Base de dados : MEDLINE
Pesquisa : E02.760 [Categoria DeCS]
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[PMID]:29358236
[Au] Autor:Wadhwa V; Brookes J
[Ad] Endereço:Eastern Health, Arnold Street, Box Hill, Victoria 3128, Australia.
[Ti] Título:We must support junior doctors working after hours.
[So] Source:BMJ;360:k241, 2018 01 22.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Corpo Clínico Hospitalar/psicologia
Apoio Social
Carga de Trabalho/psicologia
[Mh] Termos MeSH secundário: Seres Humanos
Corpo Clínico Hospitalar/educação
Corpo Clínico Hospitalar/organização & administração
Organização e Administração/normas
Assistência ao Paciente/normas
Risco
Tolerância ao Trabalho Programado/psicologia
[Pt] Tipo de publicação:LETTER
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180124
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k241


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[PMID]:27770385
[Au] Autor:Hwang AS; Atlas SJ; Hong J; Ashburner JM; Zai AH; Grant RW; Hong CS
[Ad] Endereço:Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Gray Bigelow 730, 55 Fruit Street, Boston, MA, 02114, USA. ahwang1@partners.org.
[Ti] Título:Defining Team Effort Involved in Patient Care from the Primary Care Physician's Perspective.
[So] Source:J Gen Intern Med;32(3):269-276, 2017 Mar.
[Is] ISSN:1525-1497
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: A better understanding of the attributes of patients who require more effort to manage may improve risk adjustment approaches and lead to more efficient resource allocation, improved patient care and health outcomes, and reduced burnout in primary care clinicians. OBJECTIVE: To identify and characterize high-effort patients from the physician's perspective. DESIGN: Cohort study. PARTICIPANTS: Ninety-nine primary care physicians in an academic primary care network. MAIN MEASURES: From a list of 100 randomly selected patients in their panels, PCPs identified patients who required a high level of team-based effort and patients they considered complex. For high-effort patients, PCPs indicated which factors influenced their decision: medical/care coordination, behavioral health, and/or socioeconomic factors. We examined differences in patient characteristics based on PCP-defined effort and complexity. KEY RESULTS: Among 9594 eligible patients, PCPs classified 2277 (23.7 %) as high-effort and 2676 (27.9 %) as complex. Behavioral health issues were the major driver of effort in younger patients, while medical/care coordination issues predominated in older patients. Compared to low-effort patients, high-effort patients were significantly (P < 0.01 for all) more likely to have higher rates of medical (e.g. 23.2 % vs. 6.3 % for diabetes) and behavioral health problems (e.g. 9.8 % vs. 2.9 % for substance use disorder), more frequent primary care visits (10.9 vs. 6.0 visits), and higher acute care utilization rates (25.8 % vs. 7.7 % for emergency department [ED] visits and 15.0 % vs. 3.9 % for hospitalization). Almost one in five (18 %) patients who were considered high-effort were not deemed complex by the same PCPs. CONCLUSIONS: Patients defined as high-effort by their primary care physicians, not all of whom were medically complex, appear to have a high burden of psychosocial issues that may not be accounted for in current chronic disease-focused risk adjustment approaches.
[Mh] Termos MeSH primário: Comportamento Cooperativo
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
Assistência ao Paciente/métodos
Médicos de Atenção Primária
Atenção Primária à Saúde/organização & administração
[Mh] Termos MeSH secundário: Fatores Etários
Doença Crônica/terapia
Estudos de Coortes
Continuidade da Assistência ao Paciente/organização & administração
Feminino
Seres Humanos
Masculino
Meia-Idade
Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos
Padrões de Prática Médica
Risco Ajustado
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161023
[St] Status:MEDLINE
[do] DOI:10.1007/s11606-016-3897-6


