ORCID Profile
0000-0002-9138-5043
Current Organisation
VA Portland Health Care System
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Publisher: Informa UK Limited
Date: 07-11-2019
DOI: 10.1080/13561820.2019.1676706
Abstract: Interprofessional clinical education programs have the potential to impact participants' professional expectations and practices related to team-based care. In this qualitative study, research team members interviewed 38 graduates and 19 faculty members from such an interprofessional training program, the Department of Veterans Affairs (VA) Centers of Excellence in Primary Care Education (CoEPCE). Semi-structured interviews with participants enquired about skills gained, impact on career expectations, and barriers to implementing interprofessional skills in the post-training workplace. Data were coded and analyzed using a hybrid inductive/deductive approach. Participants perceived that the program was successful in creating new norms of flattened team hierarchies, broadening graduates' understanding of role interaction, and teaching interactional skills involving teamwork. Participants reported organizational and systemic barriers to changing existing primary care practice. Interprofessional clinical education programs may help new professionals recognize and act on opportunities for improvement in existing practice. Healthcare employers must recognize changed expectations and provide opportunities for interprofessional collaboration to attract graduates from such programs.
Publisher: Informa UK Limited
Date: 23-11-2018
DOI: 10.1080/09638237.2018.1521924
Abstract: The OpenNotes initiative provides patients online access to their clinical notes. Mental health clinicians in the Veterans Health Administration report a need for guidance on how to provide care, write notes, and discuss them in the context of OpenNotes. To provide mental health clinicians recommendations identified by patients and clinicians that help them effectively practice in the context of OpenNotes. Twenty-eight mental health clinicians and 28 patients in mental health care participated in semi-structured interviews about their experiences and perceptions with OpenNotes. A rapid review approach was used to analyze transcripts. Analysis of interviews identified three domains of advice for mental health clinicians: writing notes that maintain the therapeutic relationship, communicating with patients about their notes and utilizing clinical notes as a patient resource to enhance care. Specific recommendations are provided. Findings provide mental health clinicians with guidance from service users and clinicians on how to leverage clinical notes to maintain - and potentially enhance -therapeutic relationships in a healthcare system in which patients are able to read their mental health notes online.
Publisher: Springer Science and Business Media LLC
Date: 08-2015
DOI: 10.1007/S11414-015-9472-9
Abstract: The capacity of electronic health records (EHRs) to capture desired information depends on the practices of health care providers. These practices have not been well studied in relation to post-traumatic stress disorder (PTSD). This qualitative study investigated how providers write EHR notes on PTSD through 38 interviews with providers working at five Veterans Affairs (VA) hospitals across the United States of America. Two overarching themes were prominent in the results. Providers used progress notes primarily to remember and access details for direct patient care, but only rarely for care coordination. Providers infrequently recorded information not judged to directly contribute to improved care, sometimes deliberately omitting information perceived to jeopardize patients' access to, or quality of, care. Omitted information frequently included sexual or non-military trauma. Understanding providers' thought processes can help clinicians be aware of the limitations of EHR notes as a tool for learning the histories of new patients. Similarly, researchers relying on EHR data for PTSD research should be aware of likely areas of missing data.
Publisher: Wiley
Date: 05-01-2018
DOI: 10.1002/HPM.2483
Abstract: Striking changes in the funding and implementation of international health programs in recent decades have stimulated debate about the role of communities in deciding which health programs to implement. An important yet neglected piece of that discussion is the need to change norms in program evaluation so that analysis of community ownership, beyond various degrees of "participation," is seen as central to strong evaluation practices. This article challenges mainstream evaluation practices and proposes a framework of Critical Evaluation with 3 levels: upstream evaluation assessing the "who" and "how" of programming decisions midstream evaluation focusing on the "who" and "how" of selecting program objectives and downstream evaluation, the focus of current mainstream evaluation, which assesses whether the program achieved its stated objectives. A vital tenet of our framework is that a community possesses the right to determine the path of its health development. A prerequisite of success, regardless of technical outcomes, is that programs must address communities' high priority concerns. Current participatory methods still seldom practice community ownership of program selection because they are vulnerable to funding agencies' predetermined priorities. In addition to critiquing evaluation practices and proposing an alternative framework, we acknowledge likely challenges and propose directions for future research.
Publisher: Springer Science and Business Media LLC
Date: 21-02-2014
Publisher: Elsevier BV
Date: 06-2014
DOI: 10.1016/J.PEC.2014.03.002
Abstract: Understand patients' experiences with primary care services for congestive heart failure (CHF) and explore the relationship between health services and self-management. We conducted semi-structured interviews with thirty-nine patients with CHF receiving care at one Veterans Affairs Medical Center (VA). We analyzed data using thematic content analysis. Participants acknowledged the importance of ongoing engagement in the plan of care for CHF. They attributed success in this effort to be greatly influenced by personal advocates. The advocates included both members of the healthcare team with whom they had a continuity relationship and friends or family members who assisted on a daily basis. Participants also identified psychological symptoms as a major barrier to carrying out self-care. Patients identify relationships with health care workers, help from family and friends, and mental health problems as major influences on the ability to manage their CHF. Efforts to optimize CHF self-management should attend to health system and psychosocial barriers to care.
Publisher: Oxford University Press (OUP)
Date: 12-2002
DOI: 10.1093/JRS/15.4.409
Publisher: JMIR Publications Inc.
