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"Mid Level Provider"

Eilish McAuliffe, Marie Galligan, Paul Revill, Francis Kamwendo, Mohsin Sidat, Honorati Masanja, Helen de Pinho, Edson Araujo
BACKGROUND: Task shifting from established health professionals to mid-level providers (MLPs) (professionals who undergo shorter training in specific procedures) is one key strategy for reducing maternal and neonatal deaths. This has resulted in a growth in cadre types providing obstetric care in low and middle-income countries. Little is known about the relative importance of the different factors in determining motivation and retention amongst these cadres. METHODS: This paper presents findings from large sample (1972 respondents) discrete choice experiments to examine the employment preferences of obstetric care workers across three east African countries...
December 20, 2016: Globalization and Health
Amy Sims Sanyahumbi, Craig A Sable, Melissa Karlsten, Mina C Hosseinipour, Peter N Kazembe, Charles G Minard, Daniel J Penny
BACKGROUND: Echocardiographic screening for rheumatic heart disease in asymptomatic children may result in early diagnosis and prevent progression. Physician-led screening is not feasible in Malawi. Task shifting to mid-level providers such as clinical officers may enable more widespread screening. Hypothesis With short-course training, clinical officers can accurately screen for rheumatic heart disease using focussed echocardiography. METHODS: A total of eight clinical officers completed three half-days of didactics and 2 days of hands-on echocardiography training...
December 19, 2016: Cardiology in the Young
Richard Ehrlichman, Zachary Dezman, Joel Klein, Jean Jeudy, Daniel Lemkin
BACKGROUND: Computed tomography (CT) is a useful and necessary part of many emergency department (ED) assessments. However, the costs of imaging and the health risks associated with radiation exposure have sparked national efforts to reduce CT ordering in EDs. STUDY OBJECTIVE: We analyzed CT ordering habits prior to and following implementation of a feedback tool at a community hospital. METHODS: In this intervention study, we identified the CT-ordering habits of physicians and mid-level care providers (physician assistants and nurse practitioners) at baseline and after implementation of a system that sent quarterly feedback reports comparing their ordering habits with those of their peers...
December 9, 2016: Journal of Emergency Medicine
Philip B Cawkwell, Lily Lee, Jenni Shearston, Scott E Sherman, Michael Weitzman
INTRODUCTION: There has been a sharp decline in adolescents who smoke cigarettes but no national-level study evaluating the impact of smoking cessation counseling by pediatricians or other clinicians who care for children. METHODS: Combined data from ambulatory portions of the National Hospital Ambulatory Care Survey and National Ambulatory Medical Care Survey from 1997-1999 and 2009-2011 were analyzed to determine changes in the frequency of pediatric visits that included clinician-reported tobacco counseling and how such counseling varied by child, family, and clinician characteristics...
November 2016: Nicotine & Tobacco Research: Official Journal of the Society for Research on Nicotine and Tobacco
Njoki Ng'ang'a, Mary Woods Byrne, Margaret E Kruk, Aloisia Shemdoe, Helen de Pinho
BACKGROUND: In sub-Saharan Africa, the capacity of human resources for health (HRH) managers to create positive practice environments that enable motivated, productive, and high-performing HRH is weak. We implemented a unique approach to examining HRH management practices by comparing perspectives offered by mid-level providers (MLPs) of emergency obstetric care (EmOC) in Tanzania to those presented by local health authorities, known as council health management teams (CHMTs). METHODS: This study was guided by the basic strategic human resources management (SHRM) component model...
2016: Human Resources for Health
David A Nelson, Leslie A Ruffalo, Alexandra J Dyer, Karen H Nelson
OBJECTIVES: The prevalence of overweight and obese individuals in the United States is growing, and primary health care represents a setting in which providers may address weight with their patients. However, many providers and medical trainees feel ill-prepared to address the full scope of complexities associated with weight loss. This study sought to investigate patients' perceptions of the barriers and facilitators they encountered in their weight loss journeys. The results of the mixed-methods study will be used to inform a better understanding among providers and medical students of how to address weight loss with their patients...
May 2016: International Journal of Psychiatry in Medicine
Hangsheng Liu, Michael Robbins, Ateev Mehrotra, David Auerbach, Brandi E Robinson, Lee F Cromwell, Douglas W Roblin
BACKGROUND: There has been concern that greater use of nurse practitioners (NP) and physician assistants (PA) in face-to-face primary care may increase utilization and spending. OBJECTIVE: To evaluate a natural experiment within Kaiser Permanente in Georgia in the use of NP/PA in primary care. STUDY DESIGN: From 2006 through early 2008 (the preperiod), each NP or PA was paired with a physician to manage a patient panel. In early 2008, NPs and PAs were removed from all face-to-face primary care...
