Exploration of 'micro' level factors that affect the involvement of clinical pharmacists in interprofessional ward rounds in hospitals: Through the lens of social cognitive theory.

BACKGROUND: Macro and meso level factors that influence the participation by clinical pharmacists in ward rounds include pharmacy management culture, commitment to ward rounds and adequate time for ward rounds being included in workload models. The 'micro' level factors that affect the involvement of clinical pharmacists in ward rounds have not been widely explored. OBJECTIVE: Explore 'micro' level factors to gain insight into clinical pharmacists' participation in interprofessional ward rounds in inpatient settings through the lens of social cognitive theory. METHOD: A qualitative focused ethnographic study with five clinical pharmacists, four medical practitioners, one allied health professional and one nurse was conducted in three metropolitan hospitals in Southern Australia. Seven hours of semi-structured interview (n = 11) and 76-h of observations (n = 5) were conducted. A qualitative descriptive analysis was conducted (guided by Spradley) followed by reflexive thematic-analysis (according to Braun and Clarke's technique). RESULTS: Three micro level factors influencing clinical pharmacist participation in ward rounds are: (1) Cognitive mindset of clinical pharmacists, (2) Behavioural conduct of clinical pharmacists, and (3) Social rules of the ward. Clinical pharmacists that did not participate in ward round reconciled their moral distress by transferring information without clinical judgement or interpretation of the patient scenario to medical practitioners. Clinical pharmacists that did participate in ward rounds demonstrated credibility by making relevant recommendations with a holistic lens. This enabled clinical pharmacists to be perceived as trustworthy by medical practitioners. Positive experiences of participating in ward rounds contributed to their cognitive upward spiral of thoughts and emotions, fostering continued participation. CONCLUSION: Clinical pharmacists participate in ward rounds when they develop a positive mindset about ward round participation and perceive ward rounds as an enabler to the establishment of trusted professional relationships with medical practitioners. This trusted relationship creates an environment where the pharmacist develops confidence in making relevant recommendations.

[The role of private geriatricians in the health care system (2/2): comprehensive qualitative analysis using semi-structured interviews]. / Rôle des gériatres libéraux dans le système de santé (2/2) : analyse qualitative compréhensive par entretiens semi-dirigés.

Private geriatricians report heterogeneous practices, while the specialty as a whole is questioning its model. We conducted semi-structured interviews to understand how private geriatricians viewed their role in the health care system. They report a certain homogeneity in their conception of their role, which corresponds to that of geriatricians as a whole: there seems to be a professional identity for geriatrics.

[Role of private geriatricians in the health care system (1/2): quantitative descriptive analysis by questionnaire]. / Rôle des gériatres libéraux dans le système de santé (1/2) : analyse quantitative descriptive par questionnaire.

Private practice geriatrics is a little known practice modality. We conducted a questionnaire survey to try to describe the role of private geriatricians in the health care system. Although few in number, private geriatricians report very different practices, including their conception of their role. This is the first monograph on the activity of private geriatricians, and the results have motivated us to propose a comprehensive analysis of this role.

Collaborative attitudes between pharmacists and physicians in Brazil

Abstract Pharmacist-physician collaboration is a strategy for optimizing patient care and improving health outcomes. Nevertheless, there is a lack of information in Brazil about collaborative practices among these professionals. The aim of this study was to measure collaborative attitude of pharmacists and physicians who were working together in a teaching hospital. A cross-sectional study was conducted from June 2018 to January 2019 with pharmacists and physicians working in a teaching hospital in Northeastern Brazil. These professionals were invited to provide responses to the Brazilian version of the "Scale of Attitudes Towards Pharmacist-Physician Collaboration" (SATP2C); their scores ranged between 16 and 64 points. The software Epi Info TM (version 3.5.4) was used for data analysis, and data were expressed in means. Forty-four professionals participated in this study. The mean age was 33.5 (DP = 7.1) years. More than half of participants were male (n = 25, 56.8%). The means from the SATP2C for pharmacists and physicians were 54.20 and 50.91, respectively, indicating good collaborative attitudes. There was no statistical difference between the mean scores of pharmacists and physicians. Participants showed a predisposition for collaborative teamwork. Future studies should focus on understanding the process by which collaboration translates into clinical practice

Formação interprofissional na graduação em saúde: revisão sistemática de estratégias educativas / Interprofessional education in undergraduate health courses: systematic review

