scholarly journals Cross-sector pre-registration pharmacist placements in general practice in England: lessons from a national evaluation

2021 ◽  
Vol 29 (Supplement_1) ◽  
pp. i40-i41
Author(s):  
A Hindi ◽  
S Willis ◽  
S Jacobs ◽  
E Schafheutle
Keyword(s):  
General Practice ◽  
Wide Spectrum ◽  
Geographical Location ◽  
Unintended Consequences ◽  
Final Report ◽  
Contributing Factors ◽  
Training Experience ◽  
Good Communication ◽  
Patient Pathways ◽  
Study Sites

Abstract Introduction In 2019/2020, the Pharmacy Integration Fund commissioned delivery of cross-sector pre-registration pharmacist training incorporating 3–6 month placements in general practice (GP). GP placements were managed by Health Education England (HEE) and organised as one (or more) blocks, or as spilt weeks/days across base sector (hospital/community) and GP. Trainees had a pharmacist tutor at base and in GP. Aim to evaluate the implementation of cross-sector pre-registration pharmacy placements in GP in England, and to identify barriers and enablers of a successful placement. Methods A qualitative approach was taken, with case study sites purposively sampled for maximum variation: pharmacy base (hospital/community), number of pre-registration pharmacist trainees in base doing GP placement, length of GP placement, organisation of GP placement and geographical location. With consent, trainees and tutors identified as meeting sampling criteria were emailed invitation letters and participant information sheets. Where the trainee and their tutor(s) agreed to participate, semi-structured telephone interviews were conducted January - July 2020. Questions developed from literature(1, 2) and the HEE handbook were tailored to understanding trainees’ and tutors’ views on the implementation of pre-registration pharmacist placements in GP, including benefits, unintended consequences and impacts. Thematic analysis across sites was undertaken with a focus on exploring inter and intra group themes. Results Thirty-four interviews were completed in 11 study sites (5 GP/hospital; 6 GP/community pharmacy). Trainees and tutors considered GP placements had been successful. Contributing factors were: placement planning (induction, contingency arrangements for cover should GP tutor be unavailable); tutors working together (good communication and collaboration); GP tutor support (regular contact, reflection; identifying learning needs; opportunities for learning); integration of GP placements within training year (specific learning/training activities at base during GP placement); and GP tutors having backing of their organisation to supervise effectively. A lack of these impacted negatively. Trainees completed a wide spectrum of activities and gradually moved from administrative to clinical tasks. They built up confidence to undertake patient-facing activities, with more direct supervision at the beginning moving to indirect supervision using debriefing. Thirteen weeks in GP was considered an appropriate minimum duration by all trainees and tutors; those based in community felt that 26 weeks in GP provided more opportunities for clinical and consultation skills learning. Cross-sector experience facilitated a better understanding of patient pathways and the importance of holistic patient care. All trainees considered working in GP in future but highlighted the lack of a cross-sector GP foundation programme. Base tutors felt the time commitment was comparable to single sector placements. Base and GP tutors felt that a clear set of competencies for GP placements and a broader governance framework would ensure standards and consistency. Conclusion This is the first national evaluation of cross-sector pre-registration pharmacists in general practice placements in England. Sampling as case studies enabled data triangulation and generated a multi-faceted understanding on factors impacting GP placements. A key limitation was the volunteer bias associated with recruitment. Key attributes of a successful pre-registration cross-sector training experience are highlighted and can inform policy reforms including change from pre-registration to foundation year training. References 1. Gray N. Review of Experience of Pre-registration Pharmacist Placements in the General Practice Setting – Final Report. 2019. 2. Jee SD, Schafheutle EI, Noyce PR. Is pharmacist pre-registration training equitable and robust? Higher Education, Skills and Work-Based Learning. 2019;9(3):347–58.

