正しい方法がわかる臨床基本手技 : from the New England journal of medicine

http://library.um.ac.id/free-contents/downloadpdf.php/buku/focus-groups-as-qualitative-research-by-morgan-david-l-11476.pdf

Focus groups as qualitative research / by Morgan, David L.

BACKGROUND: The delivery of effective, high-quality patient care is a complex activity. It demands health and social care professionals collaborate in an effective manner. Research continues to suggest that collaboration between these professionals can be problematic. Interprofessional education (IPE) offers a possible way to improve interprofessional collaboration and patient care. OBJECTIVES: To assess the effectiveness of IPE interventions compared to separate, profession-specific education interventions; and to assess the effectiveness of IPE interventions compared to no education intervention.
SEARCH METHODS: For this update we searched the Cochrane Effective Practice and Organisation of Care Group specialised register, MEDLINE and CINAHL, for the years 2006 to 2011. We also handsearched the Journal of Interprofessional Care (2006 to 2011), reference lists of all included studies, the proceedings of leading IPE conferences, and websites of IPE organisations. SELECTION CRITERIA: Randomised controlled trials (RCTs), controlled before and after (CBA) studies and interrupted time series (ITS) studies of IPE interventions that reported objectively measured or self reported (validated instrument) patient/client or healthcare process outcomes. DATA COLLECTION AND ANALYSIS: At least two review authors independently assessed the eligibility of potentially relevant studies. For included studies, at least two review authors extracted data and assessed study quality. A meta-analysis of study outcomes was not possible due to heterogeneity in study designs and outcome measures. Consequently, the results are presented in a narrative format. MAIN RESULTS: This update located nine new studies, which were added to the six studies from our last update in 2008. This review now includes 15 studies (eight RCTs, five CBA and two ITS studies). All of these studies measured the effectiveness of IPE interventions compared to no educational intervention. Seven studies indicated that IPE produced positive outcomes in the following areas: diabetes care, emergency department culture and patient satisfaction; collaborative team behaviour and reduction of clinical error rates for emergency department teams; collaborative team behaviour in operating rooms; management of care delivered in cases of domestic violence; and mental health practitioner competencies related to the delivery of patient care. In addition, four of the studies reported mixed outcomes (positive and neutral) and four studies reported that the IPE interventions had no impact on either professional practice or patient care. AUTHORS' CONCLUSIONS: This updated review reports on 15 studies that met the inclusion criteria (nine studies from this update and six studies from the 2008 update). Although these studies reported some positive outcomes, due to the small number of studies and the heterogeneity of interventions and outcome measures, it is not possible to draw generalisable inferences about the key elements of IPE and its effectiveness. To improve the quality of evidence relating to IPE and patient outcomes or healthcare process outcomes, the following three gaps will need to be filled: first, studies that assess the effectiveness of IPE interventions compared to separate, profession-specific interventions; second, RCT, CBA or ITS studies with qualitative strands examining processes relating to the IPE and practice changes; third, cost-benefit analyses.

/pdf/interprofessional-education-effects-on-professional-practice-frwteh5fla.pdf

Interprofessional education: effects on professional practice and healthcare outcomes (update)

Background
Educational meetings are widely used for continuing medical education. Previous reviews found that interactive workshops resulted in moderately large improvements in professional practice, whereas didactic sessions did not.

Objectives
To assess the effects of educational meetings on professional practice and healthcare outcomes.

Search methods
We updated previous searches by searching the Cochrane Effective Practice and Organisation of Care Group Trials Register and pending file, from 1999 to March 2006.

Selection criteria
Randomised controlled trials of educational meetings that reported an objective measure of professional practice or healthcare outcomes.

Data collection and analysis
Two authors independently extracted data and assessed study quality. Studies with a low or moderate risk of bias and that reported baseline data were included in the primary analysis. They were weighted according to the number of health professionals participating. For each comparison, we calculated the risk difference (RD) for dichotomous outcomes, adjusted for baseline compliance; and for continuous outcomes the percentage change relative to the control group average after the intervention, adjusted for baseline performance. Professional and patient outcomes were analysed separately. We considered 10 factors to explain heterogeneity of effect estimates using weighted meta-regression supplemented by visual analysis of bubble and box plots.

Main results
In updating the review, 49 new studies were identified for inclusion. A total of 81 trials involving more than 11,000 health professionals are now included in the review. Based on 30 trials (36 comparisons), the median adjusted RD in compliance with desired practice was 6% (interquartile range 1.8 to 15.9) when any intervention in which educational meetings were a component was compared to no intervention. Educational meetings alone had similar effects (median adjusted RD 6%, interquartile range 2.9 to 15.3; based on 21 comparisons in 19 trials). For continuous outcomes the median adjusted percentage change relative to control was 10% (interquartile range 8 to 32%; 5 trials). For patient outcomes the median adjusted RD in achievement of treatment goals was 3.0 (interquartile range 0.1 to 4.0; 5 trials). Based on univariate meta-regression analyses of the 36 comparisons with dichotomous outcomes for professional practice, higher attendance at the educational meetings was associated with larger adjusted RDs (P < 0.01); mixed interactive and didactic education meetings (median adjusted RD 13.6) were more effective than either didactic meetings (RD 6.9) or interactive meetings (RD 3.0). Educational meetings did not appear to be effective for complex behaviours (adjusted RD -0.3) compared to less complex behaviours; they appeared to be less effective for less serious outcomes (RD 2.9) than for more serious outcomes.

