scholarly journals Defensive pharmacy practice: a gap in our understanding

Author(s):  
Juliette O’Connell

AbstractDefensive practice is prevalent across healthcare disciplines and much study has been performed on this behaviour in medicine and nursing. However, little research has been carried out on defensive practice in pharmacy, despite its potential to increase healthcare costs, reduce quality of care and affect pharmacist job satisfaction. With a more litigious society emerging and greater level of regulation, the pharmacy profession shares many of the influences of defensive practice identified in other healthcare professions. As a result, pharmacists too may engage in defensive practice behaviours in order to protect themselves from the perceived risk of litigation. Research in this area is necessary to identify how this phenomenon affects the profession and to develop methods of improving pharmacy practice. While this type of research would not be without challenges, it could form the basis for policy change and greater professional representation, ultimately improving quality of care for patients.

2021 ◽  
Author(s):  
Oliver T. Nguyen ◽  
Amir Alishahi Tabriz ◽  
Jinhai Huo ◽  
Karim Hanna ◽  
Christopher M. Shea ◽  
...  

BACKGROUND E-visits involve asynchronous communication between providers and patients through a secure web-based platform, such as a patient portal, to elicit symptoms and determine a diagnosis and treatment plan. E-visits are now reimbursable through Medicare due to the COVID-19 pandemic. The state of the evidence regarding e-visits, such as the impact on clinical outcomes and healthcare delivery, is unclear. OBJECTIVE To address this gap, this systematic review examines how e-visits have impacted clinical outcomes and healthcare quality, access, utilization, and costs. METHODS MEDLINE, Embase, and Web of Science were searched from January 2000 through October 2020 for peer-reviewed studies that assessed e-visits’ impact on clinical and healthcare delivery outcomes. RESULTS Out of 1,858 papers, 19 studies met the inclusion criteria. E-visit usage was associated with improved or comparable clinical outcomes, especially for chronic disease management (e.g., diabetes care, blood pressure management). The impact on quality of care varied across conditions. Quality of care was equivalent or better for chronic conditions but variable quality was observed in infection management (e.g., appropriate antibiotic prescribing). Similarly, the impact on healthcare utilization varied across conditions (e.g., lower utilization for dermatology) but mixed impact in primary care. Healthcare costs were lower for e-visits for a wide-range of conditions (e.g., dermatology and acute visits). No studies examined the impact of e-visits on healthcare access. Available studies are observational in nature and it is difficult to draw firm conclusions about effectiveness or impact on care delivery. CONCLUSIONS Overall, the evidence suggests e-visits may provide comparable clinical outcomes to in-person care and reduce healthcare costs for certain healthcare conditions. At the same time, there is mixed evidence on healthcare quality, especially regarding infection management (e.g., sinusitis, urinary tract infections, conjunctivitis). Further studies are needed to test implementation strategies that might improve delivery (e.g., clinical decision support for antibiotic prescribing) and to assess which conditions are amenable to e-visits and which conditions require in-person or face-to-face care (e.g., virtual visit). CLINICALTRIAL not applicable


2018 ◽  
Vol 74 (5) ◽  
pp. 1208-1219 ◽  
Author(s):  
Nicolas Gillet ◽  
Evelyne Fouquereau ◽  
Hélène Coillot ◽  
Baptiste Cougot ◽  
Leïla Moret ◽  
...  

2020 ◽  
pp. JOP.19.00583
Author(s):  
Julien Lejeune ◽  
Severine Chevalier ◽  
Evelyne Fouquereau ◽  
Denis Chenevert ◽  
Hélène Coillot ◽  
...  

PURPOSE: Psychological health at work for care providers is an important issue, because they are directly involved in quality of patient care. Managerial and organizational determinants have been found to be indicators of psychological health at work. The main objective of this study was to explore the relationships between the psychological health at work of pediatric oncology care workers with managerial and organizational determinants and with quality of care. MATERIALS AND METHODS: We performed regression analysis between psychological health at work (quality of work life [QWL], job satisfaction, and so on), managerial determinants (transformational leadership, perceived autonomy support), organizational determinants (organizational support, organizational justice, and participatory approach), and perceived quality of care. RESULTS: Participants were 510 health care professionals working in French pediatric oncology centers. No significant differences in the psychological health at work of the participants were found based on age, sex, length of employment, or professional discipline. In simple regression, significant associations were found between psychological health at work with all managerial and organizational determinants. In multiple regression, a significant link was found between QWL and perceived organizational support (β = .21; P < .001), organizational justice (β = .20, P < .001), and overall participatory approach (β = .10; P < .02). Job satisfaction was also related to perceived organizational support (β = .16; P < .01). Finally, perceived quality of care was linked to QWL (β = .15; P < .01) and job satisfaction (β = .30; P < .001). CONCLUSION: These results emphasize the importance of the role of managers and the organization in psychological health at work of health care providers and also in the quality of patient care