January 2017: Medical Care
Joseph Arthur, Sriram Yennurajalingam, Janet Williams, Kimberson Tanco, Diane Liu, Saneese Stephen, Eduardo Bruera
BACKGROUND: A question prompt sheet (QPS) is a structured list of potential questions available for patients to ask their doctor during a clinical encounter. Although it has been shown to improve physician-patient interaction during clinical consultations, there is paucity of data on its use in the palliative care setting. The aim of this study was to develop a single-page consensus list of prompt questions for use by patients attending outpatient palliative care. METHOD: An expert group of experienced physicians and mid-level providers were invited to participate in the study conducted in three Delphi rounds...
August 2016: Journal of Palliative Medicine
Kerri Leyda Nicoll, Elizabeth Phillips, H Luke Shaefer, Teague Simoncic
PURPOSE: The purpose of this study was to explore low-income parents' perceptions of oral health and of mid-level dental providers as a means of improving access to care. As states increasingly consider adding mid-level providers to the dental workforce, understanding the views of potential patients toward such providers is important, since the success of this strategy will depend, in part, upon the willingness of potential patients to be treated by them. METHODS: Because little is known about the social acceptability of mid-level dental providers, the researchers employed a qualitative methodology, conducting in-depth interviews with 20 low-income parents in order to assess their perceptions of oral health, access to and need for dental care, and potential acceptance of mid-level dental providers...
April 2016: Journal of Dental Hygiene: JDH
Therese McGinn, Sara E Casey
BACKGROUND: Although sexual and reproductive health services have become more available in humanitarian settings over the last decade, safe abortion services are still rarely provided. The authors' observations suggest that four reasons are typically given for this gap: 'There's no need'; 'Abortion is too complicated to provide in crises'; 'Donors don't fund abortion services'; and 'Abortion is illegal'. DISCUSSION: However, each of these reasons is based on false premises...
2016: Conflict and Health
Syed Khurram Azmat, Waqas Hameed, Hasan Bin Hamza, Ghulam Mustafa, Muhammad Ishaque, Ghazunfer Abbas, Omar Farooq Khan, Jamshaid Asghar, Erik Munroe, Safdar Ali, Wajahat Hussain, Sajid Ali, Aftab Ahmed, Moazzam Ali, Marleen Temmerman
BACKGROUND: Family planning (FP) interventions aimed at reducing population growth have negligible during the last two decades in Pakistan. Innovative FP interventions that help reduce the growing population burden are the need of the hour. Marie Stopes Society--Pakistan implemented an operational research project--'Evidence for Innovating to Save Lives', to explore effective and viable intervention models that can promote healthy timing and spacing of pregnancy in rural and under-served communities of Sindh, Punjab and Khyber Pakhtunkhwa provinces of Pakistan...
March 17, 2016: Reproductive Health
Tiziana Leone, Ernestina Coast, Divya Parmar, Bellington Vwalika
Zambia has one of the most liberal abortion laws in sub-Saharan Africa. However, rates of unsafe abortion remain high with negative health and economic consequences. Little is known about the economic burden on women of abortion care-seeking in low income countries. The majority of studies focus on direct costs (e.g. hospital fees). This article estimates the individual-level economic burden of safe and unsafe abortion care-seeking in Zambia, incorporating all indirect and direct costs. It uses data collected in 2013 from a tertiary hospital in Lusaka, (n = 112) with women who had an abortion...
September 2016: Health Policy and Planning
Waqas Hameed, Syed Khurram Azmat, Muhammad Ishaque, Wajahat Hussain, Erik Munroe, Ghulam Mustafa, Omar Farooq Khan, Ghazunfer Abbas, Safdar Ali, Qaiser Jamshaid Asghar, Sajid Ali, Aftab Ahmed, Hasan Bin Hamza
BACKGROUND: Long-acting reversible contraceptives, such as the intrauterine device (IUD), remain underutilised in Pakistan with high discontinuation rates. Based on a 24-month prospective client follow-up (nested within a larger quasi-experimental study), this paper presents the comparison of two intervention models, one using private mid-level providers branded as "Suraj" and the other using community midwives (CMWs) of Maternal Newborn and Child Health Programme, for method continuation among IUD users...
