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Thoonsen AC, van Schoten SM, Merten H, van Beusekom I, Schoonmade LJ, Delnoij DMJ, de Bruijne MC. Stimulating implementation of clinical practice guidelines in hospital care from a central guideline organization perspective: A systematic review. Health Policy 2024; 148:105135. [PMID: 39128438 DOI: 10.1016/j.healthpol.2024.105135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 06/11/2024] [Accepted: 07/18/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND The uptake of guidelines in care is inconsistent. This review focuses on guideline implementation strategies used by guideline organizations (governmental agencies, scientific/professional societies and other umbrella organizations), experienced implementation barriers and facilitators and impact of their implementation efforts. METHODS We searched PUBMED, EMBASE and CINAHL and conducted snowballing. Eligibility criteria included guidelines focused on hospital care and OECD countries. Study quality was assessed using the Mixed Methods Appraisal Tool. We used framework analysis, narrative synthesis and summary statistics. RESULTS Twenty-six articles were included. Sixty-two implementation strategies were reported, used in different combinations and ranged between 1 and 16 strategies per initiative. Most frequently reported strategies were educational session(s) and implementation supporting materials. The most commonly reported barrier and facilitator were respectively insufficient healthcare professionals' time and resources; and guideline's credibility, evidence base and relevance. Eighty-five percent of initiatives that measured impact achieved improvements in adoption, knowledge, behavior and/or clinical outcomes. No clear optimal approach for improving guideline uptake and impact was found. However, we found indications that employing multiple active implementation strategies and involving external organizations and hospital staff were associated with improvements. CONCLUSION Guideline organizations employ diverse implementation strategies and encounter multiple barriers and facilitators. Our study uncovered potential effective implementation practices. However, further research is needed on effective tailoring of implementation approaches to increase uptake and impact of guidelines.
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Affiliation(s)
- Andrea C Thoonsen
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands.
| | - Steffie M van Schoten
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands
| | - Hanneke Merten
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands
| | - Ilse van Beusekom
- Zorginstituut Nederland, Department of Care, Willem Dudokhof 1, NL-1112 ZA Diemen, the Netherlands
| | - Linda J Schoonmade
- Vrije Universiteit Amsterdam, Medical Library, De Boelelaan 1117, NL-1081 HV Amsterdam, the Netherlands
| | - Diana M J Delnoij
- Zorginstituut Nederland, Department of Care, Willem Dudokhof 1, NL-1112 ZA Diemen, the Netherlands; Erasmus Universiteit Rotterdam, Erasmus School of Health Policy & Management Health Care Governance, Burgemeester Oudlaan 50, NL-3062 PA Rotterdam, the Netherlands
| | - Martine C de Bruijne
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Van der Boechorststraat 7, NL-1081 BT Amsterdam, the Netherlands
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Eriksson M, Blomberg K, Arvidsson E, Van Poel E, Ares-Blanco S, Astier-Peña MP, Collins C, Gabrani J, Stylianou N, Tkachenko V, Willems S. Did the organization of primary care practices during the COVID-19 pandemic influence quality and safety? - an international survey. BMC Health Serv Res 2024; 24:737. [PMID: 38877434 PMCID: PMC11179335 DOI: 10.1186/s12913-024-11173-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024] Open
Abstract
BACKGROUND Changes in demographics with an older population, the illness panorama with increasing prevalence of non-communicable diseases, and the shift from hospital care to home-based care place demand on primary health care, which requires multiprofessional collaboration and team-based organization of work. The COVID-19 pandemic affected health care in various ways, such as heightened infection control measures, changing work practices, and increased workload. OBJECTIVES This study aimed to investigate the association between primary care practices' organization, and quality and safety changes during the COVID-19 pandemic. DESIGN Data were collected from 38 countries in a large online survey, the PRICOV-19 study. For this paper, the participating practices were categorized as "Only GPs", comprising practices with solely general practitioners (GPs) and/or GP trainees, without any other health care professionals (n = 1,544), and "Multiprofessional," comprising practices with at least one GP or GP trainee and one or more other health professionals (n = 3,936). RESULTS Both categories of practices improved in infection control routines when compared before and during the COVID-19 pandemic. A larger proportion of the multiprofessional practices changed their routines to protect vulnerable patients. Telephone triage was used in more "Multiprofessional" practices, whereas "Only GPs" were more likely to perform video consultations as an alternative to physical visits. Both types of practices reported that the time to review new guidelines and scientific literature decreased during the pandemic. However, both had more meetings to discuss directives than before the pandemic. CONCLUSIONS Multiprofessional teams were keener to introduce changes to the care organization to protect vulnerable patients. However, practices with only GPs were found to be more aligned with video consultations, perhaps reflecting the close patient-doctor relationship. In contrast, telephone triage was used more in multiprofessional teams.
