Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Workforce

  • care workforce
  • health workforce
  • medical workforce
  • mental health workforce
  • nursing workforce
  • physician workforce
  • skilled workforce

  • Terms modified by Workforce

  • workforce composition
  • workforce development
  • workforce issues
  • workforce participation
  • workforce planning
  • workforce reduction
  • workforce shortage
  • workforce training

  • Selected Abstracts


    ABSTRACT:,This article examines the relationship between emerging work arrangements and national settlement patterns. While growth is centralized in large cities, social commentators continue to suggest that workplace restructuring,facilitated by technological progress,encourages more dispersed settlement patterns, evoking concern about the environmental sustainability of the trend. Multivariate analysis using Canadian census data shows that with the exception of self-employed professionals, the home workers, and self-employed in nonmanual occupations have a lower tendency to reside in large cities than otherwise similar wage and salary earning commuters. However, household mobility and temporal trends suggest that workplace restructuring is not dispersing workers away from large cities by inducing mobility, but that take-up is higher in more remote areas. It is argued that workplace restructuring permits more dispersed national settlement patterns than if workers needed to move to large cities for proximity to employment growth. The article reflects on the implications of the findings for urban sustainability policies that promote compact urban forms and the policies that emphasize consumption amenities of cities to attract mobile workers. [source]


    David Wilkinson
    ABSTRACT: The aim of the present study was to compare selected characteristics of the Australian general medical practitioner workforce in capital cities and regional areas. Data were derived from the 1996 Census of Population and Housing. Characteristics included age, sex, full- or part-time work, place of birth and change in residential address. Analyses were performed for each state and territory in Australia, the statistical division containing each capital city and all other statistical divisions in each state and territory. Of the 26 359 general medical practitioners identified, 68% were male. More female than male general medical practitioners were aged < 45 years (74 vs 52%, respectively; P < 0.0001). The proportion of general medical practitioners aged < 35 years was higher in capital cities (30%) than regional areas (24%; P < 0.0001). Overall, 32% of the general medical practitioner workforce was female and almost 50% of those aged < 35 years were female. The proportion of female general medical practitioners was higher in capital cities than regional areas, by up to 30%. While 13% of male general medical practitioners reported part-time work, 42% of females also reported part-time work and these figures were similar in capital cities and regional areas. Approximately 40% of the Australian general medical practitioner workforce was born outside Australia and while fewer migrants have entered in recent years they were more likely to be living in regional areas than the capitals. The census provides useful medical workforce data. The regional workforce tends to be made up of more males and is older than in capital cities. Monitoring trends in these characteristics could help to evaluate initiatives aimed at addressing regional workforce issues. [source]


    Jeannine Millsteed
    ABSTRACT The unequal distribution of health workers across Australia in favour of urban areas affects the provision of effective health services to rural and remote communities. Additional pressures on the current and future supply of occupational therapists may arise from a restructuring of the health labour force and demographic changes in the age structure of the population. Projections made on the basis of these data indicate that employment growth for occupational therapists will create a demand for 9600 therapists in 2005, or 79.9% more than the number of occupational therapists employed in 1994. Factors such as reductions in the level of immigration and the number of people of working age, and a diminishing population of school leavers to fill student places in universities will make it difficult to meet the projected demand for occupational therapists. Occupational therapy labour force planning suffers from a lack of detailed data on under-serviced areas. Such data are critical for clarifying the magnitude of the projected discrepancy between future demand and supply needs for occupational therapists in rural and urban areas in Australia. [source]

