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Assessing the educational needs of Canadian gastroenterologists and gastroenterology nurses: challenges to optimal care in Crohn's Disease.

https://arctichealth.org/en/permalink/ahliterature146668
Source
Can J Gastroenterol. 2009 Dec;23(12):805-10
Publication Type
Article
Date
Dec-2009
Author
Martin Dupuis
John K Marshall
Sean M Hayes
Kayla Cytryn
Suzanne Murray
Author Affiliation
AXDEV Group Inc, Brossard, Quebec J4W 3H2, Canada. dupuism@axdevgroup.com
Source
Can J Gastroenterol. 2009 Dec;23(12):805-10
Date
Dec-2009
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Canada
Communication
Continuity of Patient Care - organization & administration
Crohn Disease - diagnosis - therapy
Data Collection
Disease Progression
Female
Gastroenterology - education - organization & administration - standards
Health Knowledge, Attitudes, Practice
Humans
Male
Middle Aged
Needs Assessment
Nurse's Role
Nurse-Patient Relations
Patient compliance
Physician's Role
Physician-Patient Relations
Young Adult
Abstract
A national needs assessment of Canadian gastroenterologists and gastroenterology nurses was undertaken to determine the perceived and unperceived educational and performance barriers to caring for patients with Crohn's disease (CD).
A triangulated, mixed-method approach (qualitative and quantitative) was used to determine the nature and extent of knowledge gaps and barriers in the care of patients with CD.
Qualitative interviews were conducted with nine gastroenterologists, four gastroenterology nurses and nine patients with CD. Based on this exploratory research, a survey was designed and launched nationally (37 gastroenterologists, 36 gastroenterology nurses). Findings indicated that Canadian gastroenterologists and gastroenterology nurses lacked clarity regarding their roles and responsibilities across the continuum of CD care, and face communication gaps within the health care team, undermining their effectiveness. Gastroenterologists identified challenges in optimal diagnosis due to unclear testing and diagnostic criteria. They recognized knowledge gaps when treating patient subgroups and in prescribing biological therapies. Furthermore, gastroenterologists self-identified gaps in skill, knowledge, and confidence in monitoring disease progression and effectively assessing response to therapy. When managing patients with CD, gastroenterologists expressed challenges with patient issues outside their domain of medical expertise, particularly with the skills needed to facilitate effective patient communication and education that would enhance adherence to recommended treatments.
Educational initiatives should address diagnostic and treatment guidelines, as well as enhancement of clinical performance gaps in health care team processes and the patient-professional therapeutic relationship. To impact care and patient outcomes, these initiatives must be relevant to clinical practice settings and applicable to the practice context.
Notes
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PubMed ID
20011732 View in PubMed
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Atrial fibrillation care: challenges in clinical practice and educational needs assessment.

https://arctichealth.org/en/permalink/ahliterature136937
Source
Can J Cardiol. 2011 Jan-Feb;27(1):98-104
Publication Type
Conference/Meeting Material
Article
Author
Suzanne Murray
Patrice Lazure
Carolyn Pullen
Paule Maltais
Paul Dorian
Author Affiliation
AXDEV Group Inc., Brossard, Québec, Canada.
Source
Can J Cardiol. 2011 Jan-Feb;27(1):98-104
Language
English
Publication Type
Conference/Meeting Material
Article
Keywords
Adult
Anti-Arrhythmia Agents - adverse effects - therapeutic use
Atrial Fibrillation - diagnosis - etiology - therapy
Canada
Cardiology - education
Catheter Ablation
Clinical Competence
Curriculum
Data Collection
Diffusion of Innovation
Education, Medical, Continuing
Emergency Medicine - education
Evidence-Based Medicine
Family Practice - education
Female
Humans
Internal Medicine - education
Male
Middle Aged
Neurology - education
Practice Guidelines as Topic
Abstract
Current debates around the choice of management strategy for patients with atrial fibrillation (AF) combined with limited efficacy and frequent adverse effects of current pharmacotherapies cause uncertainty and confusion, challenging optimal care delivery to AF patients.
To determine gaps in knowledge, skill, and competencies of Canadian physicians caring for patients with AF as well as underlying causes of these gaps.
A mixed-method approach --consisting of qualitative (semistructured interviews) and quantitative data collection techniques (online survey) --was conducted. Findings were triangulated to ensure the reliability and trustworthiness of findings. The combined sample (n = 161) included 43 family physicians/general practitioners, 23 internal medicine specialists, 48 cardiologists, 28 emergency physicians, 14 neurologists, and 5 patients.
Gaps and barriers impeding optimal care were related to an unclear definition of AF, uncertainty of its pathophysiology, and knowledge gaps across the care continuum, including screening, diagnosis, and treatment. Clinical decision-making, individualized patient therapy, communication with patients and between professionals, and application of guidelines were found to be particularly challenging. These issues are discussed in the context of the newly revised Canadian Cardiovascular Society (CCS) AF Guidelines.
Educational gaps exist across the entire continuum of care. Results from this study, along with the 2011 CCS guidelines for AF management, provide direction for solutions through physician education and professional development.
Notes
Erratum In: Can J Cardiol. 2011 May-Jun;27(3):388
PubMed ID
21329867 View in PubMed
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Barriers to the implementation of practice guidelines in managing patients with nonvariceal upper gastrointestinal bleeding: A qualitative approach.

