1
|
Henderson DAG, Donaghy E, Dozier M, Guthrie B, Huang H, Pickersgill M, Stewart E, Thompson A, Wang HHX, Mercer SW. Understanding primary care transformation and implications for ageing populations and health inequalities: a systematic scoping review of new models of primary health care in OECD countries and China. BMC Med 2023; 21:319. [PMID: 37620865 PMCID: PMC10463288 DOI: 10.1186/s12916-023-03033-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 08/15/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Many countries have introduced reforms with the aim of primary care transformation (PCT). Common objectives include meeting service delivery challenges associated with ageing populations and health inequalities. To date, there has been little research comparing PCT internationally. Our aim was to examine PCT and new models of primary care by conducting a systematic scoping review of international literature in order to describe major policy changes including key 'components', impacts of new models of care, and barriers and facilitators to PCT implementation. METHODS We undertook a systematic scoping review of international literature on PCT in OECD countries and China (published protocol: https://osf.io/2afym ). Ovid [MEDLINE/Embase/Global Health], CINAHL Plus, and Global Index Medicus were searched (01/01/10 to 28/08/21). Two reviewers independently screened the titles and abstracts with data extraction by a single reviewer. A narrative synthesis of findings followed. RESULTS A total of 107 studies from 15 countries were included. The most frequently employed component of PCT was the expansion of multidisciplinary teams (MDT) (46% of studies). The most frequently measured outcome was GP views (27%), with < 20% measuring patient views or satisfaction. Only three studies evaluated the effects of PCT on ageing populations and 34 (32%) on health inequalities with ambiguous results. For the latter, PCT involving increased primary care access showed positive impacts whilst no benefits were reported for other components. Analysis of 41 studies citing barriers or facilitators to PCT implementation identified leadership, change, resources, and targets as key themes. CONCLUSIONS Countries identified in this review have used a range of approaches to PCT with marked heterogeneity in methods of evaluation and mixed findings on impacts. Only a minority of studies described the impacts of PCT on ageing populations, health inequalities, or from the patient perspective. The facilitators and barriers identified may be useful in planning and evaluating future developments in PCT.
Collapse
Affiliation(s)
- D A G Henderson
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E Donaghy
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - M Dozier
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - B Guthrie
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - H Huang
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - M Pickersgill
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - E Stewart
- School of Social Work and Social Policy, University of Strathclyde, Glasgow, UK
| | - A Thompson
- School of Social and Political Sciences, University of Edinburgh, Edinburgh, UK
| | - H H X Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - S W Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK.
| |
Collapse
|
2
|
Lapão LV, Peyroteo M, Maia M, Seixas J, Gregório J, Mira da Silva M, Heleno B, Correia JC. Implementation of Digital Monitoring Services During the COVID-19 Pandemic for Patients With Chronic Diseases: Design Science Approach. J Med Internet Res 2021; 23:e24181. [PMID: 34313591 PMCID: PMC8396539 DOI: 10.2196/24181] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/14/2021] [Accepted: 07/02/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic is straining health systems and disrupting the delivery of health care services, in particular, for older adults and people with chronic conditions, who are particularly vulnerable to COVID-19 infection. OBJECTIVE The aim of this project was to support primary health care provision with a digital health platform that will allow primary care physicians and nurses to remotely manage the care of patients with chronic diseases or COVID-19 infections. METHODS For the rapid design and implementation of a digital platform to support primary health care services, we followed the Design Science implementation framework: (1) problem identification and motivation, (2) definition of the objectives aligned with goal-oriented care, (3) artefact design and development based on Scrum, (4) solution demonstration, (5) evaluation, and (6) communication. RESULTS The digital platform was developed for the specific objectives of the project and successfully piloted in 3 primary health care centers in the Lisbon Health Region. Health professionals (n=53) were able to remotely manage their first patients safely and thoroughly, with high degrees of satisfaction. CONCLUSIONS Although still in the first steps of implementation, its positive uptake, by both health care providers and patients, is a promising result. There were several limitations including the low number of participating health care units. Further research is planned to deploy the platform to many more primary health care centers and evaluate the impact on patient's health related outcomes.
