Application of the ambulatory care groups in the primary care of a European national health care system: does it work?

BACKGROUND: Ambulatory Care Groups (ACGs), a US case-mix system that uses the patient as the unit of analysis, is particularly appropriate for health care systems in which physicians serve a defined list of patients. OBJECTIVE: To determine the extent to which the categorization of patients according to ACGs would account for the utilization of primary care services in a national health care system within the European Union. METHODS: Of all subjects continuously assigned to 9 physicians from public primary health care centers in Bizkaia, Basque Country (Spain) over a 12-month period, those visited at least once (n = 9,093) were included. According to the subject's age, sex, and ICD-9-CM diagnoses assigned during a year of patient-provider encounters, patients were classified by means of the ACGs system. RESULTS: Multiple linear regression analyses indicated that age and sex did not explain more than 7.1% of the variance in annual visits made by adults and 25.7% by children to primary care physicians. However, the r2 adjusted to the ACGs model was 50% and 48%, respectively, and even higher, that is 58% and 64% for another component of the system, the Ambulatory Diagnostic Groups (ADGs). CONCLUSIONS: Those results support the inadequacy of using the patient's age and sex alone to estimate physicians' workload in the primary health setting and the need to consider morbidity categories. The ACGs case-mix system is a useful tool for incorporating patients' morbidity in the explanation of the use of primary health care services in a European national health system.     

Nurses' accounts of locked ward doors: ghosts of the asylum or acute care in the 21st century?

The practice of locking acute ward doors in the UK to manage patient care has been reported with increasing frequency in a number of recent official documents; however, there is little research examining the practice. This study explores the perceptions and experiences of mental health nurses working on acute wards where the doors are locked for all or part of a shift. Audio-taped, semi-structured interviews were undertaken with 11 qualified mental health nurses and analysed using content analysis. Six broad categories were identified: policies and documentation, locking and unlocking the doors, communicating the decision, reasons for locking the doors, benefits and concerns. The findings suggest that there is a need for mental health nurses to reflect on the reasons for, and wider implications of locking ward doors before their wholesale implementation is considered in the UK.     

There is no health without mental health: Are we educating Australian nurses to care for the health consumer of the 21st century?

One in five Australians has a diagnosable mental illness and the impact of the illness on the individual, their family, and the community is significant. Since comprehensive nursing was introduced in the 1980s there have been repeated concerns raised regarding the preparedness of graduates from Australian undergraduate nursing programs to care for people who have a mental illness. In 2009, despite a recent comprehensive national review of the mental health/illness content in pre‐registration curricula, these concerns remain. The nursing profession must have a responsibility to the global community to ensure that registered nurses are educated to meet evolving health challenges and the needs of the health consumer in the 21^st Century. The purpose of this paper is to highlight the prevalence and impact of mental illness on health care outcomes in all settings and to challenge the profession to acknowledge that mental health nursing content must be a core area of all undergraduate curricula. A nationally coordinated response to address the long standing identified deficits in the educational preparation of comprehensive nurses is now a priority to ensure that nurses remain a major stakeholder group in the delivery of health care and key health informants and decision makers within the global health care arena.     

Interprofessionality in health and social care: the Achilles' heel of partnership?

Partnership working is now a central plank of public policy in the UK, especially in the field of health and social care. However, much of the policy thrust has been at the level of interorganisational working rather than at the level of interprofessional partnerships. The empirical and theoretical literature is largely sceptical about the feasibility of effective joint working between separate but related professionals--the 'pessimistic tradition'. Based upon an empirical study of general practitioners, community nurses and social workers in northern England, this article challenges such a tradition and proposes an 'optimistic hypothesis' for further investigation.     

Physiotherapists in occupational health — the Australian experience

Abstract

Occupational health physiotherapy (OHP) as a distinct discipline has been practised in Australia since the 1970s. In 1984, a national special interest group was formed within the Australian Physiotherapy Association (APA) to provide professional support and education for the growing numbers of physiotherapists in the field. In its latest form the group has nearly 300 members with chapters in each of the six states and in one of two territories. Since 1999, the APA has facilitated the development of a structured tiered career pathway for its members in all the special interest groups. To date, a number of OHP members have successfully completed the recognition process for advanced standing in the field of OHP and become either Titled or Specialist. It is planned to increase the numbers of physiotherapists working at advanced practitioner levels in workplace health and safety and continue to have OHP representatives on peak national health and safety groups and key bodies in the workers' rehabilitation and compensation field. The way forward for the special interest group lies in furthering educational opportunities for group members, and improving knowledge of other stakeholders including the physiotherapy profession about the skills group members have. Opportunities for networking and sharing resources via an international subgroup may be a reality in the near future.     

