Journal of evaluation in clinical practice最新文献

{"title":"Efficacy of Home–School Collaboration in Enhancing College Students' Mental Health","authors":"YunFeng Liu","doi":"10.1111/jep.14273","DOIUrl":"10.1111/jep.14273","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the efficacy of home–school collaboration in enhancing college students' mental health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The convenience sampling method was used to select 500 students studying at University as survey participants. By designing a questionnaire, college students' mental health, self-identity, satisfaction and the status quo of home–school collaborative education were investigated. Pearson's correlation analysis was conducted to explore the relationships among these factors. Furthermore, the PROCESS model was used to study the mediating effect, which was tested using the Bootstrap sampling method.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Cronbach's coefficient α was above 0.7 for each index in the questionnaire, indicating good reliability. After excluding invalid questionnaires, 463 valid ones remained, with a validity rate of 97.1%. College students' mental health and self-identity were found to be positively correlated with home–school collaboration in terms of total scores and scores for each dimension. The highest degree of correlation was observed for identity moratorium and identity foreclosure, with a correlation coefficient of 0.479. Satisfaction and college students' self-identity contribute to the relationship between home–school collaboration and college students' mental health in the paths ‘home–school collaboration → satisfaction → college students' mental health’ and ‘home–school collaboration → college students' self-identity → college students' mental health,’ respectively. Additionally, satisfaction and college students' self-identity for the action path ‘home–school collaboration → satisfaction → college students' self-identity → college students' mental health,’ reflecting the impact of home–school collaboration on college students' mental health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Home–school collaboration positively influences the development of college students' mental health. Satisfaction and college students' self-identity have a chain mediating effect on the relationship between home–school collaboration and college students' mental health.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828851","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"‘It Cuts Both Ways’: A Qualitative Analysis of Stakeholders' Views on the Emerging and Potential Unintended Consequences of Telehealth in Rural Australia","authors":"Sagda Osman,&nbsp;Kate Churruca,&nbsp;Louise A. Ellis,&nbsp;Jeffrey Braithwaite","doi":"10.1111/jep.14270","DOIUrl":"10.1111/jep.14270","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>Telehealth has been consistently viewed as a viable solution for addressing healthcare inaccessibility and mitigating the impact of health workforce shortages in rural areas. However, despite high utilisation in rural areas, little is known about the unintended consequences of telehealth in terms of unexpected benefits and drawbacks.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>This study aimed to investigate the unintended consequences of telehealth in rural Australia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A qualitative exploratory design was employed. Semi-structured interviews were conducted to examine the views of various stakeholders across Australia. Twenty participants were interviewed across Australia, including six telehealth consumers, six providers, six state government representatives and two primary health network representatives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Findings on the unintended consequences of telehealth fell under three overarching themes with both reported unexpected benefits and drawbacks across each theme: (1) person-centred healthcare, (2) safety and quality of healthcare and (3) sustainability of rural healthcare. Under these themes, nine sub-themes were identified.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study provides insights into the unintended consequences of telehealth. While telehealth has improved certain aspects of healthcare in rural areas such as the improved support for rural clinicians and the reduced disruption to patients' daily routines, it has also introduced unforeseen challenges such as the transfer of medicolegal burden to local clinicians in rural emergency care facilities to compensate for the absence of physical examinations. These findings feed into decision-making useful for informing and improving telehealth implementation in rural Australia to maximise unexpected benefits, minimise risks, and ensure the long-term viability of telehealth services.