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[PMID]:29285940
[Au] Autor:Beretzky Z; Péntek M
[Ad] Endereço:Gazdálkodástani Doktori Iskola, Budapesti Corvinus Egyetem Budapest.
[Ti] Título:[Characteristics and determinants of informal care in chronic diseases in Hungary: a comparative analysis].
[Ti] Título:Informális ellátás és meghatározó tényezoi krónikus betegségekben: magyarországi kutatások összehasonlító elemzése..
[So] Source:Orv Hetil;158(52):2068-2078, 2017 Dec.
[Is] ISSN:0030-6002
[Cp] País de publicação:Hungary
[La] Idioma:hun
[Ab] Resumo:INTRODUCTION: Informal care plays an important role in ageing societies. AIM: To analyse informal care use and its determinants among patients with chronic diseases in Hungary. METHOD: Patient level data from previous studies in 14 diagnoses were analysed including patients' EQ-5D-3L health status. Descriptive statistics were performed and a linear regression model was built to analyse determinants of informal care time. RESULTS: 2047 patients (female: 58%) with mean age of 58.9 (SD = 16.3) years and EQ-5D-3L index score of 0.64 (SD = 0.33) were involved. 27% received informal care, the average time of care was 7.54 (SD = 26.36) hours/week. Both the rate of informal care use and its time differed significantly between the diagnoses (p<0.05), the highest were in dementia, Parkinsons' disease and in chronic inflammatory immunological diseases. Significant determinants were age, EQ-5D-3L scores, gender and certain diagnosis dummys (R = 0.111). CONCLUSIONS: Informal care use is significant in chronic debilitating conditions. Future studies are encouraged to reveal unmet needs, preferences and further explanatory factors. Orv Hetil. 2017; 158(52): 2068-2078.
[Mh] Termos MeSH primário: Doença Crônica/terapia
Nível de Saúde
Assistência ao Paciente/estatística & dados numéricos
[Mh] Termos MeSH secundário: Fatores Etários
Idoso
Doença Crônica/enfermagem
Feminino
Seres Humanos
Hungria
Masculino
Meia-Idade
Qualidade de Vida
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171230
[St] Status:MEDLINE
[do] DOI:10.1556/650.2017.30894


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[PMID]:29233292
[Au] Autor:Felton MA; Jarrett JB; Meyer SM
[Ad] Endereço:UPMC St. Margaret Department of Medical Education, 815 Freeport Road, Pittsburgh, PA 15215, United States. Electronic address: mariafelton7@gmail.com.
[Ti] Título:Geriatric care curriculum in US PharmD programs: What's happening?
[So] Source:Curr Pharm Teach Learn;9(3):504-509, 2017 May.
[Is] ISSN:1877-1300
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES: Current Accreditation Council for Pharmacy Education (ACPE) Standards are not explicit regarding geriatrics content. The objective of this review is to describe published examples of how care for older adults is integrated into Doctor of Pharmacy (PharmD) curricula at accredited schools/colleges of pharmacy across the United States. METHODS: PubMed and Embase databases were searched. Manuscripts addressing care for older adults in pharmacy curriculum in the United States were included in the review. RESULTS: Thirteen PharmD programs have thirteen published examples of how geriatric care was integrated into their curriculum. The most common way geriatric care is integrated into PharmD programs is through Introductory Pharmacy Practice Experiences (IPPE) followed by existing course content and elective course content. CONCLUSION: There is a wide variety of curriculum strategies currently being utilized to incorporate geriatric education into PharmD programs in the United States. However, this may not be sufficient to support the care of the growing older adult population.
[Mh] Termos MeSH primário: Currículo
Educação de Pós-Graduação em Farmácia/métodos
Geriatria/educação
[Mh] Termos MeSH secundário: Seres Humanos
Assistência ao Paciente
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:29233280
[Au] Autor:Amerine LB; Valgus JM; Moore JD; Arnall JR; Savage SW
[Ad] Endereço:University of North Carolina Medical Center, Division of PACE, UNC Eshelman School of Pharmacy, 101 Manning Dr., CB #7600, Chapel Hill, NC 27514, United States. Electronic address: lindsey.amerine@unchealth.unc.edu.
[Ti] Título:Implementation of a longitudinal early immersion student pharmacist health system internship program.
[So] Source:Curr Pharm Teach Learn;9(3):421-426, 2017 May.
[Is] ISSN:1877-1300
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: The initiation, implementation, and benefits of a longitudinal early immersion student pharmacist health system internship are described. EDUCATIONAL ACTIVITY: A two-year longitudinal internship experience was implemented to provide exposure into distributional operations, direct patient care activities, and health-system pharmacy administration. The intent of the program was to create an opportunity for student pharmacists to enhance the quality of their education with practical experience by immersing them early in their careers within the healthcare system. Early in their academic training the student interns were exposed to a broad range of services and programs while contributing longitudinally to the service line through quality improvement projects and distributional operations. The first year primarily focuses on distributional operations with direct patient care shadowing, while the second year targets intern involvement in hematology/oncology direct patient care activities. In this role, they are able to serve as pharmacist extenders. SUMMARY: Our comprehensive, longitudinal two-year health-system pharmacy internship program offers student pharmacists a unique early immersion experience that builds upon itself throughout their didactic training but is outside of the academic requirements. Students are exposed to distributional operations, direct patient care activities, and health system pharmacy administration prior to APPE rotations.
[Mh] Termos MeSH primário: Sistemas de Medicação no Hospital
Assistência ao Paciente
Administração Farmacêutica
Residências em Farmácia/organização & administração
Desenvolvimento de Programas
[Mh] Termos MeSH secundário: Institutos de Câncer
Seres Humanos
Residências em Farmácia/métodos
Serviço de Farmácia Hospitalar
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171214
[St] Status:MEDLINE


