Evolution of the peer specialist role during COVID-19: Challenges and opportunities for innovation beyond the COVID-19 era.

OBJECTIVE: To examine peer specialist role-related challenges and opportunities in adapting to a new model of service provision during and beyond the COVID-19 era. METHOD: This mixed-methods study analyzes data from a survey (n = 186) as well as in-depth interviews (n = 30) with certified peer specialists in Texas. RESULTS: Peers described facing several challenges related to COVID-19 service delivery (e.g., fewer options for providing peer support, issues with access to reliable technology) as well as challenges related to adapting to changes to the peer role (e.g., challenges supporting people in services' community resource needs, challenges building rapport with people in services virtually). However, results also indicate that a new model of service provision during and beyond the COVID-19 pandemic presented peers with new opportunities to provide enhanced peer services, new career development opportunities, and new opportunities related to increased job flexibility. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Results suggest the importance of developing trainings on providing virtual peer support, increasing technological access for peers and individuals in services, and providing peers with flexible job options and resiliency-focused supervision. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effectiveness of a Digital Peer Support Training Program Designed for Rapid Uptake Among Peer Support Specialists Pilot Study.

Peer telemental health recently became Medicaid reimbursable during the COVID-19 crisis, increasing the need for standardized training on digital peer support (DPS) services. DPS has the potential to reduce barriers to services and expand the reach of peer support specialists. The 4-h Digital Peer Support Training program was developed to train peer support specialists for rapid uptake in providing digital peer support during the COVID-19 crisis. The purpose of this study was to examine the impact of the 4-h DPS course for peer support specialists. Surveys were administered to examine pre-post changes in DPS course for participants (N = 75) related to attitudes/ beliefs towards DPS, ability to use/ engage in DPS, and organizational readiness to implement DPS. Data were analyzed by conducting paired samples t-tests. Linear mixed models were used to explore significant results further. Statistically significant (< .05) changes were observed related to readiness to use DPS, attitudes/ beliefs towards DPS, and ability to use/ engage in DPS. The 4-h DPS course may be beneficial in providing diverse groups of peer support specialists with a standardized training framework. Widespread dissemination of the DPS short course may be beneficial in rapidly equipping peer support specialists with the skills and resources needed to expand the reach of peer support services during the COVID-19 crisis and beyond.

Exploring the availability of specialist health workforce education in East and Southern Africa: a document analysis.

BACKGROUND: Specialist health professionals improve health outcomes. Most low-income and middle-income countries do not have the capacity to educate and retain all types of specialists across various health professions. This study sought to explore and describe the opportunities available for specialist health professions education and the pathways to becoming a specialist health professional in East and Southern Africa (ESA). Understanding the regional capacity for specialist education provides opportunities for countries to apply transnational education models to create prospects for specialist education. METHODS: A document analysis on specialist training programmes for health professionals was conducted in twenty countries in ESA to establish the capacity of specialist education for health professionals. Data were collected from policy documents, grey literature and websites at the country and institution levels. FINDINGS: We found 288 specialist health professions education programmes across ten professional categories in 157 health professions education institutions from 18 countries in the ESA are reported. Medical and Nursing specialist programmes dominate the list of available specialist programmes in the region, while Kenya, South Africa and Ethiopia have the highest number of specialist programmes. Most included specialist programmes were offered at the Master's level or as postgraduate diplomas. There is a general uneven distribution of specialist health professions education programmes within the ESA region despite sharing almost similar sociogeographical context and disease patterns. Current national priorities may be antecedent to the diversity and skewed distribution of specialist health professions programmes. CONCLUSION: Attention must be paid to countries with limited capacity for specialist education and to professions that are severely under-represented. Establishing regional policies and platforms that nurture collaborations towards specialist health professions education may be a proximal solution for increased regional capacity for specialist education.

Expanding the strategic and clinical leadership role of accredited specialists.

