Physical and Occupational Therapy Practice Improvement Following Interprofessional Evidence-Based Falls Prevention Training.

AIMS: Evaluate changes in physical therapy (PT) and occupational therapy (OT) practice following evidence-based practice (EBP) interprofessional modules that teach assessments and interventions to reduce falls in community-dwelling older adults. METHODS: Medical records of post-fall patients in three Programs of All-Inclusive Care for the Elderly (PACE) sites were analyzed to assess differences in documented falls and the OT and PT use of EBP assessment and interventions implemented following fall prevention training. RESULTS: In training year 1, PT demonstrated a 34.6% practice improvement in risk assessments performed (z=3.0, p<0.005). In training year 2, PT demonstrated a 66.7% practice change in the implementation of EBP interventions (z=2.1, p<0.05) and OT demonstrated a 22.2% practice improvement in the implementation of recommended EBP interventions (z=2.0, p<0.05). In training year 3, OT achieved a 6.8% increase in the execution of home environment modifications (z=2.0, p<0.05), and PT demonstrated a 23.3% practice improvement in the implementation of recommended EBP interventions (z=3.1, p<0.005). CONCLUSION: The delivery of EBP assessment and intervention training modules for falls prevention resulted in PT and OT practice changes and improved adherence to published guidelines.

Perceived self-efficacy gains following an interprofessional faculty development programme in geriatrics education.

This study was designed to document outcomes of a 10-month, 160-hour interprofessional faculty development programme in geriatrics. The programme was structured around a series of collaborative competencies in older adult care established. Six domains covering 23 competencies were used to create an evaluation instrument designed to measure changes in self-efficacy as a result of the training programme. These competencies are covered through a series of interactive and didactic seminars offered on a monthly basis throughout the academic year. Twenty-six faculty participants indicated their levels of perceived self-efficacy with respect to each partnership for health in aging competency before and after the training. Statistically significant results were found with respect to every competency in each domain. Prior to the training self-efficacy levels were lower than the mean ratings collected 10 months later when the training concluded. The largest perceived self-efficacy gains were seen in the "evaluation and assessment", "care planning and coordination across the care spectrum", and "healthcare systems and benefits" domains. These may reflect areas that were not covered extensively during the participants' previous healthcare-related training. Overall, the data demonstrate how a carefully constructed interprofessional faculty development programme can successfully engender confidence in geriatric competencies across multiple professions.

Screening and Brief Intervention for Alcohol Misuse in Older Adults: Training Outcomes Among Physicians and Other Healthcare Practitioners in Community-Based Settings.

Screening and brief intervention (SBI) is increasingly available to older adults who engage in at-risk drinking. This study examined the extent to which SBI training influenced the willingness of healthcare providers in a community-based hospital and other clinical settings to promote the implementation of SBI. Ninety-three healthcare practitioners (primarily physicians, nurses, and social workers) who attended SBI training were asked about their intentions to apply the information in their professional practice, as well as their enthusiasm about recommending the training to others in their profession. Although there were no differences among the professions in terms of commitment to apply the information or level of comfort using the techniques, physicians were less interested in promoting SBI training among their colleagues. Although it may be more difficult to promote SBI in locations that don't primarily provide mental health services, results suggest that primary care settings are precisely where training may be most useful.

Facilitating Lewin's change model with collaborative evaluation in promoting evidence based practices of health professionals.

Evidence based practices (EBPs) in clinical settings interact with and adapt to host organizational characteristics. The contextual factors themselves, surrounding health professions' practices, also adapt as practices become sustained. The authors assert the need for better planning models toward these contextual factors, the influence of which undergird a well-documented science to practice gap in literature on EBPs. The mechanism for EBP planners to anticipate contextual effects as programs Unfreeze their host settings, create Movement, and become Refrozen (Lewin, 1951) is present in Lewin's 3-step change model. Planning for contextual change appears equally important as planning for the actual practice outcomes among providers and patients. Two case studies from a Geriatric Education Center network will illustrate the synthesis of Lewin's three steps with collaborative evaluation principles. The use of the model may become an important tool for continuing education evaluators or organizations beginning a journey toward EBP demonstration projects in clinical settings.

The development of an educational collaborative to address comprehensive pressure ulcer prevention and treatment.

The prevention and treatment of pressure ulcers is a growing public policy concern. Driven by a more informed consumer and the exploding costs of care, policy makers are looking for ways to integrate health-care research and long-term care practices in an effort to improve the quality of care and ultimately reduce costs. This paper presents a case study that demonstrates how training is being integrated at the facility level, utilizing a collaborative. The collaborative was a joint public-private partnership supported through resources from state, federal, and private agencies, with an overarching goal of delivering high-quality, easily accessible geriatric education and training. Direct care providers and other practitioners were recruited to attend a live, interactive videoconference that featured nationally known experts. The content of the educational program was drawn from nationally accepted guidelines that discuss appropriate procedures for wound cleansing, dressings, positioning techniques, proper nutrition and risk assessment protocols. Evaluation of the program indicated that the highest-rated objectives related to the application of training content in the implementation of treatment and prevention procedures important to quality patient care. An examination of publicly available data revealed that an escalating increase in the percentage of facilities in the state cited for deficiencies because of the incidence of pressure ulcers from 1996 to 1999 was reversed in 2000, subsequent to the videoconference. Future programs are planned to sustain the availability of opportunities for practitioners to get critical updates from the experts in the field via live interactive sessions.