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[PMID]:29189464
[Au] Autor:Aldrich K
[Ad] Endereço:Kelly Aldrich is an informatics nurse specialist and chief clinical transformation officer at the Center for Medical Interoperability in Nashville, Tenn.
[Ti] Título:Partner with IT to reduce frustration, improve patient care.
[So] Source:Nursing;47(12):68-69, 2017 12.
[Is] ISSN:1538-8689
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Tecnologia da Informação
Enfermeiras e Enfermeiros/psicologia
Assistência ao Paciente/normas
[Mh] Termos MeSH secundário: Atitude do Pessoal de Saúde
Frustração
Seres Humanos
Papel do Profissional de Enfermagem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180212
[Lr] Data última revisão:
180212
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:171201
[St] Status:MEDLINE
[do] DOI:10.1097/01.NURSE.0000526895.15251.02


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[PMID]:28464300
[Au] Autor:Saseen JJ; Ripley TL; Bondi D; Burke JM; Cohen LJ; McBane S; McConnell KJ; Sackey B; Sanoski C; Simonyan A; Taylor J; Vande Griend JP
[Ad] Endereço:American College of Clinical Pharmacy, Lenexa, Kansas.
[Ti] Título:ACCP Clinical Pharmacist Competencies.
[So] Source:Pharmacotherapy;37(5):630-636, 2017 May.
[Is] ISSN:1875-9114
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The purpose of the American College of Clinical Pharmacy (ACCP) is to advance human health by extending the frontiers of clinical pharmacy. Consistent with this mission and its core values, ACCP is committed to ensuring that clinical pharmacists possess the knowledge, skills, attitudes, and behaviors necessary to deliver comprehensive medication management (CMM) in team-based, direct patient care environments. These components form the basis for the core competencies of a clinical pharmacist and reflect the competencies of other direct patient care providers. This paper is an update to a previous ACCP document and includes the expectation that clinical pharmacists be competent in six essential domains: direct patient care, pharmacotherapy knowledge, systems-based care and population health, communication, professionalism, and continuing professional development. Although these domains align with the competencies of physician providers, they are specifically designed to better reflect the clinical pharmacy expertise required to provide CMM in patient-centered, team-based settings. Clinical pharmacists must be prepared to complete the education and training needed to achieve these competencies and must commit to ongoing efforts to maintain competence through ongoing professional development. Collaboration among stakeholders will be needed to ensure that these competencies guide clinical pharmacists' professional development and evaluation by educational institutions, postgraduate training programs, professional societies, and employers.
[Mh] Termos MeSH primário: Competência Clínica/normas
Farmacêuticos/normas
Papel Profissional
Sociedades Farmacêuticas/normas
[Mh] Termos MeSH secundário: Seres Humanos
Assistência ao Paciente/normas
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180112
[Lr] Data última revisão:
180112
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1002/phar.1923


