RESUMEN

PURPOSE: The privileging of pharmacists for clinical activities and the impact that privileging has on enhancing the scope of pharmacy practice in health systems are reviewed. SUMMARY: Health-system pharmacists or pharmacy leaders must gain a thorough understanding of the credentialing and privileging process as they broaden their scope of practice. Clinical privileging affords an expanded scope of practice that is recognized at the institutional level and formally elevates the pharmacist to that of a nonphysician provider. The installation of privileging processes is expected to take many months to complete for individual institutions and should begin now in anticipation of provider status. Model institutions, including Truman Medical Centers, Johns Hopkins Hospital, and The Ohio State University Wexner Medical Center, are highlighted in this article and provide their individual approach to clinical privileging that can be applied to other institutions. The development and evaluation of these programs have given valuable insight into how this individual approach translates to health systems across the country and how the pharmacy profession can continue to unite to convey the value of pharmacists in improving patient care. CONCLUSION: In preparation for the potential approval of pharmacist provider status across the United States, it is essential that pharmacists are privileged by the medical staff at their respective institution. Clinical privileges must be strategically developed with a focus on cost and quality aims and meeting the needs of patients. Implementation and maintenance of high-performing pharmacy privileging programs require both successful leadership and management skills and an understanding of the interprofessional nature of healthcare.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

In an attempt to identify the fellows' concerns about the future of the field of vascular surgery, we conducted a survey consisting of 22 questions at an annual national meeting in March from 2004 to 2007. In order to obtain accurate data, all surveys were kept anonymous. The fellows were asked (1) what type of practice they anticipated they would be in, (2) what the new training paradigm for fellows should be, (3) to assess their expectation of the needed manpower with respect to the demand for vascular surgeons, (4) what were major threats to the future of vascular surgery, (5) whether they had heard of and were in favor of the American Board of Vascular Surgery (ABVS), (6) who should be able to obtain vascular privileges, and (7) about their interest in an association for vascular surgical trainees. Of 273 attendees, 219 (80%) completed the survey. Males made up 87% of those surveyed, and 60% were between the ages of 31 and 35 years. Second-year fellows made up 82% of those surveyed. Those expecting to join a private, academic, or mixed practice made up 35%, 28%, and 20% of the respondents, respectively, with 71% anticipating entering a 100% vascular practice. Forty percent felt that 5 years of general surgery with 2 years of vascular surgery should be the training paradigm, while 45% suggested 3 and 3 years, respectively. A majority, 79%, felt that future demand would exceed the available manpower, while 17% suggested that manpower would meet demand. The major challenges to the future of vascular surgery were felt to be competition from cardiology (82%) or radiology (30%) and lack of an independent board (29%). Seventeen percent were not aware of the ABVS, and only 2% were against it; 71% suggested that vascular privileges be restricted to board-certified vascular surgeons. Seventy-six percent were interested in forming an association for vascular trainees to address the issues of the future job market (67%), endovascular training during fellowship (56%), increasing focus on the vascular fellows at national meetings (49%), and representation for the fellows on the national councils (37%). This survey suggests that several significant issues exist in the minds of vascular trainees that have not been addressed and may present opportunities for further dialogue.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

Interpreted in historical context, Kubie's 1948 proposal to move the professional aspects of clinical psychology training and the awarding of the doctorate into the medical-school environment was an attempt to remedy a critical shortage of psychotherapists while maintaining medical control over the professional practice of psychology. The proposal failed, in part, because medicine had no legitimate claim to either training or regulating clinical psychologists. A parallel was drawn between that post-war situation and the current one in which many psychological practitioners are pressing for prescribing privileges in regard to psychoactive drugs, and similarities and important differences are noted between the two conditions. The requirement that medicine be involved importantly in the psychopharmacologic training of psychologists poses an acute problem concerning the maintenance of professional independence.

