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UK — National Confidential Inquiry into Suicide and Homicide by People with Mental Illness

March 27, 2015 Comments off

National Confidential Inquiry into Suicide and Homicide by People with Mental Illness
Source: University of Manchester

We found 18 deaths by suicide per year in in-patients under observation across the UK during 2006-12. We found that half of deaths examined occurred when checks were carried out by less experienced staff or agency staff who were unfamiliar with the patient. A common feature was that staff did not follow the observation plan because the ward was busy or poorly designed. We found that the current observation approach is not working safely enough. New models need to be developed and evaluated.

The Future of Home Health Care: Workshop Summary (2015)

March 26, 2015 Comments off

The Future of Home Health Care: Workshop Summary (2015)
Source: Institute of Medicine/National Research Council

Individuals with disabilities, chronic conditions, and functional impairments need a range of services and supports to keep living independently. However, there often is not a strong link between medical care provided in the home and the necessary social services and supports for independent living. Home health agencies and others are rising to the challenges of meeting the needs and demands of these populations to stay at home by exploring alternative models of care and payment approaches, the best use of their workforces, and technologies that can enhance independent living. All of these challenges and opportunities lead to the consideration of how home health care fits into the future health care system overall.

On September 30 and October 1, 2014, the Institute of Medicine and the National Research Council convened a public workshop on the future of home health care. The workshop brought together a spectrum of public and private stakeholders and thought leaders to improve understanding of the current role of Medicare home health care in supporting aging in place and in helping high-risk, chronically ill, and disabled Americans receive health care in their communities. Through presentations and discussion, participants explored the evolving role of Medicare home health care in caring for Americans in the future, including how to integrate Medicare home health care into new models for the delivery of care and the future health care marketplace. The workshop also considered the key policy reforms and investments in workforces, technologies, and research needed to leverage the value of home health care to support older Americans, and research priorities that can help clarify the value of home health care. This summary captures important points raised by the individual speakers and workshop participants.

Preparing for the inevitable: The path to physician success in a value-based world

March 23, 2015 Comments off

Preparing for the inevitable: The path to physician success in a value-based world
Source: Deloitte

The evolution of the U.S. health care system from volume- to value-based care (VBC) is under way, spurred by unsustainable costs, a push for improved outcomes, and the desire for more value for money spent. While this evolution impacts all health care stakeholders, VBC cannot work without the participation of physicians.

How are physicians faring in the inevitable shift to a value-based world? What resources, capabilities, and skills do they think could help put them on a path to success in VBC?

The Deloitte 2014 Survey of U.S. Physicians examines physicians’ current and expected levels of VBC engagement and what physicians feel they need to be more confident about their participation.

Building Skills in North and Central America: Barriers and Policy Options toward Harmonizing Qualifications in Nursing

March 16, 2015 Comments off

Building Skills in North and Central America: Barriers and Policy Options toward Harmonizing Qualifications in Nursing
Source: Migration Policy Institute

Amid aging populations and the growth of chronic diseases, the demand for skilled health-care professionals is on the rise in the three countries of North America. In the United States alone, an estimated 5.6 million vacancies for health-care professionals at all skill levels will open up between 2010 and 2020, and the numbers in Canada and Mexico tell a similar story. At the same time, the countries of Central America, particularly El Salvador and Guatemala, are facing a critical nurse shortage.

Thus far, regional approaches to increasing the supply of qualified nurses have been rare. One promising yet underexplored avenue is the harmonization of nurse qualifications across the region, a process by which countries that face similar health-care challenges work together to develop an understanding of one another’s training and education systems, identify gaps between these systems, and create strategies to bridge these gaps over time.

This report explores the policy implications, benefits, and challenges of harmonizing nursing qualifications in North America. The payoffs of such cooperation are substantial: it can decrease brain waste and deskilling among nurses, increase the quality of care in all countries involved, and expand opportunities for nurses to practice where their skills are needed and to take advantage of new job opportunities in medical tourism and tele-health. However, as the report discusses, policymakers and private-sector actors must first overcome a range of obstacles to harmonization. Challenges include differences among the countries involved in the educational requirements of entering into nursing programs, dispersal of decision-making power among a patchwork of institutions regulating the nursing profession, and administrative barriers to recognition of qualifications—the flurry of red tape that nurses must pass through to take up nursing again after moving across borders.

New Physician Workforce Projections Show the Doctor Shortage Remains Significant

March 5, 2015 Comments off

New Physician Workforce Projections Show the Doctor Shortage Remains Significant
Source: Association of American Medical Colleges

The nation will face a shortage of between 46,000-90,000 physicians by 2025, according to a report released today by the AAMC (Association of American Medical Colleges). The study, which is the first comprehensive national analysis that takes into account both demographics and recent changes to care delivery and payment methods, projects shortages in both primary and specialty care, with specialty shortages particularly acute.