Critical medical ecology and intersectionality perspectives in schistosomiasis prevention and control in selected communities in Mindanao, the Philippines

2022 ◽  
pp. 1-20
Author(s):  
Soledad Natalia M. Dalisay ◽  
Vicente Y. Belizario ◽  
Joseph Aaron S. Joe ◽  
Carlo R. Lumangaya ◽  
Reginaldo D. Cruz
Keyword(s):  
Geographical Location ◽  
Integrated Approach ◽  
The Philippines ◽  
Schistosomiasis Japonica ◽  
Health Concern ◽  
Power Structures ◽  
Morbidity Control ◽  
At Risk Populations ◽  
Study Sites ◽  
And Control

Abstract Schistosomiasis japonica remains a public health concern in many areas of the Philippines. Periodic Mass Drug Administration (MDA) to at-risk populations is the main strategy for morbidity control of schistosomiasis. Attaining MDA coverage targets is important for the reduction of morbidity and prevention of complications due to the disease, and towards achieving Universal Health Care. The study employed a qualitative case study design. Key informant interviews and focus group discussions were conducted to provide in-depth and situated descriptions of the contexts surrounding the implementation of MDA in two selected villages in known schistosomiasis-endemic provinces in Mindanao in the Philippines. Data analysis was done using the Critical Ecology for Medical Anthropology (CEMA) model coupled with the intersectionality approach. It was found that within various areas in the CEMA model, enabling as well as constraining factors have been encountered in MDA in the study settings. The interplay of income class, geographical location, gender norms and faith-based beliefs may have led to key populations being missed during the conduct of MDA in the study sites. The constraints faced by the target beneficiaries of MDA, as well as programme implementers, must be addressed to enhance service delivery and to control morbidity due to schistosomiasis. Improving compliance with MDA also requires a holistic, integrated approach to addressing barriers to participation, which are shaped by wider socio-political and power structures.

Further Regional Studies

War Epidemics ◽  
2004 ◽  
Author(s):  
Matthew Smallman-Raynor ◽  
Andrew Cliff
Keyword(s):  
World War Ii ◽  
World War I ◽  
South African ◽  
Geographical Location ◽  
Prisoners Of War ◽  
World War ◽  
The South ◽  
South African War ◽  
Forced Labour ◽  
Study Sites

In Chapters 7 to 11, we have examined a series of recurring themes in the geography of war and disease since 1850 through regional lenses. In this chapter, we conclude our regional–thematic survey by illustrating further prominent themes which, either because of their subject-matter or because of their geographical location, were beyond the immediate scope of the foregoing chapters. In selecting regional case studies for this chapter, we concentrate on wars which have not been examined in depth to this point (the South African War and the Cuban Insurrection) or which, on account of their magnitude and extent, merit examination beyond that afforded in previous sections (World War I and World War II). Four principal issues are addressed: (1) Africa: population reconcentration and disease (Section 12.2), illustrated with reference to civilian concentration camps in the South African War, 1899–1902; (2) Americas: peace, war, and epidemiological integration (Section 12.3), illustrated with reference to the civil settlement system of Cuba, 1888–1902; (3) Asia: prisoners of war, forced labour, and disease (Section 12.4), illustrated with reference to Allied prisoners on the line of the Burma–Thailand Railway, 1942–4; (4) Europe: civilian epidemics and the world wars (Section 12.5), illustrated with reference to the spread of a series of diseases in the civil population of Europe during, and after, the hostilities of 1914–18 and 1939–45. As before, the study sites in (1) to (4) span a broad range of epidemiological environments, from the cool temperate latitudes of northern Europe, through the tropical island and jungle environments of the Caribbean and Southeast Asia, to the warm temperate and subtropical savannah lands of the South African Veld. Diseases have been sampled to reflect this epidemiological range. The South African War (1899–1902) has been described as the last of the ‘typhoid campaigns’ (Curtin, 1998)—a closing chapter on the predominance of disease over battle as a cause of death among soldiers (Pakenham, 1979: 382). From the military perspective, typhoid was indeed the major health issue of the war, accounting for a reported 8,020 deaths in the British Army (Simpson, 1911: 57).

scholarly journals Skill-mix change in general practice: a qualitative comparison of three ‘new’ non-medical roles in English primary care

2019 ◽  
Vol 69 (684) ◽  
pp. e489-e498 ◽  
Author(s):  
Pauline A Nelson ◽  
Fay Bradley ◽  
Anne-Marie Martindale ◽  
Anne McBride ◽  
Damian Hodgson
Keyword(s):  
General Practice ◽  
Unintended Consequences ◽  
Structured Interviews ◽  
Implementation Barriers ◽  
Qualitative Comparison ◽  
Factors Affecting ◽  
Skill Mix ◽  
Final Sample ◽  
Advanced Practitioner ◽  
Training Schemes