Asunto(s)

Asunto(s)

Asunto(s)

RESUMEN

BACKGROUND: We surveyed family physicians in the US to determine how many include obstetric services in their practices and to compare trends over time. METHODS: In the 1993 Practice Profile Survey, the American Academy of Family Physicians (AAFP) surveyed a random sample of active members whose mailing address was in one of the 50 states or the District of Columbia. The sample was stratified by nine census divisions; after two mailings 2460 responses were received from the 4400 physicians in the sample (56 percent response). RESULTS: Eighty-seven percent of active members had hospital admission privileges. Although there were regional disparities in the proportion of family physicians with various hospital privileges, overall 94 percent perceived that the privileges afforded them were appropriate. Approximately 26 percent of AAFP active members in 1993, compared with 29 percent in 1988, included routine obstetric care in their hospital practices. A higher proportion of family physicians in the West North Central census division had privileges at various levels of obstetric care than did family physicians in other census divisions; for example, while 57 percent of family physicians in the West North Central census division had privileges in routine obstetric care, only 9 percent of family physicians in the East South Central division had these privileges. For those family physicians who did not have privileges for any obstetric care, most indicated that they chose not to include obstetric care in their hospital practices. Family physicians most likely to have had obstetric privileges included those who practiced in nonmetropolitan areas (39 percent of family physicians had privileges in routine obstetric care compared with 21 percent in an urban setting) and those who completed a family practice residency program (33 percent with routine obstetric privileges compared with 13 percent who did not complete a 3-year residency in family practice.

Asunto(s)

RESUMEN

As medicine has developed more and more into a business, the process of medical staff credentialing has evolved. Today, physicians need to be affiliated with a hospital or other health care entity in order to practice. Health care entities, in turn, must be able to ensure quality of care and efficiency. The mechanisms that have developed to achieve these purposes comprise the process of medical staff credentialing as it now exists and will shape the continued evolution of credentialing in the future.

Asunto(s)

Asunto(s)

RESUMEN

A clinical privileges program for pharmacists is described. In 1985 and 1989 the Department of Veterans Affairs (VA) issued circulars defining policy on clinical privileges for pharmacists at its medical centers. Pharmacists at one large VA medical center responded by developing a clinical privileges program. Bylaws under which medical staff members are granted clinical privileges were used as a model for the pharmacist program. A pharmacist seeking privileges prepares an application detailing his or her background and the practice areas involved in the request; the applicant also drafts a quality assurance protocol. The application is reviewed by a pharmacist clinical privileges review board (PCPRB). The PCPRB uses the quality assurance plan to verify that adequate measures are in place to meet standards of care. If a question of patient safety arises, the board meets to review the pharmacist's activities. Each pharmacist who is granted privileges must have a physician sponsor. Since the first meeting of the PCPRB in 1990, clinical privileges have been requested by all 24 clinical pharmacy specialists at the center. No pharmacist has been denied privileges, although the board has required additional training or improved quality assurance protocols for many. Acceptance of the program by the medical staff has been good. A clinical privileges program at a VA medical center offers pharmacists the opportunity to practice pharmaceutical care.

Asunto(s)

RESUMEN

New technologies are rapidly transforming hospital surgery, shifting a majority of procedures to outpatient settings and cutting stays for inpatients. This shift is forcing hospitals to re-evaluate physician privileging, surgical staffing and scheduling, facility planning and strategic planning. Meanwhile, the Health Care Financing Administration's efforts to reform Medicare's payment system for outpatient surgery and other ambulatory procedures is on a slower track.

Asunto(s)

RESUMEN

Regardless of the speed of the evolution from a MSO to a PSO, it is inevitable. During the course of this evolution, hospital management must be certain that individual clinicians and the PSO as a whole perform technical services that are integrated into the hospital's overall effort to achieve its goals. Although nonclinician managers cannot deliver clinical services or independently judge quality, they can obtain the expert advice and technical assistance needed to understand individual and aggregate PSO practice. Doing so allows managers to not only meet their ethical and legal responsibilities but also implement continuous quality improvement in the hospital, an activity of critical importance in the 1990s.

Asunto(s)

Asunto(s)

RESUMEN

The proportion of all private doctors performing surgery in the FRG (7.7%) and breakdown of service in the areas of general surgery, accident and emergency surgery and vascular surgery in Lower Saxony, FRG. The demands are described made on the skill of the surgeon and on the private hospital are outlined, as is the legal situation with regard to the hospital owner, staff and other private doctors. Also included is information regarding anaesthesia, laboratory and roentgen. Guarantee of presence and the operation catalogue.

Asunto(s)

RESUMEN

Switzerland has 6.7 million inhabitants and 700 practising surgeons, half of whom work in private hospitals. A description is given of the situation in private practices and hospitals including structural and financing problems. The author outlines his range of professional activities and give two examples of frequently performed operations. The relationship of personal trust between patient and doctor is an integral part of this system and is fundamental to the fulfillment of our Hippocratic oath. Belegarzt is defined as specialist/practitioner with hospital affiliation.

Asunto(s)