Attitudes and Perceptions of Non-Clinical Health Care Students’ Towards Interprofessional Learning

Background Research on interprofessional learning and education has primarily focused on undergraduate programs, intervention-based programs and clinical programs. Efforts should also be made to examine attitudes of graduate students who are enrolled in non-clinical health profession programs. Purpose: The purpose of this study was to explore attitudes of non-clinical graduate health care students towards interprofessional learning and to examine differences in these attitudes and perceptions among students from differing university health programs. Methods: A quantitative survey adapted from the Readiness for Interprofessional Learning Scale survey was sent to students enrolled in non-clinical graduate health programs at a university. A demographic section was added to collect information about the participants. Results: Two hundred and ninety six students from eight different health programs participated in this study, representing an 85.54% completion rate. Of the total respondents, 47.6% were enrolled in the Doctor of Health Science program and 55.5% worked in health organizations. Findings suggested that students in different health programs considered teamwork and collaboration important to function in health care. Students felt that focus on interprofessional learning may lead to improvement in communication and problem-solving abilities. Conclusion: Implementation of interprofessional learning curricula may enhance understanding of the work of other health professionals which could result in better patient care. These findings could help educational institutions as they advance towards implementing interprofessional educational curricula

National survey of clinical communication assessment in medical education in the United Kingdom (UK)

Background All medical schools in the UK are required to be able to provide evidence of competence in clinical communication in their graduates. This is usually provided by summative assessment of clinical communication, but there is considerable variation in how this is carried out. This study aimed to gain insight into the current assessment of clinical communication in UK medical schools. Methods The survey was sent via e-mail to communication leads who then were asked to consult with all staff within their medical school involved in the assessment of communication. Results Results were obtained from 27 out of 33 schools (response rate 82%) and a total of 34 courses. The average number of assessments per year was 2.4 (minimum 0, maximum 10). The Objective Structured Clinical Exam (OSCE) was the most commonly used method of assessment (53%). Other assessments included MCQ and workplace based assessments. Only nine courses used a single method of assessment. Issues raised included, logistics and costs of assessing mainly by OSCE, the robustness and reliability of such exams and integration with other clinical skills. Conclusions It is encouraging that a variety of assessment methods are being used within UK medical schools and that these methods target different components of clinical communication skills acquisition.Publisher PDFPeer reviewe

An international comparison of the deinstitutionalisation of mental health care:Development and findings of the Mental Health Services Deinstitutionalisation Measure (MENDit)

BACKGROUND: Despite its inclusion as a key aspect of successful mental health care service provision by the World Health Organization, there exists a lack of consensus regarding the definition, key components and implementation of deinstitutionalisation. This lack of consensus has also contributed to subjectivity in assessments of countries' progress towards deinstitutionalisation which act as a barrier to its evaluation and success. In order to provide for reliable within and cross country evaluations of the success of deinstitutionalisation we aimed to develop a quantitative measure of country-level progress towards deinstitutionalisation through the (1) identification of key markers of deinstitutionalisation; (2) development of an assessment tool based on the identified markers; (3) evaluation of the tool's psychometric properties; and (4) comparison of progress towards deinstitutionalisation across Europe. METHODS: National care standards from 10 European countries and World Health Organization recommendations were used to identify items for the tool. A draft version was reviewed by an international expert panel and assessed for test-retest reliability and internal consistency. Once a final version had been agreed, progress towards deinstitutionalisation was assessed for 30 European countries. We used this opportunity to test convergent validity through comparison with local experts' assessments. Country total as well as individual item scores were described and compared. RESULTS: The five-item Mental Health Services Deinstitutionalisation Measure (MENDit) is an objective tool with moderate to very good test-retest reliability (Kappa range: 0.46-1.00) and internal consistency (α = 0.70, 95 % CI 0.25, 0.92). A statistically significant difference between groups was found by one-way ANOVA (F(3,26) = 6.77, p = 0.002). Post-hoc testing found significant differences between MENDit scores of countries categorised as having advanced levels of deinstitutionalisation and not started or just started. Across Europe, MENDit scores suggest substantial variety in progress towards deinstitutionalisation. CONCLUSIONS: The MENDit has good psychometric properties which support its use in research and as a benchmarking tool to measure national progress towards deinstitutionalisation by policy makers. Across Europe a high proportion of psychiatric beds are still located in psychiatric hospitals. Additionally, low numbers of mental health professionals in many countries may hinder further deinstitutionalisation. These findings corroborate previous mental health systems research and highlight some of the difficulties of deinstitutionalisation