BackgroundGeneral practice is currently facing a significant workforce challenge. Changing the general practice skill mix by introducing new non-medical roles is recommended as one solution; the literature highlights that organisational and/or operational difficulties are associated with skill-mix changes.AimTo compare how three non-medical roles were being established in general practice, understand common implementation barriers, and identify measurable impacts or unintended consequences.Design and settingIn-depth qualitative comparison of three role initiatives in general practices in one area of Greater Manchester, England; that is, advanced practitioner and physician associate training schemes, and a locally commissioned practice pharmacist service.MethodSemi-structured interviews and focus groups with a purposive sample of stakeholders involved in the implementation of each role initiative were conducted. Template analysis enabled the production of pre-determined and researcher-generated codes, categories, and themes.ResultsThe final sample contained 38 stakeholders comprising training/service leads, role holders, and host practice staff. Three key themes captured participants’ perspectives: purpose and place of new roles in general practice, involving unclear role definition and tension at professional boundaries; transition of new roles into general practice, involving risk management, closing training–practice gaps and managing expectations; and future of new roles in general practice, involving demonstrating impact and questions about sustainability.ConclusionThis in-depth, in-context comparative study highlights that introducing new roles to general practice is not a simple process. Recognition of factors affecting the assimilation of roles may help to better align them with the goals of general practice and harness the commitment of individual practices to enable role sustainability.

scholarly journals What happens to patient experience when you want to see a doctor and you get to speak to a nurse? Observational study using data from the English General Practice Patient Survey

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018690 ◽  
Author(s):  
Charlotte A M Paddison ◽  
Gary A Abel ◽  
Jenni Burt ◽  
John L Campbell ◽  
Marc N Elliott ◽  
...  
Keyword(s):  
General Practice ◽  
Patient Experience ◽  
Secondary Analysis ◽  
Patient Survey ◽  
Models Of Care ◽  
Unintended Consequences ◽  
Multidisciplinary Teams ◽  
Face To Face ◽  
Patient Reported ◽  
Practice Patient

ObjectivesTo examine patient consultation preferences for seeing or speaking to a general practitioner (GP) or nurse; to estimate associations between patient-reported experiences and the type of consultation patients actually received (phone or face-to-face, GP or nurse).DesignSecondary analysis of data from the 2013 to 2014 General Practice Patient Survey.Setting and participants870 085 patients from 8005 English general practices.OutcomesPatient ratings of communication and ‘trust and confidence’ with the clinician they saw.Results77.7% of patients reported wanting to see or speak to a GP, while 14.5% reported asking to see or speak to a nurse the last time they tried to make an appointment (weighted percentages). Being unable to see or speak to the practitioner type of the patients’ choice was associated with lower ratings of trust and confidence and patient-rated communication. Smaller differences were found if patients wanted a face-to-face consultation and received a phone consultation instead. The greatest difference was for patients who asked to see a GP and instead spoke to a nurse for whom the adjusted mean difference in confidence and trust compared with those who wanted to see a nurse and did see a nurse was −15.8 points (95% CI −17.6 to −14.0) for confidence and trust in the practitioner and −10.5 points (95% CI −11.7 to −9.3) for net communication score, both on a 0–100 scale.ConclusionsPatients’ evaluation of their care is worse if they do not receive the type of consultation they expect, especially if they prefer a doctor but are unable to see one. New models of care should consider the potential unintended consequences for patient experience of the widespread introduction of multidisciplinary teams in general practice.

Engagement of primary care practice in Australia: learnings from a diabetes care project

2019 ◽  
Vol 25 (1) ◽  
pp. 82
Author(s):  
Rajna Ogrin ◽  
Tracy Aylen ◽  
Toni Rice ◽  
Ralph Audehm ◽  
Arti Appannah
Keyword(s):  
General Practice ◽  
Chronic Disease ◽  
Diabetes Care ◽  
Descriptive Analysis ◽  
Healthcare Providers ◽  
Pilot Project ◽  
Care Practice ◽  
Structured Interviews ◽  
Contributing Factors ◽  
Practice Nurses

