What Practice Issues Over 25 Years Most Interest Registered Dietitians? Survey and Interview Results

Dietetics has changed substantially; a mixed-methods project was undertaken to: (i) gauge interest in the profession history since 1993, (ii) identify preferred format(s), (iii) identify possible topics, and (iv) identify possible key informants. An online bilingual survey was conducted in 2018, with follow-up phone interviews among interested respondents. Survey content was organised as 12 major topics. Respondents were invited via a Dietitians of Canada (DC) newsletter, Facebook groups, and at the DC national conference. Survey data, including respondent-generated topics of interest and interview content, were descriptively analyzed. The online survey garnered 360 responses; 332 (92%) completed more than 10% of the survey and were interested in history. Detailed responses were analyzed (296 English; 36 French); 51 were interviewed. An online timeline was the most preferred format (79%). Review of the rise in technology and obesity, aging, supermarket registered dietitians (RDs), the local/organic movement, Practice-based Evidence in Nutrition (PEN), the changes in training models and scope of practice, public awareness of the profession, and advocacy and unique career paths were of most interest (≥ 50% of respondents). These results confirm interest in the recent history of the profession among RDs and provide guidance on preferred format and topics for further work.

Family Medicine and Emergency Redeployment: Unrealized Potential

Background and Objectives: Discussions of scope of practice among family physicians has become a crucial topic amidst the COVID-19 pandemic, coupled with new attention to residency training requirements. Family medicine has seen a gradual narrowing of practice due to a host of issues, including physician choice, expanding scope of practice from physician assistants and nurses, an increased emphasis on patient volume, clinical revenue, and residency training competency requirements. We sought to demonstrate the flexibility of the family medicine workforce as shown through their scopes of practice, and argue that this is indication of their potential for redeployment during emergencies. Methods: This study computes scopes of practice for 78,416 family physicians who treat Medicare beneficiaries. We used Evaluation and Management (E/M) codes in Medicare’s 2017 Part-B public use file to calculate volumes of services done across six sites of service per physician. We aggregated counts and proportions of physicians and the E/M services they provided across sites of practice to characterize scope, and performed a separate analysis on rural physicians. Results: The study found most family physicians practicing at a single site, namely, the ambulatory clinic. However, family physicians in rural areas, where need is greater, exhibit broader scope. This suggests that a significant number of family physicians have capacity for COVID-19 deployment into other settings, such as emergency rooms or hospitals. Conclusions: Family physicians are a potential resource for emergency redeployment, however the current breadth of scope for most family physicians is not aligned with current residency training requirements and raises questions about the future of family medicine scope of practice.

Use of research evidence varied in efforts to expand specific pharmacist autonomous prescriptive authority: an evaluation and recommendations to increase research utilization

Background An expanding body of literature shows that pharmacists’ interventions improve health outcomes and are cost-saving. However, diverse state regulations of pharmacists’ scope of practice create a discrepancy between what pharmacists are trained to do and what they legally can do. This study investigated how stakeholders utilized research evidence when developing expanded scope of practice policies in their respective states. Methods Using autonomous pharmacist prescriptive authority as a surrogate for general pharmacist scope of practice, a general policy document analysis was performed to understand the scope of practice landscape for pharmacists across the United States. Next, semi-structured interviews with policy-makers and pharmacy advocates were conducted to explore how the identified states in the policy document analysis utilized evidence during the policy-making process. Investigators analysed findings from the transcribed interviews through application of the SPIRIT Action Framework. Resulting codes were summarized across themes, and recommendations to researchers about increasing utilization of research evidence were crafted. Results Sixteen states with 27 autonomous pharmacist prescriptive authority policies were identified. Public health need and safety considerations motivated evidence engagement, while key considerations dictating utilization of research included perceptions of research, access to resources and experts, and the successful implementation of similar policy. Research evidence helped to advocate for and set terms for pharmacist prescribing. Barriers to research utilization include stakeholder opposition to pharmacist prescribing, inability to interpret research, and a lack of relevant evidence. Recommendations for researchers include investigating specific metrics to evaluate scope of practice policy, developing relationships between policy-makers and researchers, and leveraging pharmacy practice stakeholders. Conclusions Overall, alignment of researcher goals and legislative priorities, coupled with timely communication, may help to increase research evidence engagement in pharmacist scope of practice policy. By addressing these factors regarding research engagement identified in this study, researchers can increase evidence-based scope of practice, which can help to improve patient outcomes, contain costs, and provide pharmacists with the legal infrastructure to practise at the top of their license.

Who Will Take Care of Me?

Foreseeing the needs and availability of anaesthesiologists across Europe is a challenging task. This is influenced by different factors that include the composition of the workforce and the organization and structure of health services in every country. Some trends call for attention, such as changes in work patterns brought about by an ageing specialist population, the increasing numbers of women in anaesthesia, or cultural and societal shifts towards work-life balance. Anaesthesiology is a challenging specialty with an expanding scope of practice, requiring highly motivated professionals, frequent long work hours, and addressing stressful situations often. To ensure quality anaesthesia provision, the wellbeing of this diverse population of anaesthesiologists should be addressed. Achieving rational and flexible work hours, adequate compensation, and promotion of a workplace culture that fosters safety, motivation to learn, and equal opportunities for leadership or academia positions are challenges to be addressed to make sure that excellence in patient care is maintained.

Médicos de Família e Comunidade ou médicos da Estratégia Saúde da Família? / Family and Community doctors, or doctors from the Family Health strategy?

Em resposta à revisão integrativa “Papel do Médico de Família e Comunidade no Manejo da Hipertensão Arterial na Atenção Primaria à Saúde”, cumpre destacar que os médicos de família e comunidade constituem uma especialidade médica, enquanto os médicos da estratégia Saúde da Família constituem uma ocupação. Discute-se a não sobreposição entre as duas categorias no mercado de trabalho, e a distinção no que diz respeito ao escopo da prática, com ênfase na saúde mental.---Abstract: In response to the integrative review “Role of the Family and Community Doctor in theManagement of Hypertension in Primary Health Care”, it should be noted that family and communitydoctors are a medical specialty, while doctors of the Family Health strategy constitute an occupation. Itdiscusses the non-overlapping between the two categories in the labor market, and the distinctionregarding the scope of practice, with an emphasis on mental health.