Authors' conclusions
Educational meetings alone or combined with other interventions, can improve professional practice and healthcare outcomes for the patients. The effect is most likely to be small and similar to other types of continuing medical education, such as audit and feedback, and educational outreach visits. Strategies to increase attendance at educational meetings, using mixed interactive and didactic formats, and focusing on outcomes that are likely to be perceived as serious may increase the effectiveness of educational meetings. Educational meetings alone are not likely to be effective for changing complex behaviours.

Continuing education meetings and workshops: effects on professional practice and health care outcomes

Motivational Interviewing: Preparing People for Change

The effect of training in communication skills on medical doctors' and nurses' self-efficacy. A randomized controlled trial.

Introduction:Despite the knowledge of good communication as a precondition for optimal care and treatment in health care, serious communication problems are still experienced by patients as well as by health care professionals. An orthopedic surgery department initiated a 3-day communication skills

Communication skills training increases self-efficacy of health care professionals.

Objective. To analyse the patients’ inclination to comment in generic patient surveys, and to evaluate how these comments were received and used for quality improvement by the hospitals. Design. The study is based on quantitative and qualitative data from four rounds of patient satisfaction surveys from 1999 to 2006. The open-ended questions and their applicability were evaluated by hospital and department management teams in a survey and by hospital employees and leaders, in semi-structured interviews.

/pdf/the-value-of-open-ended-questions-in-surveys-on-patient-4nd4qi9h3f.pdf

The value of open-ended questions in surveys on patient experience: number of comments and perceived usefulness from a hospital perspective

Objective To identify parents’ priorities and satisfaction in relation to pediatric care to assess nurses’ and physicians’ ability to provide care and treatment that fulfill parents’ needs. Design, Setting, and Participants The study took place in the pediatric ward of a regional hospital in Denmark. It included 300 parents of children admitted for acute care, and the data were collected by means of a self-administered questionnaire. After admission, parents were asked about priorities. After discharge from the hospital, parents were asked to report their level of satisfaction with the elements of care they had received during their stay. Results A total of 253 questionnaires were returned for the first section (a response rate of 84%), and 170 questionnaires were returned for the second section (response rate of 67%). The greatest gap between priorities and satisfaction was in the waiting time related to admission, waiting time related to fulfillment of the child’s needs, and information given about care and treatment. Parents were most satisfied with the nurses’ behavior; however, physicians’ performance was given the highest priority score. Conclusions Parents’ priorities and assessments of inpatient pediatric care rest heavily on the communication between physicians and parents. The present study pointed to the need for improved and clearer communication. In addition, the poor performance with regard to waiting time indicates that this is a major area for improvement.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/485926/poa40117.pdf

Parents' priorities and satisfaction with acute pediatric care.

The purpose of the study was to determine the views of intensive care nurses, intensivists, and primary physicians regarding collaboration and other aspects of withholding and withdrawing therapy in the intensive care unit (ICU). A questionnaire survey was conducted in seven hospitals in the Region of Southern Denmark, including six regional and four university ICUs. Four hundred ninety-five nurses, 135 intensivists, and 146 primary physicians participated in the study. The primary physicians came from two regional hospitals. The unified response rate was 84%. “Futile therapy” and “Patient’s wish” were for all participants the main reasons for considering withholding or withdrawing therapy. Of primary physicians 63% found their general experience of collaboration very or extremely satisfactory compared to 36% of intensivists and 27% of nurses. Forty-three percent of nurses, 29% of intensivists, and 2% of primary physicians found that decisions regarding withdrawal of therapy were often, very often, or always unnecessarily postponed. Intensivists with ICU as their main workplace were more satisfied with the collaboration and more rarely found that end-of-life decisions were changed or postponed compared to intensivists who did not have ICU as their main workplace. Nurses, intensivists and primary physicians differ in their perception of collaboration and other aspects of withholding and withdrawing therapy practises at the ICU. Multi-disciplinary patient conferences, nurse involvement in the decision-making process, and guidelines for withholding and withdrawing therapy are recommended.

Jette Ammentorp

Papers

The effect of training in communication skills on medical doctors' and nurses' self-efficacy. A randomized controlled trial.

Communication skills training increases self-efficacy of health care professionals.

The value of open-ended questions in surveys on patient experience: number of comments and perceived usefulness from a hospital perspective

Parents' priorities and satisfaction with acute pediatric care.

Withholding or withdrawing therapy in intensive care units: an analysis of collaboration among healthcare professionals