Search

\nKey pointsInsomnia is one of the most prevalent sleep disorders in Australia, estimated to affect up to 25% of the population. Psychologists provide the gold-standard intervention for insomnia, Cognitive Behaviour Therapy for Insomnia (CBTi), however 90% of general practice consultations for insomnia result in a medication being prescribed. The current scope of practice for Australian psychologists does not include providing consultation or management of pharmacotherapies, preventing them from tapering and ceasing patients’ hypnotic medications once they are receiving behavioural sleep medicine intervention. Despite its low-risk profile, current scope also prevents psychologists from prescribing and advising on optimum timing of melatonin as a sleep phase shifting agent in circadian rhythm disorders. Whilst a growing number of US states have enacted psychologist psychopharmacology authority (RxP), and the UK is rapidly expanding non-medical prescribers, pharmacotherapy models of care for psychology have yet to be trialled in Australia. This paper outlines the rationale for limited RxP in an Australian hospital outpatient behavioural sleep medicine setting – the ExPEDiTe Sleep project (Expanding psychology scope of practice for Pharmacotherapies Emphasising Deprescribing during behavioural Treatment of Sleep).What is already known about this topic: Current scope of practice for Australian psychologists does not permit prescribing, deprescribing, or managing pharmacotherapies.Psychologist prescribing (RxP) has now been implemented in seven states of the USA following postdoctoral training in clinical psychopharmacology.Queensland law permits expanded scope of practice pharmacotherapy models of care for allied health professionals under research frameworks or extended practice authorities.Current scope of practice for Australian psychologists does not permit prescribing, deprescribing, or managing pharmacotherapies.Psychologist prescribing (RxP) has now been implemented in seven states of the USA following postdoctoral training in clinical psychopharmacology.Queensland law permits expanded scope of practice pharmacotherapy models of care for allied health professionals under research frameworks or extended practice authorities.What this topic adds: Psychologists being unable to advise on tapering and ceasing hypnotic medications or to prescribe melatonin compounds delays for patients and adds additional medical occasions of service.A limited sleep psychology pharmacotherapy scope has the potential to optimise patient outcomes and value in healthcare.ExPEDiTe Sleep is the first project to articulate a model of care for expanded psychologist scope of practice for pharmacotherapies in Australia.Psychologists being unable to advise on tapering and ceasing hypnotic medications or to prescribe melatonin compounds delays for patients and adds additional medical occasions of service.A limited sleep psychology pharmacotherapy scope has the potential to optimise patient outcomes and value in healthcare.ExPEDiTe Sleep is the first project to articulate a model of care for expanded psychologist scope of practice for pharmacotherapies in Australia. [ABSTRACT FROM AUTHOR]

Copyright of Medizinische Klinik: Intensivmedizin & Notfallmedizin is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Policymakers aiming to increase access to health care while simultaneously keeping costs low and quality high are considering expanding the practice authority and prescriptive authority of nurse practitioners in order to address primary care shortages. While we know this increases access, some researchers argue that the expansion of job autonomy of nurse practitioners can compromise the quality and safety of rendered medical services. This paper investigates quality and safety outcomes in prescribing behaviors of nurse practitioners who have prescribed opioids for Medicare Part D beneficiaries using a unique source of policy variation, nurse practitioners with the ability to prescribe medication who move to either states with or without physician supervision. We find that scope of practice expansions do not compromise quality and safety in terms of potential abuse or misuse of prescriptive authority. [ABSTRACT FROM AUTHOR]

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Nursing care delivery models influence nursing workload. Problem: Poorly designed nursing workforce models may lead to lack of satisfaction in practice, inability to recruit staff, and nursing turnover. Approach: This paper describes a process that our team undertook to evaluate one nursing unit's nursing care delivery model and provides a recommendation for a nursing workforce model that ensures practice to top of scope while maintaining a balanced workload. Team brainstorming and affinity diagramming tools were used. Outcomes: The team findings resulted in a recommendation for an innovative care-based nursing model pilot. Conclusions: The use of brainstorming and affinity diagramming is an effective method for identifying opportunities to improve a nursing workforce model. [ABSTRACT FROM AUTHOR]

Practicing speech-language pathologists and graduate students identify a need for counseling training but feel unprepared to implement counseling in everyday practice. Within speech-language pathology, there is a dearth of evidence about best teaching practices for counseling. The current investigation examines the collaborative counseling program, which involves hands-on training with authentic clients with communication disorders. Thirty-six students across two cohorts participated in this study. Students composed individual reflections after each collaborative counseling session. Each cohort also participated in oral debriefings after each session. Reflections and debriefing transcripts were analyzed qualitatively through open and axial coding via micro and macro analyses. Micro analysis of individual reflections resulted in six overarching domains, 12 themes and numerous subthemes. Macro analysis of group and individual reflections resulted in three overarching themes: the learner's state of being, client's state of being, and skill development. Students gained confidence and efficacy in the ability to implement counseling and motivational interviewing techniques in authentic counseling interactions. They learned the value of exploring client values, perspectives, and how to capture this through notes that scaffold their ability to implement person-centered techniques. They also learned numerous counseling techniques and skills that they strengthened through repeated practice opportunities and feedback. [ABSTRACT FROM AUTHOR]

We explore the labor market effects of state‐level scope of practice (SOP) reform for nurse practitioners that grants full practice authority (FPA) on the earnings and labor supply decisions of physicians and nurse practitioners. We employ a difference‐in‐differences research design using data from the American Community Survey between 2010 and 2019 to find that SOP laws granting FPA increase earnings of nurse practitioners and have some impacts on their labor supply. However, we find no effects on the earnings of physicians. To examine mechanisms, we use aggregated Medicare data from the Dartmouth Atlas to show no change on physician reimbursements. [ABSTRACT FROM AUTHOR]

