Search

Abstract: Rich social relationships contribute to improved well‐being and health outcomes, yet aged care client assessments tend to focus almost exclusively on physical issues. We aim to explore the experiences of aged care staff following their use of social engagement and well‐being instruments as part of routine assessments for home‐care clients. The social engagement (Australian Community Participation Questionnaire, ACPQ) and well‐being (ICEpop CAPability Measure for Older Adults, ICECAP‐O) instruments were embedded into the centralised information system of an Australian aged care provider. Staff administered these instruments during routine client assessments across a 9‐month period involving 289 assessments. Semistructured interviews with 12 staff members were conducted and themes explored using qualitative content analysis. Key factors related to the acceptability of instrument adoption were found. Staff reported the instruments were convenient to use and were valuable in eliciting information for care plan development. Staff found that the instruments complemented their standard assessment procedures and did not disrupt their routine workload. They emphasised that the information gained greatly assisted their discussions with clients, identified social needs, and enhanced client involvement in decisions about desired services. There were also some challenging elements, including staff concerns regarding their ability to deal with emotional responses from clients evoked by the survey questions. ACPQ and ICECAP‐O are useful tools for identifying psychosocial client needs, are feasible for use by large‐scale aged care organisations and provide valuable information to guide decision‐making about services. Future research should identify the long‐term effects on improving social participation and client outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To identify the main concerns of a broad range of hospital staff about the implementation of a new Computerized Provider Order Entry (CPOE) system for medication management. Methods: The study was conducted in a large Australian teaching hospital using semi-structured interviews (n =20) and focus groups (six focus groups involving a total of 30 participants) from a broad section of health professionals including doctors, nurses, managers, pharmacists and senior health executives. Systematic concurrent analysis of the data was undertaken by a team of researchers. Results: We identified 20 recurrent themes related to nine areas of shared concern including work practices, software/hardware, relationships/communication, education and training, inexperienced staff and de-skilling. A higher level of analysis identified four interrelated constructs that highlight what people are concerned about: (1) Will it help? (2) Will it work? (3) Will we cope? (4) Will it impair existing interaction? Limitations: The research provides a snapshot overview of perceptions from a range of hospital personnel in the lead up to CPOE implementation. Generalizability is limited by the size of the sample and the contextual circumstances of the hospital being studied. Discussion: This work contributes valuable evidence about an often-neglected dimension in the evaluation of computer systems in hospitals, namely the pre-implementation concerns of staff. These pre-conceptions can have a significant effect on how technology is implemented and utilised. Acknowledging and addressing people''s concerns can contribute to the establishment of durable channels of negotiation and communication. Further research informed by the findings of this study will help advance this process. [Copyright &y& Elsevier]

The purpose of this qualitative study was to identify differences in the utilisation of an electronic medical record test–result management system between two acute care departments. Field observations (130 min) and semi-structured interviews (n = 24) were conducted in the Intensive Care Unit and Emergency Department of an Australian hospital. Work processes identified from audio transcripts were modelled using business process modelling. Comparison of the Emergency Department and Intensive Care Unit identified the following: (1) test ordering variations according to clinical roles, (2) differences in the use of electronic medical record functionality according to specific demands of the clinical environment and (3) the non-linear components of the test–result management process. Variations were identified in the number of process decisions, external collaborations and temporal process workflows. Modelling the business processes, collaboration and communication needs of individual clinical environments can aid in enhancing the quality and appositeness of health information technology interventions and thus contribute to improving patient safety. Future health information technology interventions/evaluations aimed at improving the safety of test–result management processes need to address both the nuances of the clinical environment and accommodate the individual work practices of clinicians within that environment. [ABSTRACT FROM AUTHOR]

