Preventive health patient education and counseling: a role for medical assistants?

Collaborative office-based team approaches may provide a unique means to increase the low rates of preventive services delivery. This study aimed to assess what role medical assistants may have in the delivery of preventive services to patients. A 35-item questionnaire was mailed to 402 medical assistants living in Maryland in July 2005. The questionnaire assessed current levels of preventive service delivery, attitudes toward patient education, and willingness to educate patients. A total of 281 surveys were returned for a response rate of 71%. Study findings revealed that a fair amount of preventive services delivery was already being delivered in health care settings by medical assistants. Medical assistants were more likely to discuss diet/nutrition and exercise with patients. Findings also highlight that medical assistants held positive beliefs about educating patients and nearly all respondents (90%) were willing to deliver preventive services. Given the increased presence of medical assistants in the health care setting, it may be feasible to delegate some preventive care delivery to this willing team member. Future research needs to explore how to better incorporate and delegate preventive health care delivery in medical settings.     

Multidisciplinary team dynamics in the production of problem-based-learning cases in issues related to older adults

Two important goals in allied health education are to prepare future allied health professionals to function as members of interdisciplinary teams and to increase their awareness of issues related to the growing older adult population. The responsibility for achieving these goals rests on the faculty and administrators of allied health education programs, who may not themselves be proficient in either of these domains. A multidisciplinary team of health educators and administrators was brought together to produce six problem-based learning (PBL) cases related to older adults. Members of the team represented a variety of disciplines in health care, diverse philosophies of educational development, a variety of roles in allied health education, and differing levels of knowledge of issues related to older adults--parameters similar to those found in the members of an interdisciplinary healthcare team. The methods by which this multidisciplinary group functioned and the dynamics in attaining the goals of the project are presented.     

全国省级疾病预防控制中心教育培训管理现状及新职工培训需求调查分析

目的 分析全国省级CDC 2012-2014年教育培训管理现状及新职工培训需求,为今后做好疾控领域教育培训工作提供参考和依据。方法 采用问卷调查,对我国32个省级和5个计划单列市(大连市、青岛市、宁波市、厦门市、深圳市)级CDC,收集、分析其教育培训管理情况、新职工岗前培训开展情况及新职工培训需求等。结果 36个CDC共有156名教育培训管理人员,中级及以上职称所占比例最高(70%);培训硬件配备各地间差别较大;2014年共有各类教育培训师资1214人,公共卫生相关专业技术领域师资占66%;2012-2014年,全国36个CDC共对5084人次新职工开展了岗前培训,投入约75万元;新职工培训需求率为99.5%,74%的调查对象认为2~5 d是最合适的培训时间,79%的新职工认为实践操作是最适合的培训方法。结论 全国各省级CDC教育培训机构设置有待明确,管理人员队伍需要补充,应不断增加培训经费投入、完善培训配套的场地、食宿、师资等相关软、硬件配备,重视疾控机构人员尤其是新职工的教育培训工作。     

Mental health training for nursing home staff using computer-based interactive video: a 6-month randomized trial