Streaming primary urgent care: a prospective approach

Aim: To identify the appropriate service provider attendees of emergency departments (EDs) and walk-in centres (WiCs) in North East London and to match this to local service provision and patient choice. Design: An anonymous patient survey and a retrospective analysis of a random sample of patient records were performed. A nurse consultant, general practitioner (GP) and pharmacist used the presenting complaints in the patients’ records to independently stream the patient to primary care services, non-National Health Services or ED. Statistical analysis of level of agreement was undertaken. A stakeholder focus group reviewed the results. Subjects and setting Adult health consumers attending ED and urgent care services in North East London. Results The health user survey identified younger rather than older users (mean age of 35.6 years – SD 15.5), where 50% had not seen a health professional about their concern, with over 40% unable to obtain a convenient or emergency appointment with their GP. Over a third of the attendees were already receiving treatment and over 40% of these saw their complaint as an emergency. Over half of respondents expected to see a doctor, one-quarter expected to see a nurse and only 1% expected to see a pharmacist across both services, although WiCs are nurse-led services. More respondents expected a prescription from a visit to a WiC, whereas in the ED a third of respondents sought health advice or reassurance. Conclusion: A number of unscheduled care strategies are, or have just been, developed with the emphasis on moving demand into community-based services. Plurality of services provides service users with a range of alternative access points but can cause duplication of services and repeat attendance. Managing continued increase in emergency and unscheduled care is a challenge. The uncertainties in prospective decision making could be used to inform service development and delivery

[a] Project for the Sub-Centre

In the aftermath of the 2011 earthquake, a state of polycentric urbanity was thrust upon New Zealand’s second largest city. As the city-centre lay in disrepair, smaller centres started to materialise elsewhere, out of necessity. Transforming former urban peripheries and within existing suburbs into a collective, dispersed alternative to the city centre, these sub-centres prompted a range of morphological, socio-cultural and political transformations, and begged multiple questions: how to imbue these new sub-centres with gravity? How to render them a genuine alternative to the CBD? How do they operate within the wider city? How to cope with the physical and cultural transformations of this shifting urbanscape and prevent them occurring ad lib? Indeed, the success and functioning of the larger urban structure hinges upon a critical, informed response to these sub-centre urban contexts. Yet, with an unrelenting focus on the CBD rebuild - effectively a polycentric denial - little such attention has been granted. Taking this urban condition as its premise and its provocation, this thesis investigates architecture’s role in the emergent sub-centre. It asks: what can architecture do in these urban contexts; how can architecture act upon the emergent sub-centre in a critical, catalytic fashion? Identifying this volatile condition as both an opportunity for architectural experimentation and a need for critical architectural engagement, this thesis seeks to explore the sub-centre (as an idea and actual urban context) as architecture’s project: its raison d’etre, impetus and aspiration. These inquiries are tested through design-led research: an initial design question provoking further, broader discursive research (and indeed, seeking broader implications). The first section is a site-specific, design for Sumner, Christchurch. Titled ‘An Agora Anew’; this project - both in conception and outcome - is a speculative response to a specific sub-centre condition. The second section ‘The Sub-centre as Architecture’s Project’ explores the ideas provoked by the design project within a discursive framework. Firstly it identifies the sub-centre as a context in desperate need of architectural attention (why architecture?); secondly, it negotiates a possible agenda for architecture in this context through terms of engagement that are formal, critical and opportunistic (how architecture?): enabling it to take a position on and in the sub-centre. Lastly, a critical exegesis positions the design in regards to the broader discursive debate: critiquing it an architectural project predicated upon the idea of the sub-centre. The implications of this design-led thesis are twofold: firstly, for architecture’s role in the sub-centre (especially to Christchurch); secondly for the possibilities of architecture’s productive engagement with the city (largely through architectural form), more generally. In a century where radical, new urban contexts (of which the sub-centre is just one) are commonplace, this type of thinking – what can architecture do in the city? - is imperative