Scope of practice is a phrase used to describe the types of services that can be performed by non‐physician healthcare providers. In the United States, the range of services a practitioner may offer is not determined by representatives of the profession, but instead through a state‐level legislative process. Researchers in this space have focused on understanding the effects of these state policies on the accessibility, quality, and cost‐effectiveness of healthcare for patients. As the physician shortage grows, understanding areas where non‐physician providers can bridge this care gap presents potential solutions to healthcare barriers. This introduction outlines the themes of the issue, what has been done in the literature, what is yet to be done, and the current conversation within state and federal legislatures. [ABSTRACT FROM AUTHOR]

Public safety is often used as an argument against expanding scope of practice (SOP) for nurse practitioners, despite the benefit of filling unmet health care demand. As a response to the COVID‐19 Pandemic, some states expanded SOP for nurse practitioners to accommodate the unprecedented healthcare challenge. We analyze the effect of the expansion of SOP on daily COVID‐19‐related mortality, exploiting the quasi‐random state policy changes at the beginning of the COVID‐19 pandemic. Checking different model specifications, we do not find evidence that expanding SOP for nurse practitioners during the pandemic causes adverse effects on patients measured by COVID‐19 mortality. [ABSTRACT FROM AUTHOR]

I evaluate whether nurse practitioners (NPs) and physician assistants (PAs) change how they practice when states relax the scope‐of‐practice laws governing these professions. I find little evidence that NPs or PAs begin providing specialty services following relaxation. Some evidence suggests that NPs specialize more in rural areas following the relaxation of scope‐of‐practice laws, but no indication that they do so generally. Overall, the evidence developed here suggests that NPs and PAs do not change how they care for patients following the relaxation of scope‐of‐practice laws, undermining patient safety arguments along these lines. [ABSTRACT FROM AUTHOR]

Type 2 Diabetes mellitus patients require regular monitoring and preventive care from healthcare professionals to avoid costly and potentially life‐threatening complications. One approach for expanding access to primary care for diabetic patients is to change scope of practice laws for nurse practitioners to allow full practice authority (FPA). We find that state‐level implementation of FPA reduces total health care costs for diabetics by approximately 20% in urban areas and reduces rural usage of advanced medical services for diabetics by about 10%. However, we see no effects of FPA on primary care claims, high A1c tests, or diabetic debridements. [ABSTRACT FROM AUTHOR]

We examine how the emergence of optometrists as new "eye doctors" affected population eye health outcomes and optometrist earnings in the United States. Using the staggered adoption of optometrist prescription authority across states, we find suggestive evidence that optometrist scope of practice expansion reduced vision impairment and mitigated racial and ethnic disparities in eye health. We also find that the policy is associated with an increase in hourly wages among optometrists who are not self‐employed. These findings imply that allowing optometrists to use medications for eye treatments effectively expanded the primary eye care workforce and therefore improved public eye health. [ABSTRACT FROM AUTHOR]

The prescription‐privileges movement has advocated for state laws enabling trained psychologists to prescribe psychotropic medication. We examine the impact of these laws on healthcare access and outcomes. Using staggered difference‐in‐differences analysis and Data Axle data, we estimate the number of new mental health establishments per 100,000 people after policy implementation. Using CDC data, we analyze the policy's impact on suicide rates. We find the policy increased the number of psychology and counseling practices without decreasing the number of psychiatric practices, implying that these practices are complements rather than substitutes. Quality held steady, with no notable change in the suicide rate. [ABSTRACT FROM AUTHOR]

Background: Obesity and being overweight can hinder participation in daily activities and impact engagement. Occupational therapists offer a unique perspective on this issue, yet their practice is seldom described in the literature. Aim: To explore how Australian occupational therapists use their occupational perspective when working with people who are obese or overweight. Methods: A qualitative dominant crossover mixed methods approach was adopted. Eleven semi-structured interviews with occupational therapists were conducted and analysed. Questions explored clinical decision-making, barriers, facilitators, and therapist knowledge and confidence about working with these clients. Three Likert scale questions on client contact frequency, perceived intervention effectiveness and knowledge of weight-related occupational therapy provided contextualisation. Results: Occupational therapists reported average confidence and variability in the effectiveness of weight-related interventions. Three key themes were identified: 1) Exploring clients' needs for weight management; 2) Incorporating weight management strategies in occupational therapy intervention; and 3) Organisation of current occupational therapy practice for people with obesity. Conclusion: Occupational therapists should leverage an occupational perspective to enhance participation and engagement for people with obesity, thereby ensuring the client's best interests are met. Significance: As change agents, occupational therapists can advocate for shifts in care culture, influence leadership and challenge systemic issues that limit occupational performance and participation for people with obesity. [ABSTRACT FROM AUTHOR]

Purpose Immunization rates can be influenced by community access to immunizations and vaccine promotion from eligible providers. The purpose of this study was to assess the perceptions, willingness, and challenges of vaccine administration among Indiana dental hygienists. Methods This cross-sectional study targeted Indiana-licensed dental hygienists. The survey instrument consisted of six multiple-choice demographic questions; 13 items used a 5-point Likert-type rating scale to measure perceptions about vaccines and willingness to administer vaccines; one rank-in-order question of seven challenges associated with administering vaccines; and two openended questions for additional information and comments. Purposive sampling was used, and the electronic survey was promoted through emails, social media, and direct messages. Categorical variables were analyzed and reported using percentages and frequencies. Open-ended answers were examined and reported in the results. Results Seventy-one Indiana-licensed dental hygienists responded to the survey and were included in the analysis. Most had positive perceptions on vaccines and administering vaccines; 62.3% of the respondents agreed that offering vaccinations in the dental office would improve access to immunizations for patients; 76.8% were willing to receive training to administer vaccines and 66.7% were willing to consider administering vaccines if permitted by the Indiana State Practice Act. While most respondents (77.9%) perceived licensed dental hygienists as competent to administer vaccines, fewer felt comfortable administering vaccines to children (57.8%) as compared adults (63.1%). Education and training were identified as the greatest challenges associated with administering vaccines. Conclusion Dental hygienists in this study indicated a willingness to fill the role of non-traditional vaccinators. Increasing the number of eligible healthcare workers, who can administer vaccines in Indiana would increase vaccine access and improve state immunization rates. Policymakers should consider amending the dental hygiene practice act to include vaccine administration as part of the permitted duties for dental hygienists in Indiana. [ABSTRACT FROM AUTHOR]