Collapse
Affiliation(s)
- Luís Velez Lapão
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
- Comprehensive Health Research Center, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- Research and Development Unit in Mechanical and Industrial Engineering (UNIDEMI), NOVA School of Science and Technology, Universidade Nova de Lisboa, Caparica, Portugal
| | - Mariana Peyroteo
- Comprehensive Health Research Center, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
- NOVA School of Science and Technology, Universidade Nova de Lisboa, Caparica, Portugal
| | - Melanie Maia
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
- NOVA School of Social Sciences and Humanities, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jorge Seixas
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - João Gregório
- Research Center for Biosciences and Health Technologies, Universidade Lusófona de Humanidades e Tecnologias, Lisbon, Portugal
| | | | - Bruno Heleno
- Comprehensive Health Research Center, NOVA Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Jorge César Correia
- Unit of Patient Education, Division of Endocrinology, Diabetology, Nutrition and Patient Education, Department of Medicine, Geneva University Hospitals and University of Geneva, Geneva, Switzerland
| |
Collapse
|
3
|
Pereira MA, Marques RC, Ferreira DC. An Incentive-Based Framework for Analyzing the Alignment of Institutional Interventions in the Public Primary Healthcare Sector: The Portuguese Case. Healthcare (Basel) 2021; 9:healthcare9070904. [PMID: 34356282 PMCID: PMC8305205 DOI: 10.3390/healthcare9070904] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
Over the years, the Portuguese National Health Service has undergone several reforms to face the challenges posed by internal and external factors on the access to and quality of its health services. One of its most recent reforms addressed the primary healthcare sector, where understanding the incentives behind the actors of the inherent institutional interventions and how they are aligned with the governing health policies is paramount for reformative success. With the purpose of acknowledging the alignment of the primary healthcare sector's institutional interventions from an incentive-based perspective, we propose a framework resting on a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis, which was built in cooperation with a panel of decision-making actors from the Portuguese Ministry of Health. In the end, we derive possible policy implications and strategies. This holistic approach highlighted the positive impact of the primary healthcare reform in the upgrade of physical resources and human capital but stressed the geosocial asymmetries and the lack of intra- and inter-sectorial coordination. The proposed framework serves also as a guideline for future primary healthcare reforms, both national- and internationally.
Collapse
Affiliation(s)
- Miguel Alves Pereira
- Centro de Estudos de Gestão do Instituto Superior Técnico (CEG-IST), Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal
- Civil Engineering Research and Innovation for Sustainability (CERIS), Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal; (R.C.M.); (D.C.F.)
- Correspondence: ; Tel.: +351-968105420
| | - Rui Cunha Marques
- Civil Engineering Research and Innovation for Sustainability (CERIS), Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal; (R.C.M.); (D.C.F.)
| | - Diogo Cunha Ferreira
- Civil Engineering Research and Innovation for Sustainability (CERIS), Instituto Superior Técnico, Universidade de Lisboa, 1049-001 Lisbon, Portugal; (R.C.M.); (D.C.F.)