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Managing Pandemic Threats—The Need for Adaptive Leadership","authors":"Scott Worman,&nbsp;Joachim P. Sturmberg","doi":"10.1111/jep.14268","DOIUrl":"10.1111/jep.14268","url":null,"abstract":"<div>\u0000 \u0000 <p>The threat of the H5N1-influenza virus prompts reflection on COVID-19 pandemic experiences. This paper integrates insights from a first responder using the Cynefin framework to advocate for an adaptive strategic approach to future pandemics. Balancing individual freedoms with containment measures serves to leverage the human capital needed for rapid learning and resource distribution. The Cynefin framework aids in understanding complex problem-solving dynamics which involve varying degrees of order and chaos. Hierarchies in the ordered world support heterarchies which explore the unordered world. Both operate within scale free human systems which must adapt to existential challenges such as pandemics. Experience leading to knowledge and understanding occurs simultaneously at all dimensions of human existence. Ultimately, adaptive leadership and decentralized decision-making, supported by the best available knowledge, enable effective pandemic management and restoration of normal societal functions.</p>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Commentary: Without Values, Complexity is Reduced to Mathematics","authors":"Trisha Greenhalgh","doi":"10.1111/jep.14263","DOIUrl":"10.1111/jep.14263","url":null,"abstract":"<p>This commentary on Sturmberg and Mercuri's paper ‘Every Problem is Embedded in a Greater Whole’ [1] argues that those authors have approached complexity from a largely mathematical perspective, drawing on the work of Sumpter. Whilst such an approach allows us to challenge the simple linear causality assumed in randomised controlled trials, it is itself limited. Mathematical complexity can explain nonlinearity and network effects but it cannot explain human values. It overlooks, for example, how science itself is historically and culturally shaped and how values-driven misunderstandings and conflicts are inevitable when people with different world views come together to try to solve a problem. This paper argues that the mathematical version of complexity thinking is necessary but not sufficient in medical research, and that we need to enhance such thinking further with attention to human values.</p>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11635397/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Gap: Understanding Patient and Clinician Preferences When Designing Preoperative Education Programs","authors":"Rochelle Furtado,&nbsp;Joy C. MacDermid,&nbsp;Christina Ziebart,&nbsp;Dianne Bryant,&nbsp;Kenneth J. Faber","doi":"10.1111/jep.14259","DOIUrl":"10.1111/jep.14259","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Traditionally, health information has been created from the perspective of the providers with minimum patient consultation, hindering engagement and adherence. The rate of shoulder replacements has increased over the past decade, is associated with shorter hospital stays, and patients are relying on education to be able to participate in shared decision-making. Therefore, to ensure creation of accessible education programs for shoulder replacement procedures, we explored patient and clinician preferences regarding content and device choices for a preoperative shoulder replacement education program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study used an interpretive descriptive qualitative approach to understand patient and clinician preferences. We included a subset of patient and healthcare provider perspectives, from those who had previously completed our quantitative survey. Interviews were conducted in English by one researcher. Analysis was conducted through a descriptive thematic analysis with open coding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 10 patients and 9 healthcare providers were interviewed. Findings were categorized into four main themes described the process of creating patient education material (1) methods of accessing information, (2) deciding on educational content, (3) deciding on device use, and the last theme of factors affecting engagement can be further divided as (4-1) promotors of engagement and (4-2) barriers of engagement.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>A multimodal program of a website with videos and a written booklet, that covers basic information regarding the surgery, timelines for recovery, sling use, use of therapeutic devices/aids post-surgery, patient expectations to improve surgery satisfaction, postoperative restrictions, pain management, rehabilitation and home supports is desired by both patients and clinicians.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632912/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is Ecological Anxiety Due to Climate Change Associated With the Fertility Preferences of Women?","authors":"Asibe Özkan,&nbsp;Merve Kolcu,&nbsp;Aydan Yilmaz,&nbsp;Gonca Akbaş","doi":"10.1111/jep.14265","DOIUrl":"10.1111/jep.14265","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Eco-anxiety caused by climate change, which is a significant public health problem, has negative effects on sexual and reproductive health, and these effects are expected to increase continuously. This study was conducted to determine the relationship between eco-anxiety caused by climate change and the fertility preferences of women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This descriptive study was conducted between June and August 2024 with 491 women at the ages of 18 to 49 who were registered at a family health center. A personal information form, the Attitudes toward Fertility and Childbearing Scale, and the Hogg Eco-Anxiety Scale were used to collect data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The mean total AFCS score of the participants was 66.1 ± 14.2, while their mean total HEAS score was 27.1 ± 7.0. There was a weak negative correlation between the AFCS scores and HEAS scores of the participants (<i>r</i> = −0.124, <i>p</i> = 0.006).