Debridement, a mainstay of nursing clinical practice, refers to the removal of dead or unhealthy tissue from a wound to facilitate healing. Debridement is one component of the concept of wound bed preparation that has long guided the approach to wound management. The ability of a wound to heal must be determined prior to the initiation of any method of debridement. In areas where high-quality, comparative studies on the relative benefits of different debridement modalities are lacking, nurses should adopt an evidence-informed approach to care. To do this, nurses must understand the importance of following a comprehensive, holistic approach when treating chronic wounds. Nurses should have knowledge of inflammation and infection control and of the fundamentals of moisture management, recognize the need for debridement in healable wounds, and be familiar with different debridement options. This article provides nurses with a wound management framework, an overview of wound debridement options based on the potential for wound healing, and scope of practice considerations for developing a plan of care. A composite case is presented to illustrate the critical considerations in wound care. This article provides nurses with a wound management framework, an overview of wound debridement options based on the potential for wound healing, and scope of practice considerations for developing a plan of care. [ABSTRACT FROM AUTHOR]

Objectives: There is very little literature examining the workload and impact of nurse practitioners (NPs) working in emergency departments (ED) in regional and rural Australia. The aim of this paper was to review the ED NPs scope of practice in the ED discharge stream and patient outcomes at Cairns Hospital over a 7‐month period. Methods: This retrospective study examined the ED electronic medical record between 14 May 2019 and 31 December 2019. Cases managed by ED NPs, referrals, procedures performed, representations and disposition data were collected. Adverse events were sought from the Qld Health adverse events register (Riskman), the department complaints register and the ED M&M meeting minutes. Results: A total of 1443 patients were treated by NPs, with ages ranging from 0 to 98 years (median 40 years). Australasian Triage Score (ATS) 3 cases made up 30% of the workload. Other than ATS 3 cases, time to being seen was better than the general department. There were very few unexpected representations, complaints or adverse events. Conclusions: This study supports the view that NPs working in a regional emergency department can safely manage a variety of patients outside a fast‐track model, with a wide age range and a variety of triage categories and diagnoses. We believe this has important implications for the provision of emergency care, especially in regional and rural Australia. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this scoping review was to explore whether clear guidelines for the practice of occupational therapists in psychiatric day hospitals exist, both locally and globally. Methodology: Searches were conducted in January 2024; 38 articles were screened and 22 were identified for data extraction. Articles were imported onto Covidence software. Data charting was done, and data were exported into a Microsoft Excel sheet, where content analysis was performed based on the review's objectives. Synthesis of the results was done through discussion and reported according to the PRISMA for Scoping Reviews guidelines. Results: Thirty-eight articles were included but only 22 were relevant Group therapy, individualised therapy, vocational and community workshops were identified as common modes of intervention in psychiatric day hospitals. Occupation-based activities are integral to intervention. However, there was no explicit definition regarding the role of occupational therapy and practice Conclusion: The general scope of occupational therapy remains the same for overnight hospitals, day hospitals and community- based centres. It is mainly occupation-centred, function-orientated, and patient-centred. However, there remains ambiguity on specific practice principles and guidelines that clearly define the role of occupational therapists in day hospitals. There is a need for occupational therapy practice guidelines specific for psychiatric day [ABSTRACT FROM AUTHOR]

Background: Medical emergencies can and do present in primary care dental practices. Approximately 60% of dentists experience at least one emergency a year. This article was prompted by several recent interactions; one being an anaphylaxis where the responding paramedics were unfamiliar with dental therapists and, most recently, where first responders were unfamiliar with the availability of oxygen within a primary dental practice. Aims: This article aims to enhance paramedics' knowledge of dental team members that may be present, their scope of practice, what qualifications they may have, what equipment is available, what drugs can be administered and the most frequently presenting medical emergencies. Methods: This article reviews and consolidates medical emergency guidance and regulations for primary dental practice. Findings: There is limited guidance concerning what drugs dental care professionals can and cannot administer during a medical emergency. Going forward, additional guidance from regulators is needed. Conclusion: Responding emergency services need to be aware of all dental professionals they may encounter as well as their qualifications and limitations to ensure patients receive gold standard care. [ABSTRACT FROM AUTHOR]