| |
Collapse
|
4
|
Almeida A, Vales J. The impact of primary health care reform on hospital emergency department overcrowding: Evidence from the Portuguese reform. Int J Health Plann Manage 2020; 35:368-377. [DOI: 10.1002/hpm.2939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/10/2019] [Indexed: 11/11/2022] Open
Affiliation(s)
- Alvaro Almeida
- Center for Economics and Finance (cef.up), Faculty of EconomicsUniversity of Porto Porto Portugal
| | - Joana Vales
- Centro Hospitalar do Tâmega e Sousa, EPE Penafiel Portugal
| |
Collapse
|
5
|
Maia MR, Castela E, Pires A, Lapão LV. How to develop a sustainable telemedicine service? A Pediatric Telecardiology Service 20 years on - an exploratory study. BMC Health Serv Res 2019; 19:681. [PMID: 31547824 PMCID: PMC6757431 DOI: 10.1186/s12913-019-4511-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/04/2019] [Indexed: 12/04/2022] Open
Abstract
Background Telemedicine services are promoting more access to healthcare. Portugal was an early adopter of telemedicine to overcome both its geological barriers and the shortage of healthcare professionals. The Pediatric Cardiology Service (PCS) at Coimbra University Hospital Centre (CHUC) has been using telemedicine to increase access and coverage since 1998. Their Pediatric Telecardiology Service has been daily connecting CHUC with 13 other Portuguese national hospitals, and regularly connecting with Portuguese-speaking African countries, through a teleconsultation platform. Methods This study aims at exploring the Pediatric Telecardiology Service’s evolution, through a comprehensive assessment of the PCS’s development, evolution and impact in public health, to better understand the critical factors for implementation and sustainability of telemedicine, in the context of healthcare services digitalization. A case study was performed, with cost-benefit, critical factors and organizational culture assessment. Finally, the Kingdon’s framework helped to understand the implementation and scale-up process and the role of policy-making. Results With the total of 32,685 out-patient teleconsultations, growing steadily from 1998 to 2016, the Pediatric Telecardiology Service has reached national and international recognition, being a pioneer and an active promotor of telemedicine. This telemedicine service has saved significant resources, about 1.1 million euros for the health system (e.g. in administrative and logistic costs) and approximately 419 euros per patient (considering an average of 1777 patients per year). PCS presents a dominant “Clan” culture. The Momentum’s critical factors for telemedicine service implementation enabled us to understand how barriers were overcome (e.g. political forces). Willingness, perseverance and teamwork, allied with partnership with key stakeholders, were the foundation for professionals’ engagement and service networking development. Its positive results, new regulations and the increasing support from the hospital board, set up a window of opportunity to establish a sustainable telemedicine service. Conclusion The Pediatric Telecardiology Service enables real-time communication and the sharing of clinical information, overcoming many barriers (from geographical ones to shortage of healthcare professionals), improving access to specialized care both in Portugal and Africa. Motivation and teamwork, and perseverance, were key for the Pediatric Telecardiology Service to tackle the window of opportunity which created conditions for sustainability.
Collapse
Affiliation(s)
- Mélanie Raimundo Maia
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisboa, Portugal.
| | - Eduardo Castela
- Pediatric Hospital, Centro Hospitalar e Universitário de Coimbra, CHUC, 3000-075, Coimbra, Portugal
| | - António Pires
- Pediatric Hospital, Centro Hospitalar e Universitário de Coimbra, CHUC, 3000-075, Coimbra, Portugal
| | - Luís Velez Lapão
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008, Lisboa, Portugal
| |
Collapse
|
6
|
Lapão LV, Pisco L. [Primary health care reform in Portugal, 2005-2018: the future and challenges of coming of age]. CAD SAUDE PUBLICA 2019; 35Suppl 2:e00042418. [PMID: 31411303 DOI: 10.1590/0102-311x00042418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 02/19/2019] [Indexed: 11/22/2022] Open
Abstract
In order to reform Portugal's primary health care (PHC), the Ministry of Health planned a change that was launched in 2005 and 2006, and which is still under way today. This article aims to analyze PHC reform in Portugal according to different phases in its development, using Kingdon's multiple streams model to reflect on the evolution in the reform process and its future, from the perspective of a process that seeks to achieve universal access to health. The working methodology was a document and case study with a qualitative approach and evaluative dimensions. The study was based on material on PHC in Portugal, published both in Portugal and elsewhere. Kingdon's multiple streams model was used to explain the actual and contextual development of policies implemented during the PHC reform. Three phases were identified in the reform, each lasting about five years. The first phase, starting in 2005, featured family health units with a voluntary basis. The second phase began in 2010, with the model's consolidation. In the third phase, since 2015 and still under way, the model came of age, benefiting from the end of the financial crisis but still suffering from its effects. The three reform cycles represent three distinct periods with consistency in the coalition that the policymaker was able to establish, in which the windows of opportunity for internally built change were heavily influenced by external factors. The article identifies the contribution by PHC reform to improvement of the Portuguese population's health status.