OBJECTIVE: Mental health education for the staffs of nursing homes is difficult to provide and often inadequate. The objectives of this study were to design and assess a curriculum of staff training on depression and dementia that is accessible, educational, and relevant. DESIGN: A core curriculum of 12 computer-based interactive video training modules was created in a television news-documentary format to educate nursing home staffs. A randomized trial of the first six modules, which are dedicated to mental health and aging, was conducted at a computer site (CS), a "lecture site" (LS), and control site (CON). SETTING: Three not-for-profit nursing facilities in Western Pennsylvania. PARTICIPANTS: The certified nursing assistants, and other nursing staff participated in the study as part of their required training. INTERVENTION: Nursing staffs at the two intervention sites (CS and LS) were mandated to participate in monthly educational sessions. At the CS, the computer program scheduled staff members each month for 45 minutes of individual, self-paced training using the interactive video modules. At the LS, staff members were scheduled to attend a 45-minute monthly lecture with identical learning objectives delivered by an advanced degree nurse educator. A videotape of the lectures was shown at two additionally scheduled times during the month to accommodate all shifts. MEASUREMENTS: Compliance and satisfaction with training were monitored at both intervention sites. Knowledge was assessed at the CS, LS, and CON, before each monthly training session, and with a cumulative post-training exam, administered at the end of the 6-month study. RESULTS: Over the 6-month period, training compliance was 66% and 22% at CS and LS, respectively (P < 0.001). Satisfaction with training and the relevance of training were rated significantly higher at the CS (P < 0.0001). Before the study, assessed knowledge was similar at the CS, LS, and CON. After 6 months, the CS scored significantly higher than the LS and CON in terms of knowledge (P < 0.005). CONCLUSION: Individual, self-paced, interactive video education for nursing home staff resulted in greater compliance and satisfaction with training compared to staff receiving lectures. Knowledge of core concepts was greater for staff of the computer site compared to the staffs of either the lecture or control sites at the end of this 6-month study.     

Effects of Community-Based Health Worker Interventions to Improve Chronic Disease Management and Care Among Vulnerable Populations: A Systematic Review

Background. Community-based health workers (CBHWs) are frontline public health workers who are trusted members of the community they serve. Recently, considerable attention has been drawn to CBHWs in promoting healthy behaviors and health outcomes among vulnerable populations who often face health inequities.Objectives. We performed a systematic review to synthesize evidence concerning the types of CBHW interventions, the qualification and characteristics of CBHWs, and patient outcomes and cost-effectiveness of such interventions in vulnerable populations with chronic, noncommunicable conditions.Search methods. We undertook 4 electronic database searches—PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and Cochrane—and hand searched reference collections to identify randomized controlled trials published in English before August 2014.Selection. We screened a total of 934 unique citations initially for titles and abstracts. Two reviewers then independently evaluated 166 full-text articles that were passed onto review processes. Sixty-one studies and 6 companion articles (e.g., cost-effectiveness analysis) met eligibility criteria for inclusion.Data collection and analysis. Four trained research assistants extracted data by using a standardized data extraction form developed by the authors. Subsequently, an independent research assistant reviewed extracted data to check accuracy. Discrepancies were resolved through discussions among the study team members. Each study was evaluated for its quality by 2 research assistants who extracted relevant study information. Interrater agreement rates ranged from 61% to 91% (average 86%). Any discrepancies in terms of quality rating were resolved through team discussions.Main results. All but 4 studies were conducted in the United States. The 2 most common areas for CBHW interventions were cancer prevention (n = 30) and cardiovascular disease risk reduction (n = 26). The roles assumed by CBHWs included health education (n = 48), counseling (n = 36), navigation assistance (n = 21), case management (n = 4), social services (n = 7), and social support (n = 18). Fifty-three studies provided information regarding CBHW training, yet CBHW competency evaluation (n = 9) and supervision procedures (n = 24) were largely underreported. The length and duration of CBHW training ranged from 4 hours to 240 hours with an average of 41.3 hours (median: 16.5 hours) in 24 studies that reported length of training. Eight studies reported the frequency of supervision, which ranged from weekly to monthly. There was a trend toward improvements in cancer prevention (n = 21) and cardiovascular risk reduction (n = 16). Eight articles documented cost analyses and found that integrating CBHWs into the health care delivery system was associated with cost-effective and sustainable care.Conclusions. Interventions by CBHWs appear to be effective when compared with alternatives and also cost-effective for certain health conditions, particularly when partnering with low-income, underserved, and racial and ethnic minority communities. Future research is warranted to fully incorporate CBHWs into the health care system to promote noncommunicable health outcomes among vulnerable populations.     