This opinion consolidates regulatory frameworks, legal cases, workforce data, and research studies to advocate for the advancement of licensed practical nurses to registered nurses within correctional health care. By emphasizing adherence to nursing scope of practice and proposing a sustainable workforce development model, this article aims to enhance patient care and elevate standards in correctional facilities. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the current utilization of advanced practice providers (APPs) within the field of reproductive endocrinology and infertility. Design: Cross-sectional. Setting: Web-based. Patients: A total of 201 APPs surveyed through the American Society of Reproductive Medicine APP Professional Group. Exposure: Anonymized online survey. Main Outcome Measures: Demographics, scope of practice and responsibilities, and training and onboarding. Results: Respondents were primarily Family Nurse Practitioners (26.4%), Women’s Health Nurse Practitioners (33.3%), or Physician Associates (29.8%). Two-thirds (67.4%) reported that their scope of practice is limited by their employer or practice, 43.5% by state restrictions, and 25.2% by insurance. Survey respondents reported that 44.4% of their time at work is dedicated to performing procedures and scans and 30.6% to conducting consults and follow-ups. The most commonly reported duties were physical examinations (88.6%), intrauterine inseminations (86.6%), saline sonohysterograms (79.6%), endometrial biopsies (76.6%), ultrasounds (74.6%), and problem visits such as for pain, cysts, and bleeding (73.1%). Most survey respondents (61.7%) reported having autonomy in deciding protocols and treatment options for patients in their practice. Respondents described their onboarding training as including observation/on-the-job training (94.0%), independent reading of texts and journals (66.7%), American Society of Reproductive Medicine online courses (45.3%), formal orientation (34.8%), and practice-organized training programs (29.4%). Conclusions: Advanced practice providers are highly trained members of the care team, but continue to be underused within the field of reproductive endocrinology and infertility. Improvements in educational resources and/or use of a formalized program to train APPs to their full scope of practice may help increase clinic efficiency and improve patient access to care.

Increased engagement of nurse practitioners (NPs) has been recommended as a way to address care delivery challenges in settings that struggle to attract physicians, such as primary care and rural areas. Nursing homes also face such physician shortages. We evaluated the role of state scope of practice regulations on NP practice in nursing homes in 2012-2019. Using linear probability models, we estimated the proportion of NP-delivered visits to patients in nursing homes as a function of state scope of practice regulations. Control variables included county demographic, socioeconomic, and health care workforce characteristics; state fixed effects; and year indicators. The proportion of nursing home visits conducted by NPs increased from 24% in 2012 to 42% in 2019. Expanded scope of practice regulation was associated with a greater proportion and total volume of nursing home visits conducted by NPs in counties with at least 1 NP visit. These relationships were concentrated among short-stay patients in urban counties. Removing scope of practice restrictions on NPs may address clinician shortages in nursing homes in urban areas where NPs already practice in nursing homes. However, improving access to advanced clinician care for long-term care residents and for patients in rural locations may require additional interventions and resources.

OBJECTIVES: (1) Assess and compare the perceptions of pet owners and veterinary professionals pertaining to the extent of veterinary workforce and access to care challenges in 2023 in Colorado, and (2) Assess what programs, policies, and resources veterinary professionals and pet owners believe would be most effective at addressing access to care and workforce challenges in Colorado. SAMPLE: 736 veterinarians, veterinary technicians, or practice/owner manager (veterinary professionals) in Colorado. A total of 1,209 pet owners (919 from an online survey and 290 from in-person surveying). PROCEDURES: Distribution of an online anonymous survey to veterinary professionals in Colorado. Pet owners were surveyed both online and in-person at pet pantry or shelter events. RESULTS: Veterinary professionals reported significant workforce challenges, including having to frequently divert clients, clients forced to decline medical care or having to euthanize their pets due to cost. Veterinary professionals were especially supportive of policy efforts to enhance recruitment and retention of technicians, including through mechanisms such as clarifying their scope of practice, loan repayment programs, and enhancing career pathways. Colorado pet owners responses pertaining to the scope of access to care challenges were similar to prior national research. Pet owners reported particularly needing low-cost emergency clinics in their community as well as resources to reduce the cost of care. Pet owners were generally supportive of expanding veterinary care access through telemedicine; indicating they would feel comfortable seeing a veterinarian via telemedicine, even for the first time, and that expanded use of telemedicine would increase their ability to obtain care. CONCLUSIONS AND CLINICAL RELEVANCE: Colorado pet owners and veterinary professionals both identified numerous access to care challenges as well as indicated support for the development of several potential initiatives to address the problem. Low-cost clinics that provide sick and emergency care was the resource rated as being most helpful among pet owners. Further exploration of grants, voucher programs, expansion of telemedicine, increased utilization and title protection for CVTs, and the creation of the veterinary professional associate position are all initiatives that were noted to be worthy of further exploration.

BACKGROUND: Recent legislative advances now permit pharmacists to prescribe tobacco cessation medications in 17 states. While national initiatives are underway to prepare the pharmacy profession for this expanded role, patient perceptions of this role have not been explored. OBJECTIVE: The objective of this study was to characterize patient perceptions, attitudes, and awareness of pharmacists prescribing for tobacco cessation medications. METHODS: A cross-sectional survey of English and Spanish-speaking patients was conducted at 12 locations of a federally-qualified health center in Northwest Indiana. Survey measures assessed sociodemographics, tobacco use history and interest in quitting, prior interactions with pharmacists and awareness of pharmacists ability to prescribe tobacco cessation medications, and perceptions of pharmacists assisting with cessation. The Theory of Planned Behavior (TPB) served as a framework for item development. Multivariable logistic regression was used for modeling. RESULTS: A total of 2082 individuals (1878 English, 204 Spanish) completed the survey (42.4%). Among current users (n = 592; 28.4%), 46.2% had made a quit attempt in the past year, and 41.0% reported having used a tobacco cessation medication in the past. Over half (60.5%) of current users would be comfortable talking with a pharmacist about quitting, 31.9% intended to talk with a pharmacist about quitting, and 31.7% intended to ask a pharmacist to prescribe a medicine to help with quitting. In multivariable modeling, intention to (a) talk with a pharmacist about quitting and (b) ask a pharmacist to prescribe a medication were significantly associated with TPB constructs. Current tobacco users were receptive to pharmacist-facilitated assistance with quitting, including prescribing of tobacco cessation medications. CONCLUSIONS: Patients attitudes, subjective norms, and perceived behavioral control, from the Theory of Planned Behavior, were important predictors of intention to engage with pharmacists for quitting and intention to ask a pharmacist to prescribe a cessation medication.

