Journal of evaluation in clinical practice
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Providing high-quality primary care in patient-centred medical homes (PCMHa) requires competencies that can only be provided by interprofessional (IP) education. The benefits of collaborative training have been documented for learners, but less is known about the perceptions of the clinical professionals who train the learners or the patients receiving IP primary care. This investigation compared stakeholder attitudes about IP education, training, and providing collaborative care prior to developing a new IP training programme. ⋯ This is the first reported data comparing perceptions about IP training and care across these three stakeholder groups. Results suggest the need to clarify scope of practice, define professional roles, and bridge gaps between teaching PCMH principles and subsequently providing high-quality health care. Results inform faculty development needs in learning ways to train learners across professions and outline ways to structure interactions with patients.
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Primary health care often has overall responsibility for elderly patients and their medication treatment. This is a challenging task due to the issue of multiple caregivers, different systems for documentation and multimorbidity among the elderly. The multiprofessional project SÄKLÄK2 was developed to raise drug safety in Swedish primary health care, and this study aimed to assess whether the action agreements that emerged from the model were effective enough to potentially improve drug use in elderly patients. ⋯ The SÄKLÄK2 intervention model is considered effective in setting up a variety of relevant measures to improve drug safety in primary health care, which are possible to implement in the near future. Hence, the model is regarded as effective and should therefore be offered in a wider context.
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Competency-based medical education (CBME) has gained momentum as an improved training model, but literature on outcomes of CBME, including evaluation of implementation processes, is minimal. We present a case for the following: (a) the development of a program theory is essential prior to or in the initial stages of implementation of CBME; (b) the program theory should guide the strategies and methods for evaluation that will answer questions about anticipated and unintended outcomes; and (c) the iterative process of testing assumptions and hypotheses will lead to modifications to the program theory to inform best practices of implementing CBME. ⋯ Deliberately pairing evaluation alongside change is an important activity and, when accomplished, yields valuable information from the experiences of those implementing and experiencing a program. Evaluation and the development of an updated program theory facilitate the introduction of new changes and theories that build on these findings, which also supports the desired goal of contributing toward cumulative science rather than "reinventing the wheel."
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This paper explores the economic value of rehabilitation to South Africa, using a costed example of cerebrovascular accident (CVA) (stroke) rehabilitation. ⋯ The value of rehabilitation should not be considered in terms of cost-effectiveness alone, but also as an investment for the country. A staged, prioritized approach should be considered in future South African national health budget.
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Background This article responds to one by Graham Martin and colleagues, who offered a critique of my previous publications on face coverings for the lay public in the Covid-19 pandemic. Their paper reflects criticisms that have been made of face coverings policies more generally. Method Narrative rebuttal. ⋯ I challenge my critics' apparent assumption that a particular kind of systematic review should be valorised over narrative and real-world evidence, since stories are crucial to both our scientific understanding and our moral imagination. Conclusion I conclude by thanking my academic adversaries for the intellectual sparring match, but exhort them to remember our professional accountability to a society in crisis. It is time to lay straw men to rest and embrace the full range of evidence in the context of the perilous threat the world is now facing.