    Recent Changes in the Workforce and Practice of Dermatologic Surgery

    BACKGROUND The increasing number of American College of Mohs Surgery (ACMS) fellowship positions over the last decade has resulted in a greater number of fellowship-trained surgeons in dermatologic surgery. METHODS Mohs micrographic fellowship-trained surgeons (MMFTSs) and non-Mohs fellowship-trained surgeons performing Mohs micrographic surgery (NMMFTSs) were compared using the American Academy of Dermatology Practice Profile Survey (2002/05). An analysis of recent Mohs fellowship classes was also performed. RESULTS In 2005, there was an equivalent proportion of MMFTSs and NMMFTSs in the workforce (ratio MMFTS:NMMFTS=0.9) but, in 2005, there was a shift in the youngest age cohort (29,39) to a greater proportion of MMFTSs (MMFTS:NMMFTS=1.55). In 2005, the youngest MMFTSs (29,39) were more likely to be female (47.1%) than of MMFTSs overall (24%). MMFTSs were 5 times as likely to be in full-time academic positions and performed 2 to 3 times as many Mohs cases per week as NMMFTSs. CONCLUSIONS Consistent with demographic shifts in dermatology, differences have emerged in the demographics, surgical volumes, and settings of MMFTSs and NMMFTSs. Recent increases in the ACMS fellowship positions have resulted in a greater proportion of MMFTSs among younger dermatologic surgeons. It will be important to follow how this increase in fellowship trainees affects the dermatologic surgery workforce. [source]

    An Educational Needs Assessment of Pennsylvania Workforce: Opportunities to Redefine Secondary Career and Technical Education to Meet Food Industry Needs

    Larry Napoleon
    ABSTRACT: This article describes the outcomes of a needs assessment concerning current training needs and performance targets for non-degreed employees in the food industry. Focus groups were used to gather data from 5 food-processing companies: a fresh vegetable company, a canned vegetable company, 2 snack food companies, and a meat company. Focus group participants consisted of 1 senior-level manager each from human resource, production, quality assurance, purchasing, and product development departments within each company. The needs assessment identified 4 major themes that employers indicated as beneficial knowledge and skills for employees to possess: safety training, knowledge of food and production systems, learning and applying mathematical skills, and professional conduct. The authors anticipate that the knowledge of industry needs, with respect to the desired incoming workforce competencies and knowledge, will facilitate the development of integrated curriculum modules for secondary career and technical education programs (high school grades). These integrated curriculum modules will address the growing needs of the food industry and facilitate the development of employment skills required to function and prosper in the new global economy. [source]

    Case Management Workforce in the United States

    Eun-Jun Park RN
    Abstract Purpose: The purpose of this study was to investigate and compare characteristics of the case management (CM) workforce in the US by age, years of experience, and original profession. Design: This study was an exploratory, descriptive secondary analysis of demographic and job characteristics of 24,085 certified case managers (CCMs). Methods: Descriptive statistics, Chi-square tests, and correlation coefficients were calculated. Findings: The majority of the case-management workforce is made up of RNs (93.3%). The CCMs were older, with a mean age of 55.0 years, than were those in their original profession and started to work as CCMs late in their careers. The educational level of RN-CCMs was lower than that of CCMs from other professions. Also, job titles and work settings of CCMs were diverse, with different focus areas depending on clients' needs. The distribution of CCMs was associated with the number of managed-care enrollees. Conclusions: Profiles of CCMs in this study are valuable for clinical practice and can assist with deployment of the CM workforce. Clinical Relevance: To develop and deploy CCMs better matched to societal healthcare needs, characteristics of CCMs should be precisely understood. Managing the CM workforce is expected to be critical because of a shortage of RN workers and aging-of-the-workforce issues in the US. [source]

    Improving oral healthcare delivery systems through workforce innovations: an introduction

    Elizabeth A. Mertz PhD
    Abstract The objective of this paper is to describe the purpose, rationale and key elements of the special issue, Improving Oral Healthcare Delivery Systems through Workforce Innovations. The purpose of the special issue is to further develop ideas presented at the 2009 Institute of Medicine (IOM) workshop, Sufficiency of the U.S. Oral Health Workforce in the Coming Decade. Using the IOM discussions as their starting point, the authors evaluate oral health care delivery system performance for specific populations' needs and explore the roles that the workforce can play in improving the care delivery model. The contributing articles provide a broad framework for stimulating and evaluating innovation and change in the oral health care delivery system. The articles in this special issue point to many deficits in the current oral health care delivery system and provide compelling arguments and proposals for improvements. The issues presented and solutions recommended are not entirely new, but add to a growing body of work that is of critical importance given the context of wider health care reform. [source]

