A systematic review of online team based learning approaches in health professional education.

AIMS AND OBJECTIVES: The purpose of this study was to systematically review studies related to the use of online Team Based Learning (TBL) platforms with a focus on health professional education. The objectives were to identify best practices, highlight what technological platforms are effective for TBL processes and evaluate educational outcomes in terms of student experience, learning and preference. DESIGN: A systematic review of published TBL research was undertaken between August and October 2021 and supplemented in September 2022. DATA SOURCES: ERIC, PsycINFO, Scopus, Embase, Medline, and Cinahl databases were used. The keywords were identified from researchers' knowledge and PICO/PICo framework. REVIEW METHODS: Titles and abstracts were screened individually by two reviewers for eligibility. Data extraction was undertaken by two researchers independently and checked for consistency by discussion between the two. Articles were appraised using the Mixed Methods Appraisal Tool (MMAT). RESULTS: Out of 656 articles 14 were involved in the final review. All others were rejected due to duplication, ineligibility, or poor quality. The studies were from a range of countries and focussed on a range of health professionals including nursing. Inconsistencies in approaches for TBL, platforms used and mixed results in terms of outcomes were noted. There was no real consensus other than that TBL was equally as effective if carried out online or face-to-face, with no clear differences to outcomes related to satisfaction in online or traditional TBL approaches. CONCLUSIONS: It is recommended that further research is carried out into the outcomes of TBL on learning and experiences of students in health professional courses. The development and appraisal of integrated TBL platforms should be invested in and infrastructure and resources are put in place to support this.

Prototype development of the Mental Health benchmarking Industry Tool for residential aged Care (MHICare Tool): a protocol paper of a two-stage sequential and mixed methods codesign study.

OBJECTIVES: Current mental health practices for people living in residential aged care (RAC) facilities are poor. In Australia, there are no mechanisms to monitor and promote mental health for people living in RAC, including those who experience changed behaviours and psychological symptoms. The aim of this study is to improve current practices and mental health outcomes for people living in RAC facilities by codesigning a Mental Health benchmarking Industry Tool for residential aged Care (MHICare Tool). METHODS: A two-stage sequential and mixed methods codesign methodology will be used. Stage 1 will include qualitative interviews and focus groups to engage with residents, family/care partners and RAC staff to ascertain mental healthcare practices and outcomes of greatest significance to them. Adapted concept mapping methods will be used to rank identified issues of concern in order of importance and changeability, and to generate draft quality indicators. Stage 2 will comprise a Delphi procedure to gain the wider consensus of expert panel views (aged care industry, academic, clinical) on the performance indicators to be included, resulting in the codesigned MHICare Tool. ETHICS AND DISSEMINATION: This study has been reviewed and approved by the University of Queensland Human Research Ethics Committee (HREC/2019002096). This project will be carried out according to the National Statement on Ethical Conduct in Human Research (2007). The study's findings will be published in peer-reviewed journals and disseminated at national and international conferences and through social media. CONCLUSION: This protocol reports structured methods to codesign and develop a mental health performance indicator tool for use in Australian RAC.

Technology in aged care: a qualitative survey of academic, research, and technology industry professionals.

AIMS AND OBJECTIVES: The study's aim was two-fold: (1) to explore the experiences and perceptions of industry, academic, and research professionals concerning technologies used within aged care; and (2) to identify needs-led priorities for the future development and application of technologies within aged care. BACKGROUND: Global population ageing requires a recalibration of aged care policies, systems, and services to promote and support healthy ageing. It is expected that technology will play an important role in this regard. This study qualitatively assessed the landscape of technology use in aged care from the perspective of industry, academic, and research professionals. DESIGN: A purposefully designed cross-sectional survey collecting experiences, perspectives, and barriers about technology through open responses. METHODS: Using convenience sampling, thirty-five participants completed an online survey between April and October 2020. A descriptive qualitative content analysis approach was used to analyse the written responses. Reporting of findings followed the EQUATOR's Standards for Reporting Qualitative Research checklist. RESULTS: Four themes were identified that characterised the use of technologies within aged care: (1) User Perceptions and Attitudes: wariness and reluctance to technology; (2) Systemic Issues within Aged Care: Under-resourced with opportunities for innovation; (3) Technology-Related Barriers: Equity, costs, privacy, integration, and interoperability and (4) Research Priorities: Co-design and integration of technology. CONCLUSIONS: The existing technology does not meet the needs of older people, aged care personnel and the system in general, which prevents its successful implementation and uptake.