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Affiliation(s)
- Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden.
| | - Karin Blomberg
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Eva Arvidsson
- Futurum, Region Jönköping County, Jönköping, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Ares-Blanco
- Federica Montseny Health Centre, Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Maria Pilar Astier-Peña
- Healthcare Quality Territorial Unit, Territorial Health Directorate, Institute of Health of Catalonia, Camp de Tarragona, Barcelona, Spain
| | - Claire Collins
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Irish College of General Practitioners, Dublin, Ireland
| | | | - Neophytos Stylianou
- Department of data analysis, NS Intelligence Solutions Ltd, Nicosia, Cyprus
- Akesis Home Care, Nicosia, Cyprus
| | - Victoria Tkachenko
- Department of Family Medicine, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Warreman EB, Ester WA, Geurts HM, Vermeiren RRJM, Nooteboom LA. How do primary care providers and autistic adults want to improve their primary care? A Delphi-study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:449-460. [PMID: 37194206 PMCID: PMC10851648 DOI: 10.1177/13623613231172865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
LAY ABSTRACT Autistic adults often encounter different types of healthcare barriers. Because autistic adults also have an increased risk for health problems, the aim of this study was to evaluate barriers and to explore how primary care providers and autistic adults want to improve their primary healthcare. In this co-created study, semi-structured interviews with three autistic adults, two parents of autistic children and six care providers were performed to evaluate barriers in Dutch healthcare. Next, in the survey-study (using the Delphi-method including controlled feedback in three consecutive questionnaires), 21 autistic adults and 20 primary care providers rated the impact of barriers and the usefulness and feasibility of recommendations to improve primary healthcare. In the interviews, 20 barriers in Dutch healthcare for autistic people were found. In the survey-study, the primary care providers rated the negative impact of most barriers lower than the autistic adults. This survey-study resulted in 22 recommendations to improve primary healthcare focused on: primary care providers (including education in collaboration with autistic people), autistic adults (including improvement of preparation for general practitioner-appointments) and organization of general practice (including improvement of continuity in care). In conclusion, primary care providers seem to view healthcare barriers as less impactful than autistic adults. In this co-created study, recommendations to improve primary healthcare for autistic adults were identified, based on the needs of autistic adults and primary care providers. These recommendations provide a basis for primary care providers, autistic adults and their support network to start conversations about, for example, strategies to improve primary care providers' knowledge, autistic adults' preparation for a general practitioner-appointment and organization of primary care.
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Affiliation(s)
- Eva B Warreman
- Leiden University Medical Center Curium, the Netherlands
| | - Wietske A Ester
- Leiden University Medical Center Curium, the Netherlands
- Parnassia Psychiatric Institute, the Netherlands
- Sarr Autisme Rotterdam, the Netherlands
| | - Hilde M Geurts
- University of Amsterdam, the Netherlands
- Dr. Leo Kannerhuis, Youz, Parnassia Psychiatric Institute, the Netherlands
| | - Robert RJM Vermeiren
- Leiden University Medical Center Curium, the Netherlands
- Parnassia Psychiatric Institute, the Netherlands
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Ragamin A, van Halewijn KF, Schuttelaar ML, Lugtenberg M, Pasmans SG, Elshout G, Schappin R. Perceived adherence and associated barriers to the national atopic dermatitis guideline: A survey among general practitioners. Eur J Gen Pract 2023; 29:2242583. [PMID: 37603039 PMCID: PMC10443994 DOI: 10.1080/13814788.2023.2242583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 07/12/2023] [Accepted: 07/24/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND General practitioners (GPs) have an important role in managing patients with atopic dermatitis (AD). Although pivotal, adherence to dermatological guidelines in general practice has not been assessed. OBJECTIVES To assess GPs' perceived adherence and barriers to the Dutch AD guideline. METHODS A survey was conducted among 391 GPs in the Netherlands between December 2021 and May 2022. GPs rated their perceived adherence and perceived barriers concerning five key recommendations of the AD guideline, following an existing framework. The correlation between perceived adherence and barriers was investigated using Spearman's rank correlation. RESULTS A total of 213 GPs (54%) participated. Perceived adherence rates varied across recommendations (43.7% to 98.1%). Lowest adherence was reported for recommendations concerning topical corticosteroids (TCS). Across all recommendations, patient factors (65.6%; SD 11.6) and lack of applicability to specific patient groups (29.5%; SD 10.5) were reported most frequently as barriers. The overall correlation between adherence and barriers was strongest for knowledge (ρ .55; SD .10) and attitude-related factors (range: ρ .40--.62). CONCLUSION GPs' perceived adherence and barriers vary substantially across recommendations of the AD guideline. In particular, GPs reported lower adherence to recommendations concerning TCS. Next to patient-related factors, strong correlations between adherence perceived by GPs and knowledge and attitude-related barriers suggest the importance of addressing these factors as well to improve adherence.