    Workforce: the new core curriculum for medical schools

    MEDICAL EDUCATION, Issue 4 2006
    David Prideaux
    No abstract is available for this article. [source]

    The Diversity Imperative: Strategies to Address a Diverse Nursing Workforce

    NURSING FORUM, Issue 3 2008
    Joanne Noone PhD
    TOPIC. There has been a call to action for the need to create a more diverse nursing workforce. PURPOSE. The purpose of this article is to outline and review strategies that schools of nursing education can use to increase the recruitment, retention, and success of a diverse nursing student body. SOURCES OF INFORMATION. A review of the nursing literature was performed using CINAHL and hand-searching references. Abstracts were reviewed and articles included if the topic of the article referred to strategies to increase the diversity of nursing students. CONCLUSIONS. A variety of strategies are being used to address this issue. A multifaceted approach is recommended. [source]

    Returning Nurses to the Workforce: Developing a Fast Track Back Program

    NURSING FORUM, Issue 3 2006
    Helen K. Burns PhD
    TOPIC., Fast Track Back: Re-entry into Nursing Practice program. PURPOSE AND SOURCES OF INFORMATION.,Describes the development, implementation, and evaluation of a state-of-the-art re-entry program facilitating the return of licensed nonpracticing RNs to the workforce through a quality education program that retools them for the workforce in the areas of pharmacology, skill development using the latest technology, practice standards, and nursing issues. The program consists of didactic content taught via classroom, Internet, skills laboratory, and high fidelity human simulated technology and a clinical component. CONCLUSIONS.,The program is a mechanism that enables re-entry nurses to improve skills and competencies necessary to practice in today's healthcare environment. [source]

    Strategies for Developing a High-Skilled Workforce

    Catherine M. Sleezer
    ABSTRACT This article focuses on the human performance improvement and human resource development task of providing an organization with a skilled workforce. We begin by describing the U.S. demographic trends and the changing job skill requirements that will lead to a shortage of skilled workers and that highlight the importance of considering the various strategies that are available for developing a skilled workforce. Then, using perspectives found in the literature, we examine four strategies for developing a skilled workforce: (1) hire and then train the workers, (2) transfer individual workers, (3) relocate the work, and (4) create an educational infrastructure within a community to develop a workforce with the needed skills. We conclude by comparing the four strategies and identifying the advantages, disadvantages, and most effective uses of each. [source]

    Change to Strange: Create a Great Organization by Building a Strange Workforce by Daniel M. Cable

    Article first published online: 3 SEP 200
    No abstract is available for this article. [source]

    National Health Service Corps Staffing and the Growth of the Local Rural Non-NHSC Primary Care Physician Workforce

    Donald E. Pathman MD
    ABSTRACT:,Context: Beyond providing temporary staffing, National Health Service Corps (NHSC) clinicians are believed by some observers to contribute to the long-term growth of the non-NHSC physician workforce of the communities where they serve; others worry that NHSC clinicians compete with and impede the supply of other local physicians. Purpose: To assess long-term changes in the non-NHSC primary care physician workforce of rural underserved counties that have received NHSC staffing support relative to workforce changes in underserved counties without NHSC support. Methods: Using data from the American Medical Association and NHSC, we compared changes from 1981 to 2001 in non-NHSC primary care physician to population ratios in 2 subsets of rural whole-county health professional shortage areas: (1) 141 counties staffed by NHSC physicians, nurse practitioners, and/or physician assistants during the early 1980s and for many of the years since and (2) all 142 rural health professional shortage area counties that had no NHSC clinicians from 1979 through 2001. Findings: From 1981 to 2001, counties staffed by NHSC clinicians experienced a mean increase of 1.4 non-NHSC primary care physicians per 10,000 population, compared to a smaller, 0.57 mean increase in counties without NHSC clinicians. The finding of greater non-NHSC primary care physician to population mean ratio increase in NHSC-supported counties remained significant after adjusting for baseline county demographics and health care resources (P < .001). The estimated number of "extra" non-NHSC physicians in NHSC-supported counties in 2001 attributable to the NHSC was 294 additional physicians for the 141 supported counties, or 2 extra physicians, on average, for each NHSC-supported county. Over the 20 years, more NHSC-supported counties saw their non-NHSC primary care workforces grow to more than 1 physician per 3,500 persons, but no more NHSC-supported than nonsupported counties lost their health professional shortage area designations.Conclusions: These data suggest that the NHSC contributed positively to the non-NHSC primary care physician workforce in the rural underserved counties where its clinicians worked during the 1980s and 1990s. [source]

