A cross-sectional evaluation of community pharmacists’ perceptions of intermediate care and medicines management across the healthcare interface

Background Despite the importance placed on the concept of the multidisciplinary team in relation to intermediate care (IC), little is known about community pharmacists’ (CPs) involvement. 
Objective To determine CPs’ awareness of and involvement with IC services, perceptions of the transfer of patients’ medication information between healthcare settings and views of the development of a CP–IC service. 
Setting Community pharmacies in Northern Ireland. 
Methods A postal questionnaire, informed by previous qualitative work was developed and piloted. 
Main outcome measure CPs’ awareness of and involvement with IC. Results The response rate was 35.3 % (190/539). Under half (47.4 %) of CPs ‘agreed/strongly agreed’ that they understood the term ‘intermediate care’. Three quarters of respondents were either not involved or unsure if they were involved with providing services to IC. A small minority (1.2 %) of CPs reported that they received communication regarding medication changes made in hospital or IC settings ‘all of the time’. Only 9.5 and 0.5 % of respondents ‘strongly agreed’ that communication from hospital and IC, respectively, was sufficiently detailed. In total, 155 (81.6 %) CPs indicated that they would like to have greater involvement with IC services. ‘Current workload’ was ranked as the most important barrier to service development.
Conclusion It was revealed that CPs had little awareness of, or involvement with, IC. Communication of information relating to patients’ medicines between settings was perceived as insufficient, especially between IC and community pharmacy settings. CPs demonstrated willingness to be involved with IC and services aimed at bridging the communication gap between healthcare settings.

Primary Health Care Providers' Perspectives: Facilitating Older Patients' Access to Community Support Services

The purpose of the study examined in this article was to understand how non-physician health care professionals working in Canadian primary health care settings facilitate older persons’ access to community support services (CSSs). The use of CSSs has positive impacts for clients, yet they are underused from lack of awareness. Using a qualitative description approach, we interviewed 20 health care professionals from various disciplines and primary health care models about the processes they use to link older patients to CSSs. Participants collaborated extensively with interprofessional colleagues within and outside their organizations to fi nd relevant CSSs. They actively engaged patients and families in making these linkages and ensured follow-up. It was troubling to fi nd that they relied on out-of-date resources and ineffi cient search strategies to fi nd CSSs. Our fi ndings can be used to develop resources and approaches to better support primary health care providers in linking older adults to relevant CSSs. 

Community satisfaction with indoor residue spraying for Malaria control in Karonga, Northern Malawi

Background The Malawi National Malaria Control Program conducted Indoor Residual Spraying (IRS) in 2010 and 2013 in selected hot districts along the valleys including Karonga, but no study has been done to measure community satisfaction levels in these areas. Aim To assess satisfaction levels of community with IRS in both rural and urban settings, in Karonga district. Methods A cross-sectional study was conducted in urban village of Mwahimba and rural village of Fundi. Qualitative and quantitative data was collected from households’ representatives through Focus Group Discussions (FGDs) using De Wets’s Schutte tool. Qualitative data was analysed using thematic analysis while numbers and percentages were generated using Microsoft excel. Results Overall level of satisfaction in Fundi was estimated at 69% while that of Mwahimba was at 60.9%. In Fundi village, 66.1 % (37) of the household representatives were satisfied while in Mwahimba village, 60.7 % (34) were satisfied with the IRS programme. Factors that led to satisfaction were minimal adverse effects of the chemical on people after spraying, killing of other insects, sprayer’ courtesy and good communication. Factors behind dissatisfaction include: short residual effect of the chemical used, over-dilution of the chemical and minimal community involvement. Conclusion Despite finding high satisfaction levels in rural village than in an urban village, overall all the villages reported low levels of satisfaction with IRS due to various factors some of which common to both villages. Karonga District Health Office needs to involve the community in the process of spraying by recruiting sprayers from the target area and also explaining the purpose of dilution and the dilution factor to community members.

Functions of code-switching in multilingual student community

Dissertação de Mestrado, Ciências da Linguagem, Faculdade de Ciências Humanas e Sociais, Universidade do Algarve, 2013

Tackling risky alcohol consumption in sport: a cluster randomised controlled trial of an alcohol management intervention with community football clubs

BACKGROUND: An increased prevalence of risky alcohol consumption and alcohol-related harm has been reported for members of sporting groups and at sporting venues compared with non-sporting populations. While sports clubs and venues represent opportune settings to implement strategies to reduce such risks, no controlled trials have been reported. The purpose of the study was to examine the effectiveness of an alcohol management intervention in reducing risky alcohol consumption and the risk of alcohol-related harm among community football club members.

METHOD: A cluster randomised controlled trial of an alcohol management intervention was undertaken with non-elite, community football clubs and their members in New South Wales, Australia. Risky alcohol consumption (5+ drinks) at the club and risk of alcohol-related harm using the Alcohol Use Disorders Identification Test (AUDIT) were measured at baseline and postintervention.

RESULTS: Eighty-eight clubs participated in the trial (n=43, INTERVENTION; n=45, CONTROL) and separate cross-sectional samples of club members completed the baseline (N=1411) and postintervention (N=1143) surveys. Postintervention, a significantly lower proportion of intervention club members reported: risky alcohol consumption at the club ( INTERVENTION: 19%; CONTROL: 24%; OR: 0.63 (95% CI 0.40 to 1.00); p=0.05); risk of alcohol-related harm ( INTERVENTION: 38%; CONTROL: 45%; OR: 0.58 (95% CI 0.38 to 0.87); p<0.01); alcohol consumption risk ( INTERVENTION: 47%; CONTROL: 55%; OR: 0.60 (95% CI 0.41 to 0.87); p<0.01) and possible alcohol dependence ( INTERVENTION: 1%; CONTROL: 4%; OR: 0.20 (95% CI 0.06 to 0.65); p<0.01).