Collapse
Affiliation(s)
- Luís Velez Lapão
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.,WHO Collaborating Center for Health Workforce Policy and Planning, Lisboa, Portugal
| | - Luís Pisco
- Administração Regional de Saúde de Lisboa e Vale do Tejo, Ministério da Saúde, Lisboa, Portugal.,Nova Medical School, Lisboa, Portugal
| |
Collapse
|
7
|
Figueroa CA, Harrison R, Chauhan A, Meyer L. Priorities and challenges for health leadership and workforce management globally: a rapid review. BMC Health Serv Res 2019; 19:239. [PMID: 31014349 PMCID: PMC6480808 DOI: 10.1186/s12913-019-4080-7] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 04/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Health systems are complex and continually changing across a variety of contexts and health service levels. The capacities needed by health managers and leaders to respond to current and emerging issues are not yet well understood. Studies to date have been country-specific and have not integrated different international and multi-level insights. This review examines the current and emerging challenges for health leadership and workforce management in diverse contexts and health systems at three structural levels, from the overarching macro (international, national) context to the meso context of organisations through to the micro context of individual healthcare managers. METHODS A rapid review of evidence was undertaken using a systematic search of a selected segment of the diverse literature related to health leadership and management. A range of text words, synonyms and subject headings were developed for the major concepts of global health, health service management and health leadership. An explorative review of three electronic databases (MEDLINE®, Pubmed and Scopus) was undertaken to identify the key publication outlets for relevant content between January 2010 to July 2018. A search strategy was then applied to the key journals identified, in addition to hand searching the journals and reference list of relevant papers identified. Inclusion criteria were independently applied to potentially relevant articles by three reviewers. Data were subject to a narrative synthesis to highlight key concepts identified. RESULTS Sixty-three articles were included. A set of consistent challenges and emerging trends within healthcare sectors internationally for health leadership and management were represented at the three structural levels. At the macro level these included societal, demographic, historical and cultural factors; at the meso level, human resource management challenges, changing structures and performance measures and intensified management; and at the micro level shifting roles and expectations in the workplace for health care managers. CONCLUSION Contemporary challenges and emerging needs of the global health management workforce orient around efficiency-saving, change and human resource management. The role of health managers is evolving and expanding to meet these new priorities. Ensuring contemporary health leaders and managers have the capabilities to respond to the current landscape is critical.
Collapse
Affiliation(s)
- Carah Alyssa Figueroa
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, 2052 Australia
| | - Reema Harrison
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, 2052 Australia
| | - Ashfaq Chauhan
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, 2052 Australia
| | - Lois Meyer
- School of Public Health and Community Medicine, University of New South Wales, UNSW, Sydney, 2052 Australia
| |
Collapse
|
8
|
Lapão LV, Arcêncio RA, Popolin MP, Rodrigues LBB. The role of Primary Healthcare in the coordination of Health Care Networks in Rio de Janeiro, Brazil, and Lisbon region, Portugal. CIENCIA & SAUDE COLETIVA 2018; 22:713-724. [PMID: 28300981 DOI: 10.1590/1413-81232017223.33532016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 12/08/2016] [Indexed: 11/22/2022] Open
Abstract
Considering the trajectory of Rio de Janeiro e Lisboa region regarding strengths of the their health local systems to achieve health for all and equity, the study aimed to compare the organization of the Primary Healthcare from both regions, searching to identify the advancement which in terms of the Delivery Health Networks' coordination. It is a case study with qualitative approach and assessment dimensions. It was used material available online such as scientific manuscripts and gray literature. The results showed the different grades regarding Delivery Health Networks. Lisboa region present more advancement, because of its historic issues, it has implemented Primary Healthcare expanded and nowadays it achieved enough maturity related to coordination of its health local system and Rio de Janeiro suffers still influence from historic past regarding Primary Healthcare selective. The both regions has done strong bids in terms of electronic health records and telemedicine. After of the study, it is clearer the historic, cultural and politics and legal issue that determined the differences of the Primary Healthcare coordinator of the Delivery Health Network in Rio de Janeiro and Lisboa region.