Date: 27-03-2013
DOI: 10.2196/JMIR.2356
Publisher: Springer Science and Business Media LLC
Date: 29-07-2020
Publisher: Emerald
Date: 17-11-2011
DOI: 10.1108/17479891111206292
Abstract: Aware that “those who aren't counted don't count” in health program planning, a community coalition, called African Partnership for Health, attempts a current estimate of the African community living in Portland, Oregon, USA. This paper seeks to describe the findings. The paper's definition of the “African community” was crucially informed by community participation in the research process. The authors drew on existing publicly available data sources to estimate the size of the target population and identified the strengths and weaknesses of each source. Conservative estimations are of a 2010 African community population of 11,500‐15,500 for the Portland metropolitan area. No data source on its own would have resulted in this estimate. Areas for further research include creating practical systems to collect data on country of origin and to address an existing data bias towards refugees over immigrants. In the USA, more robust data collection systems are needed to estimate the impact of secondary migration on the size and characteristics of refugee and immigrant communities. Health program planners should be aware that existing data may include more information about some groups (refugees as opposed to immigrants) and emphasize some characteristics (race as opposed to country of origin). Including immigrant and refugee community members in the research process can result in more relevant definition of that community, which may lead to more effective program targeting and design.
Publisher: Elsevier BV
Date: 09-2019
DOI: 10.1016/J.WHI.2019.03.007
Abstract: Research on intimate partner violence (IPV) faces unique challenges to recruitment and retention. Little is known about successful strategies for recruiting and retaining in research women who have experienced IPV, and their experiences of research participation. This article presents findings on recruitment, retention, and research participation experiences from a longitudinal observational study of IPV among women receiving care through the Veterans Health Administration. Administrative tracking data were analyzed to identify strengths, challenges, and outcomes of multiple recruitment strategies for an observational study of women patients who had experienced past-year IPV. Qualitative interviews with a purposively selected subset of the larger s le were used to identify motivations for and experiences of study participation. Of the total s le (N = 169), 92.3% were recruited via direct outreach by the research team (63.3% via letter, 29.0% in person), compared with provider or patient self-referral (3.6% and 4.1%, respectively) 88% returned for a follow-up assessment. In qualitative interviews (n = 50), participants expressed a desire to help others as a primary motivation for study participation. Although some participants experienced emotional strain during or after study visits, they also expressed perceiving value in sharing their experiences, and several participants found the experience personally beneficial. Participants expressed that disclosure was facilitated by interviewers' empathic and neutral stance, as well as the relative anonymity and time-limited nature of the research relationship. Direct outreach to women Veterans Health Administration patients to participate in research interviews about IPV experience was feasible and effective, and proved more fruitful for recruitment than reliance on provider or patient self-referral. Women who have experienced IPV may welcome opportunities to contribute to improvements in care through participation in interviews.
Publisher: Public Library of Science (PLoS)
Date: 16-05-2018
Publisher: Project MUSE
Date: 2013
Publisher: American Psychological Association (APA)
Date: 11-2021
DOI: 10.1037/SER0000427
Publisher: Springer Science and Business Media LLC
Date: 09-09-2020
Publisher: Project MUSE
Date: 2013
Abstract: As in other communities in the United States, information is lacking about the health needs of Africans refugees and immigrants living in Portland, Oregon. In 2008, the African Partnership for Health coalition (APH) was formed to carry out research, advocacy and education to improve the health and well-being of Africans in Oregon. This was APH's initial project. The purposes of this study were to gather data about the perceived health needs and barriers to health care Africans encounter, and lay the foundation for a program of action to guide APH's future work. Community-based participatory research (CBPR) methods were used to collect data on how to improve the health of the African community in the Portland area and define an agenda for future projects. Popular education principles guided the engagement and training of African community members, who conducted nine house meetings with 56 Africans from 14 countries. The results were analyzed by African community members and researchers and prioritized at a community meeting. Three themes emerged: The stressfulness of life in America, the challenges of gaining access to health care, and the pervasive feelings of disrespect and lack of understanding of Africans' health needs, culture, and life experiences by health providers and staff members. Using CBPR methods, we identified and prioritized the needs of the African community. This information provides a framework for future work of the African Partnership for Health and other service and advocacy groups.
Publisher: American Medical Association (AMA)
Date: 05-2019
Publisher: Springer Science and Business Media LLC
Date: 08-06-2020
Publisher: American Psychiatric Association Publishing
Date: 05-2018
Publisher: Cambridge University Press (CUP)
Date: 04-2009
DOI: 10.1017/S1744133109004824
Abstract: This paper argues on ethical and practical grounds for more widespread use of an integrated approach to refugee healthcare, and proposes a basic model of assessment for integrated systems. A defining element of an integrated approach is an equal ability by refugee and host nationals to access the same healthcare resources from the same providers. This differs fundamentally from parallel care, currently the predominant practice in Africa. The authors put forward a general model for evaluation of integrated healthcare with four criteria: (1) improved health outcomes for both hosts and refugees, (2) increased social integration, (3) increased equitable use of healthcare resources, and (4) no undermining of protection. Historical ex les of integrated care in Ethiopia and Uganda are examined in light of these criteria to illustrate how this evaluative model would generate evidence currently lacking in debates on the merit of integrated healthcare.
Publisher: Wiley
Date: 26-10-2018
DOI: 10.1002/ACR.23541
Publisher: Elsevier BV
Date: 06-2020
Publisher: Springer Science and Business Media LLC
Date: 09-04-2014
No related grants have been discovered for Anaïs Tuepker.