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Affiliation(s)
- Aviël Ragamin
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Dermatology, Center of Pediatric Dermatology, Sophia Children’s Hospital, Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Karlijn F. van Halewijn
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Marie L.A. Schuttelaar
- Department of Dermatology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolein Lugtenberg
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Suzanne G.M.A. Pasmans
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Dermatology, Center of Pediatric Dermatology, Sophia Children’s Hospital, Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Gijs Elshout
- Department of General Practice, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Renske Schappin
- Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Dermatology, Center of Pediatric Dermatology, Sophia Children’s Hospital, Erasmus MC University Medical Center Rotterdam-Sophia Children’s Hospital, Rotterdam, The Netherlands
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Abelsen B, Pedersen K, Løyland HI, Aandahl E. Expanding general practice with interprofessional teams: a mixed-methods patient perspective study. BMC Health Serv Res 2023; 23:1327. [PMID: 38037165 PMCID: PMC10691031 DOI: 10.1186/s12913-023-10322-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/14/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Across healthcare systems, current health policies promote interprofessional teamwork. Compared to single-profession general practitioner care, interprofessional primary healthcare teams are expected to possess added capacity to care for an increasingly complex patient population. This study aims to explore patients' experiences when their usual primary healthcare encounter with general practice shifts from single-profession general practitioner care to interprofessional team-based care. METHODS Qualitative and quantitative data were collected through interviews and a survey among Norwegian patients. The interviews included ten patients (five women and five men) aged between 28 and 89, and four next of kin (all women). The qualitative analysis was carried out using thematic analysis and a continuity framework. The survey included 287 respondents, comprising 58 per cent female and 42 per cent male participants, aged 18 years and above. The respondents exhibited multiple diagnoses and often a lengthy history of illness. All participants experienced the transition to interprofessional teamwork at their general practitioner surgery as part of a primary healthcare team pilot. RESULTS The interviewees described team-based care as more fitting and better coordinated, including more time and more learning than with single-profession general practitioner care. Most survey respondents experienced improvements in understanding and mastering their health problems. Multi-morbid elderly interviewees and interviewees with mental illness shared experiences of improved information continuity. They found that important concerns they had raised with the nurse were known to the general practitioner and vice versa. None of the interviewees expressed dissatisfaction with the inclusion of a nurse in their general practitioner relationship. Several interviewees noted improved access to care. The nurse was seen as a strengthening link to the general practitioner. The survey respondents expressed strong agreement with being followed up by a nurse. The interviewees trusted that it was their general practitioner who controlled what happened to them in the general practitioner surgery. CONCLUSION From the patients' perspective, interprofessional teamwork in general practice can strengthen management, informational, and relational continuity. However, a prerequisite seems to be a clear general practitioner presence in the team.
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Affiliation(s)
- Birgit Abelsen
- Department of Community Medicine, National Centre for Rural Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037, Tromsø, Norway.
| | - Kine Pedersen
- Oslo Economics, Klingenberggata 7, Oslo, 0161, Norway
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Cassou M, Mousquès J, Franc C. General Practitioners activity patterns: the medium-term impacts of Primary Care Teams in France. Health Policy 2023; 136:104868. [PMID: 37567092 DOI: 10.1016/j.healthpol.2023.104868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 06/27/2023] [Accepted: 06/30/2023] [Indexed: 08/13/2023]
Abstract
Faced with the fragmentation of the French primary care system, public policies aim to promote multiprofessional teamwork to improve both delivery efficiency and health professionals' working conditions. Thus, a practice-level add-on payment backed by cooperation commitments is implemented to foster and sustain the development of multiprofessional primary care groups (MPCGs). We study the impact of practising in MPCGs for general practitioners (GPs) in terms of the supply of care, practice patterns and income. Based on this quasiexperimental framework with a panel dataset covering the period 2005-2017, we account for the selection into MPCGs by combining a difference-in-differences design with propensity score matching to prebalance samples. We show that GPs in MPCGs increased their patient list more rapidly than control GPs (+10% increase of encountered patients) without increasing their provision of services (number of visits and drug prescriptions) more rapidly. Instead, compared to control GPs, MPCG GPs had a significantly faster reduction in the average number of visits (+5.5% reduction) and the euro-amounts of drug prescriptions per patient (+7.2% reduction) and other prescriptions. The growth of these effects between the short and medium term moreover suggests that the properties of multi-professional coordination and cooperation need time to develop.