Collapse
Affiliation(s)
- Luís Velez Lapão
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa. R. da Junqueira 100. 1349-008 Lisboa Portugal.
| | | | | | | |
Collapse
|
9
|
de Oliveira APC, Dussault G, Craveiro I. Challenges and strategies to improve the availability and geographic accessibility of physicians in Portugal. HUMAN RESOURCES FOR HEALTH 2017; 15:24. [PMID: 28335776 PMCID: PMC5364681 DOI: 10.1186/s12960-017-0194-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 02/17/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Shortages of physicians in remote, rural and other underserved areas and lack of general practitioners limit access to health services. The aims of this article are to identify the challenges faced by policy and decision-makers in Portugal to guarantee the availability and geographic accessibility to physicians in the National Health Service and to describe and analyse their causes, the strategies to tackle them and their results. We also raise the issue of whether research evidence was used or not in the process of policy development. METHODS We analysed policy and technical documents, peer-reviewed papers and newspaper articles from 1995 to 2015 through a structured search of government websites, Portuguese online newspapers and PubMed and Virtual Health Library (Biblioteca Virtual em Saúde (BVS)) databases; key informants were consulted to validate and complement the documentary search. RESULTS The challenges faced by decision-makers to ensure access to physicians were identified as a forecasted shortage of physicians, geographical imbalances and maldistribution of physicians by level of care. To date, no human resources for health policy has been formulated, in spite of most documents reviewed stating that it is needed. On the other hand, various isolated and ad hoc strategies have been adopted, such as incentives to choose family health as a specialty or to work in an underserved region and recruitment of foreign physicians through bilateral agreements. CONCLUSIONS Health workforce research in Portugal is scarce, and therefore, policy decisions regarding the availability and accessibility of physicians are not based on evidence. The policy interventions described in this paper should be evaluated, which would be a good starting point to inform health workforce policy development.
Collapse
Affiliation(s)
- Ana Paula Cavalcante de Oliveira
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
| | - Gilles Dussault
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
| | - Isabel Craveiro
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, 1349-008 Lisbon, Portugal
| |
Collapse
|
10
|
Rodrigues LBB, Dos Santos CB, Goyatá SLT, Popolin MP, Yamamura M, Deon KC, Lapão LMV, Santos Neto M, Uchoa SADC, Arcêncio RA. Assessment of the coordination of integrated health service delivery networks by the primary health care: COPAS questionnaire validation in the Brazilian context. BMC FAMILY PRACTICE 2015; 16:87. [PMID: 26198100 PMCID: PMC4510885 DOI: 10.1186/s12875-015-0299-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Accepted: 06/26/2015] [Indexed: 11/12/2022]
Abstract
BACKGROUND Health systems organized as networks and coordinated by the Primary Health Care (PHC) may contribute to the improvement of clinical care, sanitary conditions, satisfaction of patients and reduction of local budget expenditures. The aim of this study was to adapt and validate a questionnaire - COPAS - to assess the coordination of Integrated Health Service Delivery Networks by the Primary Health Care. METHODS A cross sectional approach was used. The population was pooled from Family Health Strategy healthcare professionals, of the Alfenas region (Minas Gerais, Brazil). Data collection was performed from August to October 2013. The results were checked for the presence of floor and ceiling effects and the internal consistency measured through Cronbach alpha. Construct validity was verified through convergent and discriminant values following Multitrait-Multimethod (MTMM) analysis. RESULTS Floor and ceiling effects were absent. The internal consistency of the instrument was satisfactory; as was the convergent validity, with a few correlations lower then 0.30. The discriminant validity values of the majority of items, with respect to their own dimension, were found to be higher or significantly higher than their correlations with the dimensions to which they did not belong. CONCLUSION The results showed that the COPAS instrument has satisfactory initial psychometric properties and may be used by healthcare managers and workers to assess the PHC coordination performance within the Integrated Health Service Delivery Network.
