More physicians are not the answer

Levine's Conservation Model: A Framework for Advanced Gerontology Nursing Practice

PURPOSE

Growing numbers of older adults place increased demands on already burdened healthcare systems. The cost of managing chronic illnesses mandates greater emphasis on management and prevention. This article explores the adaptation of Levine's Conservation Model as a structure for providing care to the older adult by the adult-gerontology primary care nurse practitioner (AGNP).

CONCLUSION

The AGNP role, designed to provide quality care to adult and older adult populations, offers the opportunity to not only manage health care of the elderly, but to also advocate, lead in collaborative care efforts, conduct advanced planning, and manage and negotiate health delivery systems. The use of nursing models can foster the design of effective interventions that promote health of the older adult, particularly in the long-term care environment.

PRACTICE IMPLICATION

Levine's Conservation Model provides a useful structure for older adult care in the long-term care setting. As an ideal care manager, the AGNP would be well served to consider use of the model to guide advanced nursing practice. Recommendations for clinical practice, research, and health policy.

Medical guidelines, physician density, and quality of care: evidence from German SHARE data

We use German SHARE data to study the relationship between district general practitioner density and the quality of preventive care provided to older adults. We measure physician quality of care as the degree of adherence to medical guidelines (for the management of risk factors for cardiovascular disease and the prevention of falls) as reported by patients. Contrary to theoretical expectations, we find only weak and insignificant effects of physician density on quality of care. Our results shed doubt on the notion that increasing physician supply will increase the quality of care provided in Germany's present health care system.

A randomized controlled trial of team-based care: impact of physician-pharmacist collaboration on uncontrolled hypertension

OBJECTIVE

Evaluate the effectiveness of collaborative management of hypertension by primary care-pharmacist teams in community-based clinics.

STUDY DESIGN

A 12-month prospective, single-blind, randomized, controlled trial in the Providence Primary Care Research Network of patients with hypertension and uncontrolled blood pressure.

METHODS

As compared to usual primary care, intervention consisted of pharmacy practitioners participating in the active management of hypertension in the primary care office according to established collaborative treatment protocols. At baseline, there was no significant difference in blood pressure between groups. Primary outcome measures were the differences in mean systolic and diastolic blood pressures between arms at study end. Secondary measures included blood pressure goal attainment (<140/90 mmHg), hypertension-related knowledge, medication adherence, home blood pressure monitoring, resource utilization, quality of life, and satisfaction.

RESULTS

A total of 463 subjects were enrolled (n = 233 control, n = 230 intervention). Subjects receiving the intervention achieved significantly lower systolic (p = 0.007) and diastolic (p = 0.002) blood pressures compared to control (137/75 mmHg vs. 143/78 mmHg). In addition, 62% of intervention subjects achieved target blood pressure compared to 44% of control subjects (p = 0.003). The intervention group received more total office visits (7.2 vs. 4.9, p < 0.0001), however had fewer physician visits (3.2 vs. 4.7, p < 0.0001) compared to control. Intervention subjects were prescribed more antihypertensive medications (2.7 vs. 2.4, p = 0.02), but did not take more antihypertensive pills per day (2.4 vs. 2.5, p = 0.87). There were minimal differences between groups in hypertension-related knowledge, medication adherence, quality of life, or satisfaction.

CONCLUSIONS

Patients randomized to collaborative primary care-pharmacist hypertension management achieved significantly better blood pressure control compared to usual care with no difference in quality of life or satisfaction.

Restriction of duty hours for residents in internal medicine: a question of quality of life but what about education and patient safety?

Like in other medical specialities, training in internal medicine is confronted with the duty hours regulation. A reduction to a maximum of 48 duty hours has been introduced in Belgium in 1999 for all residents and is still under debate in the European Communities. A reduction of duty hours to a maximum of 80 hours per week was recently adopted in the USA. Several surveys were conducted in this country before and after the introduction of the new system to evaluate its impact on training and patient care. A reduction of duty hours appears to improve the mental health and the security and the quality of life of the trainees. On the other hand, it is suspected that reducing training hours can have a negative effect not only on education but also on patient safety and satisfaction giving the fragmentation of care. This appears to be a key problem, particularly in internal medicine, as it implies more frequent transfers of medical information, a source of medical errors and a loss of responsibility.

A Profile of Colorado Nurse—Midwives

Nurse—midwives provide significant health care to underserved and vulnerable women, yet there is limited information about the nature of nurse—midwifery practices and compensation for services. This study reports the results of a Colorado statewide survey of nurse—midwives ( N = 217). Electronic survey was utilized to detail practice in seven areas: demographics, type of practice, compensation, leadership, legislativep riorities,teaching involvement, and practice satisfaction. Responses( N = 114) were analyzed using SPSS 13.0. Results found wide variation in compensation and practice types. Respondents largely worked in urban settings, cared for low to moderate risk patients, and were generally older and White. Restriction from medical staffm membership, prescriptive authority constraints, and liability issues were practice limitations. While teaching a wide variety of learners, nurse—midwives do limited mentoring of nurse—midwifery students, a finding which is concerning given the decreasing numbers of nurse—midwives. Findings are compared to known national data, with implications for the provision of health care services detailed.