International Consensus Recommendation Guidelines for Subcutaneous Infusions of Hydration and Medication in Adults: An e-Delphi Consensus Study.

Infusion of fluids and medications is traditionally performed intravenously. However, venous depletion in patients has led to the quest for vessel health preservation. A safe, effective, acceptable, and efficient alternative is the subcutaneous route. A lack of organizational policies may contribute to the slow uptake of this practice. This modified e-Delphi (electronic) study aimed to derive international consensus on practice recommendations for subcutaneous infusions of fluids and medications. A panel of 11 international clinicians, with expertise in subcutaneous infusion research and/or clinical practice, rated and edited subcutaneous infusion practice recommendations from evidence, clinical practice guidelines, and clinical expertise within an Assessment, Best Practice, and Competency (ABC) domain guideline model. The ABC Model for Subcutaneous Infusion Therapy provides a systematic guideline of 42 practice recommendations for the safe delivery of subcutaneous infusions of fluids and medications in the adult population in all care settings. These consensus recommendations provide a guideline for health care providers, organizations, and policy makers to optimize use of the subcutaneous access route.

Consumer and Provider Perspectives on Technologies Used Within Aged Care: An Australian Qualitative Needs Assessment Survey.

We undertook a qualitative assessment of aged care technology needs from the perspective of consumers and providers using a cross-sectional survey that assumed a largely open-response format. We recruited a convenience sample of individuals aged 18 years or older, lived in Australia, and self-identified as either an older adult (n = 133), an informal caregiver of an older adult (n = 27), and/or clinician, healthcare practitioner, and aged care provider (n = 148). Survey responses were analyzed using a descriptive qualitative content analysis approach to interpret meaning from written survey responses. We identified seven themes reporting that technologies used in aged care do not appear to be meeting end-user needs. Supporting the Technology Acceptance Model, consumers and providers perceive usefulness of the technology and its actual ease of use as drivers of acceptance toward gerontechnology. Ten recommendations are proposed to support technology use and the quality of aged care.

Subcutaneous hydration and medications infusions (effectiveness, safety, acceptability): A systematic review of systematic reviews.

OBJECTIVE: To synthesize the current evidence for subcutaneous hydration and medication infusions from systematic reviews and to assess their methodological quality. INTRODUCTION: Peripheral intravascular cannula/catheter insertion is a common invasive procedure for administering fluids and medications. Venous depletion is a growing concern for several patient populations. Subcutaneous access for the administration of isotonic solutions and medications is an alternative; however, vascular access assessment and planning guidelines rarely consider this route. METHODS: Systematic review of systematic reviews (PROSPERO CRD42018046504). We searched 6 databases published in English language from 1990 to June 2020, identifying subcutaneous infusions an alternate route for fluids or medication. Methodological quality was evaluated using AMSTAR 2 criteria and data for mechanisms of infusion and outcomes related to effectiveness, safety, efficiency and acceptability extracted. The Johanna Briggs Institute's grades of recommendation informed the strength of recommendation. RESULTS: The search yielded 1042 potential systematic reviews; 922 were excluded through abstract and duplicate screen. Of the remaining articles, 94 were excluded, and 26 were included. Overall, evidence is strong for recommending subcutaneous hydration infusions for older adults, weak for pediatric patients and inconclusive for palliative patients. There is strong evidence for 10 medications; weak evidence supporting 28 medications; however, there are eight medications with inconclusive evidence to make a recommendation and four medications not appropriate for subcutaneous delivery. CONCLUSION: Subcutaneous access should be considered alongside intravenous therapy for hydration in older adults, and several medications. There are additional benefits in terms of ease of use and cost-effectiveness of this mode. Inclusion of subcutaneous access in clinical guidelines may promote uptake of this route to help preserve vessel health of vulnerable patients. Further high-quality research is needed to inform subcutaneous infusion therapy in a variety of populations (including pediatrics and palliative care) and medications and clarifying the mechanism of delivery.