Characterization of nursing activities in public health developed in the Northern Regional Health Unit of the Federal District

The purpose of this study is to identify and analyze the activities developed by the nursing team at the Northern Regional Health Unit of the Federal District. A questionnaire, which described a variety of daily nursing activities, was administered to 29 nurses, 91 nurse assistants and 42 health care agents. Focus group sessions for each of the professional categories were also conducted. Results showed that all members of the nursing team concentrate their effort in organizing, controlling and attending spontaneous demands as well as providing support to doctors. As a consequence, these professionals prioritize individual attendance to detriment of collective practice.     

Smoking attitudes, behaviours and risk perceptions among primary health care personnel in urban family medicine centers in Alexandria

Smoking is a major public health problem which is responsible for large number of preventable health problems. Health professionals continue to use tobacco, often at a rate similar to, if not higher than, that of the general public. The aim of the present study was to estimate the prevalence of smoking among primary health care (PHC) personnel in 4 randomly selected urban family medicine centers in Alexandria, Egypt and to assess their attitudes, behaviours and risk perceptions towards smoking. A sample of 220 PHC personnel was included in the study. Data collection was done through using a self-administered questionnaire which was composed of 3 main parts regarding: personal data of the PHC personnel, their attitudes' towards smoking, and their personal smoking behaviours and risk perceptions. The results of the present study revealed that the prevalence of current smoking among PHC personnel was high (45%), especially among physicians (51.1%) and nurses (27.3%). Also, 88% of males, 22.7% of females, and 47.6% of married personnel were current smokers. About 59.1% of the PHC personnel had positive attitudes towards smoking cessation, and 17.3% had negative attitudes. Non smoker PHC personnel had statistically significant better attitudes than current smokers. Only 16.8% of PHC personnel found themselves very well prepared to counsel their patients about smoking cessation. Therefore, continuous medical education to all health team members should be encouraged. Smoking cessation activities should be an integral part of the PHC system, and to be provided by all PHC team members during their routine daily activity.     

A capacity mapping approach to public health training resources

The capacity mapping approach can be used to identify existing community resources. As part of this approach, inventories are used to provide information for a capacity map. The authors describe the development of two inventories and a capacity map for public health workforce development. For the first inventory, the authors contacted 754 institutions to determine available public health training resources; 191 institutions reported resources, including 126 directly providing distance learning technologies and courses or modules addressing important competency domains. Distance learning technologies included video conferencing facilities (61%) and satellite download facilities (50%). For the second inventory, the authors obtained information on 129 distance-accessible public health training modules. The workforce development capacity map produced from these two inventories revealed substantial resources available for use by individuals or agencies wishing to improve training in public health competencies.     

Integrating the science of team training: guidelines for continuing education

The provision of high-quality, efficient care results from the coordinated, cooperative efforts of multiple technically competent health care providers working in concert over time, spanning disciplinary and professional boundaries. Accordingly, the role of medical education must include the development of providers who are both expert clinicians and expert team members. However, the competencies underlying effective teamwork are only just beginning to be integrated into medical school curricula and residency programs. Therefore, continuing education (CE) is a vital mechanism for practitioners already in the field to develop the attitudes, behaviors (skills), and cognitive knowledge necessary for highly reliable and effective team performance.The present article provides an overview of more than 30 years of evidence regarding team performance and team training in order to guide, shape, and build CE activities that focus on developing team competencies. Recognizing that even the most comprehensive and well-designed team-oriented CE programs will fail unless they are supported by an organizational and professional culture that values collaborative behavior, ten evidence-based lessons for practice are offered in order to facilitate the use of the science of team-training in efforts to foster continuous quality improvement and enhance patient safety.     