2018 ◽  
Vol 8 (9) ◽  
pp. 87
Author(s):  
Kaisa Bjuresäter ◽  
Sister Tessy Sebastian ◽  
Bhalchandra Kulkarni ◽  
Elsy Athlin

Introduction: This study is a part of a project aimed at implementing and evaluating the Collaborative Model of Best Practice, (CMBP) to promoting evidence-based practice (EBP) in health care contexts. The aim of the study was to assess nurses’ interest, attitudes, utilisation, and views on promotors of and resources related to EBP before and after taking part in the CMBP project, and to investigate their views on the CMBP in relation to collaboration between the academy and clinical practice, the earning environment, job satisfaction, and nursing quality.Methods: A descriptive, comparative design was used with pre- and post-test measurements. The Research Utilization Questionnaire (RUQ) and study-specific questions were distributed to ward nurses (n = 67) in a rural Indian hospital.Results: Most of the nurses thought that the CMBP had a positive impact on quality of care, on their attitudes to, interest in, and knowledge EBP, and on their job satisfaction. They also considered that the collaboration between the nursing college and clinical practice had a positive impact on the learning environment and that more resources were available at the end of the project.Conclusions: The CMBP project was an attempt to improve the quality of care for patients and the learning environment for nursing students and nurses on the project wards. The results indicated fulfilment of these goals, which strengthens the usability of the model. Implementation of EBP is challenging and requires long-lasting activities and comprehensive support from leaders and facilitators. More studies are needed in which EBP is systematically implemented, accomplished, evaluated, and reported.


2013 ◽  
Vol 21 (3) ◽  
pp. 765-772 ◽  
Author(s):  
Marcia Raquel Panunto ◽  
Edinêis de Brito Guirardello

OBJECTIVE: to evaluate the characteristics of the professional nursing practice environment and its relationship with burnout, perception of quality of care, job satisfaction and the intention to leave the job in the next 12 months. METHOD: cross-sectional study with a quantitative approach to data. The sample was composed of 129 nurses working in adult Intensive Care Units from a region in the interior of São Paulo, Brazil. RESULTS: The structural equation modeling, using path analysis, revealed that characteristics of the environment influence job satisfaction, perception of quality of care, and having an intention to leave their job, when mediated by emotional exhaustion. Nurses with limited autonomy, poor control over their practice, and poor relationships with physicians, experience a greater level of emotional exhaustion, which can negatively influence their perception of quality of care, job satisfaction and an intention to abandon their jobs. CONCLUSION: the mediating role of emotional exhaustion may negatively influence care delivery. Therefore, there is a need to adopt strategies to minimize this condition among nurses.


2011 ◽  
Vol 41 (2) ◽  
pp. 71-77 ◽  
Author(s):  
Marcia S. Faller ◽  
Michael G. Gates ◽  
Jane M. Georges ◽  
Cynthia D. Connelly

2018 ◽  
Vol 41 (4) ◽  
pp. 615-630 ◽  
Author(s):  
Dawon Baik ◽  
Brenda Zierler

Despite continuing interest in interprofessional teamwork to improve nurse outcomes and quality of care, there is little research that focuses on nurse job satisfaction and retention after an interprofessional team intervention. This study explored registered nurse (RN) job satisfaction and retention after a purposeful interprofessional team training and structured interprofessional bedside rounds were implemented. As part of a larger study, in this comparative cross-sectional study, pre- and post-intervention data on RN job satisfaction and turnover rate were collected and analyzed. It was found that RNs had significantly higher job satisfaction after the interprofessional team intervention. The 6-month period turnover rate in the post-intervention period was slightly lower than the 6-month period turnover rate in pre-intervention period; however, the rate was too low to provide statistical evidence. Ongoing coaching and supportive work environments to improve RN outcomes should be considered to enhance quality of care and patient safety in healthcare.


Nursing Open ◽  
2020 ◽  
Vol 7 (6) ◽  
pp. 1707-1714
Author(s):  
Irene Aasen Andersen ◽  
Ole T. Kleiven ◽  
Lars Kyte ◽  
Marny Alice Solhaug Pettersen

2019 ◽  
Vol 48 (4) ◽  
pp. 716-737 ◽  
Author(s):  
Kim C. Brimhall

Nonprofit leaders and managers are recognizing the benefits of creating inclusive organizations in which everyone feels valued and appreciated, yet little is known about how leaders can foster workplace inclusion. This study examined the relationships among leader engagement, inclusion, innovation, job satisfaction, and perceived quality of care in a diverse nonprofit health care organization. Data were collected at three points in 6-month intervals from a U.S. nonprofit hospital. Multilevel path analysis indicated significant direct associations between leader engagement, inclusion, and innovation. Innovation was directly linked to improved job satisfaction and perceived quality of care. Significant indirect effects were found from leader engagement to increased job satisfaction and perceived quality of care through increased climates for inclusion and innovation. Findings suggest that nonprofit leaders who engage others in critical organizational processes can help foster an inclusive climate that leads to increased innovation, employee job satisfaction, and perceived quality of care.


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