November 25, 2015: Health Research Policy and Systems
Mark A Strom, Jonathan I Silverberg
INTRODUCTION: Chronic disease is a barrier to delivery of preventive health care and health maintenance. However, health behaviors of adults and children with eczema, a chronic skin disorder, have not been examined. This study examined associations of eczema with vaccination, disease screening, health maintenance, and healthcare utilization. METHODS: This study investigated 34,613 adults and 13,298 children from the 2012 National Health Interview Survey, a prospective questionnaire-based study...
February 2016: American Journal of Preventive Medicine
Channa R Jayasekera, Ryan B Perumpail, David T Chao, Edward A Pham, Avin Aggarwal, Robert J Wong, Aijaz Ahmed
BACKGROUND: Despite the availability of safe and effective direct-acting antiviral drugs (DAAs), the vast majority of patients with chronic hepatitis C (HCV) in the USA remain untreated, in part due to lack of access to specialist providers. AIMS: To determine the effectiveness of DAA-based treatment in medically underserved areas in California, in a healthcare model dependent on task-shifting--wherein a visiting hepatologist assesses patients for treatment eligibility, but subsequent routine follow-up evaluation of patients prescribed treatment is devolved to a part-time licensed vocational nurse under remote supervision of the hepatologist...
December 2015: Digestive Diseases and Sciences
Jessica Langsjoen, Cara Goodell, Eduardo Castro, Jen Thomas, Thomas J Kuehl, Hania Wehbe-Janek, Meghan Hinskey
Current cervical cancer screening guidelines for the care of healthy women include HPV cotesting with all Papanicolaou (Pap) smears after the age of 30. To improve compliance with current guidelines, we instituted two processes: first, simplifying the ordering process to a single order for Pap smear plus HPV cotesting using an electronic medical record system (EMR); and second, providing education for clinic staff. Baseline and postintervention data were collected by retrospective chart review. Patients were selected during three intervals: prior to the transition to Epic EMR, after the transition to Epic, and after an educational intervention...
October 2015: Proceedings of the Baylor University Medical Center
Marleen H Lovink, Anke Persoon, Anneke J A H van Vught, Raymond T C M Koopmans, Lisette Schoonhoven, Miranda G H Laurant
AIM: This protocol describes a systematic review that evaluates the effects of physician substitution by mid-level providers (nurse practitioners, physician assistants or nurses) in primary healthcare for older people and long-term care facilities. The secondary aim is to describe facilitators and barriers to the implementation of physician substitution in these settings. BACKGROUND: Healthcare for older people is undergoing major changes, due to population ageing and reforms that shift care to the community...
December 2015: Journal of Advanced Nursing
Kristina L Wanyonyi, David R Radford, Paul R Harper, Jennifer E Gallagher
BACKGROUND: In primary care dentistry, strategies to reconfigure the traditional boundaries of various dental professional groups by task sharing and role substitution have been encouraged in order to meet changing oral health needs. AIM: The aim of this research was to investigate the potential for skill mix use in primary dental care in England based on the undergraduate training experience in a primary care team training centre for dentists and mid-level dental providers...
2015: Human Resources for Health
Benjamin R Doolittle, Daniel Tobin, Inginia Genao, Matthew Ellman, Christopher Ruser, Rebecca Brienza
BACKGROUND: In recent years, physician groups, government agencies and third party payers in the United States of America have promoted a Patient-centered Medical Home (PCMH) model that fosters a team-based approach to primary care. Advocates highlight the model's collaborative approach where physicians, mid-level providers, nurses and other health care personnel coordinate their efforts with an aim for high-quality, efficient care. Early studies show improvement in quality measures, reduction in emergency room visits and cost savings...
January 2015: Education for Health: Change in Training & Practice
Stephen H Thomas, Shannon Mumma, Amanda Satterwhite, Tyler Haas, Annette O Arthur, Knox H Todd, Sharon Mace, Deborah B Diercks, Charles V Pollack
BACKGROUND: Effective, appropriate, and safe opioid analgesia administration in the Emergency Department (ED) is a complex issue, with risks of both over- and underutilization of medications. OBJECTIVE: To assess for possible association between practitioner status (physician [MD] vs. mid-level provider [MLP]) and use of opioids for in-ED treatment of musculoskeletal pain (MSP). METHODS: This was a secondary, hypothesis-generating analysis of a subset of subjects who had ED analgesia noted as part of entry into a prospective registry trial of outpatient analgesia...
October 2015: Journal of Emergency Medicine
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