老年医学继续教育对社区医务人员“知信行”的影响

目的调查社区医务人员对老年医学理念的理解及知晓程度,探讨老年医学继续教育及相应的工作指导对社区医务人员老年医学知识接受及应用的影响。方法入选2013年11月至2015年9月期间在岗的社区上门服务机构医务人员70人。采用"知信行"(KABP)调查问卷,对社区医务人员在老年医学继续教育培训前后的KABP行为进行调查评估,并比较培训前后的变化。结果培训前调查回收有效问卷58人;培训后调查回收有效问卷70人。培训后与培训前比较,医务人员对老年共病、老年综合征、前列腺增生、良性位置性眩晕、骨质疏松、肿瘤筛查、营养不良、肌少症、跌倒、痴呆、谵妄、尿失禁、睡眠障碍及压疮认知程度的提高均达到统计学意义(P0.05),对于便秘、营养不良、多重用药、尿失禁、睡眠障碍、肌少症、痴呆和谵妄的处理及行为均得到显著提升(P0.05)。结论社区医务工作者对老年医学知识掌握普遍不足,有针对性的老年医学继续教育,以及对社区进行的老年医学实践指导,可以有效提高社区医务人员的认知水平和实践能力。     

The effects of two continuing medical education programs on communication skills of practicing primary care physicians

Purpose: To evaluate and compare the effects of two types of continuing medical education (CME) programs on the communication skills of practicing primary care physicians. Participants: Fifty-three community-based general internists and family practitioners practicing in the Portland, Oregon, metropolitan area and 473 of their patients. Method: For the short program (a 4 1/2-hour workshop), 31 physicians were randomized to either the intervention or the control group. In the long program (a 2 1/2-day course), 20 physicians participated with no randomization. A research assistant visited all physicians’ offices both one month before and one month after the CME program and audiotaped five sequential visits each time. Data were based on analysis of the content and the affect of the interviews, using the Roter Interactional Analysis Scheme. Results: Based on both t-test analysis and analysis of covariance, no effect on communication was evident from the short program. The physicians enrolled in the long program asked more open-ended questions, more frequently asked patients’ opinions, and gave more biomedical information than did the physicians in the short program. Patients of the physicians who attended the long program tended to disclose more biomedical and psychosocial information to their physicians. In addition, there was a decrease in negative affect for both patient and physician, and patients tended to demonstrate fewer signs of outward distress during the visit. Conclusion: This study demonstrates some potentially important changes in physicians’ and patients’ communication after a 2 1/2-day CME program. The changes demonstrated in both content and affect may have important influences on both biologic outcome and physician and patient satisfaction.     

The development of academic geriatric medicine in the United States 2005 to 2010: an essential resource for improving the medical care of older adults

Academic geriatric medicine programs are critical for training the physician workforce to care effectively for aging Americans. This article updates the progress made by U.S. medical schools from 2005 to 2010 in developing these programs. Academic leaders in geriatrics in accredited allopathic and osteopathic medical schools were surveyed in the winter of 2010 (60% response rate), and results were compared with findings from a similar 2005 survey (68% response rate). Physician faculty in geriatrics increased from 9.6 (mean) full‐time equivalents (FTEs) in 2005 to 11.2 by 2010. In 2010, faculty and staff effort was mostly devoted to clinical practice (mean = 37%) and education (mean = 33%), with only seven responding schools devoting more than 40% of faculty effort to research. Schools that have been designated as Centers of Excellence had a median 20 FTE physician faculty, compared with seven at the other schools (P < .001). In 2010, 27% of medical schools required a geriatrics clerkship, and 87% (n = 83) had an elective geriatric clerkship. In summary, more fellows and faculty were recruited and trained in 2010 than in 2005, and some academic programs have emerged with strong education, research, and clinical initiatives. Medical student exposure to geriatrics curriculum has increased, but few academic geriatricians are pursuing research careers, and the number of practicing geriatricians is declining. New approaches to training the entire physician workforce to care for older adults will be required to ensure adequate medical care for aging Americans.     

Paper stamp checklist tool enhances asthma guidelines knowledge and implementation by primary care physicians

BACKGROUND:

The Canadian Clinical Practice Guidelines (CPGs) for the management of asthmatic patients were last published in 1999, with updates in 2001 and June 2004. Large disparities exist in the implementation of these guidelines into clinical practice.

