Interprofessional communication with hospitalist and consultant physicians in general internal medicine : a qualitative study

This study helps to improve our understanding of the collaborative environment in GIM, comparing the communication styles and strategies of hospitalist and consultant physicians, as well as the experiences of providers working with them. The implications of this research are globally important for understanding how to create opportunities for physicians and their colleagues to meaningfully and consistently participate in interprofessional communication which has been shown to improve patient, provider, and organizational outcomes

Psychologists and Medications in the Era of Interprofessional Care: Collaboration is Less Problematic and Costly Than Prescribing

Increasing emphasis on interprofessionalism and teamwork in healthcare renders psychologists’ collaborations critical and invites reexamination of psychologists’ roles related to medications. The Collaboration Level outlined by the APA’s Ad Hoc Task Force is more achievable and in synch with health reform than prescription privileges (RxP). RxP remains controversial due to training and safety concerns, lacking support from health professionals, psychologists, and consumers. Differences in educational preparation of psychologists relative to prescribing professionals are discussed. Enactment of only three of 170 RxP initiatives reveals RxP to be a costly, ineffectual agenda. Alternatives (e.g., integrated care, collaboration, telehealth) increase access without risks associated with lesser medical knowledge. Concerns about RxP and the movement toward team-based care warrant reconsideration of the profession’s objectives regarding psychopharmacology

Primary Care Health Workforce in the United States

Synthesizes findings about trends in the composition, supply, and distribution of the primary care workforce; demand for and pressures on primary care providers; and the impact of technologies, payment policies, market forces, and scope of practice laws

Effects of Implementing a Health Team Communication Redesign on Hospital Readmissions Within 30 Days

Background and Rationale Poor communication between health team members can interfere with timely, coordinated preparation for hospital discharge. Research on daily bedside interprofessional health team rounds and nursing bedside shift handoff reports provides evidence that these strategies can improve communication. Aims To improve health team communication and collaboration about hospital discharge; improve patient experience of discharge measured by patient‐reported quality of discharge teaching, readiness for discharge, and postdischarge coping difficulty; and reduce readmissions and emergency department (ED) visits postdischarge. Methods A two‐sample pre‐ and postintervention design provided baseline data for redesign of health team communication processes and comparison data for evaluation of the new process’ impact. Health team members (n = 105 [pre], n = 95 [post]) from two surgical units of an academic medical center in the midwestern United States provided data on discharge‐related communication and collaboration. Patients (n = 413 [pre], n = 191 [post]) provided data on their discharge experience (quality of discharge teaching, readiness for discharge, postdischarge coping difficulty) and outcomes (readmissions, ED visits). Chi‐square and t tests were used for unadjusted pre‐ and postintervention comparisons. Logistic regression of readmissions with a matched pre‐ and postintervention sample included adjustments for patient characteristics and hospitalization factors. Results Readmissions decreased from 18% to 12% (p \u3c .001); ED visits decreased from 4.4% to 1.5% (p \u3c .001). Changes in health team communication and collaboration and patients’ experience of discharge were minimal. Discussion The targeted outcomes of readmission and ED visits improved after the health team communication process redesign. The process indicators did not improve; potential explanations include unmeasured hospital and unit discharge, and other care process changes during the study timeframe. Linking Evidence to Practice Evidence from daily interprofessional team bedside rounding and bedside shift report studies was translated into a redesign of health team communication for discharge. These strategies support readmission reduction efforts

Embracing Accountability: Physician Leadership, Public Reporting, and Teamwork in the Wisconsin Collaborative for Healthcare Quality

Based on interviews, presents a case study of how a "bottom-up" physician-led group of healthcare providers realized voluntary public reporting of comparative performance information as a quality improvement tool. Shares requirements and lessons learned

The Rhetoric of Health and Medicine as a “Teaching Subject”: Lessons from the Medical Humanities and Simulation Pedagogy

The rhetoric of health and medicine has only begun to intervene in health pedagogy. In contrast, the medical humanities has spearheaded curriculum to address dehumanizing trends in medicine. This article argues that rhetorical scholars can align with medical humanities’ initiatives and uniquely contribute to health curriculum. Drawing on the author’s research on clinical simulation, the article discusses rhetorical methodologies, genre theory, and critical lenses as areas for pedagogical collaboration between rhetoricians and health practitioners