Collapse
Affiliation(s)
- Ludmila Barbosa Bandeira Rodrigues
- Institute for Health Sciences, Federal University of Mato Grosso (UFMT), 1200 Alexandre Ferronato Avenue - Industrial Sector, 78557267, Sinop, MT, Brazil.
| | - Claudia Benedita Dos Santos
- Mother-Baby Department, University of São Paulo at Ribeirão Preto, College of Nursing, 3900 Bandeirantes Avenue, 14040-902, Ribeirão Preto, SP, Brazil.
| | - Sueli Leiko Takamatsu Goyatá
- Nursing Department, Federal University of Alfenas, 700 Gabriel Monteiro da Silva St., 37130000, Alfenas, MG, Brazil.
| | - Marcela Paschoal Popolin
- Mother-Baby Department, University of São Paulo at Ribeirão Preto, College of Nursing, 3900 Bandeirantes Avenue, 14040-902, Ribeirão Preto, SP, Brazil.
| | - Mellina Yamamura
- Mother-Baby Department, University of São Paulo at Ribeirão Preto, College of Nursing, 3900 Bandeirantes Avenue, 14040-902, Ribeirão Preto, SP, Brazil.
| | - Keila Christiane Deon
- Physical Education Department, Federal University of Rio Grande do Sul Physical Education College, 750 Felizardo St., Jardim Botânico, 90690-200, Porto Alegre, RS, Brazil.
| | - Luis Miguel Veles Lapão
- WHO Collaborating Center for Health Workforce Policy and Planning, International Public Health and Biostatistics, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 100 Junqueira, Lisbon, 1349-008, Portugal.
| | - Marcelino Santos Neto
- Mother-Baby Department, University of São Paulo at Ribeirão Preto, College of Nursing, 3900 Bandeirantes Avenue, 14040-902, Ribeirão Preto, SP, Brazil.
| | - Severina Alice da Costa Uchoa
- Public Health Department, Federal University of Rio Grande do Norte. Campus Universitário, Salgado Filho Avenue, Natal, RN, Brazil.
| | - Ricardo Alexandre Arcêncio
- Mother-Baby Department, University of São Paulo at Ribeirão Preto, College of Nursing, 3900 Bandeirantes Avenue, 14040-902, Ribeirão Preto, SP, Brazil.
| |
Collapse
|
11
|
Lapão LV. Seriously Implementing Health Capacity Strengthening Programs in Africa: Comment on "Implementation of a Health Management Mentoring Program: Year-1 Evaluation of Its Impact on Health System Strengthening in Zambézia Province, Mozambique". Int J Health Policy Manag 2015; 4:691-3. [PMID: 26673182 DOI: 10.15171/ijhpm.2015.130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 07/10/2015] [Indexed: 11/09/2022] Open
Abstract
Faced with the challenges of healthcare reform, skills and new capabilities are needed to support the reform and it is of crucial importance in Africa where shortages affects the health system resilience. Edwards et al provides a good example of the challenge of implementing a mentoring program in one province in a sub-Saharan country. From this example, various aspects of strengthening the capacity of managers in healthcare are examined based on our experience in action-training in Africa, as mentoring shares many characteristics with action-training. What practical lessons can be drawn to promote the strengthening so that managers can better intervene in complex contexts? Deeper involvement of health authorities and more rigorous approaches are seriously desirable for the proper development of health capacity strengthening programs in Africa.