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Affiliation(s)
- Matthieu Cassou
- Institute for Research and Information in Health Economics, (IRDES), 21 rue des Ardennes 75019 Paris, France.
| | - Julien Mousquès
- Institute for Research and Information in Health Economics, (IRDES), 21 rue des Ardennes 75019 Paris, France; EHESP, SHS department, ARENES - UMR 6051, 15 Av. du Professeur Léon Bernard, 35043 Rennes, France.
| | - Carine Franc
- Institute for Research and Information in Health Economics, (IRDES), 21 rue des Ardennes 75019 Paris, France; Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research, (INSERM U1018), Université Paris-Saclay, Université, Paris-Sud, UVSQ, 16 Avenue Paul Vaillant Couturier, 94807 Cedex Villejuif, France.
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Burgmann S, Paier-Abuzahra M, Sprenger M, Avian A, Siebenhofer A. Identifying key policy objectives for strong primary care: a cross-sectional study. Prim Health Care Res Dev 2023; 24:e52. [PMID: 37577950 PMCID: PMC10466205 DOI: 10.1017/s1463423623000403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 08/15/2023] Open
Abstract
AIM The aim of this study was to identify key policy objectives by investigating the perception of important stakeholders and affected professionals concerning relevance and feasibility of a successful primary care (PC) reform. BACKGROUND Since 2013, the Austrian PC system has been undergoing a reform process to establish multiprofessional primary care units. The reforms have various defined objectives and lack clear priorities. METHODS After the definition and consensus-based selection of 12 policy objectives, a cross-sectional online survey on their relevance and feasibility was distributed via email and social media to PC and public health networks. The survey was conducted in the period from January to February 2020. Results were analyzed descriptively, and further, Pearson Chi-Square Test or Fisher's Exact Test was performed for group comparison regarding respondents' characteristics. Open-ended responses were analyzed using qualitative content analysis. FINDINGS In total, 169 questionnaires were completed. A total of 46.3% of the responders had more than 20 years of professional experience (female: 60.5%). A mandatory internship in general practice, vocational training for general practice, and a modern remuneration system were the three top-rated policy objectives regarding relevance. A mandatory internship in general practice, specialization in general practice, and coding of services and diagnosis were assessed as the most feasible objectives. The group comparisons regarding working field, years of professional experience, age, and sex did not show any meaningful results in the evaluation of relevance and feasibility. DISCUSSION In the view of the study participants, easily obtainable objectives include adapting the duration and setting of internships for medical students, as well as mandatory vocational training for GP trainees. Further efforts are necessary to achieve complex objectives such as the adoption of a modern remuneration scheme and a comprehensive quality assurance program. Building capacity and creating team-oriented environments are also important aspects of a successful PC reform.
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Affiliation(s)
- Sarah Burgmann
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Muna Paier-Abuzahra
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Martin Sprenger
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
| | - Andrea Siebenhofer
- Institute of General Practice and Evidence-based Health Services Research, Medical University of Graz, Neue Stiftingtalstraße 6, Graz8010, Austria
- Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Frankfurt60590, Germany
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Arnold C, Hennrich P, Wensing M. Information exchange networks for chronic diseases in primary care practices in Germany: a cross-sectional study. BMC PRIMARY CARE 2022; 23:56. [PMID: 35346050 PMCID: PMC8958478 DOI: 10.1186/s12875-022-01649-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Coordination of care requires information exchange between health workers. The structure of their information exchange networks may influence the quality and efficiency of healthcare delivery. The aim of this study was to explore and classify information exchange networks in primary care for patients with chronic diseases in Germany.
Methods
A cross-sectional study was carried out between 2019 and 2021. As part of a larger project on coordination of care, this study focused on information exchange in practice teams regarding patients with type 2 diabetes (DM), coronary heart disease (CHD) and chronic heart failure (CHF). Social network analysis was applied to determine the number of connections, density and centralization for each of the health conditions for each of the practices. On the basis of the descriptive findings, we developed typologies of information exchange networks in primary care practices.
Results
We included 153 health workers from 40 practices, of which 25 practices were included in the social network analysis. Four types of information exchange structures were identified for the three chronic diseases: highly connected networks with low hierarchy, medium connected networks with medium hierarchy, medium connected networks with low hierarchy and lowly connected networks. Highly connected networks with low hierarchy were identified most frequently (18 networks for DM, 17 for CHD and 14 for CHF). Of the three chronic conditions, information sharing about patients with DM involved the most team members. Information exchange outside the family practice took place mainly with nurses and pharmacists.