Abstract Background Multimorbidity increases with age, leading to various adverse outcomes, including higher mortality, care dependency, hospitalizations, and healthcare costs. Polydoctoring, managing a patient with multimorbidity by multiple healthcare providers, can be a risk of fragmented care and increased healthcare expenditures. This study aims to identify patient‐related factors contributing to polydoctoring in older adults with multimorbidity. Methods This study is a cross‐sectional study using baseline data from the Kawasaki Aging and Wellbeing Project. Participants were residents of Kawasaki City aged 85–89 years, without disability in basic activities of daily living, and being able to visit study site. The regularly visited facilities (RVF) index was employed to quantify polydoctoring. Polydoctoring was defined as having two or more RVFs. Poisson regression analysis was conducted to assess the association between polydoctoring and patient demographics, including types of chronic conditions and socioeconomic factors. Results A total of, 968 participants with multimorbidity were analyzed. Increased RVF was significantly associated with eye diseases (rate ratio [RR] 1.27, 95% confidence interval [CI] 1.12–1.44), osteoporosis (RR 1.22, 95% CI 1.08–1.38), prostate diseases (RR 1.22, 95% CI 1.07–1.40), and osteoarthritis (RR 1.16, 95% CI 1.05–1.27). No significant correlation was found with educational status or financial hardship. Conclusion The study indicated that certain chronic conditions are linked to increased polydoctoring among multimorbid older adults in Japan. However, most of those conditions are considered to be within a scope of family medicine/general practice. Training general practitioners to manage these conditions could reduce healthcare costs and the treatment burden, indicating a direction for future healthcare policy and medical education.

ABSTRACT Aim Design Methods Results Conclusion Impact Reporting Methods To explore specialist homeless health professionals' perceptions of gaps in homeless health care and understand whether these might be addressed through existing nursing scopes of practice.Qualitative descriptive study.Semi‐structured interviews and focus groups with a purposive sample of 22 staff in nursing (11) and non‐nursing (11) roles, engaged with a Homeless Health Service. Data were collected via videoconferencing and recordings transcribed verbatim. An exploratory framework guided deductive and inductive thematic analysis.Service gap themes included the need for integration with mainstream health services, more specialised health professionals, and adaptations to the existing models of care. Addressing these gaps involved enhancements to the broad scope of nursing practice, workforce development by establishing homeless health as a nursing specialty and optimising organisational governance to minimise risk.The most pressing homeless health service delivery gap was lack of health service integration, and it was unclear how this could be resolved through nursing scopes of practice. Other service gaps could be addressed through skilling nurses to practice preventative health care, as well as crisis management. Enhancing nurses' capability in physical and mental health assessment skills including alcohol and other drugs and procedural skills would support wraparound care for people experiencing homelessness. We conclude that a homeless health nursing specialty could be established that formalises the scope of practice of nurses in this field to ensure future post‐graduate training aligns with service gaps.This study identifies opportunities to optimise nursing scopes of practice to address Homeless Health Service gaps through reviewing models of care and nursing practice. For example, enhancing nurses' capability to provide preventative and wraparound care. This research may inform a development pathway to enhance education and training for nurses working with vulnerable populations.COREQ 32‐item checklist.No patient or public contribution. [ABSTRACT FROM AUTHOR]

The success of healthcare reform hinges on policymaker, regulator, and administrator actions that shape policies at various levels. These policies can either facilitate or hinder the practice of healthcare professionals and collaborative work environments. It is imperative for all healthcare professionals to fully utilize their education and certification, as fostering an equitable workplace culture is vital for retaining staff and improving access to care. Using nurse practitioners (NPs) as an exemplar, this article aims to specify systemic barriers to healthcare reform and call for policymakers, regulators, and clinical agency administrators to enact change. Barriers to NP practice include restrictive oversight by external stakeholders, financial incentives for indirect billing, and hierarchical constraints that limit NP contributions to the healthcare system. The growing healthcare provider shortage disproportionately impacts primary care and rural settings. NPs are increasingly more likely to fill these roles than medical doctors and have documented positive patient health outcomes. Removing systemic obstacles for NP practice increases access to care. Nursing—the largest healthcare workforce with diverse roles—operates under complex oversight from multiple organizations for licensure, accreditation, certification, and education. The recent trend of external stakeholders influencing and requiring additional oversight has created barriers to nursing practice. Despite national education, accreditation, and certification standards, nursing licensure and practice are increasingly negotiated with external stakeholders and supervised at the state and institutional levels. Supporting all healthcare professionals to practice according to their education and certification can advance healthcare reform, address workforce shortages, increase access to care, and improve health. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic required residential aged care facilities (RACFs) to meet the high care needs of residents in the context of stringent public health measures and staffing pressures. Given the likelihood of ongoing COVID-19 waves and seasonal surges in acute respiratory infection outbreaks, this study explored RACF staff experiences in providing care while limiting COVID-19 risk. Ten focus groups were conducted across six RACFs in metropolitan and regional New South Wales, Australia. Findings highlighted the impact of negative media representation on staff and the need for risk-based clear public health messages to reduce complacency. Findings also highlighted challenges in meeting clinical needs while keeping residents safe, and the benefit of new initiatives and opportunities for future training. Clear, targeted communication is essential to ensure ongoing understanding and adoption of public health measures when required. Awareness of the challenges provides RACFs and policymakers valuable insights for future planning including staff support and training needs. Key areas that require attention include promoting work in RACFs as a valued profession, clear public health risk messaging, strategies to facilitate prioritizing care, and broadened scope of skills. [ABSTRACT FROM AUTHOR]