BACKGROUND: We sought to explore the value and benefits of accredited specialists employed in the National Health Service (NHS), and proposed strategies for expanding their role. AIMS: To explore the core characteristics of accredited specialists and to examine how their skills could be further utilized to enhance occupational health (OH) services. METHODS: Mixed methods comprising a survey and qualitative work. RESULTS: OH survey was completed by 65 of 128 (51%) respondents. Nine accredited specialists and 16 stakeholders contributed qualitative data. Most OH departments were located in acute NHS trusts and additionally provided externally contracted services. We found a large variation in OH staffing and OH services delivered. The COVID pandemic created unprecedented challenges and required expansion in services to meet demand. The majority of respondents described greater recognition and appreciation by others of accredited specialists and OH teams for their specialist contribution during the pandemic. From the qualitative data, we identified two overarching themes. 'Professional credibility has currency' (Theme 1) and 'A visionary future' (Theme 2). A series of sub-themes are described. CONCLUSIONS: Accredited specialists employed in the NHS possess a core set of attributes and capabilities, and are skilful at delivering strong, influential and impactful clinical and strategic leadership across the NHS hierarchy and landscape. The COVID pandemic provided valuable opportunities for them to showcase their specialist clinical and leadership skills. The current wider reorientation of NHS clinical services offers bold new ways to expand their role beyond traditional clinical boundaries.

Towards Zero Suicide for older adults: implications of healthcare service use for implementation.

OBJECTIVE: Implementing the Towards Zero Suicide (TZS) approach to suicide prevention in older adults requires evidence-based adaptation. This paper aims to highlight important differences and opportunities in healthcare service use by older adults relevant to implementation. CONCLUSION: The TZS approach may prevent suicide in older adults, but only if implementation aligns with systemic differences in healthcare utilisation by older people. Of greatest importance in older adults are (1) most mental healthcare is delivered outside of specialist mental health services; (2) physical conditions and disability are major modifiable contributors to suicide that must be addressed within TZS; and (3) older people have very low use of Medicare-funded psychological services. Primary healthcare providers, who may be seeing older people at risk of suicide, are often neither equipped to provide expert assessment and care planning for often complex needs, nor may see this as their role. However, they are essential in providing pathways to care, which may prevent suicide. Leaders must recognise TZS for older people will usually involve multiple transitions. This requires engagement of key services with clear roles, targeted training, rapid access to specialist older persons mental health support and development of a new TZS element: the navigator.

[Rheumatologic inpatient treatment-more than a complex treatment : Data reflecting services and structures]. / Akutstationäre Rheumatologie ­ mehr als eine Komplexbehandlung : Versorgungsdaten und -strukturen.

To review and be prepared for upcoming reforms, data from the InEK (Institut für das Entgeltsystem im Krankenhaus, institute for remuneration in hospitals) data browser and the structured quality reports for inpatient rheumatologic treatment were evaluated. Rheumatologic treatment is very diversified, both in terms of diagnoses and structures. Different specializations can be identified. Rheumatologic complex treatment (RCT) is just one of these and is performed on average in just over 10% of cases. In 2020, cases for selected rheumatological diagnoses decreased by more than 20% compared to 2019. For RCT, the decline was even more pronounced with more than 30%. Evidence of higher disease severity could not be found in the available data. It remains to be seen whether the pre-Corona caseload will be regained in the coming years. In all, 146 organizational departments with more than 20 principal diagnoses of rheumatoid arthritis (RA) were identified in 2019. Forty-seven (32%) of these coded RCT more than ten times, and 29 (20%) more than one hundred times. All 23 departments with more than 300 principle diagnoses of RA are members of the Association of Rheumatological Acute Care Hospitals (Verband rheumatologischer Akutkliniken, VRA), 15 of which participated in the KOBRA quality project and carry the VRA seal of approval. Of the 116 internal medicine departments, only 55 (47%) use a specific specialty code for a rheumatology department according to Article 301 SGB V (social insurance code). Information on specialist staffing was partly contradictory. How many cases with inflammatory rheumatic diseases are treated in specialized departments cannot be answered with the available data. Nevertheless, the available data can be used for specialist, structural, and organizational developments in acute inpatient rheumatology.

Virtual Healthcare Simulation: Implementation, Distractions, and Preferences.