OBJECTIVE:

The present study evaluated the knowlege of Quebec-based primary care physicians regarding the CPGs, as well as patient outcomes before and after introducing physicians to a new clinical tool – a memory aid in the form of a self-inking paper stamp checklist summarizing CPG criteria and guidelines for assessing asthmatic patient control and therapy. The primary objective of the present study was to assess whether the stamp would improve physicians’ knowledge of the CPGs, and as a secondary objective, to assess whether it would decrease patient emergency room visits and hospitalizations.

METHODS:

A prospective, randomized, controlled study of 104 primary care physicians located in four Quebec regions was conducted. Each physician initially responded to questions on their knowledge of the CPGs, and was then randomly assigned to one of four groups that received information about the CPGs while implementing an intervention (the stamp tool) aimed at supporting their decision-making process at the point of care. Six months later, the physicians were retested, and patient outcomes for approximately one year were obtained from the Régie de l’assurance maladie du Québec.

RESULTS:

The stamp significantly improved physicians’ knowledge of the CPGs in all Quebec regions tested, and reduced emergency room visits and hospitalizations in patients who were followed for at least one year.

CONCLUSION:

A paper stamp summarizing CPGs for asthma can be used effectively to increase the knowledge of physicians and to positively affect patient outcomes.     

A continuing medical education initiative for canadian primary care physicians: the driving and dementia toolkit: a pre- and postevaluation of knowledge, confidence gained, and satisfaction

This study examined the effect of the Driving and Dementia Toolkit on physician knowledge and confidence gained and the anticipated change in patient assessment and evaluated the extent to which physicians found the material to be useful. Before receiving the driving toolkit, 301 randomly selected primary care physicians received a copy of the pretest questionnaire; 145 responded and met the eligibility criteria. This group was then sent the toolkit, a satisfaction a survey, and a posttest questionnaire. Physicians were faxed the questionnaires (with up to three reminders) and telephoned if necessary. Changes in pre- and posttest results were analyzed using the McNemar test and Wilcoxon signed rank test nonparametric procedures included in SPSS, Version 10.0, and paired-samples t test. Pre- and posttest data were available and could be matched for 86 physicians (59.3%) response. Knowledge and confidence increased significantly (P相似文献   

Moving the needle: Providing evidence based care to older adults with behavioral issues through knowledge translation

ABSTRACT

Implementing evidence based practices into practice settings is exceedingly difficult. Knowledge translation is a framework used for moving practices from the literature into the real world. This article discusses how six articles in this special issue of Gerontology and Geriatrics Education use various knowledge translation approaches to implement evidence based practices in older adults with behavioral health issues including dementia, delirium and serious mental illness across a variety of settings, as well as lessons learned for future knowledge translation and implementation science studies.     

Knowledge and attitudes of family physicians coming to COPD continuing medical education

Purpose

COPD remains under-recognized and under-treated. Much of early COPD care is given by primary care physicians but only when COPD is recognized. This survey explores the attitudes, beliefs, and knowledge related to COPD recognition, diagnosis, and treatment from family physicians and nurse practitioners (NPs) and physician assistants (PAs) working in primary care.

Methods

We completed a survey of family physicians, and NPs/PAs attending one of three CME programs on five common chronic conditions including COPD.

Results

Return rate was 62% (n = 284) including 178 physicians and 100 NPs/PAs. Fewer than half of the respondents reported knowledge of or use of COPD guidelines. The barriers to recognition and diagnosis of COPD they reported included the multiple morbidities of most COPD patients, failure of patients to report COPD symptoms, as well as lack of knowledge and inadequate training in COPD diagnosis and management. Three quarters (74%) of respondents reported use of spirometry to diagnose COPD but only 32% said they included reversibility assessment. COPD was incorrectly assessed as a disease primarily of men (78% of respondents) that appeared after age 60 (61%). Few respondents reported that they believed COPD treatment was useful or very useful for improving symptoms (15%) or decreasing exacerbations (3%) or that pulmonary rehabilitation was helpful (3%), but 13% reported they thought COPD treatment could extend longevity.

Conclusions

Primary care physicians and NPs/PAs working in primary care continue to report lack of awareness and use of COPD guidelines, as well as correct information related to COPD epidemiology or potential benefits of available treatments including pulmonary rehabilitation. It is unlikely that diagnosis and management of COPD will improve in primary care until these knowledge gaps and discrepancies with published efficacy of therapy issues are addressed.     