To examine the association between scope-of-practice (SoP) regulations and racial disparities in pediatric mental health services. We used the National Survey of Children's Health (2016–2020; n = 33,790) to examine racial disparities in unmet mental health care needs and receipt of mental health medication between states with and without SoP expansions for psychologists and nurse practitioners (NP). Our primary outcomes were (1) unmet mental health care needs and (2) receipt of mental health medication. We examined heterogeneous treatment effects of SoP expansion on the outcomes using logistic regression with interaction terms between SoP expansion and race/ethnicity. We estimated population-level racial disparities for both outcomes stratified by SoP expansion to identify differences in racial disparities. The psychologist SoP expansion-associated reduction in unmet need was 15.8 percentage-points (CI= -25.3, -6.2) larger for Other-race children than for White children. The psychologist SoP expansion-associated increase in medication was 5.1%-points (CI=. 0.8, 9.4) larger for Black children and 5.6%-points (CI = 0.5, 10.8) for Other-race children. No differences were found for NP SoP expansion. Racial disparities in both outcomes were lower in psychologist SoP expansion states but varied in NP SoP states. Expanded SoP was generally associated with lower racial disparities in pediatric mental health care access. [ABSTRACT FROM AUTHOR]

Aim: This survey aimed to investigate a range of topics relating to the employment of dental hygienists in European countries, whose National Dental Hygienists Associations (NDHAs) were members of the EDHF. Methods: During 2020/2021, an online questionnaire and participant information leaflet were distributed by email in each of the 24 countries, whose NDHA is a member of the EFDH or to an EADPH member who was likely to respond. Results: The broad term employment of dental hygienists was taken to include current numbers, place of work (public or private clinics and other locations), whether they were currently working as dental hygienists, their pay, any planned changes in their employment and their participation in continuing education. Twenty‐four countries (92%) responded. Hungary and Poland reported that fewer than 35% of their qualified dental hygienists were working as dental hygienists. In 10 countries, often for family reasons, over 40% worked part‐time. In 14 countries, over 70% worked in private clinics. Average annual pay ranged from €8400 in public clinics in Poland to €106,000 in dental hygienist‐owned clinics in Denmark Regular participation in continuing education was mandatory in only nine countries. Conclusions: Dental hygienists play a different role within the oral healthcare system in each European country. There is a wide variation in their education, places of employment, annual pay and continuing education requirements. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity increases with age, leading to various adverse outcomes, including higher mortality, care dependency, hospitalizations, and healthcare costs. Polydoctoring, managing a patient with multimorbidity by multiple healthcare providers, can be a risk of fragmented care and increased healthcare expenditures. This study aims to identify patient‐related factors contributing to polydoctoring in older adults with multimorbidity. Methods: This study is a cross‐sectional study using baseline data from the Kawasaki Aging and Wellbeing Project. Participants were residents of Kawasaki City aged 85–89 years, without disability in basic activities of daily living, and being able to visit study site. The regularly visited facilities (RVF) index was employed to quantify polydoctoring. Polydoctoring was defined as having two or more RVFs. Poisson regression analysis was conducted to assess the association between polydoctoring and patient demographics, including types of chronic conditions and socioeconomic factors. Results: A total of, 968 participants with multimorbidity were analyzed. Increased RVF was significantly associated with eye diseases (rate ratio [RR] 1.27, 95% confidence interval [CI] 1.12–1.44), osteoporosis (RR 1.22, 95% CI 1.08–1.38), prostate diseases (RR 1.22, 95% CI 1.07–1.40), and osteoarthritis (RR 1.16, 95% CI 1.05–1.27). No significant correlation was found with educational status or financial hardship. Conclusion: The study indicated that certain chronic conditions are linked to increased polydoctoring among multimorbid older adults in Japan. However, most of those conditions are considered to be within a scope of family medicine/general practice. Training general practitioners to manage these conditions could reduce healthcare costs and the treatment burden, indicating a direction for future healthcare policy and medical education. [ABSTRACT FROM AUTHOR]

Regulations that restrict the tasks that credentialed workers are allowed to perform may affect a firm's input choices, output, and which part of the market the firm serves. Using dental practice survey data from 1989 to 2014 and a stacked difference‐in‐differences design, this paper examines the effects of state‐level scope of practice regulations on the behavior of dental practices. Results suggest that scope of practice deregulation in regards to dental hygienists' ability to administer nitrous oxide or local anesthesia is associated with fewer dentist visits per week in the short‐term, lower patient wait times, and an increased likelihood of treating lower revenue generating publicly insured patients. There is weak evidence that scope of practice deregulation alters a practice's labor inputs. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusions This study investigates the utilisation of blended tube feeding by health professionals in Australia and New Zealand, assessing factors influencing its implementation following the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding consensus statement.A cross‐sectional survey was conducted targeting health professionals across Australia and New Zealand. The survey comprised 35‐questions including multiple choice, Likert scales and open‐ended responses, to gain insights into blended tube feeding practices and perspectives. The effect of the health professional factors on outcomes was explored in pairs with a series of Chi‐squared tests. Odds ratios (ORs) were calculated using standard univariate logistic regression. An exploratory content analysis was used to code the open‐ended text responses to the survey questions which were then categorised and further synthesised into overarching themes.Out of 89 health professionals who completed the survey, the majority were dietitians, 63% reported managing fewer than five patients using blended tube feeding within their services. Parental request was the leading reason for adoption. Notable barriers included clinician time constraints, resource limitations and a lack of formal guidelines. Some health professionals considered the primary risk associated with blended tube feeding to be poor growth and/or weight loss. Professional development was pivotal in increasing confidence and advocating for blended tube feeding, with significant correlations observed between blended tube feeding training and clinical practice.This study emphasises the essential role of education, resource availability and institutional policy in promoting blended tube feeding practices for health professionals. Findings suggest that focusing on professional development and standardised resources could significantly enhance knowledge, confidence and competence of health professionals in blended tube feeding application. The outcomes point towards the need for a coordinated approach to support evidence‐based blended tube feeding practices, aligning with the Australasian Society of Parenteral and Enteral Nutrition blended tube feeding resources and recommendations. [ABSTRACT FROM AUTHOR]