Crossing Organizational Boundaries in Palliative Care: The Promise and Reality of Community Partnerships

This report presents the first of a series of findings from the Community-Oriented Palliative Care Initiative (COPCI), an innovative program testing new approaches to caring for individuals with progressive, life threatening illness. Developed and supported by the United Hospital Fund, the project was designed to initiate collaborations among health care and social service organizations, with the goal of reaching seriously ill individuals and their caregivers earlier in the course of illness and providing a broad range of coordinated services. Six such networks of diverse partners received a total of $2.1 million in grants over the two-year period from mid-2000 into 2002.The urgency to provide alternatives to current standard practice is underscored by the number of individuals affected: in New York City alone, in the year 2000, some 46,000 people died of diseases typically marked by a lengthy course from diagnosis to death. While many could have benefited from appropriate and timely palliative care services, most did not receive them.The Fund reasoned that networks including not only hospitals and hospices but also social services agencies and other community resources could collectively respond, earlier and more fully, to the complex combination of medical, social, psychological, and spiritual needs that typify the months and years leading to death. Local expertise and resources should determine the structure of each network, the partners involved, and the specific model for service delivery. Drawing on the experiences of the six pioneering projects, this report focuses on the challenges of creating such new networks

Co-innovation: the future of telemedicine in developing countries

Telemedicine which has been widely adopted in developed countries to reach all its citizens irrespective of their location is only being used for education purposes or disaster relief in developing countries. Since developing countries already suffer inadequate healthcare provision especially in remote areas, it would be essential to implement telemedicine practices for daily clinical uses rather than education use. This research argues that to understand the future of telemedicine in developing countries, both well-established technology innovations adoption factors as well as co-innovation factors should be addressed. In the context of healthcare provision, we propose a conceptual framework that integrates the healthcare resources and the organisational affiliations in co-innovation

Exploration of the Association Between Professional Interactions and Emotional Distress of Intensive Care Unit Nursing Personnel

Several studies provide evidence for the association between the quality of collaboration among intensive care unit (ICU) professionals and patients' outcomes, as well as nurses' moral distress and professional satisfaction. However, potential associations between collaboration and nurses' mental health indices have not been explored. The aim of this descriptive correlational study was to investigate the degree of satisfaction from interaction among ICU nursing personnel, as well as between ICU nursing personnel and physicians, and potential associations with ICU nursing personnel's anxiety symptoms. The sample consisted of ICU nursing personnel from 11 adult general hospitals in Greece (n = 229). Hamilton's Anxiety scale was applied for the quantitative assessment of anxiety symptoms and Stamps' Index of Work Satisfaction for the appraisal of nursing personnel's satisfaction from professional interactions. Demographic, vocational, and educational data were also recorded. Descriptive statistics were explored, and group comparisons, correlation, and regression analysis were used. The average satisfaction score from interaction among nursing personnel was moderate to high (5.3 [SD, 1.0]) and from nurse-to-physician interaction was moderate (4.0 [SD, 1.4]) (scale range, 1-7). The score of satisfaction from nurse-to-physician interaction was negatively mildly correlated with participants' (a) total anxiety score ( = ?0.160, P = .001), (b) tension ( = ?0.125, P = .015), and (c) depressive symptoms ( = ?0.148, P = .005). Weak negative correlations were detected between satisfaction from interaction among nursing personnel and participants' (a) total anxiety state ( = ?0.139, P = .003), (b) tension ( = ?0.137, P = .008), and (c) sleep disturbances ( = ? 0.150, P = .003). Overall, female respondents had higher levels of anxiety symptoms than male respondents (Mann-Whitney U, P = .007). Satisfaction from professional interaction was not a strong predictor of anxiety symptoms among ICU nursing personnel (R2 = 0.046, ?0.15). Nursing personnel in Greek ICUs seem to be satisfied with the quality of relationships among them, as well as with physicians. Despite that anxiety symptoms associate with the degree of satisfaction from professional interaction, the latter may not be a significant indicator of ICU nurses' well-being. Further qualitative research is needed to identify mediating factor