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[PMID]:28448780
[Au] Autor:Joseph T; Hale GM; Eltaki SM; Prados Y; Jones R; Seamon MJ; Moreau C; Gernant SA
[Ad] Endereço:1 Department of Pharmacy Practice, Nova Southeastern University College of Pharmacy, Palm Beach Gardens, Florida.
[Ti] Título:Integration Strategies of Pharmacists in Primary Care-Based Accountable Care Organizations: A Report from the Accountable Care Organization Research Network, Services, and Education.
[So] Source:J Manag Care Spec Pharm;23(5):541-548, 2017 May.
[Is] ISSN:2376-1032
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The accountable care organization (ACO) is an innovative health care delivery model centered on value-based care. ACOs consisting of primary care providers are increasingly becoming commonplace in practice; however, medication management remains suboptimal. PROGRAM DESCRIPTION: As experts in medication management, pharmacists perform direct patient care and assist in the transition from one provider to another, which places them in an ideal position to manage multiple aspects of patient care. Pharmacist-provided care has been shown to reduce drug expenditures, hospital readmissions, length of stay, and emergency department visits. Although pharmacists have become key team members of interdisciplinary teams within traditional care settings, their role has often been overlooked in the primary care-based ACO. In 2015, Nova Southeastern University College of Pharmacy founded the Accountable Care Organization Research Network, Services, and Education (ACORN SEED), a team of pharmacy practice faculty dedicated to using innovative approaches to patient care, while providing unique learning experiences for pharmacy students by partnering with ACOs in the South Florida region. Five opportunities are presented for pharmacists to improve medication use specifically in primary care-based ACOs: medication therapy management, annual wellness visits, chronic disease state management, chronic care management, and transitions of care. OBSERVATIONS: Several challenges and barriers that prevent the full integration of pharmacists into primary care-based ACOs include lack of awareness of pharmacist roles in primary care; complex laws and regulations surrounding clinical protocols, such as collaborative practice agreements; provider status that allows compensation for pharmacist services; and limited access to medical records. By understanding and maximizing the role of pharmacists, several opportunities exist to better manage the medication-use process in value-based care settings. IMPLICATIONS/RECOMMENDATIONS: As more organizations realize benefits and overcome barriers to the integration of pharmacists into patient care, programs involve pharmacists will become an increasingly common approach to improve outcomes and reduce the total cost of care and will improve the financial viability of primary care-based ACOs. DISCLOSURES: No outside funding supported this research. The authors report no conflicts of interest related to this manuscript. Study concept and design were contributed by Joseph, Hale, and Eltaki, with assistance from the other authors. Prados and Jones took the lead in data collection and data interpretation and analysis, with assistance from the other authors. The manuscript was written primarily by Joseph and Hale, along with the other authors, and revised primarily by Seamon and Gernant, along with the other authors.
[Mh] Termos MeSH primário: Organizações de Assistência Responsáveis/organização & administração
Assistência Farmacêutica/organização & administração
Farmacêuticos/organização & administração
Atenção Primária à Saúde/organização & administração
[Mh] Termos MeSH secundário: Organizações de Assistência Responsáveis/economia
Assistência à Saúde/economia
Assistência à Saúde/organização & administração
Seres Humanos
Conduta do Tratamento Medicamentoso
Assistência ao Paciente/economia
Assistência ao Paciente/normas
Equipe de Assistência ao Paciente/economia
Equipe de Assistência ao Paciente/organização & administração
Assistência Farmacêutica/economia
Farmacêuticos/economia
Atenção Primária à Saúde/economia
Papel Profissional
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180111
[Lr] Data última revisão:
180111
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.18553/jmcp.2017.23.5.541


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[PMID]:28448777
[Au] Autor:Vande Griend JP; Rodgers M; Nuffer W
[Ad] Endereço:1 Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, and Department of Family Medicine, University of Colorado School of Medicine, Aurora.
[Ti] Título:Effect of an Advanced Pharmacy Practice Experience on Medication Therapy Management Services in a Centralized Retail Pharmacy Program.
[So] Source:J Manag Care Spec Pharm;23(5):561-565, 2017 05.
[Is] ISSN:2376-1032
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Medication therapy management (MTM) delivery is increasingly important in managed care. Successful delivery positively affects patient health and improves Centers for Medicare & Medicaid Services star ratings, a measure of health plan quality. As MTM services continue to grow, there is an increased need for efficient and effective care models. The primary objectives of this project were to describe the delivery of MTM services by fourth-year Advanced Pharmacy Practice Experience (APPE) students in a centralized retail pharmacy system and to evaluate and quantify the clinical and financial contributions of the students. The secondary objective was to describe the engagement needed to complete comprehensive medication reviews (CMRs) and targeted interventions. PROGRAM DESCRIPTION: From May 2015 to December 2015, thirty-five APPE students from the University of Colorado Skaggs School of Pharmacy provided MTM services at Albertsons Companies using the OutcomesMTM and Mirixa platforms. Students delivered patient care services by phone at the central office and provided face-to-face visits at pharmacies in the region. With implementation of the MTM APPE in 2015, the team consisted of 2 MTM pharmacists and pharmacy students, as compared with 1 MTM pharmacist in 2014. The number of CMRs and targeted interventions completed and the estimated additional revenue generated during the 2015 time period were compared with those completed from May through December 2014. The patient and provider engagement needed to complete the CMRs and targeted interventions was summarized. OBSERVATIONS: 125 CMRs and 1,918 targeted interventions were billed in 2015, compared with 13 CMRs and 767 targeted interventions in 2014. An estimated $16,575-$49,272 of additional revenue was generated in 2015. To complete the interventions in 2015, the team engaged in 1,714 CMR opportunities and 4,686 targeted intervention opportunities. IMPLICATIONS/RECOMMENDATIONS: In this MTM rotation, students provided real-life care to patients, resulting in financial and clinical contributions. This model of education and care delivery can be replicated in the community pharmacy or managed care setting. APPE students are an important component of this model of care delivery, particularly when considering the level of patient engagement needed to complete MTM interventions. DISCLOSURES: No outside funding supported this research. The authors have no conflicts of interest to disclose related to this work. All authors contributed to study concept and design. Rodgers collected the data, and data interpretation was performed by Vande Griend, along with Rodgers and Nuffer. The manuscript was written and revised primarily by Vande Griend, along with Nuffer and Rodgers. This project was presented at the Pharmacy Quality Alliance Annual Meeting in Arlington, Virginia, in May 2016.
[Mh] Termos MeSH primário: Serviços Comunitários de Farmácia/organização & administração
Educação em Farmácia/métodos
Conduta do Tratamento Medicamentoso/organização & administração
Estudantes de Farmácia
[Mh] Termos MeSH secundário: Colorado
Seres Humanos
Programas de Assistência Gerenciada/organização & administração
Conduta do Tratamento Medicamentoso/educação
Assistência ao Paciente/métodos
Farmacêuticos/organização & administração
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180111
[Lr] Data última revisão:
180111
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170428
[St] Status:MEDLINE
[do] DOI:10.18553/jmcp.2017.23.5.561