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>As the ecological anxiety levels of women increased, their attitudes toward childbearing became more negative.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807392","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining Mental Health Conditions Within Primary Care Data: A Validation Study With a Mixed Qualitative and Quantitative Approach","authors":"Juan Carlos Bazo-Alvarez,&nbsp;Christina Avgerinou,&nbsp;Danielle Nimmons,&nbsp;Joseph F. Hayes,&nbsp;David Osborn,&nbsp;Claudia Cooper,&nbsp;Kate Walters,&nbsp;Irene Petersen","doi":"10.1111/jep.14256","DOIUrl":"10.1111/jep.14256","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To validate codelists for defining a range of mental health (MH) conditions with primary care data, using a mixed qualitative and quantitative approach and without requiring external data.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We validated Read codelists, selecting and classifying them in three steps. The qualitative step included an in-depth revision of the codes by six doctors. Simultaneously, the quantitative step performed on UK primary care data included an exploratory factor analysis to cluster Read codes in MH conditions to obtain an independent classification. The statistical results informed the qualitative conclusions, generating a final selection and classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>From a preselected list of 2007 Read codes, a total of 1638 were selected by all doctors. Later, they agreed on classifying these codes into 12 categories of MH disorders. From the same preselected list, a total of 1364 were quantitatively selected. Using data from 497,649 persons who used these Read codes at least once, we performed the exploratory factor analysis, retaining five factors (five categories). Both classifications showed good correspondence, while discrepancies informed decisions on reclassification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We produced a comprehensive set of medical codes lists for 12 MH conditions validated by a combination of clinical consensus panel and quantitative cluster analysis with cross-validation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632910/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effect of Two Types of Subcutaneous Heparin Injections on Pain, Ecchymosis, Hematoma and Drug Absorption: A Quasi-Experimental Study","authors":"Sule Biyik Bayram,&nbsp;Emel Gulnar,&nbsp;Nurcan Calıskan,&nbsp;Polat Kosucu,&nbsp;Onur Bektas,&nbsp;Aysun Bayram,&nbsp;Fatma Aksoy","doi":"10.1111/jep.14266","DOIUrl":"10.1111/jep.14266","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Subcutaneous heparin injections sometimes cause pain, ecchymosis, and hematoma. The prevalence of complications depends on the injection site, technique, and drug absorption. This study investigated the effect of two types of subcutaneous heparin injections on pain, ecchymosis, and hematoma as well as drug absorption rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study is a quasi-experimental. The research was conducted between September 2021 and May 2022. The sample consisted of 122 patients treated in the general surgery clinic of a university hospital in the Black Sea region of Türkiye. We used ultrasonography (USG) to measure the subcutaneous tissue thicknesses of the sites before heparin injections. We used the tissue-releasing technique (TRT) to administer heparin injections to 68 participants (Group TRT). We used the tissue-pinching technique (TPT) to administer heparin injections to 54 participants (Group TPT). We administered all injections into the arm or abdomen. We used a “Subcutaneous Injection Form” to collect data. We monitored all participants for the injection site, drug absorption after 1 day, pain, ecchymosis, and hematoma for 3 days.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was no significant difference in the prevalence of pain, ecchymosis, and hematoma between the groups (<i>p</i> &gt; 0.05). Most injections into the arm and abdomen resulted in drug absorption. However, one in ten injections into the arm resulted in the needle reaching the muscle rather than the subcutaneous tissue (11.7%). Abdominal injections caused no complications. The drug was administered in the right place in abdominal injections.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The tissue-releasing and TPTs are not superior to each other as far as drug absorption, pain, ecchymosis, and hematoma are concerned. In this study recommend pinching the tissue or using the abdominal region in cases where the subcutaneous tissue thickness is less than 15.96 mm. The nurse should consider Body Mass Index before choosing the right subcutaneous heparin injection site and the correct injection technique.