INTRODUCTION: Social distancing guidelines related to COVID-19 resulted in many simulation centers temporarily closing or adopting virtual simulation-based education (SBE). This mixed methods study aimed to evaluate our center's readiness to implement virtual SBE, the preferred method of delivery (virtual vs. nonvirtual), and any reported distractions. METHODS: Educators and simulation operations specialists (SOSs) used by our simulation center completed a survey focused on our center's implementation readiness for virtual SBE at 3 time points over a 3-week period. Three virtual simulation-based styles were developed: observer, vignette, and hybrid. All styles combined the use of Zoom and LearningSpace. Upon the completion of each session, learners, facilitators, and SOSs completed a survey focused on the preferred method of simulation delivery (virtual vs. nonvirtual) as well as any reported distractions during sessions. RESULTS: While some important lessons were learned, simulation team survey scores suggested an overall agreement in the center's preparedness during the 3-week implementation period. Most learners, facilitators, and SOSs preferred a nonvirtual delivery due to the "hands-on" component. Learners participating in the vignette style, however, significantly preferred virtual SBE due to "learning environment comfort" such as reduced anxiety, "better discussion," and "convenience." Reported distractions focused on "challenges with technology," "interruptions at home," "program logistics," and the "remote atmosphere." CONCLUSIONS: Most learners, facilitators, and SOSs preferred nonvirtual SBE; however, virtual SBE may prove beneficial for learners participating in the vignette style or particularly those experiencing anxiety. Future distractions may be mitigated for the simulation team and learners with proper preparedness.

Generalist versus Specialist Palliative Medicine.

The issue of generalist versus specialist palliative care is on the minds of healthcare leaders everywhere. We are amid changing demographics of physicians. The industrialization of medicine is well underway in the US and around the developing world. Is it important to identify patients who benefit the most from specialist palliative care, given that it is currently a limited resource? Should we step out of standard practice and redesign palliative care using principles of population management? The COVID pandemic rapidly introduced virtual palliative care consults. Is it a better way to promote wide access to specialty palliative care? Looking forward, should we promote ways to advance primary palliative care and reserve specialty palliative care to patients who will benefit most from this level of care? These questions, and others, are considered in this transcribed discussion between leading physicians in the field.

Earning opportunities and informal payment as influencing factors in medical students' speciality choice.

BACKGROUND: The Hungarian primary care system faces a severe shortage of family physicians. Medical students' perceptions of family medicine need to be known and medical students need to be given appropriate and comprehensible information about this speciality. The expected future salary is an important factor in career choice. Most of the family doctors are self-employed and the practices have a corrected capitation-type financing. Although the majority of health care services are covered by social health insurance and are provided for the insured patients free of charge, informal payment is an existing phenomenon with different motivations and consequences. This study aimed to investigate medical students' knowledge about their future earning opportunities and their attitudes towards informal payment. METHODS: A cross sectional survey with a self-administered questionnaire was conducted. Each of the four Hungarian medical universities were represented by their medical students who attended family medicine lectures in person from December 2019 to April 2020. The students were asked about their career plans, about their estimations of current and ideal expected salaries and about the effect of expected income for the choice of specialisation. Their attitudes towards informal payment were assessed. RESULTS: Response rate was 67.3% (N = 465/691). Almost two-thirds of the participants were women. Only 5% of the respondents (N = 23/462) plan to work as a family doctor in the future. The vast majority (91.9%) of the students had already thought about their future income. On a 10-point Likert scale (1 = 'no influence', 10 = 'very big influence') 76% answered that the expected future income exerts a considerable (≥5 Likert points) influence on their career choice in general. The mean of the ideal expected monthly income of the residents, GPs and other specialists was €1154 ± 648, €1696 ± 904 and €2174 ± 1594, respectively. The mean of the monthly income for a GP, as estimated by the studenst, was €1140 in rural and €1122 in urban settings. More than four-fifths of the students (N = 375/453) rejected the practice of informal payment. CONCLUSIONS: Expected salaray is one important aspect in the career choice of medical students, students wish to have more information on this topic. The reported ideal incomes are higher than those expected. This points to a relevant gap. However, most of the students do not accept informal payment as a possibility to close this gap. The expected and the ideal income differ from the real incomes of Hungarian GPs - this indicates the need of bringing objectoive information to the students to enhance attractivity of GP as a carer choice.