Conclusions
This study identified four types of information exchange structures, which provides a practical tool for management and improvement in primary care. Some practices had few information transfer connections and could hardly be considered a network.
Trial registration
We registered the study prospectively on 7 November 2019 at the German Clinical Trials Register (DRKS, www.drks.de) under ID no. DRKS00019219.
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Groenewegen P, Van Poel E, Spreeuwenberg P, Batenburg R, Mallen C, Murauskiene L, Peris A, Pétré B, Schaubroeck E, Stark S, Sigurdsson EL, Tatsioni A, Vafeidou K, Willems S. Has the COVID-19 Pandemic Led to Changes in the Tasks of the Primary Care Workforce? An International Survey among General Practices in 38 Countries (PRICOV-19). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15329. [PMID: 36430047 PMCID: PMC9690243 DOI: 10.3390/ijerph192215329] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/17/2022] [Accepted: 11/18/2022] [Indexed: 06/16/2023]
Abstract
The COVID-19 pandemic has had a large and varying impact on primary care. This paper studies changes in the tasks of general practitioners (GPs) and associated staff during the COVID-19 pandemic. Data from the PRICOV-19 study of 5093 GPs in 38 countries were used. We constructed a scale for task changes and performed multilevel analyses. The scale was reliable at both GP and country level. Clustering of task changes at country level was considerable (25%). During the pandemic, staff members were more involved in giving information and recommendations to patients contacting the practice by phone, and they were more involved in triage. GPs took on additional responsibilities and were more involved in reaching out to patients. Problems due to staff absence, when dealt with internally, were related to more task changes. Task changes were larger in practices employing a wider range of professional groups. Whilst GPs were happy with the task changes in practices with more changes, they also felt the need for further training. A higher-than-average proportion of elderly people and people with a chronic condition in the practice were related to task changes. The number of infections in a country during the first wave of the pandemic was related to task changes. Other characteristics at country level were not associated with task changes. Future research on the sustainability of task changes after the pandemic is needed.
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Affiliation(s)
- Peter Groenewegen
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
- Department of Sociology, Utrecht University, 3584 CS Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, 3584 CS Utrecht, The Netherlands
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Peter Spreeuwenberg
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research (NIVEL), 3500 BN Utrecht, The Netherlands
- Department of Sociology, Radboud University, 6535 XN Nijmegen, The Netherlands
| | | | - Liubove Murauskiene
- Department of Public Health, Faculty of Medicine, University of Vilnius, 03101 Vilnius, Lithuania
| | - Antoni Peris
- Castelldefels Agents de Salut (Casap), 08860 Castelldefels, Spain
| | - Benoit Pétré
- Department of Public Health, Faculty of Medicine, University of Liège, 4000 Liège, Belgium
| | - Emmily Schaubroeck
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlan-gen-Nürnberg, Germany
| | - Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), 91054 Erlan-gen-Nürnberg, Germany
| | - Emil L. Sigurdsson
- Department of family medicine, University of Iceland, 102 Reykjavík, Iceland
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, 45110 Ioannina, Greece
| | - Kyriaki Vafeidou
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, 45110 Ioannina, Greece
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries. Prim Health Care Res Dev 2022; 23:e60. [PMID: 36134523 PMCID: PMC9532851 DOI: 10.1017/s1463423622000470] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Aim: To describe variation in task shifting from GPs to practice assistants/nurses in 34 countries and to explain differences by analysing associations with characteristics of the GPs and their practices and features of the health care systems. Background: Redistribution of tasks and responsibilities in primary care are driven by changes in demand, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill-mix of primary care teams. These developments are hampered by barriers between professional domains. Methods: Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7,200 general practitioners (GPs) in 34 countries. Task shifting is measured through a composite score of GPs’ self-reported shifting of tasks. Independent variables at GP and practice level are as follows: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are as follows: demand for and supply of care, nurse prescribing, and professionalisation of practice assistants/nurses. Multilevel analysis is used to account for clustering of GPs in countries. Findings: Countries vary in the degree of task shifting. Regarding GP and practice characteristics, use of electronic health records and availability of support staff in the practice are positively associated with task shifting and GPs’ working hours negatively, in line with our hypotheses. Age of the GPs is, contrary to our hypothesis, positively related to task shifting. These variables explain 11% of the variance at GP level. Two country variables are related to task shifting: a lower percentage of practices without support staff in a country and nurse prescribing rights coincide with more task shifting. The percentage of practices without support staff has the strongest relationship, explaining 73% of the country variation.