Collapse
Affiliation(s)
- Luís Velez Lapão
- International Public Health and Biostatistics, WHO Collaborating Center on Health Workforce Policy and Planning, Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| |
Collapse
|
12
|
Segato F, Masella C. Integrated care in action: opening the “black box” of implementation. Int J Health Plann Manage 2015; 32:50-71. [DOI: 10.1002/hpm.2306] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 03/16/2015] [Accepted: 05/29/2015] [Indexed: 11/08/2022] Open
Affiliation(s)
- Federica Segato
- Department of Management, Economics and Industrial Engineering; Politecnico di Milano; Milan Italy
| | - Cristina Masella
- Department of Management, Economics and Industrial Engineering; Politecnico di Milano; Milan Italy
| |
Collapse
|
13
|
Ney MS, Pierantoni CR, Lapão LV. Sistemas de avaliação profissional e contratualização da gestão na Atenção Primária à Saúde em Portugal. SAÚDE EM DEBATE 2015. [DOI: 10.1590/0103-110420151040266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Apresenta-se um estudo de caso realizado em Portugal sobre sistemas de avaliação profissional para atenção primária. Os objetivos foram analisar a trajetória de implantação, a estrutura organizacional e as ferramentas de gestão utilizadas, bem como discutir sobre os processos que vêm sendo instituídos no Brasil com o Programa Nacional de Melhoria do Acesso e da Qualidade. Trata-se de estudo descritivo, com investigação bibliográfica de abordagem qualitativa. Os resultados indicam uma estrutura de coordenação, com descentralização dos serviços, que requer maior autonomia dos gestores de saúde e regulamentação do processo avaliativo, contribuindo para a obtenção de melhores resultados.
Collapse
|
14
|
Perelman J, Felix S, Santana R. The Great Recession in Portugal: impact on hospital care use. Health Policy 2014; 119:307-15. [PMID: 25583679 DOI: 10.1016/j.healthpol.2014.12.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 10/20/2014] [Accepted: 12/16/2014] [Indexed: 11/28/2022]
Abstract
The Great Recession started in Portugal in 2009, coupled with severe austerity. This study examines its impact on hospital care utilization, interpreted as caused by demand-side effects (related to variations in population income and health) and supply-side effects (related to hospitals' tighter budgets and reduced capacity). The database included all in-patient stays at all Portuguese NHS hospitals over the 2001-2012 period (n=17.7 millions). We analyzed changes in discharge rates, casemix index, and length of stay (LOS), using a before-after methodology. We additionally measured the association of health care indicators to unemployment. A 3.2% higher rate of discharges was observed after 2009. Urgent stays increased by 2.5%, while elective in-patient stays decreased by 1.4% after 2011. The LOS was 2.8% shorter after the crisis onset, essentially driven by the 4.5% decrease among non-elective stays. A one percentage point increase in unemployment rate was associated to a 0.4% increase in total volume, a 2.3% decrease in day cases, and a 0.1% decrease in LOS. The increase in total and urgent cases may reflect delayed out-patient care and health deterioration; the reduced volume of elective stays possibly signal a reduced capacity; finally, the shorter stays may indicate either efficiency-enhancing measures or reduced quality.
Collapse
Affiliation(s)
- Julian Perelman
- Escola Nacional de Saúde Pública (Universidade Nova de Lisboa), Avenida Padre Cruz, 1600-5605 Lisbon, Portugal.
| | - Sónia Felix
- Banco de Portugal, Rua do Comércio 148, 1100-150 Lisbon, Portugal; Nova School of Business and Economics (Universidade Nova de Lisboa) , Campus de Campolide, 1099-032 Lisbon, Portugal.
| | - Rui Santana
- Escola Nacional de Saúde Pública (Universidade Nova de Lisboa), Avenida Padre Cruz, 1600-5605 Lisbon, Portugal.