Australian health care reform: a place for nurse practitioners?

Nurses and health professionals across the board have argued for many years that the current health care system is not sustainable and reform is necessary if access to quality health care for all Australians is to continue.     

Telemedicine in the intensive care unit: A vehicle to improve quality of care?

The high demand for intensive care, which is predicted to further increase in the future, is contrasted by a shortage of trained intensivists and specialized nurses. Telemedicine has been heralded as a promising solution. Yet, there is considerable heterogeneity in tele-critical care when it comes to measurable effects. However, the focus has been on telemedical solutions substituting on-site intensivist functions, and outcome measures have primarily been mortality and length of stay. In a new model of telemedicine for the ICU, telemedicine could be used to increase adherence to best practice guidelines and indicators of process quality. Further, indicators of process quality, functional outcomes and quality of life measures should be incorporated in the evaluation of outcomes, as patients frequently value those higher than mere survival.     

“They have no idea of what we do or what we know”: Australian graduates' perceptions of working in a health care team

Globally it has been suggested that interprofessional education can lead to improvements in patient safety as well as increased job satisfaction and understanding of professional roles and responsibilities. In many health care facilities staff report being committed to working collaboratively, however their practice does not always reflect their voiced ideologies. The inability to work effectively together can, in some measure, be attributed to a lack of knowledge and respect for others' professional roles, status and boundaries. In this paper, we will report on the findings of an interpretative study undertaken in Australia, focussing specifically on the experiences of new graduate nurses, doctors and pharmacists in relation to ‘knowing about’ and ‘working with’ other health care professionals. Findings indicated there was little understanding of the roles of other health professionals and this impacted negatively on communication and collaboration between and within disciplines. Furthermore, most new graduates recall interprofessional education as intermittent, largely optional, non-assessable, and of little value in relation to their roles, responsibilities and practice as graduate health professionals. Interprofessional education needs to be integrated into undergraduate health programs with an underlying philosophy of reciprocity, respect and role valuing, in order to achieve the proposed benefits for staff and patients.     

Who cares for older people with mental illness? A survey of residential aged care facilities in the Australian Capital Territory: Implications for mental health nursing

Residential aged care facilities are increasingly becoming locations wherein the most frail and older people with mental illness live out the remainder of their lives, yet it has become apparent in recent years that these institutions are fraught with a variety of social and clinical problems. One issue of concern has been the exodus of registered nurses (both general and psychiatric), who have been increasingly replaced by carers with little or no expertise in psychiatric illness or disorders of cognitive decline. This 'de-professionalizing' of aged care has important implications for the well-being of clients, particularity those with complex mental health problems. In this survey we sought to discover demographic information concerning those who provide front-line care to this population of aged Australians, and we sought also to ascertain how much education in caring for residents who suffer specifically from neurodegenerative disorders (the dementias) and mental illness was provided by the facilities to those who care for such older people. The lack of training in the areas of mental health and cognitive impairment raises a variety of issues that mental health nurses need to address. These issues cover clinical, professional, and social justice dimensions. We believe that mental health nurses are strategically and professionally placed to take a leadership role in raising the profile of aged care in this country and they need to act proactively to secure the well-being of this particularly vulnerable client group.     

The effects of chlorhexidine gluconate bathing on health care–associated infection in intensive care units: A meta-analysis

PurposeThe purpose was to assess the effects of chlorhexidine gluconate (CHG) bathing on health care–associated infections among critically ill patients.MethodsThis meta-analysis evaluated English-language studies from the PubMed, Embase, and Cochrane databases. The Cochrane Collaboration methodology was used to evaluate all publications regarding daily CHG bathing and the risks of acquiring central line–associated bloodstream infection (CLABSI), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE). Risk ratios (RRs) and the ratio of the log RRs (RRR) were estimated with 95% confidence intervals (CIs).ResultsEighteen studies were included. Compared with conventional care, the RRs (95% CIs) for CLABSI, MRSA, and VRE with CHG bathing were 0.45 (0.37-0.55), 0.67 (0.59-0.77), and 0.60 (0.42-0.85), respectively (all, P < .05). For MRSA acquisition, CHG bathing with concomitant nasal antibiotics provided a lower incidence compared with only CHG bathing (RRR: 0.81, 95% CI: 0.66-0.98, P = .035). Greater risk reduction was also observed in studies with prolonged interventions (RRR per 1-month extension: − 0.02, P = .027).ConclusionsDaily CHG bathing was associated with reduced risks of acquiring CLABSI, MRSA, and VRE. A prolonged intervention period and concomitant nasal antibiotic use were associated with lower risks of MRSA acquisition.