    Modeling the Mental Health Workforce in Washington State: Using State Licensing Data to Examine Provider Supply in Rural and Urban Areas

    Laura-Mae Baldwin MD
    ABSTRACT:,Context: Ensuring an adequate mental health provider supply in rural and urban areas requires accessible methods of identifying provider types, practice locations, and practice productivity. Purpose: To identify mental health shortage areas using existing licensing and survey data. Methods: The 1998-1999 Washington State Department of Health files on credentialed health professionals linked with results of a licensure renewal survey, 1990 US Census data, and the results of the 1990-1992 National Comorbidity Survey were used to calculate supply and requirements for mental health services in 2 types of geographic units in Washington state,61 rural and urban core health service areas and 13 larger mental health regions. Both the number of 9 types of mental health professionals and their full-time equivalents (FTEs) per 100,000 population measured supply in the health service areas and mental health regions. Findings: Notable shortages of mental health providers existed throughout the state, especially in rural areas. Urban areas had 3 times the psychiatrist FTEs per 100,000 and more than 1.5 times the nonpsychiatrist mental health provider FTEs per 100,000 as rural areas. More than 80% of rural health service areas had at least 10% fewer psychiatrist FTEs and nonpsychiatrist mental health provider FTEs than the state ratio (10.4 FTEs per 100,000 and 306.5 FTEs per 100,000, respectively). Ten of the 13 mental health regions were more than 10% below the state ratio of psychiatrist FTEs per 100,000. Conclusions: States gathering a minimum database at licensure renewal can identify area-specific mental health care shortages for use in program planning. [source]

    The Role of Government in the Expansion of the Contingent Workforce

    Jiyoung Kim
    This article examines the government's role in expansion of the contingent workforce in South Korea. I argue that the government played a determining role in transforming the South Korean labor market and increasing the number of contingent workers. Through the active adoption of a flexible labor market policy as a part of its globalization movement, the South Korean government directly contributed to a rise in contingent work. Also, the South Korean government indirectly supported the expanded use of non-regular workers through its tacit approval of companies' illegal use of contingent workers. The existing literature on contingent workers has focused primarily on economic factors. This case study highlights the need to include the role of government as an important cause of the growth of the contingent workforce. [source]

    Controlling and Motivating the Workforce: Evidence from the Banking Industry in the Late Nineteenth and Early Twentieth Centuries

    Andrew J. SeltzerArticle first published online: 18 DEC 200
    Large banks have a considerable advantage over their smaller rivals because they are better able to diversify their portfolios. However, to achieve this advantage they must overcome agency problems associated with delegating decision making to non-owner employees. This paper uses evidence from the Union Bank of Australia to examine mechanisms used to monitor and motivate workers. Monitoring took the form of rigorous screening, beginning with the hiring process and continuing with frequent performance evaluations. Workers were also given strict rules of behaviour and incentives to supply effort in the form of seniority-based wages, performance-based promotions, and a generous pension plan. [source]