CONCLUSIONS: With large numbers of people worldwide playing, watching and sports officiating, enhancing club-based alcohol management interventions could make a substantial contribution to reducing the burden of alcohol misuse in communities.

New Chinese entrepreneurs: perspectives of Confucian attributes and social settings

This chapter uses a qualitative approach to explore the characteristics of newly-bred Chinese entrepreneurs among 14 technology-based companies in Mainland China, Taiwan, and Hong Kong. Internal and external perspectives on studying entrepreneurship were adapted to examine personality attributes and the impacts of social settings on shaping the characteristics of modern Chinese entrepreneurs. The findings show that Chinese entrepreneurs were strongly influenced by the Confucianism, in which learning was upheld as a key to develop internal innovative capabilities for sustaining enterprise growth in the dynamic environment. Chinese entrepreneurs leading technologically innovative companies were also found to be visionary, but with less risk taking; they had exceptional networking capability and political dexterity to build strong relationships with government, industry and community. The tie between the Confucian entrepreneurial attributes and strong government support appears to enable the 'innovation in Chinese way'. Implications of these results are discussed.

Improving access for community health and sub-acute outpatient services: protocol for a stepped wedge cluster randomised controlled trial

BACKGROUND: Waiting lists for treatment are common in outpatient and community services, Existing methods for managing access and triage to these services can lead to inequities in service delivery, inefficiencies and divert resources from frontline care. Evidence from two controlled studies indicates that an alternative to the traditional "waitlist and triage" model known as STAT (Specific Timely Appointments for Triage) may be successful in reducing waiting times without adversely affecting other aspects of patient care. This trial aims to test whether the model is cost effective in reducing waiting time across multiple services, and to measure the impact on service provision, health-related quality of life and patient satisfaction.

METHODS/DESIGN: A stepped wedge cluster randomised controlled trial has been designed to evaluate the impact of the STAT model in 8 community health and outpatient services. The primary outcome will be waiting time from referral to first appointment. Secondary outcomes will be nature and quantity of service received (collected from all patients attending the service during the study period and health-related quality of life (AQOL-8D), patient satisfaction, health care utilisation and cost data (collected from a subgroup of patients at initial assessment and after 12 weeks). Data will be analysed with a multiple multi-level random-effects regression model that allows for cluster effects. An economic evaluation will be undertaken alongside the clinical trial.

DISCUSSION: This paper outlines the study protocol for a fully powered prospective stepped wedge cluster randomised controlled trial (SWCRCT) to establish whether the STAT model of access and triage can reduce waiting times applied across multiple settings, without increasing health service costs or adversely impacting on other aspects of patient care. If successful, it will provide evidence for the effectiveness of a practical model of access that can substantially reduce waiting time for outpatient and community services with subsequent benefits for both efficiency of health systems and patient care.

Women’s health Goulburn North East community crime prevention plan – regional preventing violence against women and children strategy: summative evaluation report from the external evaluator, February 2016

This report presents the external evaluation of the Hume Regional Preventing Violence Against Women Strategy. This is one of 12 projects funded by the Department of Justice and Regulation in Victoria under its initiative to support primary prevention and early intervention-focused partnership projects that seek to prevent violence before it occurs or address the key contributing factors of violence against women and their children. The focus is on changing behaviours and attitudes that allow violence against women and children to continue. The lead agency in the project was Women’s Health Goulburn North East (WHGNE).The Hume regional strategy The focus of the project was to develop and implement a coordinated regional strategy that addresses the determinants of violence against women and builds the capacity of communities to take action to prevent such violence. At the outset it was envisaged that a key component of the strategy would be to undertake preventive activities that respond to identified gaps in the region.The first version of the strategy was completed in September 2013 and formally launched in November 2013. In October 2013, Courageous Conversations was identified as the brand to be used for activities in the strategy, including a charter and other resources. As the project evolved, the strategy was revised to reflect differing levels of engagement and progress with the different parts of the work and to identity explicitly the activities associated with the brand. A revised version of the regional strategy was produced in September 2014, with four aims:• promoting equal and respectful relationships between men and women;• working across local government, workplaces and sporting settings to coordinate a region-wide approach to preventing violence against women;• bringing about structural and systemic organisational change to promote gender equitable and non-violent cultures;• build the capacity of leaders in preventing violence against women.Different components of the activities carried out under the strategy included: partnership and capacity building; building gender equity in organisations; gender equity and masculinities training; bystander training; knowledge dissemination and the Courageous Conversations website.

Nursing students' perceptions of community pediatric experiences.

Over the last decade health care delivery has shifted from hospitals to the community resulting in a significant reduction of hospital-based clinical placements for nursing students to practice and learn. Studies have emerged describing this problem and outlining the ways in which Colleges and Universities have attempted to deal with the acute shortage of clinical areas in nursing and other health care programs. Several studies describe the development of community-based clinical experiences, and some of these examinated students' perceptions. One finding appears to be constant: student perceptions of community experiences have an effect on their settings both to contend with the shortage of hospital-based placements and to prepare students for future practice.