Current practice in dialysis central venous catheter management: Multi-disciplinary renal team perspectives.

AIM: To explore the current practices related to the insertion, management and removal of dialysis central venous catheters (CVCs) used in patients with chronic kidney disease requiring haemodialysis. METHODS: This qualitative descriptive study involved semi-structured interviews with surgeons, interventional radiologists, renal physicians, dialysis nurses, renal access nurses and renal researchers involved in the care of patients with chronic kidney disease requiring haemodialysis. Data were collected from staff at eight hospitals in six states and territories of Australia. Thirty-eight face-to-face interviews were conducted. A modified five-step qualitative content analysis approach was used to analyse the data. RESULTS: Improved visualization technology and its use by interventional radiologists has steered insertions to specialist teams in specialist locations. This is thought to have decreased risk and improved patient outcomes. Nurses were identified as the professional group responsible for maintaining catheter access integrity, preventing access failure and reducing access-related complications. While best practice was considered important, justifications for variations in practice related to local patient and environment challenges were identified. CONCLUSION: The interdisciplinary team is central in the insertion, maintenance, removal and education of patients regarding dialysis CVCs. Clinicians temper research-based decision-making about central dialysis access catheter management with knowledge of individual, environmental and patient factors. Strategies to ensure guidelines are appropriately translated for use in a wide variety of settings are necessary for patient safety.

A model for assessment and referral of clients with bowel symptoms in community pharmacies.

BACKGROUND: To expedite diagnosis of serious bowel disease, efforts are required to signpost patients with high-risk symptoms to appropriate care. Community pharmacies are a recognized source of health advice regarding bowel symptoms. This study aimed to examine the effectiveness of a validated self-administered questionnaire, Jodi Lee Test (JLT), for detection, triage, and referral of bowel symptoms suggestive of carcinoma, in pharmacies. METHOD: 'Usual Practice' was monitored for 12 weeks in 21 pharmacies in Western Australia, documenting outcomes for 84 clients presenting with bowel symptoms. Outcome measures were: acceptance of verbal advice from the pharmacist; general practitioner consultation; and diagnosis. Trial of the JLT involved staff training in the research protocol and monitoring of outcomes for 80 recruited clients over 20 weeks. Utility of the JLT was assessed by post-trial survey of pharmacy staff. RESULTS: Significantly more referrals were made by staff using the JLT than during Usual Practice: 30 (38%) vs 17 (20%). Clients' acceptance of referrals was also higher for the intervention group (40% vs 6%). Two-thirds of pharmacy staff agreed that the JLT could be incorporated into pharmacy practice, and 70% indicated they would use the JLT in the future. CONCLUSION: A pre-post design was considered more appropriate than a randomized control trial due to an inability to match pharmacies. Limitations of this study were: lack of control over adherence to the study protocol by pharmacy staff; no direct measure of client feedback on the JLT; and loss to follow-up. The JLT was effective in prompting decision-making by pharmacy staff and inter-professional care between pharmacies and general practice, in triage of clients at risk of bowel cancer.

Will Australians pay for health care advice from a community pharmacist? A video vignette study.

BACKGROUND: Large proportion of Australians have access to pharmacists' health advice at no cost. The impact of a proposed co-payment levy for general practitioner (GP) consultation by Australian government is unclear. This raises an interesting question about consumers' perceived value of health-related consultations. OBJECTIVE: This survey of representative sample of Western Australians explores the hypothesis that Australians are willing to pay for advanced model of pharmacy consultation. METHODS: Two videos illustrating current-services and quality-enhanced-service (QES) incorporating systematic assessment of symptoms and referral to GP if necessary, were used. Participants viewed videos online and completed a willingness-to-pay (WTP) questionnaire about their perception and WTP for each service. Logistic regression and McNemar tests were used to identify WTP groups. RESULTS: Of the 175 respondents, one in nine (19/175, 11%) were willing to pay and (35/175) 20% might consider paying for advice at pharmacies as per current-practice. Almost one in four (49/175, 28%) were willing to pay and (47/175) 27% would consider paying for QES (McNemar Test P < 0.001). CONCLUSIONS: The majority of West Australians may be willing to pay for consultation at pharmacies that offers more private, time-intensive experience with documented GP referral where required. Further research is warranted to test WTP with actual customers to confirm these results.