Background: Physiotherapy can improve functional ability, prevent falls and reduce pain for older adults in nursing homes. However, there are no legislations or guidelines that specify the parameters of physiotherapy required in nursing homes. With the increasing healthcare demands of ageing populations worldwide, it is important to understand the current use of physiotherapy services to ensure they are both evidence-based and promote equity. Objectives: (1) When and how are physiotherapy services used by older adults living in nursing homes? (2) What are the factors associated with use of physiotherapy services in nursing homes? (3) How are physiotherapy services in nursing homes documented and monitored? Methods: Several databases and grey literature (including MEDLINE, PubMed, Pedro and EMBASE) were searched following PRISMA guidelines in March 2018. Searches were limited to English language publications from 1997. Assessment for inclusion, data extraction and quality assessment were completed by two investigators independently using standardised forms. Studies were included if they considered any type of physiotherapy service that involved a qualified physiotherapist (such as exercise, massage and staff education) with older adults (aged 60 years and older) that were primarily permanent residents of a nursing home. Data extracted included proportion of clients that used physiotherapy services, type, frequency and duration of physiotherapy services, and factors associated with physiotherapy service use. Results: Eleven studies were included. Between 10% and 67% of nursing home clients used physiotherapy services. Factors associated with greater use of physiotherapy services included larger size facilities, and if clients had a physical impairment and mild or no cognitive impairment. Types of physiotherapy services reported were pain management and pressure ulcer management. Conclusions: Physiotherapy service use in nursing homes varied widely. The development of physiotherapy benchmarks and quality standards are needed to support older adults in nursing homes. PROSPERO registration number: CRD42018082460. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate how well general practitioners (GPs) manage and respond to laboratory results for patients with diabetes mellitus (DM) and cardiovascular disease (CVD).Data Sources: MEDLINE, CINAHL, Embase, EBM reviews, ProQuest and Scopus.Study Selection: Peer-reviewed journal articles published between 2000 and 2015 that assessed GPs' management of laboratory results for patients with DM or CVD.Data Extraction: Study design and demographics, laboratory tests and key findings relating to GP management of laboratory results were extracted from studies.Results Of Data Synthesis: Thirteen articles were included, comprising seven studies which utilized surveys, four observational studies, one cohort study and one randomized controlled trial. Findings indicate that GPs often overestimate the risk of complications associated with DM and CVD based on laboratory results and have unrealistically high expectations regarding the precision of laboratory tests. Considerable variation existed in the use of repeat testing for diagnostic confirmation and in GPs' identification of the difference between two consecutive results required to indicate a change in patient condition. GPs also often failed to initiate appropriate treatment for patients with DM and CVD based on laboratory results. Feedback to GPs about their test ordering patterns and educational messages on laboratory results improved clinical outcomes.Conclusion: Evidence about how well GPs manage results and its impact on patient outcomes remains weak and inconclusive. This review identified a number of areas where interventions could support GPs to improve the interpretation and management of laboratory test results, including feedback to GPs and educational messages on test result reports. [ABSTRACT FROM AUTHOR]

Background: Telephone consultation and triage services are increasingly being used to deliver health advice. Availability of high speed internet services in remote areas allows healthcare providers to move from telephone to video telehealth services. Current approaches for assessing video services have limitations. This study aimed to identify the challenges for service providers associated with transitioning from audio to video technology.Methods: Using a mixed-method, qualitative approach, we observed training of service providers who were required to switch from telephone to video, and conducted pre- and post-training interviews with 15 service providers and their trainers on the challenges associated with transitioning to video. Two full days of simulation training were observed. Data were transcribed and analysed using an inductive approach; a modified constant comparative method was employed to identify common themes.Results: We found three broad categories of issues likely to affect implementation of the video service: social, professional, and technical. Within these categories, eight sub-themes were identified; they were: enhanced delivery of the health service, improved health advice for people living in remote areas, safety concerns, professional risks, poor uptake of video service, system design issues, use of simulation for system testing, and use of simulation for system training.Conclusions: This study identified a number of unexpected potential barriers to successful transition from telephone to the video system. Most prominent were technical and training issues, and personal safety concerns about transitioning from telephone to video media. Addressing identified issues prior to implementation of a new video telehealth system is likely to improve effectiveness and uptake. [ABSTRACT FROM AUTHOR]