    Assessment of Emergency Physician Workforce Needs in the United States, 2005

    Carlos A. Camargo Jr MD
    Abstract Objectives:, The objective was to estimate emergency physician (EP) workforce needs, taking into account the diversity of U.S. emergency departments (EDs) and various projections of EP supply and demand. Methods:, The 2005 National ED Inventory-USA ( provided annual visit volumes for 4,828 U.S. EDs. The authors calculated annual supply based on existing emergency medicine (EM) board-certified EPs, adding newly board-certified EPs, and subtracting board-certified EPs who died or retired. Demand was estimated at each ED by dividing the number of visits by the average EP volume (based on 2.8 patients/hour, 40 hours/week, and 34% nonclinical time). The models assumed that at least 1 EP should be present 24/7 in each ED, which would require at least 5.35 full-time equivalents (FTEs) per ED. Based on annual EP attrition estimates, results for best-case, worst-case, and intermediate scenarios were calculated. Results:, In 2005, there were approximately 22,000 EM board-certified EPs, but 40,030 EPs would be needed to staff all 4,828 EDs (55% of demand met). A total of 2,492 (52%) EDs had a visit volume that required the minimum number (5.35) FTEs, of which 47% were rural. In the unrealistic (no attrition), best-case scenario, it would take until 2019 to staff all EDs with board-certified EPs. In the worst-case scenario (12% attrition), supply would never meet demand. Our intermediate scenario (2.5% attrition) suggested that board-certified EPs would satisfy workforce needs in 2038. Conclusions:, Supply of EM residency-trained, board-certified EPs is not likely to meet demand in the near future. Alternative EP staffing arrangements merit further consideration. [source]

    FS13.3 Development of risk reduction strategies for preventing dermatitis

    CONTACT DERMATITIS, Issue 3 2004
    Terry Brown
    Introduction:, A recent survey of the UK printing industry found a prevalence of 11% of occupational contact dermatitis (OCD), much higher than previously identified. Objective:, This pilot study aimed to evaluate risk reduction strategies derived from recommendations of a literature review of preventive intervention studies and a series of focus groups of printers and observations of printers undertaking their normal duties. Methods:, Four interventions were evaluated: (1) Provision of gloves of the correct size/type, plus use of an after-work skin cream; (2) Provision of information; (3) Provision of skin checks; (4) Development of best practice skin care policy. Each intervention was evaluated in two companies over a three-month period, at the end of which printers and managers were interviewed as to the effectiveness and acceptability of each intervention. Results:, Although this pilot study was short, all interventions were acceptable to some extent. The prevalence of frank dermatitis fell over the study period, particularly in intervention (3). Intervention (1) achieved an improvement of awareness in both management and workforce and an increase in the use of both gloves and cream. Intervention (2) highlighted problems of dissemination and the need for relevant information in an appropriate format. However. no single intervention was completely effective. Conclusions:, This qualitative research approach forms an essential first stage to improving understanding of ways in which OCD may be reduced among workers in the printing industry, and points towards the need for further testing of preventive strategies in larger-scale intervention trials, in printing and other industries. [source]

    Gender and Ethnic Diversity Among UK Corporate Boards

    Stephen Brammer
    This paper investigates the ethnic and gender diversity of the corporate board of UK companies, placing particular emphasis on links to board size and industry characteristics. We employ a novel dataset that covers a large sample of UK PLCs and describes a director's gender, ethnicity and position held. We find both ethnic and gender diversity to be very limited, and that diversity is somewhat less pronounced among executive positions. We find significant cross-sector variation in gender diversity, with an above average prevalence of women in Retail, Utilities, Media and Banking, while such variation in ethnic diversity is considerably less pronounced. Our evidence suggests that a close proximity to final consumers plays a more significant role in shaping board diversity than does the female presence among the industry's workforce. We argue that this shows that board diversity is influenced by a firm's external business environment and particularly an imperative to reflect corresponding diversity among its customers. [source]

    An environment for prosperity and quality living accommodating growth in the Thames Valley