The development of academic geriatric medicine: progress toward preparing the nation's physicians to care for an aging population

Academic geriatric medicine programs are critical for training the physician workforce to care effectively for aging Americans. This article describes the progress made by medical schools in developing these programs. Academic leaders in geriatrics at all 145 accredited allopathic and osteopathic medical schools in the United States were surveyed in the winter of 2005 (68% response rate) and results compared with findings from a similar 2001 survey. Physician faculty in geriatrics at U.S. medical schools increased from 7.5 (mean) full-time equivalents (FTEs) in 2001 to 9.6 FTEs in 2005. Faculty and staff effort is mostly devoted to clinical practice (mean 36.9%) and education (mean 34.6%). A small number of programs focus on research; only six responding schools devote more than 40% of faculty effort to research. Seventy-one percent reported that their medical school required a geriatrics medical student clerkship or that their geriatric training was integrated into a required clinical rotation. In summary, from 2001 to 2005, more fellows and faculty have been recruited and trained, and some academic programs have emerged with strong education, research, and clinical initiatives. Medical student exposure to geriatrics curriculum has increased, although few academic geriatricians are pursuing research careers, and the number of practicing geriatricians is declining. An expanded investment in training the physician workforce to care for older adults will be required to ensure adequate care for aging Americans.     

Reducing the burden of morbidity and medical utilization of older patients by outpatient geriatric services: Implications to primary health‐care settings

Aim: That geriatric evaluation and management (GEM) is associated with better quality of care for elderly patients has been reported by previous studies, but evidence supporting that GEM can reduce the burden of morbidity (BOM) was lacking. The aim of this study was to evaluate the benefits of outpatient GEM on reducing BOM and medical utilization in Taiwan. Methods: Data of this retrospective case–control study were obtained from the 2004–2006 Taiwan National Health Insurance Research Database (NHIRD). Patients who attended the outpatient GEM program for over 6 months in a tertiary medical center in 2005 were enrolled as the case group, and a 1:5 age and gender‐matched control group was formed by randomly‐selected patients from the same medical center for comparisons. BOM was obtained by applying the Adjusted Clinical Group (ACG) program, and medical utilization variables were totalled for each patient from the NHIRD. Patients were further reassigned to two morbidity categories, the low (resource utilization bands ≤ 3) and high (resource utilization bands > 3) morbidity category, according to their degree of morbidity before statistical analyses. Results: Data of 4254 elderly patients (709 cases, 3545 controls) were included in the study. BOM and medical utilization were increased in both groups in both morbidity categories during the study period. However, the growth of BOM, total medical expenditure, number of emergency department visit, and days and expenditure of hospitalization were significantly reduced in the case than the control group in the low morbidity category, not the high morbidity category. Conclusion: Outpatient GEM could effectively reduce growth of BOM and medical utilization for relatively healthy elderly patients in Taiwan where elderly patients haverelatively free access to general and specialty care. The results of this study implied the potential benefits of systematically implementing GEM in primary health‐care settings to improve the quality of care and slow down the growth of BOM for elderly patients. Geriatr Gerontol Int 2012; ??: ??–??.     

Hypertension,knowledge, attitudes,and practices of primary care physicians in Ulaanbaatar,Mongolia

We examined the knowledge, attitudes, and practices of primary care doctors in Ulaanbaatar, Mongolia using a recently developed World Hypertension League survey. The survey was administered as part of a quality assurance initiative to enhance hypertension control. A total of 577 surveys were distributed and 467 were completed (81% response rate). The respondents had an average age of 35 years and 90.1% were female. Knowledge of hypertension epidemiology was low (13.5% of questions answered correctly); 31% of clinical practice questions had correct answers and confidence in performing specific tasks to improve hypertension control had 63.2% “desirable/correct” answers. Primary care doctors mostly had a positive attitude toward hypertension management (76.5% desirable/correct answers) and highly prioritized hypertension management activities (85.7% desirable/correct answers). Some important highlights included the majority (> 80%) overestimating hypertension awareness, treatment, and control rates; 78.2% used aneroid blood pressure manometers; 15% systematically screened adults for hypertension in their clinics; 21.8% reported 2 or more drugs were required to control hypertension in most people; and 16.1% reported most people could be controlled by lifestyle changes alone. 55% of respondents were not comfortable prescribing more than 1 or 2 antihypertensive drugs in a patient and the percentage of desirable/correct responses to treating various high‐risk patients was low. Most (53%‐74%) supported task shifting to nonphysician health care providers except for drug prescribing, which only 13.9% supported. A hypertension clinical education program is currently being designed based on the specific needs identified in the survey.     