| |
Collapse
|
15
|
Leone C, Dussault G, Lapão LV. Reforma na atenção primária à saúde e implicações na cultura organizacional dos Agrupamentos dos Centros de Saúde em Portugal. CAD SAUDE PUBLICA 2014; 30:149-60. [DOI: 10.1590/0102-311x00135112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 08/06/2013] [Indexed: 11/22/2022] Open
Abstract
A crescente complexidade dos desafios do setor da saúde implica um aumento das responsabilidades para aqueles que nela assumem funções de gestão. Há consenso que a qualidade da força de trabalho em saúde é um fator crítico para o sucesso de qualquer reforma no setor. O objetivo desta investigação é estudar e analisar a alteração induzida por uma intervenção de formação-ação intensiva na cultura organizacional de 73 diretores executivos dos Agrupamentos dos Centros de Saúde (ACES) em Portugal durante a reforma na atenção primária à saúde. Os dados foram coletados e analisados em dois períodos temporais, antes e depois da intervenção do Programa Avançado em Gestão, Governação Clínica e Liderança para os ACES, o qual teve um ano de duração. O modelo Competing Values Framework permitiu observar que, depois da intervenção de formação-ação, as percepções dos diretores executivos sobre a sua cultura organizacional se encontram mais alinhadas com a reforma da atenção primária à saúde, valorizando o tipo de práticas e valores que esta defende. É necessário continuar a monitorizar os resultados em vários períodos temporais para elaborar conclusões a esse respeito.
Collapse
|
16
|
Jaruseviciene L, Liseckiene I, Valius L, Kontrimiene A, Jarusevicius G, Lapão LV. Teamwork in primary care: perspectives of general practitioners and community nurses in Lithuania. BMC FAMILY PRACTICE 2013; 14:118. [PMID: 23945286 PMCID: PMC3751467 DOI: 10.1186/1471-2296-14-118] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 08/12/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND A team approach in primary care has proven benefits in achieving better outcomes, reducing health care costs, satisfying patient needs, ensuring continuity of care, increasing job satisfaction among health providers and using human health care resources more efficiently. However, some research indicates constraints in collaboration within primary health care (PHC) teams in Lithuania. The aim of this study was to gain a better understanding of the phenomenon of teamwork in Lithuania by exploring the experiences of teamwork by general practitioners (GPs) and community nurses (CNs) involved in PHC. METHODS Six focus groups were formed with 29 GPs and 27 CNs from the Kaunas Region of Lithuania. Discussions were recorded and transcribed verbatim. A thematic analysis of these data was then performed. RESULTS The analysis of focus group data identified six thematic categories related to teamwork in PHC: the structure of a PHC team, synergy among PHC team members, descriptions of roles and responsibilities of team members, competencies of PHC team members, communications between PHC team members and the organisational background for teamwork. These findings provide the basis for a discussion of a thematic model of teamwork that embraces formal, individual and organisational factors. CONCLUSIONS The need for effective teamwork in PHC is an issue receiving broad consensus; however, the process of teambuilding is often taken for granted in the PHC sector in Lithuania. This study suggests that both formal and individual behavioural factors should be targeted when aiming to strengthen PHC teams. Furthermore, this study underscores the need to provide explicit formal descriptions of the roles and responsibilities of PHC team members in Lithuania, which would include establishing clear professional boundaries. The training of team members is an essential component of the teambuilding process, but not sufficient by itself.
Collapse
Affiliation(s)
- Lina Jaruseviciene
- Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Mickeviciaus 9, Kaunas LT 44307, Lithuania
| | - Ida Liseckiene
- Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Mickeviciaus 9, Kaunas LT 44307, Lithuania
| | - Leonas Valius
- Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Mickeviciaus 9, Kaunas LT 44307, Lithuania
| | - Ausrine Kontrimiene
- Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Mickeviciaus 9, Kaunas LT 44307, Lithuania
| | - Gediminas Jarusevicius
- Department of Cardiology, Lithuanian University of Health Sciences, Mickeviciaus 9, Kaunas LT 44307, Lithuania
| | - Luís Velez Lapão
- WHO Collaborating Center for Health Workforce Policy and Planning, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal, Rua da Junqueira 100, Lisbon 1349-008, Portugal
| |
Collapse
|