    Hugh Howes
    The Thames Valley is seen as the powerhouse of the British economy, and one of the best performing regions in Europe. This economic base offers opportunities for expansion with the potential for it to become the knowledge capital of Europe. Business interests view the area as a highly desirable location, not only because of its markets, skills and proximity to the City and Heathrow but also because of its high quality environment. Companies, however, complain of skills shortages, traffic congestion, lack of suitable premises and housing that is affordable to the workforce. Much of the Thames Valley is either Green Belt or Areas of Outstanding Natural Beauty. Furthermore, the availability of future water supplies, the maintenance of the quality of water in the rivers and managing flood risk are also likely to act as constraints on development in the future. How economic growth is to be achieved with minimal additional development and without detriment to the environment is the central question that is likely to dominate planning in the this region over the next few years. Is it possible to achieve more with existing resources? Copyright 2004 John Wiley & Sons, Ltd and ERP Environment. [source]

    Corporate socially responsible (CSR) practices in the context of Greek industry

    Dr Constantina Bichta
    This paper sets out to describe the level of corporate environmental responsibility of the Greek industrial sector. While the level of corporate socially responsible behaviour has been widely explored in the context of Northern European industry, the theoretical work surrounding the level of CSR practices of Greek industry is underdeveloped. A qualitative study was designed to increase awareness about the level of environmental responsibility of two Greek firms, which represented the chemical/fertilizer and metal sectors. The empirical findings suggest that a number of factors, both internal and external, determine the level of environmental policy and performance of the two companies. The environmental policy of the companies appears also to relate to the sector of operation. The paper concludes that the Greek business actor should look at his workforce in order to accelerate the environmental activities of the organization. With regard to the theory of CSR, it is argued that the development of a model of CSR is aided by the study and identification of factors that support and/or undermine the socially responsible behaviour of the European corporate sector. Copyright 2003 John Wiley & Sons, Ltd. and ERP Environment. [source]

    The Art and Science of Surge: Experience from Israel and the U.S. Military

    Boaz Tadmor MD
    In a disaster or mass casualty incident, health care resources may be exceeded and systems may be challenged by unusual requirements. These resources may include pharmaceuticals, supplies, and equipment as well as certain types of academic and administrative expertise. New agencies and decision makers may need to work together in an unfamiliar environment. Furthermore, large numbers of casualties needing treatment, newer therapies required to care for these casualties, and increased workforce and space available for these casualties all contribute to what is often referred to as "surge." Surge capacity in emergency care can be described in technical, scientific terms that are measured by numbers and benchmarks (e.g., beds, patients, and medications) or can take on a more conceptual and abstract form (e.g., decisions, authority, and responsibility). The former may be referred to as the "science" of surge, whereas the latter, an equal if not more important component of surge systems that is more conceptual and abstract, can be considered the "art" of surge. The experiences from Israel and the U.S. military may serve to educate colleagues who may be required to respond or react to an event that taxes the current health care system. This report presents concrete examples of surge capacity strategies used by both Israel and the U.S. military and provides solutions that may be applied to other health care systems when faced with similar situations. [source]

    Research Priorities for Surge Capacity

    Richard E. Rothman MD
    The 2006 Academic Emergency Medicine Consensus Conference discussed key concepts within the field of surge capacity. Within the breakout session on research priorities, experts in disaster medicine and other related fields used a structured nominal-group process to delineate five critical areas of research. Of the 14 potential areas of discovery identified by the group, the top five were the following: 1) defining criteria and methods for decision making regarding allocation of scarce resources, 2) determining effective triage protocols, 3) determining key decision makers for surge-capacity planning and means to evaluate response efficacy (e.g., incident command), 4) developing effective communication and information-sharing strategies (situational awareness) for public-health decision support, and 5) developing methods and evaluations for meeting workforce needs. Five working groups were formed to consider the above areas and to devise sample research questions that were refined further by the entire group of participants. [source]