Comparisons of nurses and physicians on an operational measure of empathy

In view of many changes taking place in today's health care marketplace, the theme of empathy in health provider-patient relations needs to be revisited. It has been proposed that patients benefit when all members of the health care team provide empathic care. Despite the role of empathy in patient outcomes, empirical research on empathy among health professionals is scarce partly because of a lack of a psychometrically sound tool to measure it. In this study, we briefly describe the development and validation of the Jefferson Scale of Physician Empathy (JSPE), an instrument that was specifically developed to measure empathy among health professionals (20 Likert-type items). The purpose of this study was to compare nurses and physicians on their responses to the JSPE. Study participants were 56 female registered nurses and 42 female physicians in the Internal Medicine postgraduate medical education program at Thomas Jefferson University Hospital. The reliability coefficients (Chronbach's coefficient alpha) were 0.87 for the nurses and 0.89 for physicians. Results of t test showed no significant difference between nurses and physicians on total scores of the JSPE; however, multivariate analyses of variance indicated statistically significant differences between the two groups on 5 of 20 items of the JSPE. Findings suggest that the JSPE is a reliable research tool that can be used to assess empathy among health professionals including nurses.     

The State Planning Committee for Health Education in Ohio

The State Planning Committee for Health Education in Ohio (SPCHEO) developed and applied a model for improving comprehensive school health programs that can be adapted and facilitated by health education coalitions or professional associations in any state. The model is based on development of a well-rounded school-community health team. SPCHEO members who assume the role of team organizers facilitate a planning process that includes building a school-community health team, assessing and analyzing school health instruction, services, environment, and administration, establishing priorities, goals, and objectives, identifying resources, implementing strategies, and evaluation. The model stimulates action toward improved comprehensive school health programs. A new adaptation of the model is being explored to expand its impact.     

我国社区公共卫生服务现状及对策分析

目的 了解我国基本公共卫生服务项目的人才队伍现状。 方法 于2017年1 — 3月,采取分阶段整群抽样的方法,收集了全国32个省级行政区域共计736家基层医疗卫生机构的人才队伍数据,并分社区卫生服务中心和乡镇卫生院进行了人员数量、结构和流失情况的分析。 结果 社区卫生服务中心专职从事公共卫生工作的人员比例（29.91 %）高于乡镇卫生院（18.86 %）,差异有统计学意义（P < 0.05）;社区卫生服务中心和乡镇卫生院专职从事公共卫生工作人员中,公共卫生执业（助理）医师所占比例分别是12.51 %和11.03 %;平均每家社区卫生服务中心每年流失医师1.02人,乡镇卫生院流失0.72人,差异有统计学意义（P < 0.05）。 结论 目前对于我国基本公共卫生服务项目的人才队伍而言,社区卫生服务中心优于乡镇卫生院,公共卫生专业人员不足,人员整体学历、职称结构良好,城市基层卫生人员流失严重。     

东阿县卫生应急专业人才队伍构成情况分析

目的分析东阿县卫生应急专业人才队伍构成情况,探讨在卫生应急专业人才队伍构成情况中存在的问题,为提高全县卫生应急队伍能力提供意见和建议。 方法通过问卷调查和人员访谈,调查东阿县县级疾病控制中心(传染病防控队伍)、县级医疗机构(医疗救援队伍)、乡镇医疗机构[卫生院、社区服务中心(卫生应急综合队伍)]的卫生应急办公室设置情况及卫生应急队伍人员结构(性别、学历、职称、参加工作时间、从事专业、参与培训)现状。 结果所调查范围内的各单位均成立了卫生应急办公室,但均由兼职人员负责日常管理工作。全县共有3类13个应急支队伍,共计170例,其中男性99例(58.2%),女性71例(41.8%),单位卫生应急队伍成员的性别分布差异无统计学意义(χ²＝0.152,P>0.05)。队员年龄30岁以下30例(17.64%)、30～39岁100例(58.8%)、40～49岁31例(18.2%)、50岁以上9例(4.7%)。队员学历以大专35例(20.6%)和本科105例(61.8%)为主,且乡镇医疗机构卫生应急队伍中低学历人员所占比例更大。全县卫生应急队员中,初、中、副高级职称人员分别为98例(56.5%)、70例(42.4%)和2例(1.2%),乡镇医疗机构(卫生应急综合队伍)卫生应急队员的初级职称比例达到76.0%(76 /100)。大部分队员的参加工作时间为10 ～ 20年[88例(51.8%)],高年资(>20年)人员33例(19.4%), 49例(28.82%)的工作时间<10年。36例(21.2%)未参加过培训,65例(38.2%)仅参加过一次培训,参加过2次培训的为42例(24.7%),3次及以上培训的仅27例(15.9%)。 结论东阿县卫生应急管理体系和人员队伍基本建成,但是各级各类专业队伍人员在构成方面还存在差距,特别是乡镇力量较薄弱,参加培训次数和人数较少。     