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[PMID]:28746075
[Au] Autor:Taylor TS; Teunissen PW; Dornan T; Lingard L
[Ad] Endereço:T.S. Taylor is simulation fellow, Department of Innovation in Medical Education, University of Ottawa Skills and Simulation Centre, and obstetrician/gynecologist, University of Ottawa, Ottawa, Ontario, Canada. P.W. Teunissen is associate professor, Department of Educational Development and Research, Faculty of Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands, and gynecologist, Vrije Universiteit Amsterdam, University Medical Center, Amsterdam, the Netherlands; ORCID: http://orcid.org/0000-0002-0930-0048. T. Dornan is emeritus professor of medical education, Department of Educational Development and Research, Faculty of Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands, and professor, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom; ORCID: http://orcid.org/0000-0001-7830-0183. L. Lingard is professor of medicine, senior scientist, and director, Centre for Education Research & Innovation, Schulich School of Medicine & Dentistry, and Professor Faculty of Education, Western University, London, Ontario, Canada.
[Ti] Título:Fatigue in Residency Education: Understanding the Influence of Work Hours Regulations in Europe.
[So] Source:Acad Med;92(12):1733-1739, 2017 Dec.
[Is] ISSN:1938-808X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:PURPOSE: Although one proposed solution to the problem of fatigued medical trainees is the implementation of work hours regulations, concerns about the effectiveness of these regulations are growing. Canada remains one of the few Western jurisdictions without legislated regulation. Recent research suggests that fatigue is a complex social construct, rather than simply a lack of sleep; thus, the authors explored how regulations and fatigue are understood in countries with established work hours frameworks to better inform other jurisdictions looking to address trainee fatigue. METHOD: Using constructivist grounded theory methodology, the authors conducted individual, semistructured interviews in 2015-2016 with 13 postgraduate medical trainees from four European countries with established work hours regulations. Data collection and analysis proceeded iteratively, and the authors used a constant comparative approach to analysis. RESULTS: Trainees reported that they were commonly fatigued and that they violated the work hours restrictions for various reasons, including educational pursuits. Although they understood the regulations were legislated specifically to ensure safe patient care and optimize trainee well-being, they also described implicit meanings (e.g., monitoring for trainee efficiency) and unintended consequences (e.g., losing a sense of vocation). CONCLUSIONS: Work hours regulations carry multiple, conflicting meanings for trainees that are captured by three predominant rhetorics: the rhetoric of patient safety, of well-being, and of efficiency. Tensions within each of those rhetorics reveal that managing fatigue within clinical training environments is complex. These findings suggest that straightforward solutions are unlikely to solve the problem of fatigue, assure patient safety, and improve trainee well-being.
[Mh] Termos MeSH primário: Fadiga
Internato e Residência/normas
Assistência ao Paciente/normas
Segurança do Paciente/normas
[Mh] Termos MeSH secundário: Europa (Continente)
Seres Humanos
Estudos Retrospectivos
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180103
[Lr] Data última revisão:
180103
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE
[do] DOI:10.1097/ACM.0000000000001831



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