Background: Employer skill requirements of graduates are monitored by Graduate Careers Australia, but health services management (HSM) specific employability skills (ES) perceived by graduates to be important on the job and their perceptions of skills they need to improve are not well reported. Academics need this feedback to improve course employment outcomes by helping current students identify and articulate appropriatecompetencies to potential employers. Also teaching of industry requirements can help improve job matching for employers. Method: Recent graduates working in HSM in New South Wales, Australia were surveyed to rate ES for importance and rate their own skill levels on the same items. The gap between these two ratings was identified for 44 ES. Results: ES important to recent graduates in rank order were: verbal communication skills, integrity and ethical conduct, time management, teamwork, priority setting, ability to work independently, organisational skills, written communication, being flexible and open minded and networking. Highest self-ratings were found for integrity and ethical conduct, ability to work independently, being flexible and open minded, tertiary qualifications, interpersonal skills, written communication skills, time management, life-long learning, priority setting and administration skills. Generally graduates rated their skills lower than their ratings of importance. Conclusions: Recent graduates can provide valuable feedback to universities about ES required for HSM positions and identify their own skill gaps for development at work or through study. Generic skills rather than job-specific skills are what they rate as most important. Closer engagement of universities and employers is recommended especially through placements. Abbreviations: ES – employability skills; GCA – Graduate Careers Australia; HEI – higher education institutions; HRM – human resource management; HSM – health services management; IPC – interpersonal and communication skills.
Background Patient-centred care by a coordinated primary care team may be more effective than standard care in chronic disease management. We synthesised evidence to determine whether patient-centred medical home (PCMH)-based care models are more effective than standard general practitioner (GP) care in improving clinical, hospital, and economic outcomes. Methods MEDLINE, CINAHL, Embase, Cochrane Library, and Scopus were searched to identify randomised (RCTs) and non-randomised controlled trials that evaluated two or more principles of PCMH among primary care patients with chronic diseases. Study selection, data extraction, quality assessment using Joanna Briggs Institute (JBI) appraisal tools, and grading of evidence using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach were conducted independently. A quantitative synthesis, where possible, was pooled using random effects models and the effect size estimates of standardised mean differences (SMDs) and odds ratios (ORs) with 95% confidence intervals were reported. Results Of the 13820 citations, we identified 78 eligible RCTs and 7 quasi trials which included 60617 patients. The findings suggested that PCMH-based care was associated with significant improvements in depression episodes (SMD − 0.24; 95% CI -0.35, -0.14) and increased odds of remission (OR 1.79; 95% CI 1.46, 2.21). There were significant improvements in the health-related quality of life (SMD 0.10; 95% CI 0.04, 0.15); self-management outcomes (SMD 0.24; 95% CI 0.03, 0.44) and hospital admissions (OR 0.83; 95% CI 0.70, 0.98). In terms of clinical outcomes, with exception to total cholesterol, PCMH-based care led to significant improvements in blood pressure, glycated haemoglobin, and low-density lipoprotein cholesterol outcomes. The incremental cost of PCMH care was identified to be small and significantly higher than standard care (SMD 0.17; 95% CI 0.08, 0.26). The quality of individual studies ranged from ‘fair’ to ‘good’ by meeting at least 60% of items on the quality appraisal checklist. Additionally, moderate to high heterogeneity across studies in outcomes resulted in downgrading the included studies as moderate or low grade of evidence. Conclusion PCMH-based care has been found to be superior to standard GP care in chronic disease management. Results of the review have important implications that may inform patient, practice, and policy-level changes.
ObjectivesThis systematic review aims to improve our knowledge of enablers and barriers to implementing obesity-related anthropometric assessments in clinical practice.DesignA mixed-methods systematic review.Data sourcesMedline, Embase and CINAHL to November 2021.Eligibility criteriaQuantitative studies that reported patient factors associated with obesity assessments in clinical practice (general practice or primary care); and qualitative studies that reported views of healthcare professionals about enablers and barriers to their implementation.Data extraction and synthesisWe used random-effects meta-analysis to pool ratios for categorical predictors reported in ≥3 studies expressed as pooled risk ratio (RR) with 95% CI, applied inverse variance weights, and investigated statistical heterogeneity (I2), publication bias (Egger’s test), and sensitivity analyses. We used reflexive thematic analysis for qualitative data and applied a convergent integrated approach to synthesis.ResultsWe reviewed 22 quantitative (observational) and 3 qualitative studies published between 2004 and 2020. All had ≥50% of the quality items for risk of bias assessments. Obesity assessment in clinical practice was positively associated with patient factors: female sex (RR 1.28, 95% CI 1.10 to 1.50, I299.8%, mostly UK/USA), socioeconomic deprivation (RR 1.21, 95% CI 1.18 to 1.24, I273.9%, UK studies), non-white race/ethnicity (RR 1.27, 95% CI 1.03 to 1.57, I299.6%) and comorbidities (RR 2.11, 95% CI 1.60 to 2.79, I299.6%, consistent across most countries). Obesity assessment was also most common in the heaviest body mass index group (RR 1.55, 95% CI 0.99 to 2.45, I299.6%). Views of healthcare professionals were positive about obesity assessments when linked to patient health (convergent with meta-analysis for comorbidities) and if part of routine practice, but negative about their role, training, time, resources and incentives in the healthcare system.ConclusionsOur evidence synthesis revealed several important enablers and barriers to obesity assessments that should inform healthcare professionals and relevant stakeholders to encourage adherence to clinical practice guideline recommendations.
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