Background: Australia's commitment to eliminate hepatitis C by 2030 is underpinned by the mobilisation of the primary care sector. Primary care nurses are well placed to contribute to achieving elimination given their unique access to people with/at risk of hepatitis C and their person-centred approach to care delivery. This study examines the enablers to primary care nurse involvement in elimination efforts. Methods: Primary care nurses involved in the care of people with/at risk of hepatitis C were recruited through two national nursing organisations. Participants provided verbal consent to participate in an electronically recorded, semi-structured interview. Interview data were transcribed verbatim, coded and analysed using a thematic analysis. Results: Sixteen interviews were conducted with nurses working in general practice, community health, alcohol and other drug services, and custodial settings, with the findings framed using a social-ecological model. The study identified individual attributes, such as empathy and advocacy for clients deemed 'too hard for everyone else'. Interpersonal enablers included participants' ability to effectively communicate with clients and colleagues, and using trusted professional relationships to improve client access to care. Public policy that addressed community factors, including stigma and confidentiality, were seen as supportive. Conclusions: This study identified the critical and varied role primary care nurses play in hepatitis C elimination. Effective scale up of hepatitis C care involves recognising the pivotal role of primary care nurses, which will help to create an enabling environment that supports nurses to work to their full scope of practice and enhance their contribution to the elimination response. Hepatitis C elimination in Australia is stalling. Primary care nurses are in regular contact with people with/at risk of hepatitis C and have a unique opportunity to contribute to the elimination effort. This study interviewed primary care nurses to identify the individual and systemic enablers that support these nurses to work to their full scope of practice and contribute to achieving Australia's elimination goal. [ABSTRACT FROM AUTHOR]

Aim: This study explores the experiences of interprofessional collaboration of Canadian midwives and obstetricians from midwives' perspective. Design: A concurrent mixed‐methods approach that combined a small validation study and qualitative thematic analysis was used to provide evidence of the nature and importance of collaboration between Registered Midwives (RMs) and obstetricians. Method: Eighteen RMs across Canada completed a demographic survey and the Midwifery‐Obstetrician Collaboration (MOC) scale in 2023. The quantitative analyses were conducted to assess the reliability of the Midwifery‐Obstetrician Collaboration (MOC) and accumulate preliminary evidence to support its validity. Semi‐structured interviews were conducted with 13 participants. After completing the interviews, themes were identified using thematic analysis. Results: The primary themes identified were knowledge of midwifery scope affects collaboration, collaboration is necessary for effective patient care, midwife‐physician collaboration is impacted by power differentials and hierarchies, and proposed methods to improve physician‐midwife collaboration. Although a small sample size did not permit extensive statistical testing, the quantitative results supported the reliability of the MOC scale. In addition, a strong correlation between the MOC and the communication subscale of the Inter‐Professional Collaboration (IPC) scale provided evidence of the MOC's concurrent validity as a measure of collaboration between midwives and physicians. Conclusion: This study provides support for the Midwifery‐Obstetrics Collaboration (MOC) Scale as an assessment tool to evaluate collaboration between midwives and OB/GYNs in obstetrics care. While the 18 RMs recruited for this study provided a fulsome analysis for the qualitative portion, a larger study is necessary to provide more extensive quantitative analysis to validate the MOC scale for continued use among RMs and OBs. Implications: The implications of this study are to foster strong interprofessional relationships between midwives and OBs and to improve the health outcomes of pregnant women and newborns. Reporting Method: The authors adhered to Consolidated criteria for reporting qualitative research (COREQ). [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) and COVID-19 are contagious diseases for which effective vaccines exist. Dental care professionals' involvement in vaccination campaigns for these conditions has been proposed, but there is a lack of understanding of dentists' roles in vaccination, specifically assessing patients' attitudes around dentists as vaccinators for HPV and COVID-19. Using a cross-sectional design and convenience sampling, a 12-item validated survey was distributed to community members to determine perceptions about dentists' roles in vaccination for HPV and COVID-19. Demographic characteristics, vaccination status, knowledge of the diseases, vaccination intentions, and willingness to receive education about, recommendations for, and administration of vaccine from a dentist were assessed. Responses were analyzed using bivariate and multivariate analysis. Of 618 participants, most were vaccinated previously against HPV and COVID-19 (n = 462 [75.6%] and n = 371 [61.0%], respectively). Participants responded more favorably to dentist involvement in educating, discussing, and administering COVID-19 vaccines than HPV vaccines (P <.05). Participants' knowledge of HPV was found to be low compared with that of COVID-19. There were significant differences across demographic groups, with race most frequently associated with differences in responses to COVID-19 and HPV-related questions. Formative data to develop interventions to support dentists' participation in vaccination campaigns are provided. Participants' acceptance of COVID-19 vaccination over HPV vaccination may reflect the public awareness of COVID-19 vs HPV due to daily relevance of this disease, or the lack of knowledge about HPV, particularly its oropharyngeal impacts. The authors provide evidence to support dentists' involvement in vaccine education and distribution, expanding previous literature into evaluation of a new disease context (COVID-19). Lack of knowledge of HPV may affect willingness to receive the HPV vaccine, presenting an opportunity for education. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to determine the public's perception of the scope of practice for oculofacial plastic and reconstructive surgeons (OFPRS). Methods: A 49-question survey was distributed by QualtricsⓇ to a panel similar to the US demographic composition. Responses collected underwent bivariate statistical analysis. Result: A total of 530 responses were obtained, with most respondents being white, female, over the age of 35, from the Midwest, and with at least a college education or above. Most respondents did not think ophthalmologists or optometrists were surgeons, and only 158 people (29.8%) knew the primary specialty of OFPRS was ophthalmology. Board certification was preferred by 98.87% of respondents, and 95.28% preferred ASOPRS-trained OFPRS. Conclusions: Our study highlights the gap in knowledge about OFPRS as a field, the qualifications and training required, and the scope of practice. Notably, even for OFPRS-specific procedures, PRS remained the leading subspecialist chosen for interventions such as orbital decompression (58.5% vs. 71.5%), orbital reconstruction (57.9% vs. 74.2%), enucleation/evisceration (48.1% vs. 53.4%), optic nerve-related surgery (39.8% vs. 43.4%), orbital cancer resection (42.8% vs. 46.8%), and tear duct surgery (41.9% vs. 52.5%). Additionally, most respondents did not feel that facial fillers, laser skin resurfacing, eyelid cancer removal, or cataract surgery were within the OFPRS scope of practice. [ABSTRACT FROM AUTHOR]

