Family physician continuity of care and emergency department use in end-of-life cancer care
2003
Burge F; Lawson B; Johnston G
Medical Care
2003
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/00005650-200308000-00012" target="_blank" rel="noreferrer">10.1097/00005650-200308000-00012</a>
Reviewing audit: barriers and facilitating factors for effective clinical audit
Physician-Patient Relations; Great Britain; Medical Staff; Leadership; Physician's Role; Interprofessional Relations; Patient Satisfaction; Quality of Health Care; Job Satisfaction; Hospitals; MEDLINE; Family Practice; Primary Health Care; Non-U.S. Gov't; Comparative Study; Evaluation Studies; retrospective studies; Databases; Hospital; Support; General; Attitude of Health Personnel; Nursing Audit; Bibliographic; Medical Audit/standards; Medical Records/standards; Partnership Practice
OBJECTIVE: To review the literature on the benefits and disadvantages of clinical and medical audit, and to assess the main facilitators and barriers to conducting the audit process. DESIGN: A comprehensive literature review was undertaken through a thorough review of Medline and CINAHL databases using the keywords of "audit", "audit of audits", and "evaluation of audits" and a handsearch of the indexes of relevant journals for key papers. RESULTS: Findings from 93 publications were reviewed. These ranged from single case studies of individual audit projects through retrospective reviews of departmental audit programmes to studies of interface projects between primary and secondary care. The studies reviewed incorporated the experiences of a wide variety of clinicians, from medical consultants to professionals allied to medicine and from those involved in unidisciplinary and multidisciplinary ventures. Perceived benefits of audit included improved communication among colleagues and other professional groups, improved patient care, increased professional satisfaction, and better administration. Some disadvantages of audit were perceived as diminished clinical ownership, fear of litigation, hierarchical and territorial suspicions, and professional isolation. The main barriers to clinical audit can be classified under five main headings. These are lack of resources, lack of expertise or advice in project design and analysis, problems between groups and group members, lack of an overall plan for audit, and organisational impediments. Key facilitating factors to audit were also identified: they included modern medical records systems, effective training, dedicated staff, protected time, structured programmes, and a shared dialogue between purchasers and providers. CONCLUSIONS: Clinical audit can be a valuable assistance to any programme which aims to improve the quality of health care and its delivery. Yet without a coherent strategy aimed at nurturing effective audits, valuable opportunities will be lost. Paying careful attention to the professional attitudes highlighted in this review may help audit to deliver on some of its promise.
2000
Johnston G; Crombie IK; Davies HT; Alder EM; Millard A
Quality In Health Care
2000
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
The WHO objectives for palliative care: to what extent are we achieving them?
Professional-Family Relations; Health Services Research; Outcome Assessment (Health Care); Organizational Objectives; Holistic Health; Non-U.S. Gov't; Pastoral Care; social support; Human; Support; Health Priorities; Terminal Care/methods; Hospices/standards; World Health Organization; Palliative Care/standards
This paper examines recent research in palliative care in the light of the guiding principles set out by the World Health Organization. It outlines the gaps in the literature and suggests priorities for future research. Areas of unmet need are documented and it is argued that research comparing outcomes across care settings and relating particular care practices to outcome measures would help to set care targets. Further definition of the expected outcomes of psychological and spiritual care, as well as care for carers, is recommended. Available measures are reviewed and suggestions made for the development of additional measures. Finally, some key methodological problems are discussed, including making cross-setting comparisons, identifying appropriate outcome measures, prioritizing patients' own identification of outcomes, using different methodologies as death approaches, and combining different perspectives offered by patients, lay carers and professional carers. The role of qualitative data as an indicator of rating scale validity is discussed in this context.
1995
Johnston G; Abraham C
Palliative Medicine
1995
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article