Effective community-based chronic disease management requires general practice engagement and ongoing improvement in care models. This article outlines a case study on contributing factors to insufficient participant recruitment through general practice for an evidence-based diabetes care pilot project. Key stakeholder semi-structured interviews and focus groups were undertaken at cessation of the pilot project. Participants (15 GPs, five practice nurses, eight diabetes educators) were healthcare providers engaged in patient recruitment. Through descriptive analysis, common themes were identified. Four major themes were identified: (1) low perceived need for intervention; (2) communication of intervention problematic; (3) translation of research into practice not occurring; and (4) the service providing the intervention was not widely viewed as a partner in chronic disease care. Engaging GPs in new initiatives is challenging, and measures facilitating uptake of new innovations are required. Any new intervention needs to: be developed with GPs to meet their needs; have considerable lead-in time to develop rapport with GPs and raise awareness; and ideally, have dedicated support staff within practices to reduce the demand on already-overburdened practice staff. Feasible and effective mechanisms need to be developed to facilitate uptake of new innovations in the general practice setting.

scholarly journals MODELING AND SIMULATION OF RELIEF INFLUENCE ON EUCALYPTUS FORESTS: INTERACTION BETWEEN SOLAR IRRADIANCE AND PRODUCTIVITY

2016 ◽  
Vol 40 (2) ◽  
pp. 319-327
Author(s):  
Yhasmin Paiva Rody ◽  
Aristides Ribeiro ◽  
Aline Santana de Oliveira ◽  
Fernando Palha Leite
Keyword(s):  
Solar Radiation ◽  
Meteorological Data ◽  
Geographical Location ◽  
Area Index ◽  
Model Simulations ◽  
Incident Solar Radiation ◽  
Eucalyptus Forest ◽  
Vertical Location ◽  
Weather Stations ◽  
Study Sites

ABSTRACT This study aimed to verify the differences in radiation intensity as a function of distinct relief exposure surfaces and to quantify these effects on the leaf area index (LAI) and other variables expressing eucalyptus forest productivity for simulations in a process-based growth model. The study was carried out at two contrasting edaphoclimatic locations in the Rio Doce basin in Minas Gerais, Brazil. Two stands with 32-year-old plantations were used, allocating fixed plots in locations with northern and southern exposure surfaces. The meteorological data were obtained from two automated weather stations located near the study sites. Solar radiation was corrected for terrain inclination and exposure surfaces, as it is measured based on the plane, perpendicularly to the vertical location. The LAI values collected in the field were used. For the comparative simulations in productivity variation, the mechanistic 3PG model was used, considering the relief exposure surfaces. It was verified that during most of the year, the southern surfaces showed lower availability of incident solar radiation, resulting in up to 66% losses, compared to the same surface considered plane, probably related to its geographical location and higher declivity. Higher values were obtained for the plantings located on the northern surface for the variables LAI, volume and mean annual wood increase, with this tendency being repeated in the 3PG model simulations.

The influence of geographical location on the complexity of rural general practice activities

2003 ◽  
Vol 179 (8) ◽  
pp. 416-420 ◽  
Author(s):  
John S Humphreys ◽  
Judith A Jones ◽  
Michael P Jones ◽  
David Mildenhall ◽  
Paul R Mara ◽  
...  
Keyword(s):  
General Practice ◽  
Geographical Location

Identifying resilient Eastern Massasauga Rattlesnake (Sistrurus catenatus) peatland hummock hibernacula

2018 ◽  
Vol 96 (9) ◽  
pp. 1024-1031 ◽  
Author(s):  
A.G. Smolarz ◽  
P.A. Moore ◽  
C.E. Markle ◽  
J.M. Waddington
Keyword(s):  
Water Table ◽  
Spatial Arrangement ◽  
Subsurface Temperature ◽  
Contributing Factors ◽  
Northern Limit ◽  
Deep Freezing ◽  
Sistrurus Catenatus ◽  
Eastern Massasauga Rattlesnake ◽  
Study Sites ◽  
Water Table Rise

At the northern limit of the Eastern Massasauga Rattlesnake’s (Sistrurus catenatus (Rafinesque, 1818)) range, individuals spend up to half the year overwintering. In hummock hibernacula found in peatlands, it is likely that subsurface temperature and water table position are contributing factors dictating habitat suitability. As a step towards assessing the vulnerability of hibernacula to anthropogenic changes, we combined subsurface temperature and water table dynamics to assess the likelihood that unflooded and unfrozen conditions were present in hummock hibernacula. Our results indicate that taller hummocks are more resilient to an advancing frost line and fluctuating water table by providing a larger area and duration of unfrozen and unflooded conditions, and a critical overwintering depth that is farther from the hummock surface. In two study sites along eastern Georgian Bay, an unflooded and unfrozen zone was present for over 90% of the overwintering period for hummocks taller than 25–27 cm. Our findings highlight the vulnerability of peatland hummocks to variability of winter weather where deep freezing and (or) water table rise may nonlinearly reduce resilience. This suggests that height is not the only component affecting the suitability of hummock hibernacula and that further research should examine the structure and spatial arrangement of hummocks within a peatland.