Notes from the Field: Prevalence of Risk Factors for Suicide Among Veterinarians — United States, 2014

February 24, 2015 Comments off

Notes from the Field: Prevalence of Risk Factors for Suicide Among Veterinarians — United States, 2014
Source: Morbidity and Mortality Weekly Report (CDC)

Veterinarians are believed to be at increased risk for suicide compared with the general population. Few data on the occurrence of suicidal behavior and suicide risk factors among U.S. veterinarians are available. Veterinarians participating in two wellness summits held during September 2013 concluded that more research is needed on veterinarians and their mental health.

During July 1–October 20, 2014, an anonymous, Web-based questionnaire was made available through the Veterinary Information Network (VIN), an online community for veterinarians; VIN News Service; JAVMA News; and monthly e-mail messages to veterinarians in 49 states (Maine was excluded) and Puerto Rico sent through the state’s veterinary medical association, agriculture or livestock department, or health department. The questionnaire asked respondents about their experiences with depression and suicidal behavior, and included standardized questions from the Kessler-6 psychological distress scale that assesses for the presence of serious mental illness. Respondents with nonresponses were included in the denominators when calculating prevalence estimates.

Responses were received from 10,254 currently employed veterinarians (10.3% of all employed U.S. veterinarians). The most commonly reported age category was 30–39 years (28.8%), and 31.3% were male. Thirty-four percent reported practicing veterinary medicine for <10 years, 24.6% for 10–19 years, 21.6% for 20–29 years, and 19.8% for ≥30 years. Most (68.6%) respondents practiced small animal medicine, and 37.8% were practice owners. In comparison, 44.4% of U.S. veterinarians are male, and 66.6% practice small animal medicine exclusively.

Approximately 6.8% (95% confidence interval [CI] = 5.9%–7.7%) of male and 10.9% (CI = 10.2%–11.6%) of female respondents were characterized as having serious psychological distress based on the Kessler-6 psychological distress scale, compared with 3.5% of male and 4.4% of female U.S. adults, respectively (5). Since graduating from veterinary school, 24.5% and 36.7% (CIs = 23.0%–26.0%, 35.6%–37.8%) of male and female respondents reported experiencing depressive episodes, respectively, 14.4% and 19.1% (CIs = 13.2%–15.7%, 18.2%–20.0%) suicidal ideation, and 1.1% and 1.4% (CIs = 0.7%–1.5%, 1.2%–1.7%) suicide attempts. In comparison, male and female U.S. adults had a lower lifetime prevalence of depressive episodes (15.1% and 22.9%, respectively) and suicidal ideation (5.1% and 7.1%) but a higher prevalence of suicide attempts (1.6% and 3.0%).

The findings in this report are subject to at least two limitations. First, the small number of veterinarians who responded compared with the number of those potentially eligible increases the likelihood of nonresponse bias. Second, the possibility exists for social desirability bias. Both of these factors could lead to overestimation or underestimation of the actual prevalence of risk factors for suicide among U.S. veterinarians. Nevertheless, these data suggest that nearly one in 10 U.S. veterinarians might suffer from serious psychological distress and more than one in six might have experienced suicidal ideation since graduation. Additional data, particularly data from representative samples, are needed to further characterize the underlying risk factors for suicidal behavior among veterinarians and identify effective prevention methods.

Divorce among physicians and other healthcare professionals in the United States: analysis of census survey data

February 20, 2015 Comments off

Divorce among physicians and other healthcare professionals in the United States: analysis of census survey data
Source: British Medical Journal (BMJ)

Objectives
To estimate the prevalence and incidence of divorce among US physicians compared with other healthcare professionals, lawyers, and non-healthcare professionals, and to analyze factors associated with divorce among physicians.

Design
Retrospective analysis of nationally representative surveys conducted by the US census, 2008-13.

Setting
United States.

Participants
48 881 physicians, 10 086 dentists, 13 883 pharmacists, 159 044 nurses, 18 920 healthcare executives, 59 284 lawyers, and 6 339 310 other non-healthcare professionals.

Main outcome measures
Logistic models of divorce adjusted for age, sex, race, annual income, weekly hours worked, number of years since marriage, calendar year, and state of residence. Divorce outcomes included whether an individual had ever been divorced (divorce prevalence) or became divorced in the past year (divorce incidence).

Results
After adjustment for covariates, the probability of being ever divorced (or divorce prevalence) among physicians evaluated at the mean value of other covariates was 24.3% (95% confidence interval 23.8% to 24.8%); dentists, 25.2% (24.1% to 26.3%); pharmacists, 22.9% (22.0% to 23.8%); nurses, 33.0% (32.6% to 33.3%); healthcare executives, 30.9% (30.1% to 31.8%); lawyers, 26.9% (26.4% to 27.4%); and other non-healthcare professionals, 35.0% (34.9% to 35.1%). Similarly, physicians were less likely than those in most other occupations to divorce in the past year. In multivariable analysis among physicians, divorce prevalence was greater among women (odds ratio 1.51, 95% confidence interval 1.40 to 1.63). In analyses stratified by physician sex, greater weekly work hours were associated with increased divorce prevalence only for female physicians.

Conclusions
Divorce among physicians is less common than among non-healthcare workers and several health professions. Female physicians have a substantially higher prevalence of divorce than male physicians, which may be partly attributable to a differential effect of hours worked on divorce.

See also: Doctors and divorce (editorial)

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