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Edwards N, Sheiman I. What next for the polyclinic? New models of primary health care are required in many former Soviet Union countries. BMC PRIMARY CARE 2022; 23:194. [PMID: 35927680 PMCID: PMC9354434 DOI: 10.1186/s12875-022-01812-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 07/12/2022] [Indexed: 11/19/2022]
Abstract
Background There is unfinished reform in primary care in Russia and other former Soviet Union (FSU) countries. The traditional ‘Semashko’ multi-specialty polyclinic model has been retained, while its major characteristics are increasingly questioned. The search for a new model is on a health policy agenda. It is relevant for many other countries. Objectives In this paper, we explore the strengths and weaknesses of the multi-specialty polyclinic model currently found in Russia and other FSU countries, as well as the features of the emerging multi-disciplinary and large-scale primary care models internationally. The comparison of the two is a major research question. Health policy implications are discussed. Methods We use data from two physicians’ surveys and recent literature to identify the characteristics of multi-specialty polyclinics, indicators of their performance and the evaluation in the specific country context. The review of the literature is used to describe new primary care models internationally. Results The Semashko polyclinic model has lost some of its original strengths due to the excessive specialization of service delivery. We demonstrate the strengths of extended practices in Western countries and conclude that FSU countries should “leapfrog” the phase of developing solo practices and build a multi-disciplinary model similar to the extended practices model in Europe. The latter may act as a ‘golden mean’ between the administrative dominance of the polyclinic model and the limited capacity of solo practices. The new model requires a separation of primary care and outpatient specialty care, with the transformation of polyclinics into centers of outpatient diagnostic and specialty services that become part of hospital services while working closely with primary care. Conclusion The comprehensiveness of care in a big setting and potential economies of scale, which are major strengths of the polyclinic model, should be retained in the provision of specialty care rather than primary care. Internationally, there are lessons about the risks associated with models based on narrow specialization in caring for patients who increasingly have multiple conditions. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01812-w. • The Semashko polyclinic model has lost strengths due to excessive specialization. • Solo and group PHC practices are no longer suitable to manage multimorbidity. • A new ‘extended general practice’ reorients the health system towards PHC. • Restructuring polyclinics is possible by transforming them into outpatient specialty units of hospital structures.
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Tynkkynen LK, Pulkki J, Tervonen-Gonçalves L, Schön P, Burström B, Keskimäki I. Health system reforms and the needs of the ageing population—an analysis of recent policy paths and reform trends in Finland and Sweden. Eur J Ageing 2022; 19:221-232. [PMID: 35465210 PMCID: PMC9012246 DOI: 10.1007/s10433-022-00699-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 01/08/2023] Open
Abstract
AbstractPopulation ageing with an increasing number of people experiencing complex health and social care needs challenges health systems. We explore whether and how health system reforms and policy measures adopted during the past two decades in Finland and Sweden reflect and address the needs of the older people. We discuss health system characteristics that are important to meet the care needs of older people and analyse how health policy agendas have highlighted these aspects in Finland and Sweden. The analysis is based on “most similar cases”. The two countries have rather similar health systems and are facing similar challenges. However, the policy paths to address these challenges are different. The Swedish health system is better resourced, and the affordability of care better ensured, but choice and market-oriented competition reforms do not address the needs of the people with complex health and social care needs, rather it has led to increased fragmentation. In Finland, the level of public funding is lower which may have negative impacts on people who need multiple services. However, in terms of integration and care coordination, Finland seems to follow a path which may pave the way for improved coordination of care for people with multiple care needs. Intensified monitoring and analysis of patterns of health care utilization among older people are warranted in both countries to ensure that care is provided equitably.
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Affiliation(s)
| | - Jutta Pulkki
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | | | - Pär Schön
- Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Equity and Health Policy Research Group, Karolinska Institutet, Stockholm, Sweden
| | - Ilmo Keskimäki
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Loftus Moran O, Casey M, O'Connor L, Cullen W. Quality care process metrics for nurses working in general practice, mapping the evidence: a scoping review protocol. HRB Open Res 2022; 5:10. [PMID: 35505692 PMCID: PMC9024129 DOI: 10.12688/hrbopenres.13483.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands, this is reflective of international primary healthcare nursing trends. However, as nursing care in general practice advances, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to assess the role and facilitate development of services are required. Nursing quality care metrics are an established mechanism which evaluate quality of care. Nursing quality care process metrics (QCP-Ms) specifically refer to measurement of care delivered directly to patients by nurses, benchmarking these interventions adherence to best practice guidance. The use of nursing metrics has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development and implementation of QCP-Ms by Irish GPNs. Aim: To explore and map the literature regarding the development and implementation of QCP-Ms within general practice settings. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O'Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCP-Ms which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about nursing QCP-Ms, their use in general practice or primary healthcare settings, enriching understanding regarding their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary healthcare.