scholarly journals TOURIST AND RECREATIONAL POTENTIAL OF THE LVIV REGION: GEOGRAPHICAL FEATURES OF USE AND RECREATION

2018 ◽  
pp. 72-79
Author(s):  
S. Zapototskyi ◽  
I. Horyn
Keyword(s):  
Swot Analysis ◽  
Geographical Location ◽  
Tourism Industry ◽  
Contributing Factors ◽  
Current Usage ◽  
Rich Natural Resource ◽  
Green Tourism ◽  
Historical Resources ◽  
Main Components ◽  
Recreational Resources

The paper determines the foundation of formation of a touristic recreational potential of Lviv region. Main contributing factors of development of the tourism industry of the region are investigated. It is established that the largest reserves of recreational resources are located in Drohobych, Zhovkva, Pustomyty, Sokal and Stryj districts. Small amounts of resources are concentrated in Brody, Zhidachiv, Kamenka-Buzka, Mykolayiv, Peremyshlyansk, Radekhiv, Sambir and Turka districts. Tourist routes of Lviv region were estimated. In particular, the most promising ones were evaluated, including the Golden Ring of the Boykivshchyna, the Russky Path – the old way through the Carpathians, Makivka – the mountain of the immortal glory of the Ukrainian Sich Riflemen. The correlation-regression relationship between the indicators forming the tourist flows and the main components of the tourism development of the studied region was determined. The level and intensity of current usage of the potential of the region were estimated. SWOT-analysis of touristic and recreational potential of the region was carried out. The study of a touristic and recreational sector of Lviv region has made it possible to establish that its development depends primarily on the advantageous geographical location of the region, rich natural-resource and historical and cultural potential, and the development of touristic and recreational infrastructure. It was established that the region has all the necessary preconditions for the long-term development of cultural-cognitive, scientific-educational, religious, medical, hunting, ecological, business, sports and excursion types of the tourism industry. Particularly important and promising is the development of rural (green) tourism in the region. The development of touristic and recreational sphere of Lviv oblast depends, first and foremost, on the rational use of natural and cultural-historical resources, the reconstruction of sanatoriums and resorts, recreational and touristic establishments, the creation of material and technical base for the development of touristic and recreational industry, promotion of investment attraction, distribution of touristic product on the domestic and world markets and strengthening of international cooperation in the field of tourism and recreation.

scholarly journals Tobacco and Cannabis Debris Survey Protocol

2022 ◽  
Author(s):  
Laurie C. Van De Werfhorst ◽  
Christopher L. Jerde ◽  
Marc W. Beutel ◽  
Andrew Brooks ◽  
Van Butsic ◽  
...  
Keyword(s):  
Water Quality ◽  
Geographical Location ◽  
The Public ◽  
Product Use ◽  
Cigarette Butts ◽  
Human Use ◽  
Study Sites ◽  
Survey Protocol ◽  
Survey Approach ◽  
Soil And Water

Abstract Tobacco and cannabis product use can result in debris (a.k.a. litter) on the landscape, with implications to soil and water quality and thus potential impacts to ecosystems. More information is needed regarding how much debris exists on the landscape, such that the magnitude of potential associated environment problems can be quantified. Such information can raise awareness in the public about environmental hazards from tobacco and cannabis product use. The goal of this protocol is to quantify, via a timed survey approach, the tobacco and cannabis debris load (i.e. cigarette butts, cannabis or e-cigarette waste) at study sites. Multiple sites in a geographical location may be of interest for comparative analysis, for example sites used regularly by humans (e.g. trails, parking lots, around buildings, garbage cans) versus other sites that are suspected to have low human use. In any case, the same survey data sheet would be used (included with this protocol). Each survey will take 15 minutes per site to conduct. In the process of surveying, debris is collected and retained for later sorting, counting, and photographic documentation. The time to sort and count the collected debris will depend on the quantity and diversity of debris collected.

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