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and Stimulating Factors for the Incorporation of Economic Considerations in Clinical Practice Guidelines: A Scoping Review","authors":"Chloé A. de Mortier,&nbsp;Jen Yaros,&nbsp;Ghislaine A. P. G. van Mastrigt,&nbsp;Daniëlle M. L. Verstegen,&nbsp;Silvia M. A. A. Evers,&nbsp;Marian H. J. M. Majoie,&nbsp;Dunja H. H. Dreesens,&nbsp;Aggie T. G. Paulus","doi":"10.1111/jep.14264","DOIUrl":"10.1111/jep.14264","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale, Aims and Objectives</h3>\u0000 \u0000 <p>The incorporation of economic considerations in clinical practice guidelines (CPGs) could help promote cost-conscious decision-making in healthcare. Though healthcare expenditures increase, and resources are becoming scarcer, the extent to which economic considerations are incorporated into CPGs remains limited. This scoping review aims to identify the challenges and potential stimulating factors to incorporate economic considerations in CPGs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>This scoping review was conducted following the Joanna Briggs Institute Methodology and findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was conducted in eight databases considering literature published from July 2017 and onwards. Data extraction was conducted via an iterative and inductive approach to identify challenges and potential stimulating factors from the included reports. Included documents focused on the (para)medical field and reported on CPG development and economic considerations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The search identified 2445 documents from which 33 documents were included for analysis. The analysis identified five challenges: discourse surrounding economic considerations in CPGs, methodological ambiguities, scarcity of (high-quality) economic evidence, transferability of evidence, and resource constraints. Additionally, three potential stimulating factors were identified: acceptance, economic evidence knowledge, and guidance on incorporating economic considerations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>These findings reflect the complexity of incorporating economic considerations in CPGs. The identified challenges highlight the need for clearer guidance (i.e. by training) and standardised methodologies for incorporating economic considerations in CPGs. The potential stimulating factors provide a roadmap for future efforts to enhance the integration of economic evidence in CPGs. Collaborative initiatives between health economists, CPG developers, and other stakeholders are essential to drive progress in this area and promote cost-conscious decision-making in healthcare.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11632911/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transformation to a Patient Centred Medical Home in an Urban Aboriginal Community Controlled Health Service: A Qualitative Study Using Normalisation Process Theory","authors":"Anton Clifford-Motopi,&nbsp;Karen Gardner,&nbsp;Renee Brown (Nununccal),&nbsp;Antoinette White (Palawa Iningai),&nbsp;Patrice Harald (Gangalu),&nbsp;Danielle Butler,&nbsp;Saira Mathew,&nbsp;Julie Mackenzie,&nbsp;Richard Mills,&nbsp;Martie Eaton","doi":"10.1111/jep.14255","DOIUrl":"10.1111/jep.14255","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Rationale</h3>\u0000 \u0000 <p>The Patient-Centred Medical Home (PCMH) is a model of team-based care that is patient centred, coordinated, accessible, and focused on quality and safety. To learn how this model of healthcare works in an Indigenous primary health care setting in Australia, we explored the experiences of health staff in an urban Aboriginal Community Controlled Health Service (ACCHS) transitioning to an adapted model of a PCMH. Normalisation Process Theory (NPT) was applied to better understand factors enabling and inhibiting implementation of the PCMH, and the work required to deliver it.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Objectives</h3>\u0000 \u0000 <p>Applying NPT, we aimed to examine enablers and barriers to implementing a PCMH in an ACCHS setting and identify practical strategies to strengthen its implementation and delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We employed semi-structured interviews with 19 health staff in an urban ACCHS to explore mechanisms that inhibit and promote the implementation and delivery of a PCMH in their setting. Interview data were analysed using thematic analysis that mapped codes against NPT constructs (Coherence, Cognitive Participation, Collective Action and Reflexive Appraisal) to generate themes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Five key themes and 14 sub-themes related to NPT constructs were identified. Broadly, health staff found the model of the PCMH to be coherent, engaged with others to adapt their roles, and worked collectively to embed new practices. Characteristics and practice norms of the clinic already aligned with the PCMH model were key enablers. Barriers were related to inadequate resourcing and ill-defined roles. Stronger leadership and support, practical learning resources for staff, workforce mapping to better define staff roles, and training to address gaps in staff skills were strategies identified for strengthening implementation of a PCMH and sustaining its delivery in the ACCHS setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Applying NPT revealed the characteristics and practice norms of Indigenous community controlled health care as key enablers of implementing a PCMH in an urban ACCHS. Less than optimal resourcing and workforce development emerged as barriers needing to be resolved to strengthen implementation and delivery of a PCMH in this setting.</p>\u0000 </section>\u0000 </div>","PeriodicalId":15997,"journal":{"name":"Journal of evaluation in clinical practice","volume":"31 1","pages":""},"PeriodicalIF":2.1,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}