https://arctichealth.org/en/permalink/ahliterature143438
Source
Can J Gastroenterol. 2010 May;24(5):289-96
Publication Type
Article
Date
May-2010
Author
Sean M Hayes
Suzanne Murray
Martin Dupuis
Martin Dawes
Ian A Hawes
Alan N Barkun
Author Affiliation
AXDEV Group Inc, Brossard, Quebec. hayess@axdevgroup.com
Source
Can J Gastroenterol. 2010 May;24(5):289-96
Date
May-2010
Language
English
Publication Type
Article
Keywords
Canada
Gastrointestinal Hemorrhage - etiology - therapy
Guideline Adherence - utilization
Hemostatic Techniques - standards
Humans
Outcome Assessment (Health Care)
Practice Guidelines as Topic
Abstract
Guidelines for the management of patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) are inconsistently applied by health care providers, potentially resulting in suboptimal care and patient outcomes. A needs assessment was performed to assess health care providers' barriers to the implementation of these guidelines in Canada.
Semistructured telephone interviews were conducted by trained research personnel with 22 selectively sampled health care professionals actively treating and managing NVUGIB patients, including emergency room physicians (ER), intensivists (ICU), gastroenterologists (GI), gastroenterology nurses and hospital administrators. Participants were chosen from a representative sample of six Canadian community- and academic-based hospitals that participated in a national Canadian audit on the management of NVUGIB.
Participants reported substantive gaps in the implementation of NVUGIB guidelines that included the following: lack of knowledge of the specifics of the NVUGIB guidelines (ER, ICU, nurses); limited belief in the value of guidelines, especially in areas where evidence is lacking (ER, ICU); limited belief in the value of available tools to support implementation of guidelines (GI); lack of knowledge of the roles and responsibilities of health care professions and disciplines, and lack of effective collaboration skills (ER, ICU and GI); variability of knowledge and skills of health care professionals within professions (eg, variability of nurses' knowledge and skills in endoscopic procedures); and perceived overuse of intravenous proton pump inhibitor treatment, with limited concern regarding cost or side effect implications (all participants).
In the present study population, ER, ICU and nurses did not adhere to NVUGIB guidelines because they were neither aware of nor familiar with them, whereas the GI lack of adherence to NVUGIB guidelines was influenced more by attitudinal and contextual barriers. These findings can guide the design of multifaceted educational and behavioural interventions when attempting to effectively disseminate existing guidelines, and for guideline implementation into practice.
Notes
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PubMed ID
20485702 View in PubMed
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Community group practices in Canada: are they ready to reform their practice?

https://arctichealth.org/en/permalink/ahliterature156891
Source
J Contin Educ Health Prof. 2008;28(2):73-8
Publication Type
Article
Date
2008
Author
Suzanne Murray
Ivan Silver
Dilip Patel
Martin Dupuis
Sean M Hayes
Dave Davis
Author Affiliation
AXDEV Group International, Brossard, Québec, Canada. murrays@axdevgroup.com
Source
J Contin Educ Health Prof. 2008;28(2):73-8
Date
2008
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Canada
Community Health Services - organization & administration
Female
Group Practice - organization & administration
Health Care Reform
Humans
Male
Patient Care Team - organization & administration
Primary Health Care - organization & administration
Abstract
Governments and healthcare organizations in Canada are reforming the clinical practice structures and policies to deliver primary care to the population. A key component of primary healthcare reform is the establishment of an interdisciplinary, community-based team approach to patient care. This study was undertaken to provide in-depth insight regarding primary healthcare providers' beliefs and attitudes in regard to their current group practice, what changes they believe are occurring and those necessary to reform group practice settings, their willingness to embrace changes, and the challenges they face to realize the proposed reform.
This study employed a mixed-method research design (qualitative and quantitative data collection techniques) through day-long focus groups of primary healthcare professionals (eg, family physicians, specialists, dieticians, psychologists) from across Canada.
There is considerable variation in the composition of primary care group practices across Canada. Respondents report that group practices are little more than an economic convenience to facilitate sharing of resources. Even when a practice is composed of several disciplines, there is little to no organized or systematic interaction among healthcare professionals aimed at improving patient care, lack of clarity as to identified leaders/managers of the team, and inconsistencies in the model of care provided to patients. However, there is a perception of value and benefit in working in a cohesive group practice to improve patient care.
Findings revealed that although healthcare providers report themselves ready to make the necessary changes and willing to move to interdisciplinary team-based practices, there are substantive challenges that impede a movement to truly effective interdisciplinary team practice and functioning. These challenges include the type and allocation of funding, interprofessional healthcare provider education, changing the healthcare provision model, and barriers among healthcare professionals regarding shared and equitable team accountability for patient health outcomes.
PubMed ID
18521875 View in PubMed
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