    Knowledge Life Cycle, Knowledge Inventory, and Knowledge Acquisition Strategies,

    DECISION SCIENCES, Issue 1 2010
    Andrew N. K. Chen
    ABSTRACT For a knowledge- and skill-centric organization, the process of knowledge management encompasses three important and closely related elements: (i) task assignments, (ii) knowledge acquisition through training, and (iii) maintaining a proper level of knowledge inventory among the existing workforce. Trade-off on choices between profit maximization in the short run and agility and flexibility in the long term is a vexing problem in knowledge management. In this study, we examine the effects of different training strategies on short-term operational efficiency and long-term workforce flexibility. We address our research objective by developing a computational model for task and training assignment in a dynamic knowledge environment consisting of multiple distinct knowledge dimensions. Overall, we find that organizational slack is an important variable in determining the effectiveness of training strategies. Training strategies focused on the most recent skills are found to be the preferred option in most of the considered scenarios. Interestingly, increased efficiencies in training can actually create preference conflict between employees and the firm. Our findings indicate that firms facing longer knowledge life cycles, higher slack in workforce capacity, and better training efficiencies actually face more difficult challenges in knowledge management. [source]

    IRSS Psychology Theory: Telling Experiences Among Underrepresented IS Doctorates

    Fay Cobb Payton
    ABSTRACT With the changing demographics of the American workforce, the National Science Foundation, along with the U.S. Department of Commerce, has highlighted the shortage of minorities in information technology (IT) careers ( Using data from a 6-year period and the psychology Involvement-Regimen-Self Management-Social (IRSS) network theory as defined by Boice (1992), we discuss lessons learned from mentoring a group of Information Systems doctoral students who are members of a pipeline that can potentially increase the number of underrepresented faculty in business schools and who made conscious decisions to renounce the IT corporate domain. While our lessons speak to the need for more diversity awareness, we conclude that effective mentoring for underrepresented groups can and should include faculty of color (though limited in numbers) as well as majority faculty who are receptive to the needs and cultural differences of these student groups. Lastly, we draw on the work of Ethnic America to provide additional insight into our findings that are not offered by IRSS network theory. [source]

    Employer burden of mild, moderate, and severe major depressive disorder: mental health services utilization and costs, and work performance,

    Howard G. Birnbaum Ph.D.
    Abstract Background: Treatment utilization/costs and work performance for persons with major depressive disorder (MDD) by severity of illness is not well documented. Methods: Using National Comorbidity Survey-Replication (2001,2002) data, US workforce respondents (n=4,465) were classified by clinical severity (not clinically depressed, mild, moderate, severe) using a standard self-rating scale [Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR)]. Outcomes included 12-month prevalence of medical services/medications use/costs and workplace performance. Treatment costs (employer's perspective) were estimated by weighing utilization measures by unit costs obtained for similar services used by MDD patients in claims data. Descriptive analysis across three severity groups generated ,2 results. Results: Using a sample of 539 US workforce respondents with MDD, 13.8% were classified mild, 38.5% moderate, and 47.7% severe cases. Mental health services usage, including antidepressants, increased significantly with severity, with average treatment costs substantially higher for severe than for mild cases both regarding mental health services ($697 vs. $388, ,2=4.4, P=.019) and antidepressants ($256 vs. $88, ,2=9.0, P=.001). Prevalence rates of unemployment/disability increased significantly (,2=11.7, P=.003) with MDD severity (15.7, 23.3, and 31.3% for mild, moderate, and severe cases). Severely and moderately depressed workers missed more work than nondepressed workers; the monthly salary-equivalent lost performance of $199 (severely depressed) and $188 (moderately depressed) was significantly higher than for nondepressed workers (,2=10.3, P<.001). Projected to the US workforce, monthly depression-related worker productivity losses had human capital costs of nearly $2 billion. Conclusions: MDD severity is significantly associated with increased treatment usage/costs, treatment adequacy, unemployment, and disability and with reduced work performance. Depression and Anxiety, 2010. 2009 Wiley-Liss, Inc. [source]

