84%), shared a high level of importance. Seventy-nine percent of chiropractic patients have MC recommended to them and nearly half of those (34%) comply. The average number of recommended MC visits was 14.4 visits per year, and the total revenue represents an estimated 23% of practice income. CONCLUSIONS: Despite educational, philosophic, and political differences, US chiropractors come to a consensus about the purpose and composition of MC. Not withstanding the absence of scientific support, they believe that it is of value to all age groups and a variety of conditions from stress to musculoskeletal and visceral conditions. This strong belief in the preventive and health promotion value of MC motivates them to recommend this care to most patients. This, in turn, results in a high level of preventive services and income averaging an estimated $50,000 per chiropractic practice in 1994. The data suggest that the amount of services and income generated by preventive and health-promoting services may be second only to those from the treatment of low-back pain. The response from this survey also suggests that the level of primary care, health promotion and prevention activities of chiropractors surpasses that of other physicians.     

Physician and patient gender concordance and the delivery of comprehensive clinical preventive services

BACKGROUND: Understanding the role of patient- and physician-gender on delivery of preventive services has important implications for identifying strategies to increase preventive service delivery. We attempt to overcome methodological limitations of previous studies in examining the association of the patient-physician gender interaction on the delivery of preventive screening, counseling, and immunization services. METHODS: In this cross-sectional study, research nurses directly observed 3256 consecutive adult patient visits to 138 family physicians. Delivery of gender neutral US Preventive Services Task Force (USPSTF) recommended screening, health behavior counseling, and immunization services was assessed by direct observation and medical record review. Multilevel regression analyses were used to test the interaction effect of physician and patient gender with preventive service delivery, controlling for patient age, insurance type, number of office visits in the past 2 years and physician age. RESULTS: The interaction effect of physician and patient gender was not significantly associated with delivery of gender neutral screening, counseling, or immunizations. Patients of female physicians were more up-to-date on counseling services (P < 0.01) and immunizations (P < 0.05) than patients of male physicians. Male patients, independent of physician gender, were more up-to-date on counseling and immunizations (P < 0.01). CONCLUSIONS: Physician-patient gender concordance is not associated with delivery of more preventive services. Rather, female physicians provide more counseling and immunization services to all of their patients. Previous research showing higher rates of gender-specific screening achieved by women physicians may have been an indication of an overall greater prevention orientation among women physicians rather than a specific benefit of gender concordance.     

A survey of home nursing services in Taiwan

This study investigated the current situation of home nursing services in Taiwan. A total of 93 home nursing agencies (response rate of 75%) responded to a mail survey. The majority of the agencies (63%) had been established within the last 3 years before the survey, were hospital-based (90%), and had less than 60 (89.3%) average total number of visits per month per nurse. Most of the home care nurses had taken home care nursing training courses and had at least 2 years of clinical experience. Half of the agencies provided care for patients on a respirator, and 28% provided in-home hospice care. Almost a third of the agencies performed poorly in the areas of supply management, supervision of home visits, and quality monitoring and improvement mechanisms. Several suggestions for the development of home nursing services in Taiwan are made.     

Management of hymenoptera sting anaphylaxis: A preventive medicine survey

The evaluation of aftercare instructions given to patients suffering from hymenoptera sting anaphylaxis was the objective of the study. Part of this evaluation included asking the physicians questions to examine the knowledge on which they based their aftercare instructions. Survey questionnaires were completed by 124 of 174 (71%) physicians who worked in an emergency department or urgent care center. Fifty-eight percent of the physicians never provided written avoidance instructions, 24% provided or prescribed anaphylaxis ID bracelets, 44% referred all of their patients to an allergist for further evaluation, and 73% reported prescribing an Epi-pen or Ana-kit to all hymenoptera sting anaphylaxis victims. Twenty-four percent of physicians did not know where to obtain anaphylaxis identification bracelets. This survey demonstrates that a substantial number of physicians practicing emergency medicine are not providing appropriate aftercare instructions to patients, and substantiates the need for educational efforts to increase the awareness of physicians concerning the implications of hymenoptera allergy and the value of proper preventive measures.     

A survey of complementary therapy services provided by hospices

A questionnaire was mailed to 300 randomly selected hospices in the United States, to gather preliminary data on the nature of complementary therapy services provided by hospices. Information included types of complementary therapies offered, utilization, staffing, obstacles, as well as suggestions for improving hospice complementary therapy services. Of a total of 169 responding hospices, 60% offered complementary therapies to patients. The most popular therapies were massage therapy and music therapy. Only a portion of patients in these hospices received complementary therapy. Many hospices were limited in the amount of complementary therapy services they could provide because of program constraints, such as funding problems, lack of qualified complementary staff, inadequate knowledge of complementary therapies and how to offer these services, and resistance to complementary therapies by some staff and patients. A crucial challenge for hospices interested in providing complementary therapies to patients is to find ways to overcome these obstacles.     

孕产妇对助产士门诊服务需求的调查分析

目的 探讨孕产妇助产士门诊服务的需求现状并分析其相关因素。 方法 采用目的抽样法,在2013年1月至2015年3月对319例孕产妇采用《孕产妇对助产士门诊服务需求调查表》进行调查。 结果 年龄层次、学历、家庭人均月收入、分娩史是孕产妇助产士门诊服务需求的影响因素;不同的职业人群、不同的医疗费用支付类型对助产士门诊的服务需求差异无统计学意义。 多元逐步回归分析结果显示,不同年龄层次、家庭人均月收入、分娩史进入了回归方程,其标准化回归系数分别为0.16、-0.27、-0.35。 结论 不同年龄层次、家庭人均月收入、分娩史是影响孕产妇助产士门诊服务需求的重要因素。 了解孕产妇对助产士门诊的服务需求,能够更好的持续改进助产服务质量。