Introduction Future multidomain operational combat environments will require combat medics to play a larger role in managing behavioral health (BH) conditions in forward environments, as soldiers in small teams may have them as their sole medical support for extended periods of time. Previously they were not expected to serve in this role, and thus, they receive minimal BH training. It is unknown to what extent combat medics consider BH tasks as falling within their scope of practice and how often they engage with their soldiers currently related to BH. Qualitative research suggests that many medics feel inadequately prepared to handle BH problems. Our aim is to further assess medic attitudes and behaviors related to BH to better understand the landscape of medic preparedness to fill an expanded role. Materials and Methods Data from 292 medics were collected before their participation in the BH Guidelines for mEdic Assessment and Response training, a day-long training for medics expected to deploy to far-forward environments. We investigated whether combat medics engage with their soldiers in areas related to BH, the extent to which they consider BH-related tasks as part of their scope of practice, and how confident they feel engaging in various BH-related tasks. We explored associations between medics' attitudes related to BH scope of practice and confidence performing BH tasks with gender, rank, component (National Guard vs. Active Duty), work-related BH experience, having suicide training in the past year, and having ever sought help for BH. Results Results indicated that in the past month, 61.4% of medics discussed BH issues, 48.3% assessed BH problems, and 41.3% provided interventions for BH problems with at least one soldier in their unit. Assessment tasks were more frequently endorsed as falling within medic's scope of practice (75%-95%) than intervention tasks (62%-83%). More medics felt confident doing assessments (39%-49% moderately confident or greater) than providing interventions (31%-37% moderately confident or greater). Medics expressed highest confidence in assessing for suicide risk (49% moderate confidence or greater). Medics with a lot of prior BH work experience and non-commissioned officers (as compared to junior enlisted) reported greater confidence in most tasks. Receiving suicide training in the past year was associated with greater confidence assessing for suicide, as well as providing interventions for suicide, general BH problems, and substance abuse. Conclusions Most medics agreed that numerous BH tasks fell within the scope of their work, but few felt confident engaging in those tasks. These findings support a need for additional training in BH-related tasks across the force. Exploring ways to provide medics BH-related work rotations would augment their general proficiency as first-line treatment providers for soldiers in combat units, and increased training in BH-related tasks should be studied to determine its ability to increase competency and confidence. If medics can learn to assess and recognize BH concerns before they escalate to needing specialty BH care, this could potentially reduce the burden on BH clinics, as well as strengthen the overall force. [ABSTRACT FROM AUTHOR]

In some countries, pharmacists have obtained prescribing rights to improve quality and accessibility of care and reduce physician workload. This case study explored pharmacists' current roles in and potential for prescribing in primary care in the Netherlands, where prescribing rights for pharmacists do not exist. Participatory observations of pharmacists working in either general practice or community pharmacy were conducted, as were semi-structured interviews about current and potential practice. The latter were extended to patients and other healthcare professionals, mainly general practitioners, resulting in 34 interviews in total. Thematic analyses revealed that pharmacists, in all cases, wrote prescriptions that were then authorized by a physician before dispensing. General practice-based pharmacists often prescribed medications during patient consultations. Community pharmacists mainly influenced prescribing through (a) medication reviews where the physician and/or practice nurse often were consulted to make treatment decisions, and (b) collaborative agreements with physicians to start or substitute medications in specific situations. These findings imply that the pharmacists' current roles in prescribing in the Netherlands resemble collaborative prescribing practices in other countries. We also identified several issues that should be addressed before formally introducing pharmacist prescribing, such as definitions of tasks and responsibilities and prescribing-specific training for pharmacists. [ABSTRACT FROM AUTHOR]

Aims: The oral health needs of frail older adults are increasing with an aging population in Canada. The objective of this study was to explore the perceptions of dentists in British Columbia regarding their view of geriatric dentistry as a distinct scope of practice and in relation to special needs dentistry. Methods and results: Qualitative data were gathered thorough semi guided interviews of a purposeful sample of dental clinicians, educators and members of organized dentistry with specialized knowledge of oral health for frail older adults. Interviews were transcribed, coded, and analyzed using a thematic approach. Thematic saturation was reached with the 10 participants in this study. Through the method of interpretative description, patient, dentist, and systemic factors that shaped scope of practice for geriatric dentistry were identified as well as the broader skill sets required for geriatric dentistry. Conclusion: The study found that participants perceived geriatric dentistry as unique scope of practice from general dentistry requiring special knowledge in the management of challenges associated with aging with frailty as well as the ability to work in long‐term care. Similar to special needs dentistry, geriatric dentistry requires person‐centered care and emphasized the need for interprofessional collaboration in alternative care settings. [ABSTRACT FROM AUTHOR]