Resumo: Introdução: A educação interprofissional (EIP) procura desenvolver habilidades colaborativas dos profissionais de saúde para a melhoria do cuidado ao paciente. Objetivo: Essa revisão explora as estratégias educacionais não pontuais utilizadas na formação interprofissional, na graduação em saúde, identificando seus potenciais e suas fragilidades. Método: A busca incluiu artigos publicados nas bases de dados BVS (LILACS), Cochrane, CINAHL, Embase e MEDLINE. Definiu-se a questão de pesquisa pelo anagrama PICO: selecionaram-se estudos que incluíssem, pelo menos, dois cursos de graduação em saúde, sendo um deles de Medicina, e que relatassem estratégia educacional mínima de 15 horas e sua avaliação. Resumos publicados em congressos, opiniões, editoriais e revisões sistemáticas foram excluídos. Resultado: Avaliaram-se 28 estudos publicados entre 2005 e 2019, sendo 31% no último biênio. Prevaleceram a simulação (36%) ou o uso de métodos combinados (29%) na avaliação de atitudes dos alunos, a compreensão dos papéis dos profissionais de saúde, o trabalho em equipe, a comunicação e o conhecimento em resposta à intervenções de EIP. Predominaram estudos nos domínios: papéis e responsabilidades (75%) e trabalho em equipe (64%). A abordagem de valores e ética (32%) e de comunicação (28%) foi menos frequente. Dos artigos, 18 (64%) apresentavam dois ou mais objetivos e seis (18%) buscavam estudar, em conjunto, os quatro domínios da EIP. Entre as intervenções utilizadas como estratégias de ensino, 36% (dez estudos) eram de simulação; 29% (oito), métodos combinados; 18% (cinco), prática clínica (trabalho colaborativo em unidades ambulatoriais ou enfermarias); 14% (quatro), observação direta (shadowing); 11%, aprendizagem baseada em problemas; e dois, aprendizado on-line (e-learning) e workshop. A qualidade geral dos estudos incluídos foi baixa, atendendo de dois a cinco dos seis critérios de qualidade. O cegamento do avaliador não foi citado em 25 publicações. O trabalho colaborativo em cenários reais é descrito como o mais eficiente. Conclusão: A EIP vem sendo incorporada ao processo de formação na saúde, e múltiplas estratégias focadas em resultados e baseadas em competências otimizam a construção de relações efetivas e o desenvolvimento de habilidades para a prática colaborativa. A fragilidade dos artigos aponta que a EIP de estudantes ainda constitui grande desafio para as instituições formadoras.

Abstract: Introduction: Interprofessional Education (IPE) seeks to develop collaborative practice among health professionals to improve patient care. Objective: This systematic review exploits the non-punctual IPE strategies in undergraduate health courses, identifying their potential and weaknesses. Method: The search included articles published in the LILACS, COCHRANE, CINAHL, EMBASE and MEDLINE. The research question was defined by the PICO anagram: studies were selected that included at least two undergraduate health courses, one of them in Medicine, and that reported a minimum educational strategy of 15 hours and its review. Abstracts published in congresses, opinions, editorials, and systematic reviews were excluded. Results: There have been 28 reviewed studies published between 2005-2019, 31% of which have been in the last two years. The dominant themes were simulation (36%) or the use of combined methods (29%) in the assessment of student attitudes, understanding of health professionals' roles, teamwork, communication, and knowledge in response to IPE interventions. Studies in the Domains - Roles and responsibilities (75%) and teamwork (64%) predominated. The approach to values and ethics (32%); communication (28%) was less frequent. 18 articles (64%) had two or more objectives and six articles (18%) sought to study the four domains of IPE together. Among the interventions used as teaching strategies, 36% (10 studies) were simulation, 29% (8 studies) combined methods, 18% (5 studies) clinical practice (collaborative work in outpatient units or wards), 14% (4 studies) direct observation (shadowing), 11% problem-based learning, and 2 online learning studies (e-learning) and workshops. The overall quality of the included studies was low, meeting two to five of the six quality criteria. Blind peer reviewing was not cited in 25 publications. Collaborative work in real settings is described as the most efficient. Conclusion: IPE has been incorporated in the process of healthcare training and multiple results-based competence optimizes effective relationship development and the abilities needed in the collaborative practice. The fragility of the articles indicates that the interprofessional education of students is still a great challenge for educational institutions.

Promoting professional and interprofessional relationship among nurses in Iran: a participatory action research.

Communication is the basis of nursing care and can have a significant effect on patient and community health. This study aimed to optimize the professional and interprofessional relationships of nurses. This participatory action research was conducted with 288 patients and 23 staff of one of the Reference Hospitals in Tehran, Iran, from 2019 to 2020. Interviews were simultaneously analyzed using the conventional content analysis method, and in the quantitative section, the communication skills checklist and a researcher-made questionnaire were used. Participants gave oral and written consent, and their confidentiality and anonymity were respected. Participants' experiences showed that the implemented programs changed the work environment. The acquired basic concepts were improving the nurse's responsibility and accountability, improving the quality of care and respecting the patient and the family. Quantitative data obtained before and after the implementation of change programs showed that patient satisfaction increased from 41.57±7.03 to 94.34±4.67 and patient and family training from 113.73±19.77 to 245.99±36.61. The length of hospital stay decreased from 5.52±2.47 to 3.57±2.35 days, nosocomial infections from 32.1±2.8 to 17.4±2.4 and readmission from 4.8±1.2 to 2.3±1.1. The results indicated that patients' quality of care and safety was increased by optimizing the nurse's professional and interprofessional relationship. Patients reported greater respect, and nurses had higher job satisfaction.

Reducing Antibiotic Prescriptions for Urinary Tract Infection in Nursing Homes Using a Complex Tailored Intervention Targeting Nursing Home Staff: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Urinary tract infection (UTI) is the most common reason for antibiotic prescription in nursing homes. Overprescription causes antibiotic-related harms in those who are treated and others residing within the nursing home. The diagnostic process in nursing homes is complicated with both challenging issues related to the elderly population and the nursing home setting. A physician rarely visits a nursing home for suspected UTI. Consequently, the knowledge of UTI and communication skills of staff influence the diagnosis. OBJECTIVE: The objective of this study is to describe a cluster randomized controlled trial with a tailored complex intervention for improving the knowledge of UTI and communication skills of nursing home staff in order to decrease the number of antibiotic prescriptions for UTI in nursing home residents, without changing hospitalization and mortality. METHODS: The study describes an open-label cluster randomized controlled trial with two parallel groups and a 1:1 allocation ratio. Twenty-two eligible nursing homes are sampled from the Capital Region of Denmark, corresponding to 1274 nursing home residents. The intervention group receives a dialogue tool, and all nursing home staff attend a workshop on UTI. The main outcomes of the study are the antibiotic prescription rate for UTI, all-cause hospitalization, all-cause mortality, and suspected UTI during the trial period. RESULTS: The trial ended in April 2019. Data have been collected and are being analyzed. We expect the results of the trial to be published in a peer-reviewed journal in the fall of 2020. CONCLUSIONS: The greatest strengths of this study are the randomized design, tailored development of the intervention, and access to medical records. The potential limitations are the hierarchy in the prescription process, Hawthorne effect, and biased access to data on signs and symptoms through a UTI diary. The results of this trial could offer a strategy to overcome some of the challenges of increased antibiotic resistance and could have implications in terms of how to handle cases of suspected UTI. TRIAL REGISTRATION: ClinicalTrials.gov NCT03715062; https://clinicaltrials.gov/ct2/show/NCT03715062. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/17710.

Condições de envio dos modelos de trabalho e comunicação entre Cirurgiões-Dentistas e Técnicos em Prótese Dentária do município de Aracajú-Sergipe na confecção de prótese fixa metalocerâmica. / Transportation conditions of work models and communication between surgeon-dentists and tecchnicians in dental prothesis of city of Aracajú-Sergipe in the making of metallo-ceramics fixed prosthesis.

O presente trabalho objetivou avaliar a condição de envio dos modelos de trabalho e a comunicação entre Cirurgiões-Dentistas e Técnicos em Prótese Dentária, na confecção de próteses fixa metalocerâmica no município de Aracajú-SE. Para. tal, foi realizada uma pesquisa de campo, por meio de um questionário com os Técnicos em Prótese Dentária cadastrados no Conselho Regional de Odontologia - secção Sergipe, atuantes no município de Aracajú. Responderam a este 12 técnicos que realizam prótese metalocerâmica rotineiramente em seus laboratórios. Com base nos dados coletados, 75% dos entrevistados afirmaram receber os trabalhos protéticos já em modelos, sendo 100% desses modelos vazados com gesso tipo especial. Metade dos entrevistados respondeu receber menos de 50% dos modelos articulados e 84% responderam receber menos de 10% dos trabalhos com os dentes pilares troquelizados. Entretanto, em relação à comunicação escrita entre o Cirurgião-Dentista e o Técnico em Prótese Dentária, observou-se que a maioria das prescrições enviadas ao laboratório não obtinham informaçõs necessárias para a realização da prótese, necessitando frequentemente o Técnico de contatar com o Cirurgião-Dentista. Observou-se que as condições dos modelos de trabalho e a comunicação entre Cirurgiões-Dentistas e o Técnico em Prótese Dentária ainda encontram-se deficientes.

The current work has the goal of assessing the condotion of transportation of the work models and the communication between Surgeon-Dentists and Technicians in Dental Prosthesis, in the making of metallo-ceramics fixed prosthesis in the city fo Aracajú-SE. A research was performed through a questionnaire with the Technicians in Dental Prosthesis registered at the Dentrist Regional Council - Secction Sergipe, operating n th city of Aracaju. Twelve technicians who used to perform metallo-ceramics in their laboratories answered to this questionnaire. Based on collected data base, 75% of the interviewed ones affirmed receiving prosthesis works already in models, being 100% of theses models casted with this special kind of gypsum. Half of the interviewed ones answered receiving less of 50% of the articulated models and 84% answered receiving less than 10% of the works with troquelized pillar teeth. As far as the written communication is concerned between the Surgeon-Dentist and the Technician in Dental Prosthesism it was observed that most of the prescriptions sent to the laboratory did not have the necessary information for doing the prosthesis. Therefore, the technician often needed to contact the Surgeon-Dentist. However, it was observed that the conditions of the work models and the communication between Surgeon-Dentists and the Technician in Dental Prosthesis are somehow deficient.

Condições de envio dos modelos de trabalho e comunicação entre Cirurgiões-Dentistas e Técnicos em Prótese Dentária do município de Aracajú-Sergipe na confecção de prótese fixa metalocerâmica. (AU) / Transportation conditions of work models and communication between surgeon-dentists and tecchnicians in dental prothesis of city of Aracajú-Sergipe in the making of metallo-ceramics fixed prosthesis

O presente trabalho objetivou avaliar a condição de envio dos modelos de trabalho e a comunicação entre Cirurgiões-Dentistas e Técnicos em Prótese Dentária, na confecção de próteses fixa metalocerâmica no município de Aracajú-SE. Para. tal, foi realizada uma pesquisa de campo, por meio de um questionário com os Técnicos em Prótese Dentária cadastrados no Conselho Regional de Odontologia - secção Sergipe, atuantes no município de Aracajú. Responderam a este 12 técnicos que realizam prótese metalocerâmica rotineiramente em seus laboratórios. Com base nos dados coletados, 75% dos entrevistados afirmaram receber os trabalhos protéticos já em modelos, sendo 100% desses modelos vazados com gesso tipo especial. Metade dos entrevistados respondeu receber menos de 50% dos modelos articulados e 84% responderam receber menos de 10% dos trabalhos com os dentes pilares troquelizados. Entretanto, em relação à comunicação escrita entre o Cirurgião-Dentista e o Técnico em Prótese Dentária, observou-se que a maioria das prescrições enviadas ao laboratório não obtinham informaçõs necessárias para a realização da prótese, necessitando frequentemente o Técnico de contatar com o Cirurgião-Dentista. Observou-se que as condições dos modelos de trabalho e a comunicação entre Cirurgiões-Dentistas e o Técnico em Prótese Dentária ainda encontram-se deficientes.

The current work has the goal of assessing the condotion of transportation of the work models and the communication between Surgeon-Dentists and Technicians in Dental Prosthesis, in the making of metallo-ceramics fixed prosthesis in the city fo Aracajú-SE. A research was performed through a questionnaire with the Technicians in Dental Prosthesis registered at the Dentrist Regional Council - Secction Sergipe, operating n th city of Aracaju. Twelve technicians who used to perform metallo-ceramics in their laboratories answered to this questionnaire. Based on collected data base, 75% of the interviewed ones affirmed receiving prosthesis works already in models, being 100% of theses models casted with this special kind of gypsum. Half of the interviewed ones answered receiving less of 50% of the articulated models and 84% answered receiving less than 10% of the works with troquelized pillar teeth. As far as the written communication is concerned between the Surgeon-Dentist and the Technician in Dental Prosthesism it was observed that most of the prescriptions sent to the laboratory did not have the necessary information for doing the prosthesis. Therefore, the technician often needed to contact the Surgeon-Dentist. However, it was observed that the conditions of the work models and the communication between Surgeon-Dentists and the Technician in Dental Prosthesis are somehow deficient.