Asthma and chronic obstructive pulmonary disease guideline implementation: Lessons learned on recruitment of primary care physicians to a knowledge translation study

BACKGROUND

Implementation of current clinical practice guidelines in asthma and chronic obstructive pulmonary disease (COPD) is suboptimal. New implementation strategies should be developed and evaluated.

METHODS:

The authors report the rationale and planned methods of a project that sought to use a multifaceted knowledge translation intervention consisting of interactive education, mentorship through quality circles and practice-based tools in primary care to address key asthma and COPD care gaps. The present study was aborted due to inadequate primary care physician recruitment. Accordingly, the authors provide a critical review of their recruitment strategies and discuss alternative approaches and examples based on previous literature.

DISCUSSION:

These practical lessons and discussion seek to inform researchers involved in designing and recruiting for future knowledge translation studies addressing chronic disease management in primary care.     

Evaluation of continuing education for long-term care personnel: impact upon attitudes and knowledge

Nursing assistants (aides) and licensed practical nurses (LPNs) from three proprietary nursing homes participated in a continuing education program designed to enhance knowledge and attitudes about the elderly in long-term care. The program covered six weeks for the initial 115 aides and one full-day seminar for the 83 LPNs. The content covered knowledge and human anatomy, the physiology of normal aging, physical and psychosocial problems of the elderly and, for the nurses, problems associated with cardiovascular accidents. The final participants (29 aides and 52 LPNs) consisted of those who were tested before and after their training with respect to knowledge, life satisfaction, and attitudes toward the elderly. Results indicated overall favorable changes for both aides and LPNs, particularly in the areas of increased knowledge and more positive attitudes. The data suggest that continuing education is an effective means of influencing the knowledge and attitudes of personnel in long-term care facilities, and it should be a first step toward improving the quality of care for elderly residents.     

Hypertension knowledge,attitudes, and practices of nurses and physicians in primary care in Ulaanbaatar Mongolia

Increased blood pressure is a leading risk for death globally, and interventions to enhance hypertension control have become a high priority. An important aspect of clinical interventions is understanding the knowledge, attitudes, and practices (KAP) of differing primary healthcare practitioners. We examined KAP surveys from 803 primary care practitioners in Ulaanbaatar, Mongolia (response rate 80%), using a comprehensive KAP survey developed by the World Hypertension League (WHL). The WHL KAP survey uniquely includes an assessment of key World Health Organization recommended interventions to enhance hypertension control. There were few substantive differences between healthcare professional disciplines. Primary care practitioners mostly had a positive attitude toward hypertension management. However, confidence and practice in performing specific tasks to control hypertension were suboptimal. A low proportion indicated they systematically screened adults for hypertension and many were not aware of the need to or were confident in prescribing more than two antihypertensive medications. It was the practice of a high proportion of doctors to not pharmacologically treat most people with hypertension who were at high cardiovascular risk. There was a reluctance by physicians to task share hypertension diagnosis, drug prescribing and assessing cardiovascular risk to nurses. The minority of health care professions use a hypertension management algorithm, and few have patient registries with performance reporting functions. There were few substantive differences based on the age, gender, and years of clinical practice of the practitioners. The study findings support the need for standardized education and training of primary care practitioners in Ulaanbaatar to enhance hypertension control.     

Medical mistakes and older patients: admitting errors and improving care

The topic of medical errors has received substantial professional and public attention over the past few years. However, very little of this attention has focused specifically on the implications of this problem for older patients or on the healthcare professionals and settings specifically serving them. This article examines some of the most salient of those implications, with particular emphasis on the physician's ethical duty to admit and address errors. Practical obstacles, including physicians' legal anxieties, to admitting and thereby reducing and mitigating medical errors are outlined, along with potential strategies for effectively addressing and overcoming those barriers.     

Continuing medical education and assessment of professional practice of general internist: stake at issue and debate

The requirements of financiers and consumers have impacted on the range of healthcare choices and the politics of public health. In fact, the healthcare policy-makers, as well as healthcare structures are mainly concerned with the implementation of quality, healthcare safety and the prevention of risks. The corollary of this for all physicians and healthcare institutions is the commitment to certification and accreditation. This approach entails an obligation to continued medical education (CMEs), an obligation to the evaluation of professional practices (EPP) and the declaration of risk-carrying events (non-serious adverse events; EPR). The expertise of midwives, as well as their role, which covers many over-lapping aspects of perinatal care, requires not only initial training and then continuous high-level education, but also a commitment to the accreditation and evaluation approach.