Development and validation of a clinical decision-making aid for screening bowel symptoms in community pharmacies.

RATIONALE, AIMS AND OBJECTIVES: Bowel symptoms are common, and community pharmacies are an ideal setting for health advice about these symptoms. The aim of this study was to develop and validate a questionnaire for use with adults presenting to community pharmacies with lower bowel symptoms. The purpose of the questionnaire was to stratify people into those requiring medical follow-up for symptoms and those with self-limiting symptoms. METHOD: A self-administered questionnaire, named the Jodi Lee test (JLT), was developed in three stages - review of the literature, questionnaire design and statistical validation - against a validated screening tool, the patient consultation questionnaire (PCQ), to assess the sensitivity and specificity of JLT. The questionnaire was developed to be simple, easy for all pharmacy staff to use and require no score calculation. Its application was designed to facilitate referral from pharmacy assistants to pharmacists and from pharmacists to medical practitioners. RESULTS: The questionnaire comprises eight questions. It has a Flesh-Kincaid reading score of 79.5. By considering different score thresholds on the PCQ, a receiver operator characteristic (ROC) curve was calculated to assess the effectiveness of the JLT. From a sample of 118 subjects, the area under the ROC curve was 0.94. At a threshold score of 30 on the PCQ, the sensitivity was 100%. The specificity was 65%. CONCLUSION: The JLT has high sensitivity for identifying patients with symptoms of serious bowel disease. It is also likely to identify patients who have symptoms of relatively benign disease who would benefit from medical advice.

Cancer care coordinator: promoting multidisciplinary care--a pilot study in Australian general practice.

AIM: We hypothesised that patients treated for breast cancer would benefit from targeted therapeutic action delivered by general practitioners on the recommendations of a multidisciplinary team based in primary care. METHODS: Patients scheduled for follow-up visits at a hospital surgical clinic were invited to complete a self-administered care needs assessment and be interviewed by a breast care nurse. Members of the multidisciplinary team discussed the audio-recorded interviews within 2 weeks. The team made recommendations for each patient, which were presented to the general practitioner as a suggested 'care plan'. Health status information was collected via the Short Form 36 and Anxiety and Depression data via the Hospital anxiety and Depression Scale at recruitment and 3 months later. RESULTS: Among the 74 women who were invited to participate, 21 were recruited over a 6-month period (28%), 19 of whom completed the study (90%). The mean age was 55 years (range 38-61 years) and the mean time in follow-up was 23 months (range 16-38 months). The team identified a median of three problems per patient (range 2-7) and made an average of two recommendations per patient for referral to an allied health professional (range 0-5). At 3 months, 17 women had attended their general practitioner, 11 of whom felt their condition had improved as a result of the intervention. There was no significant change in Short Form 36 or Hospital Anxiety and Depression Scale score after the intervention. CONCLUSIONS: Primary care-based multidisciplinary review of treated breast cancer patients is feasible and, for most, results in benefit. However, only a minority of eligible patients participated in this pilot study and the logistics of organising the reviews warrants careful consideration.

Piloting and validating an innovation to triage patients presenting with cough to community pharmacies in Western Australia.