Untimely illness:When diagnosis does not match age-related expectations

Background We explore the concept of “untimely diagnosis,” where the onset of a long-term condition occurs at a life stage which does not conform to traditional expectations, focusing on two conditions (asthma and arthritis) typically associated with a particular life stage (childhood and older adulthood, respectively). Previous literature has focused on the meaning of chronic illness in terms of life history, and the biographical lens has been used in various ways to make sense of the experience. Less attention has been paid to the condition onset when it seems dissonant with chronological age. Methods Secondary analysis of two qualitative data sets (total 58 interviews) exploring the experiences of people with adult-onset asthma and young people diagnosed with arthritis. Data from the original interview transcripts relating to diagnosis and symptom recognition were re-analysed using a “candidacy” framework to examine how age and diagnosis intersect. Results People did not always assert their candidacy for either condition because of pre-conceived expectations around age. Similarly, health professionals sometimes failed to recognize patients’ candidacy, instead pursuing “age-plausible” possibilities. In some cases, participants were proactive in suggesting a diagnosis to the health professional where diagnosis was delayed. Conclusion The diagnosis of adult-onset asthma, and arthritis in young people, may be regarded as “untimely.” We suggest that being diagnosed with what is perceived to be a “childhood” condition in adulthood, or “an older person's” condition in childhood, may be viewed as a “biographical paradox” and an “untimely breach” to the expected order

Proliferation of private online healthcare companies:Should the NHS try to keep up?

With an app for just about everything, why not one for contacting your doctor? In the United Kingdom, private companies offering primary healthcare are proliferating, with Dr Morton, a website offering email or telephone consultations, and Dr Now, a smartphone app offering video consultations. Companies in the United States are offering an Uber-type experience, where instead of a car, a doctor appears at your door. These companies operate in a climate where patients want convenience, flexibility, and speed of access, features which overstretched general practitioners in the UK are struggling to provide. Meanwhile, new companies are appearing regularly, with the UK digital health market currently worth £2bn (€2.6bn; $2.8bn) and expected to grow to £2.9bn by 2018.2 What are the implications for the NHS

Which features of primary care affect unscheduled secondary care use?:A systematic review

OBJECTIVES: To conduct a systematic review to identify studies that describe factors and interventions at primary care practice level that impact on levels of utilisation of unscheduled secondary care. SETTING: Observational studies at primary care practice level. PARTICIPANTS: Studies included people of any age of either sex living in Organisation for Economic Co-operation and Development (OECD) countries with any health condition. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was unscheduled secondary care as measured by emergency department attendance and emergency hospital admissions. RESULTS: 48 papers were identified describing potential influencing features on emergency department visits (n=24 studies) and emergency admissions (n=22 studies). Patient factors associated with both outcomes were increased age, reduced socioeconomic status, lower educational attainment, chronic disease and multimorbidity. Features of primary care affecting unscheduled secondary care were more complex. Being able to see the same healthcare professional reduced unscheduled secondary care. Generally, better access was associated with reduced unscheduled care in the USA. Proximity to healthcare provision influenced patterns of use. Evidence relating to quality of care was limited and mixed. CONCLUSIONS: The majority of research was from different healthcare systems and limited in the extent to which it can inform policy. However, there is evidence that continuity of care is associated with reduced emergency department attendance and emergency hospital admissions