无偿献血者规范化健康教育的效果评价

目的评价规范化的献血健康教育在无偿献血工作中的作用。方法把2001年实施单一、局限、泛化的卫生宣传教育时参加献血的30036名献血者设为对照组;自2002年开始实施规范化的献血健康教育程序两年后即2004年参加献血的47891名献血者定为干预组,对两组无偿献血各项指标及献血者主动退出、延期献血及不宜献血人数进行比较、评价。结果干预组的自愿献血人数、再次献血人数、一次献血400毫升人数、脂肪血人数、献血投诉人数、主动退出人数、延期献血及不宜献血人数等统计结果均明显优于对照组(P<0.01)。结论实施规范的献血健康教育,可有效提高无偿献血工作质量,确保献血者健康,用血者安全。     

Distance education for health centre staff in rural Japan

We have evaluated a course delivered by videoconferencing to rural health centre staff in Hokkaido. The course focused on the planning and evaluation of community health interventions. It included four 90 min sessions and two follow-up sessions. Fourteen professional staff members (public health nurses, nutritionists and dental assistants) attended each class. Knowledge of community health-care planning and evaluation was higher at post-education testing than pre-education testing. Ratings for 'using a computer', 'using some computer software', 'using the Internet' and 'interest in telehealth' increased significantly in post-education testing compared with pre-education testing. The course had an additional benefit in increasing the collaboration between community health workers and university staff.     

97名学校卫生培训学员调查分析

目的 了解参加安徽省2021年校医等卫生专业技术人员培训班的学员有关情况,为加强学校卫生保健队伍建设提供参考依据。方法 采用自制调查问卷对97名参训学员所在学校的校医和保健教师配备情况及其自身特征进行调查。 97名参训学员中校医72人,保健教师16人,学科教师或校总务主任9人。97名参训学员所在学校的校医和保健教师配备合格率仅为16.49%,其中幼儿园配备合格率最高(70.00%),高中配备合格率最低(2.38%),不同类型学校的校医和保健教师配备合格率差异有统计学意义(χ2=23.922,P<0.001)。88名校医和保健教师中女性62人(70.45%),年龄中位数为44.50岁,高级职称4人(4.55%),无编制38人(43.18%),平均月收入为3 558.74元;当前最想解决的问题中薪酬问题占比最高(36.36%),将来最想解决的问题中晋升问题占比最高(28.41%);近1年和近3年参加培训次数分别为0.45次和0.97次。72名校医与16名保健教师在文化程度、择业途径方面差异均有统计学意义(χ2=4.758、18.714,P值均<0.05)。 需采取切实措施加强学校卫生保健队伍建设,解决学校卫生保健人员待遇低、晋升难、继续教育缺乏等问题。     

The HIM (Health for Izhevsk Men) trial protocol

Background

HIV counseling and testing is an important intervention in the prevention, control and management of the human immunodeficiency virus (HIV). Counseling and testing can be an entry point for prevention, care and support. Knowledge of the quality of services and motivations for testing by individuals is important for effective understanding of the testing environment.

Methods

A cross sectional explorative study of clients accessing HIV voluntary counseling and testing (VCT) and counselors was conducted in 6 government health centers in Blantyre City, Malawi. We aimed to assess the availability of critical clinic supplies and identify the motivations of clients seeking counseling and testing services. We also aimed to identify the health professional cadres that were providing VCT in Blantyre city.

Results

102 VCT clients and 26 VCT counselors were interviewed. Among the VCT clients, 74% were <=29 years, 58.8% were females and only 7% reported no formal education. 42.2% were single, 45.1% married, 8.8% widowed and 3.9% divorced or separated. The primary reasons for seeking HIV counseling and testing were: recent knowledge about HIV (31.4%), current illness (22.5%), self-assessment of own behavior as risky (15.5%), suspecting sexual partner's infidelity (13.7%) and seeking HIV confirmatory test (9.8%) and other reasons (6.9%). Of the 26 VCT counselors, 14 were lay volunteers, 7 health surveillance assistants and 5 nurses. All except one had been trained specifically for HIV counseling and testing. All 6 facilities were conducting rapid HIV testing with same day test results provided to clients. Most of the supplies were considered adequate for testing.

Conclusion

HIV counseling and testing facilities were available in Blantyre city in all the six public health facilities assessed. The majority of counseling and testing clients were motivated by perceptions of being at risk of HIV infection. In a country with 12% of individuals 15 to 49 years infected, there is need to encourage testing among population groups that may not perceive themselves to be at risk of infection.     

Interdisciplinary didactic instruction at academic health centers in the United States: attitudes and barriers

Interdisciplinary care is a method of providing patient care through a team approach that incorporates the efforts of various health care providers. Studies show that this approach can improve patient care and decrease overall costs to the healthcare system. Despite the evidence for the benefits of interdisciplinary care, there are no well-defined models for training students during their didactic years to become members of an interdisciplinary team. This study utilized an investigator-developed questionnaire to determine the attitudes of administrators of professional schools in the USA toward interdisciplinary education, identified the perceived barriers to interdisciplinary education, examined the extent to which interdisciplinary education is occurring at academic health center campuses, and identified the courses that might best be taught in an interdisciplinary format. Administrators from medicine, nursing, and pharmacy hold positive attitudes toward interdisciplinary instruction. Respondents from nursing and pharmacy hold more favorable attitudes than their counterparts from medicine. Positive attitudes are seen more frequently among females than males, and among respondents from public single and multi-campuses than from private campuses. This study demonstrated that administrators espouse very positive attitudes toward interdisciplinary education, although they perceive the barriers to interdisciplinary education and the courses most suited for anointer disciplinary approach differently. More discussions among administrators of various disciplines may allow barriers to be overcome and allow development of interdisciplinary didactic courses that could test the hypothesis that these courses are more cost effective and more likely to foster interdisciplinary teamwork in the clinical setting. This revised version was published online in June 2006 with corrections to the Cover Date.     

Knowledge, Attitudes, and Interest in Breast-Ovarian Cancer Gene Testing: A Survey of a Large African-American Kindred with a BRCA1 Mutation

BACKGROUND: This study assessed counseling and testing needs from the perspective of adult members of a large African-American kindred with a BRCA1 mutation. METHODS: Interviews were conducted with 95 male and female kindred members to elicit information on sociodemographics, attitudes toward health care providers, breast cancer screening behaviors, and religious/spiritual beliefs, as well as to evaluate psychological distress, beliefs, knowledge, and attitudes related to genetic testing. RESULTS: Knowledge about breast and ovarian cancer genetics was limited. Adherence to screening recommendations was low among females with no personal breast or ovarian cancer history. The majority (67%) wished to discuss risk factors with a health care provider. Most participants (82%) indicated that they would have a genetic test if it were available. Significant predictors of intent to undergo testing were having at least one first-degree relative with breast and/or ovarian cancer (OR = 5.1; 95% CI = 1.2-20.9) and perceived risk of being a gene carrier > or =50% (OR = 64.3; 95% CI = 5.1-803.9) or reporting that they did not know their risk of being a gene carrier (OR = 10.9; 95% CI = 2.1-57.7). Cited barriers to testing included cost and availability. CONCLUSION: There is a high interest level in genetic testing despite limited knowledge about cancer genetics among these high-risk African Americans. Our study provides information for designing a genetic education and counseling intervention for this and similar families.