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Affiliation(s)
- Orla Loftus Moran
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- General Practice, Castlebar Family Practice, Castlebar, Ireland
| | - Mary Casey
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Laserina O'Connor
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Walter Cullen
- School of Medicine, Health Sciences, University College Dublin, Dublin, Ireland
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Loftus Moran O, Casey M, O'Connor L, Cullen W. Quality care metrics for nurses working in general practice, mapping the evidence: a scoping review protocol. HRB Open Res 2022; 5:10. [PMID: 35505692 PMCID: PMC9024129 DOI: 10.12688/hrbopenres.13483.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 08/27/2024] Open
Abstract
Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands over the past three decades. However, as nursing care in general practice advances at pace, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to carefully assess the role and facilitate development of services are required. Nursing quality care metrics (QCM) are an established mechanism which measure nursing care process, evaluate quality, and impact of care, and inform service development. The use of nursing QCM has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development of QCM within Irish GPN settings. Aim: To explore and map the literature regarding the use, application, and impact of nursing quality care metrics within a general practice, primary care setting. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O'Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCM which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about QCM, their use in general practice or primary care settings, and enrich understanding of their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary care in Ireland.
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Affiliation(s)
- Orla Loftus Moran
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
- General Practice, Castlebar Family Practice, Castlebar, Ireland
| | - Mary Casey
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Laserina O'Connor
- School of Nursing Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Walter Cullen
- School of Medicine, Health Sciences, University College Dublin, Dublin, Ireland
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Or Z, Shatrov K, Penneau A, Wodchis W, Abiona O, Blankart CR, Bowden N, Bernal‐Delgado E, Knight H, Lorenzoni L, Marino A, Papanicolas I, Riley K, Pellet L, Estupiñán‐Romero F, van Gool K, Figueroa JF. Within and across country variations in treatment of patients with heart failure and diabetes. Health Serv Res 2021; 56 Suppl 3:1358-1369. [PMID: 34409601 PMCID: PMC8579197 DOI: 10.1111/1475-6773.13854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/14/2021] [Accepted: 07/20/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To compare within-country variation of health care utilization and spending of patients with chronic heart failure (CHF) and diabetes across countries. DATA SOURCES Patient-level linked data sources compiled by the International Collaborative on Costs, Outcomes, and Needs in Care across nine countries: Australia, Canada, England, France, Germany, New Zealand, Spain, Switzerland, and the United States. DATA COLLECTION METHODS Patients were identified in routine hospital data with a primary diagnosis of CHF and a secondary diagnosis of diabetes in 2015/2016. STUDY DESIGN We calculated the care consumption of patients after a hospital admission over a year across the care pathway-ranging from primary care to home health nursing care. To compare the distribution of care consumption in each country, we use Gini coefficients, Lorenz curves, and female-male ratios for eight utilization and spending measures. PRINCIPAL FINDINGS In all countries, rehabilitation and home nursing care were highly concentrated in the top decile of patients, while the number of drug prescriptions were more uniformly distributed. On average, the Gini coefficient for drug consumption is about 0.30 (95% confidence interval (CI): 0.27-0.36), while it is, 0.50 (0.45-0.56) for primary care visits, and more than 0.75 (0.81-0.92) for rehabilitation use and nurse visits at home (0.78; 0.62-0.9). Variations in spending were more pronounced than in utilization. Compared to men, women spend more days at initial hospital admission (+5%, 1.01-1.06), have a higher number of prescriptions (+7%, 1.05-1.09), and substantially more rehabilitation and home care (+20% to 35%, 0.79-1.6, 0.99-1.64), but have fewer visits to specialists (-10%; 0.84-0.97). CONCLUSIONS Distribution of health care consumption in different settings varies within countries, but there are also some common treatment patterns across all countries. Clinicians and policy makers need to look into these differences in care utilization by sex and care setting to determine whether they are justified or indicate suboptimal care.