AIM: To develop a tool to assist community pharmacists to triage patients presenting with cough and to validate this against an established cough-specific quality of life (QoL) measure. METHODS: A decision-support tool, the Pharmacy Cough Assessment Tool (PCAT) was developed with reference to published guidelines and a team of clinical experts. The PCAT was validated against the Leicester Cough Questionnaire (LCQ). It was then administered at four community pharmacies in Perth, Western Australia to assess the scope to recruit and follow up participants, and to estimate the proportion of participants who would be advised to consult a general practitioner (GP). The reported outcomes of the consultations with doctors were also recorded. RESULTS: Ninety-nine subjects were recruited over 12 weeks. Thirty-seven participants were advised to consult a GP for further assessment with reference to the PCAT; seven attended their doctor. The LCQ scores of those referred to their GP were significantly lower, indicating a poorer quality of life (adjusted mean and range 13.16 [11.87, 14.46]; non-referred 15.82 [14.47, 17.18]; P < 0.001). Scores of this magnitude have previously been shown to identify patients with chronic respiratory conditions. A smaller group of participants also had a poor quality of life based on LCQ scores but were not referred to their GP. Of the seven participants who made an appointment with their GP, most were prescribed treatment or referred for investigation. There was no significant difference in LCQ score based on gender, or decision to consult a GP. CONCLUSIONS: The PCAT identifies patients with cough who might benefit from medical advice and may feasibly be used as an initial screening tool in the community pharmacy setting.

Effective recruitment strategies in primary care research: a systematic review.

BACKGROUND: Patient recruitment in primary care research is often a protracted and frustrating process, affecting project timeframes, budget and the dissemination of research findings. Yet, clear guidance on patient recruitment strategies in primary care research is limited. This paper addresses this issue through a systematic review. METHOD: Articles were sourced from five academic databases - AustHealth, CINAHL, the Cochrane Methodology Group, EMBASE and PubMed/Medline; grey literature was also sourced from an academic library and the Primary Healthcare Research & Information Service (PHCRIS) website. Two reviewers independently screened the articles using the following criteria: (1) published in English, (2) reported empirical research, (3) focused on interventions designed to increase patient recruitment in primary care settings, and (4) reported patient recruitment in primary care settings. RESULTS: Sixty-six articles met the inclusion criteria. Of these, 23 specifically focused on recruitment strategies and included randomised trials (n = 7), systematic reviews (n = 8) and qualitative studies (n = 8). Of the remaining articles, 30 evaluated recruitment strategies, while 13 addressed the value of recruitment strategies using descriptive statistics and/or qualitative data. Among the 66 articles, primary care chiefly included general practice (n = 30); nursing and allied health services, multiple settings, as well as other community settings (n = 30); and pharmacy (n = 6). Effective recruitment strategies included the involvement of a discipline champion, simple patient eligibility criteria, patient incentives and organisational strategies that reduce practitioner workload. CONCLUSION: The most effective recruitment in primary care research requires practitioner involvement. The active participation of primary care practitioners in both the design and conduct of research helps to identify strategies that are congruent with the context in which patient care is delivered. This is reported to be the optimal recruitment strategy.

Could community pharmacies offer an opportunity to improve outcomes for patients with bowel cancer?

BACKGROUND: Lower bowel symptoms are common. A significant number of patients seek to treat their symptoms by purchasing over the counter medication. AIM: To test the deployment of a self-administered questionnaire as an aid to advising patients with lower bowel symptoms. METHODS: Patients attending 21 community pharmacies were invited to complete the Patient Consultation Questionnaire (PCQ) before purchasing a medicinal product to treat their symptoms. Patients were invited to participate if they were: 1) presenting with lower bowel symptoms (rectal bleeding, constipation and/or diarrhoea); 2) 18 years of age or older; 3) able to provide informed consent; 4) not pregnant and had not been pregnant for the last three months. The PCQ was scored by a researcher and the results relayed to the patient and their general practitioner (GP) within a week. Patients were telephoned four weeks later to ascertain if they had consulted a medical practitioner. RESULTS: Ninety-one patients were recruited. Most were female. As anticipated, the majority of patients presenting to pharmacies are at low risk of pathology compared to the population of patients referred by UK GPs for specialist investigations. Only eight patients were recommended to consult their GP because their PCQ scores suggested an appreciable risk of colorectal pathology. Five consulted a GP. Conclusions The scope to intervene in the pharmacy setting to promote intervention for significant bowel disease is suggested by the significant number of patients who would be advised to consult a GP using this intervention. These data support the case for a formal trial to test the value of the PCQ to signpost symptomatic patients to appropriate health care.