    Recent Changes in the Workforce and Practice of Dermatologic Surgery

    BACKGROUND The increasing number of American College of Mohs Surgery (ACMS) fellowship positions over the last decade has resulted in a greater number of fellowship-trained surgeons in dermatologic surgery. METHODS Mohs micrographic fellowship-trained surgeons (MMFTSs) and non-Mohs fellowship-trained surgeons performing Mohs micrographic surgery (NMMFTSs) were compared using the American Academy of Dermatology Practice Profile Survey (2002/05). An analysis of recent Mohs fellowship classes was also performed. RESULTS In 2005, there was an equivalent proportion of MMFTSs and NMMFTSs in the workforce (ratio MMFTS:NMMFTS=0.9) but, in 2005, there was a shift in the youngest age cohort (29,39) to a greater proportion of MMFTSs (MMFTS:NMMFTS=1.55). In 2005, the youngest MMFTSs (29,39) were more likely to be female (47.1%) than of MMFTSs overall (24%). MMFTSs were 5 times as likely to be in full-time academic positions and performed 2 to 3 times as many Mohs cases per week as NMMFTSs. CONCLUSIONS Consistent with demographic shifts in dermatology, differences have emerged in the demographics, surgical volumes, and settings of MMFTSs and NMMFTSs. Recent increases in the ACMS fellowship positions have resulted in a greater proportion of MMFTSs among younger dermatologic surgeons. It will be important to follow how this increase in fellowship trainees affects the dermatologic surgery workforce. [source]

    Are clinical practical guidelines (CPGs) useful for health services and health workforce planning?

    DIABETIC MEDICINE, Issue 5 2010
    A critique of diabetes CPGs
    Diabet. Med. 27, 570,577 (2010) Abstract Aims, Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. Methods, This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. Results, Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. Conclusions, Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely. [source]

    Is multidisciplinary learning effective among those caring for people with diabetes?

    DIABETIC MEDICINE, Issue 10 2002
    N. Munro
    Abstract The role of multi-professional learning for those providing clinical services to people with diabetes has yet to be defined. Several assumptions are generally made about education in the context of multi-professional settings. It is argued that different professions learning together could potentially improve professional relationships, collaborative working practices and ultimately standards of care. Greater respect and honesty may emerge from a team approach to learning with a commensurate reduction in professional antagonism. Personal and professional confidence is reportedly enhanced through close contact with other professionals during team-based learning exercises. We have examined current evidence to support multidisciplinary learning in the context of medical education generally as well as in diabetes education. Previous investigation of available literature by Cochrane reviewers, aimed at identifying studies of interprofessional education interventions, yielded a total of 1042 articles, none of which met the stated inclusion criteria. Searches involving more recent publications failed to reveal more robust evidence. Despite a large body of literature on the evaluation of interprofessional education, studies generally lacked the methodological rigour needed to understand the impact of interprofessional education on professional practice and/or health care outcomes. Nevertheless, planners continue to advocate, and endorse, joint training between different groups of workers (including nurses, doctors and those in professions allied to medicine) with the objective of producing an integrated workforce of multidisciplinary teams. Whilst the concept of multi-professional learning has strong appeal, it is necessary for those responsible for educating health care professionals to demonstrate its superiority over separate learning experiences. [source]

    The International Adult Literacy Survey in Britain: Impact on policy and practice

    DYSLEXIA, Issue 2 2003
    Angela J. Fawcett
    Abstract There is increasing concern for the skills of the workforce in the UK and elsewhere, but despite this concern until recently there has been little information available which objectively measures basic skills in adults. In this paper, evidence derived from the prose scale of the International Adult Literacy Survey (IALS, 1996) is outlined, with emphasis on the performance of adults at the lowest levels, 1 and 2 in the United Kingdom. A new analysis based on the 183 adults who self-reported learning disabilities demonstrates that over 50% of this group perform at level 1 on the prose scale. Over 60% report that these disabilities persist into adult life, although this number falls to 50% in the youngest age group, reflecting changes in recognition of learning disabilities within the education system. The paper concludes with a case study of the redefinition of basic skill levels in Britain based on the IALS levels. The impact of the IALS findings on policy and practice, and in particular through the recommendations of the Moser report, are discussed. Copyright 2002 John Wiley & Sons, Ltd. [source]