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Affiliation(s)
- Zeynep Or
- Institute for Research and Information in Health Economics (IRDES)ParisFrance
- Department of Economics (LEDa)University Dauphine PSLParisFrance
| | - Kosta Shatrov
- KPM Center for Public ManagementUniversity of BernBernSwitzerland
- Swiss Institute of Translational and Entrepreneurial MedicineBernSwitzerland
| | - Anne Penneau
- Institute for Research and Information in Health Economics (IRDES)ParisFrance
- Department of Economics (LEDa)University Dauphine PSLParisFrance
| | - Walter Wodchis
- Institute of Health Policy Management & EvaluationUniversity of TorontoTorontoOntarioCanada
- Institute for Better Health, Trillium Health PartnersMississaugaOntarioCanada
- ICESTorontoOntarioCanada
| | - Olukorede Abiona
- Centre for Health Economics Research and Evaluation (CHERE)University of TechnologySydneyNew South WalesAustralia
| | - Carl Rudolf Blankart
- KPM Center for Public ManagementUniversity of BernBernSwitzerland
- Swiss Institute of Translational and Entrepreneurial MedicineBernSwitzerland
- Hamburg Center for Health EconomicsUniversität HamburgHamburgGermany
| | - Nicholas Bowden
- Dunedin School of MedicineUniversity of OtagoDunedinNew Zealand
| | | | | | - Luca Lorenzoni
- Organisation for Economic Co‐operation and Development (OECD)ParisFrance
| | - Alberto Marino
- Organisation for Economic Co‐operation and Development (OECD)ParisFrance
- Department of Health PolicyLondon School of EconomicsLondonUK
| | | | - Kristen Riley
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
| | - Leila Pellet
- Institute for Research and Information in Health Economics (IRDES)ParisFrance
| | | | - Kees van Gool
- Centre for Health Economics Research and Evaluation (CHERE)University of TechnologySydneyNew South WalesAustralia
| | - Jose F. Figueroa
- Department of Health Policy and ManagementHarvard T.H. Chan School of Public HealthBostonMassachusettsUSA
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16
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Groenewegen PP, Boerma WGW, Spreeuwenberg P, Seifert B, Schäfer W, Batenburg R, van Tuyl L. Task shifting from general practitioners to practice assistants and nurses in primary care: a cross-sectional survey in 34 countries. Prim Health Care Res Dev 2021; 22:e66. [PMID: 34753532 PMCID: PMC8581458 DOI: 10.1017/s1463423621000657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 08/02/2021] [Accepted: 09/30/2021] [Indexed: 11/16/2022] Open
Abstract
AIM To describe variation in task shifting from general practitioners (GPs) to practice assistants/nurses in 34 countries, and to explain differences by analysing associations with characteristics of the GPs, their practices and features of the health care systems. BACKGROUND Redistribution of tasks and responsibilities in primary care are driven by changes in demand for care, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill mix of primary care teams. However, these developments are hampered by barriers between professional domains, which can be rigid as a result of strict regulation, traditional attitudes and lack of trust. METHODS Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7200 GPs in 34 countries. The dependent variable 'task shifting' is measured through a composite score of GPs' self-reported shifting of tasks. Independent variables at GP and practice level are: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are: institutional development of primary care; demand for and supply of care; nurse prescribing as an indicator for professional boundaries; professionalisation of practice assistants/nurses (indicated by professional training, professional associations and journals). Multilevel analysis is used to account for the clustering of GPs in countries. FINDINGS Countries vary in the degree of task shifting by GPs. Regarding GP and practice characteristics, use of electronic health record applications (as an indicator for innovativeness) and age of the GPs are significantly related to task shifting. These variables explain only little variance at the level of GPs. Two country variables are positively related to task shifting: nurse prescribing and professionalisation of primary care nursing. Professionalisation has the strongest relationship, explaining 21% of the country variation.
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Affiliation(s)
- Peter P. Groenewegen
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
- Department of Sociology and Department of Human Geography, Utrecht University, PO Box 80.115, 3508 TCUtrecht, The Netherlands
| | - Wienke G. W. Boerma
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
| | - Bohumil Seifert
- Institute of General Practice, Charles University, Prague, Czechia
| | - Willemijn Schäfer
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
- Northwestern University, Feinberg School of Medicine, Department of Surgery, Chicago, IL60611, USA
| | - Ronald Batenburg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
- Department of Sociology, Radboud University, Nijmegen, The Netherlands
| | - Lilian van Tuyl
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BNUtrecht, The Netherlands
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Helgheim BI, Sandbaek B. Who Is Doing What in Home Care Services? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910504. [PMID: 34639804 PMCID: PMC8508197 DOI: 10.3390/ijerph181910504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/23/2021] [Accepted: 10/02/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: This paper investigates the distribution of work hours by activity, for the main staff categories in home care services in three rural Norwegian municipalities. In Norway these categories are registered nurses, assistant nurses and assistant health workers. (2) Methods: The three categories of home care staff recorded 20,964 eligible observations over 8 weeks. We identified 19 activities, which were recorded. The majority of staff used a smartphone application for the time measuring, while some staff used a manual form for reporting purposes. (3) Results: The registered nurses (RNs) spent 32% of their time on direct patient work, while driving accounted for 18%. