Social workers in the substance abuse treatment field: a snapshot of service activities

This article describes the results of the first Practice Research Network (PRN) survey conducted by the National Association of Social Workers, a collaborative project funded by the Center for Substance Abuse Treatment. The objectives of the PRN survey were to develop broad knowledge about social work practices and more specific knowledge about social workers' involvement with substance abuse services. Although 71 percent of the employed social workers reported taking some action related to substance abuse diagnosis and treatment in the preceding 12 months, 53 percent reported receiving no training in substance abuse during the same period. More than 25 percent of the clients seen by the sample were reported to have either a primary or a secondary substance use disorder, yet only 2 percent of the respondents reported addictions as their primary practice area. The results of the survey indicate a need to further assess social workers' role in substance abuse services and to identify training opportunities for the profession.     

Ob/Gyn training in abortion care: results from a national survey

BackgroundAbortion is one of the most common health services utilized by women in the USA. Training new providers is an important factor in ensuring an adequate supply of clinicians to provide comprehensive reproductive health services.Study DesignData came from a mailed survey of obstetrician/gynecologists who completed residency in 2007.ResultsParticipation in first-trimester procedures training was lower than that in second-trimester procedures training. Notably, residents reported less exposure to medication abortion than nearly all other abortion procedures; only 41% of survey participants reported having received training in mifepristone/misoprostol. Significantly more respondents who trained in programs with routine training participated in first-trimester procedures, specifically medication abortion, manual vacuum aspiration and electric vacuum aspiration, compared to those who attended programs with elective training.DiscussionAs the vast majority of abortions in the USA occur during the first trimester, exposure to the full array of common first-trimester abortion procedures, including both medication abortion and aspiration abortion procedures, warrants attention. These findings suggest that residency education guidelines may need to be revised to ensure adequate training in medication abortion.     

慢性病服务跨机构协作模式探索及效果评价——基于医务人员的调查

目的:对比医务人员对干预前后在跨机构协作效果上的评价变化,为促进医务人员的跨机构沟通和协调、完善慢性病服务跨机构协作模式提供实证依据。方法:采用典型抽样和多阶段随机抽样相结合,对县、乡、村医务人员进行问卷调查,运用倾向得分匹配干预前后样本,并对结果进行统计学分析。结果:干预方案实施一年后,县级医院参与度提高,但工作认同感降低;乡级医疗卫生机构以患者为中心提供慢性病服务水平提升,但从培训中得到的帮助效果有限;慢性病服务跨机构协作对改善村医诊疗水平帮助大。建议:在跨机构协作模式政策制定层面,重视县级医院医务人员工作需求,改善利益激励方式,明确晋升渠道及标准;建立健全跨机构培训机制,注重理论与实际相结合,发挥对个人发展的激励作用;从慢性病提供连续性角度,探索县、乡、村在跨机构协作中的角色和任务。     

Impact of the limited generalist (no hospital,no procedures) model on the viability of family practice training

BACKGROUND: Some doubt the desirability and cost-effectiveness of continuing to provide an expanded scope of primary care practice. Additionally, there has been concern about declining reimbursement from Medicaid and Medicare. Although an expanded scope of patient care services are required for training, we wanted to determine whether these services drain resources and time from other primary care activities. METHODS: To determine the financial impact of deleting services other than office visits from an urban primary care practice, we tabulated charges, economic case mix, and actual collections during 12 consecutive months. Using regional and national norms, the practice set charges for hospital services, office visits, and procedures at approximately 50th percentile as a maximum. Common diagnostic and therapeutic procedures were tabulated, and gross charges per item per year were tabulated. To validate net collection predictions for a predominately TennCare (Medicaid) practice and compare these with projected net collections from private practice, charges were compared with projected collections using two expectations (40% net and 80% net). Overall collections were projected and then compared with actual collection. For hospital services and office procedures, costs were attributed to equipment, training, liability insurance, and lost opportunity for office visits. The setting was an urban family practice teaching program providing hospital services, hospital deliveries, newborn care, office visits, and a variety of office procedures. There were 30,262 office visits, 510 non-pregnant hospitalizations, 252 deliveries, 1,352 office radiographs, and a variety of common office-based diagnostic and therapeutic procedures, such as electrocardiograms (408), skin surgeries (265), gastrointestinal endoscopies (306), diagnostic obstetric sonograms (525), non-stress tests (95), and colposcopy (161). The main outcome measures were the financial values calculated after subtracting costs for hospitalist services, office visits, and procedures. RESULTS: After lost opportunities for office visits are deducted, hospital services created positive revenue ranging from $167,306 to $340,612, depending on the net collection scenario chosen (ie, worst case versus best case). CONCLUSIONS: Revenue was adequate for reimbursement of equipment, staff, and physician time in either case. For procedural activities in the office, there was a net gain of $372,974 in charges once opportunities for lost office visits were deducted. Even within the 40% net collection scenario, revenue was more than adequate to pay for overhead and equipment. For this practice with 84% Medicaid-Medicare accounts, projected collections of 40% underestimated slightly the actual net revenue.     

Stories matter: the role of narrative in medical ethics.: Rita Charon, Martha Montello (eds). (254 pages, {pound}16.99.) Routledge, 2002. ISBN 0-415-92838-9.

This book recognizes that moral perceptiveness and discernmentare forms of narrative activity and makes a compelling casefor literary studies informing the training and work of bioethicists.Ethical problems arising in case histories are subtly linkedto biographical understandings and forms of narrative depiction.But moral theory alone neither equips practitioners with     

Community asthma clinics: 1993 survey of primary care by the National Asthma Task Force.

OBJECTIVES--To establish a baseline of work done in primary care asthma clinics in the United Kingdom and to assess the degree of clinical delegation to nurses and the appropriateness of their training. DESIGN--Prospective questionnaire survey of asthma care in general practices and a subsidiary survey of all family health services authorities (FHSAs) of the number of asthma clinics in their area. SETTING--All 14,251 general practices in the United Kingdom and 117 FHSAs or health boards (Scotland and Northern Ireland). RESULTS--Questionnaires were returned by 4327 (30.4%) general practices, 54% being completed by practice nurses and 22% by general practitioners; in 24% profession was not stated. In all, 77.2% (3339/4327) of respondents ran an asthma clinic. 60 FHSAs state the number of asthma clinics at the time of the general practice survey (total 3653 clinics); within responding FHSAs 1702 (46.6%) practices running an asthma clinic replied to the general practice survey. Clinics exclusive for patients with asthma mostly occurred in practices with five or more general practitioners (70.2%), compared with single-handed practices (31.7%). The average number of asthma clinics run per practice was five a month; the average duration was 2 hours and 20 minutes. 1131 (48.8%) nurses ran clinics by themselves, 1180 (47.9%) with the doctor, and 39 (1.7%) had no medical input. Comprehensive questioning occurred other than for nasal (872, 26.1%) or oesophageal (335, 10.0%) symptoms and use of aspirin and non-steroidal drugs (1161, 33.4%). Growth in children was measured by only a third of respondents. Of the 1131 nurses who ran clinics alone, 251 (22.2%) did so without formal training entailing assessment. CONCLUSION--Asthma clinics are now common in general practice and much of their work is done by nurses, a significant minority of whom may not have had sufficient training. IMPLICATIONS--As this survey is probably biased toward the more asthma aware practices, greater deficiencies in training and standards may exist in other practices. Further evaluation of the effectiveness of asthma clinics is needed.     

Achievements and challenges on policies for allied health professionals who use telehealth in the Canadian Arctic

We formulated policies and procedures for allied health professionals (AHPs) who provide services using telehealth in Nunavut, Canada's newest Arctic territory. These are a supplement to the clinical policies and procedures already established for Nunavut physicians and nurses. The services were in the areas of audiology, dietetics/nutrition, midwifery, occupational therapy, ophthalmic services, pharmacy, physiotherapy, psychology, respiratory therapy, social work and speech therapy. Documents specific to each of the services were developed, drawing on information from Government of Nunavut data, Nunavut healthcare providers and links made through the Internet. Topics included the scope and limitations of telehealth services, staff responsibilities, training and reporting, professional standards and cultural considerations. We also considered generic policies covering common issues such as jurisdiction, licensing and liability. The policies and procedures for AHPs will enhance and expand the successes already achieved with telehealth in Nunavut. The challenges are to balance the preferred approaches to service provision with the realities of health care and communications in an Arctic setting.     

Rehabilitation of Infant Oral Feeding Difficulties: A Survey of Occupational Therapists Practice Approaches

This study identifies the scope of occupational therapy practice for the rehabilitation of oral feeding difficulties in infants who are in the neonatal intensive care unit (NICU). A written survey was administered to 127 occupational therapists who work with infants in the NICU. All 68 (54%) respondents used a client-centered approach, taking into consideration the infant (intrinsic), caregiver, and environmental (extrinsic) factors. Family and health team education was the most commonly provided service with the majority of occupational therapists providing services only until feeding problems were resolved. Continuing education (n = 20, 30%) and own clinical experience (n = 22, 33%) were the two most common justifications to support their choice of practice. These results suggest a client-centered approach in the rehabilitation of oral feeding difficulties is commonly used, but services are not extended beyond hospitalization. Few occupational therapists used peer-reviewed journals as sources of evidence for their practice strategies.     

Practice expenses in the MFS (Medicare fee schedule): the service-class approach

The practice expense component of the Medicare fee schedule (MFS), which is currently based on historical charges and rewards physician procedures at the expense of cognitive services, is due to be changed by January 1, 1998. The Physician Payment Review Commission (PPRC) and others have proposed microcosting direct costs and allocating all indirect costs on a common basis, such as physician time or work plus direct costs. Without altering the treatment of direct costs, the service-class approach disaggregates indirect costs into six practice function costs. The practice function costs are then allocated to classes of services using cost-accounting and statistical methods. This approach would make the practice expense component more resource-based than other proposed alternatives.     

Determining the Need for Simulated Training of Invasive Procedures

Unlike the airline industry, where pilots first learn to fly on simulators before navigating planes, physicians practice invasive procedures on real patients. To determine the need for the simulated training of invasive procedures prior to working on patients, we studied the views of physicians-in-training. Five hundred medical students, residents, and fellows at Harvard Medical School were asked if there was a problem with the way medical procedures presently are learned in health care. Next, they were surveyed to inquire whether using a simulator would be beneficial. Finally, they were asked what specific procedures would be most suitable for virtual training. The effects of respondent gender, level of training, specialty, and previous experience using simulation on survey results was tested using Student t-tests. One hundred and fifty-eight trainees responded that they were uncomfortable learning to perform invasive procedures on patients. Students and physicians were very interested in obtaining simulated training prior to practicing on patients. The more complicated the procedure, the greater the feeling that it should be simulated prior to attempting it on patients. Respondents most preferred that simulation be used to teach chest tube placement. Respondent gender, specialty, level of training, and prior simulation experience did not affect survey results (p > 0.05). Simulation should be incorporated into the education of medical students and residents as a tool to practice invasive procedures prior to working on patients.     

Children in hospital: II. Reading therapy and children in hospital

Following the survey of book and library services described in the first of these two articles (Health Libraries Review, 8, 210-219), a research project funded by BNB Research Fund in 1991 investigated the theory and practice of reading therapy with children in hospital. Hospital play staff had been identified as the therapists most commonly involved and a number of them were interviewed using advance notice questionnaires and structured discussion. The following aspects were investigated: definitions of reading therapy, children in hospital, the reading therapy process, materials used, evaluation, services to facilitate and promote reading therapy, training and the role of libraries and librarians. Recommendations relate to practice, to provision and listing of materials, to evaluation procedures and to training. The final conclusions relate to the role of librarians in the processes and development of reading therapy with children in hospital.     

Professional Competencies and Training Needs of Professional Social Workers in Integrated Behavioral Health in Primary Care

The Affordable Care Act has led to a widespread movement to integrate behavioral health services into primary care settings. Integrated behavioral health (IBH) holds promise for treating mild to moderate psychiatric disorders in a manner that more fully addresses the biopsychosocial spectrum of needs of individuals and families in primary care, and for reducing disparities in accessing behavioral health care. For behavioral health practitioners, IBH requires a shift to a brief, outcome-driven, and team-based model of care. Despite the fact that social workers comprise the majority of behavioral health providers in IBH settings, little research has been done to assess the extent to which social workers are prepared for effective practice in fast-paced primary care. We conducted a survey of social workers (N = 84) in IBH settings to assess the following: (1) Key competency areas for social work practice in IBH settings and (2) Self-rated preparedness for effective practice in IBH settings. Online snowball sampling methods were used over a period of 1 month. Results indicate that social workers feel prepared for general practice in IBH settings, but would benefit from additional training in IBH-specific competency areas identified in the survey. Findings can help guide social work training to improve workforce preparedness for practice in IBH settings in the wake of health care reform.     

Current Practice in Meeting Child Health Needs in Family Support Services: Variation by Service Type and Perspectives on Future Developments

The needs of all service users include those related to physical, emotional, sexual and mental health. This article documents where child health needs are recognised and being met within family support services in the west of Ireland, investigates whether there is variation across different types of family support services and presents the views of service providers as to how health needs could be more fully addressed. Four randomly selected service managers were interviewed; followed by a census survey of managers within the region. Thirty-three managers returned questionnaires (80% response) on their formal briefs in relation to health, perceived health needs being met and unmet, approaches to meeting health needs and resources required to adequately meet client health needs. Emotional and mental health needs were most frequently being met within current services, while group work, one-to-one work and referring on were all popular approaches. Systematic differences emerged by service size and client group. Access to expertise and staff training were perceived as the most popular approaches to improving service provision. These data illustrate that there is a need to develop guidelines for practice, foster links between services and provide for specialised staff training in relation to child health issues.     

HIV Prevention in Practice: An Assessment of the Public Health Response of Physicians and Nurses in the Midwest

Epidemiological trends in HIV infection in the United States suggest existing primary and secondary prevention efforts are inadequate. Healthcare providers may be missing valuable opportunities to engage in necessary public health services, such as prevention education, risk assessment, and case finding. This study examined the HIV-related practice behaviors and training needs of physicians and nurses in the Midwest. A cross-sectional survey method was employed. A questionnaire was mailed to a probability sample of 1,500 physicians and registered nurses licensed as of August 1999 in one of six Midwestern states. A total of 534 physicians and nurses replied to the survey, and over half had received prior HIV-related continuing medical education and training. One third of nurses and 26.8 percent of physicians reported that they did not engage in any HIV-related public health role in their practice. Physicians with prior HIV continuing medical education and training were 3.1 times more likely to report HIV-related public health services in their practice than providers without prior training (p = .004). Nurses with prior experience serving HIV-infected patients were 2.0 times more likely to identify a public health role (p = .012). These findings reflect the need for greater awareness among medical providers of the importance of assuming a public health role with the HIV epidemic.     

A survey of community exercise programmes for stroke survivors in Scotland

Stroke is the most common cause of complex disability in the community. Physical fitness is often reduced after stroke, but training can improve fitness and function. UK and international stroke clinical guidelines recommend long-term exercise participation for stroke survivors. However, there has been no previous research into what services are available to support this. In 2009, we conducted the first European survey of community Exercise after Stroke services. A link to our web-based survey was emailed to health, leisure service and stroke charity contacts in Scotland with email and telephone follow-up to non-respondents. The overall response rate was 64% (230/361). A total of 14 Exercise after Stroke services were identified, the majority of which were run by charity collaborations (7/14), followed by leisure centre services (4/14) and health services (3/14). We sought information on session content, referral and assessment processes, and the qualifications of exercise instructors. This information was cross-referenced with current clinical and exercise guidelines to determine whether existing resources were sufficient to meet stroke survivors' needs for safe, effective and sustainable access to exercise. The results indicated a shortage of stroke-specific community exercise programmes. Further service development is required to ensure appropriate instructor training and referral pathways are in place to enable stroke survivors to access exercise services in accordance with current guidelines.     

Constraints on the Performance of Minor Surgery by Family Physicians: Study of a 'Mock' Skin Biopsy Procedure

Despite the availability of a procedure room equipped for theperformance of common surgery procedures, physicians in a familymedicine training programme have reported that minor surgerytraining objectives are not being accomplished. To examine thisissue, the frequency of minor surgery procedures was auditedamong 357 randomly selectd medical records. The frequency ofdocumented sigmoidoscopy in this group of active patients overtheage of 50 years was 4.8%. A similar low frequency for the performanceof skin biopsy was also observed. All 15 senior residents participated in an attitude survey anda timed exercise in which they sought to find the necessaryitems for performance of a skin biopsy. In a questionnaire thegroup agreed that sigmoidoscopy and skin biopsies were proceduresappropriate for their family practice goals. In their offices,these residents required over nine minutes to partially locateequipment chosen for skin biopsy. The attitude survey revealedfew constraints other than insufficient time to perform indicatedelective procedures. Further study of procedure room utilizationand family physicians' office surgery skills is recommended.     

Dentists' responses to drug misusers

A survey among a sample of illicit drug misusers in 1993 indicated under-use of dental services, in spite of a high prevalence of dental problems, whilst a survey of dentists revealed reluctance to treat such patients. Most dentists use additional infection control procedures when they detect 'at-risk' patients, but their screening procedures are unlikely to be effective. Most dentists in the survey would welcome extra training focused on drug misuse.     

A generic simulation model to assess the performance of sterilization services in health establishments

The work presented here is with a view to improving performance of sterilization services in hospitals. We carried out a survey in a large number of health establishments in the Rhône-Alpes region in France. Based on the results of this survey and a detailed study of a specific service, we have built a generic model. The generic nature of the model relies on a common structure with a high level of detail. This model can be used to improve the performance of a specific sterilization service and/or to dimension its resources. It can also serve for quantitative comparison of performance indicators of various sterilization services.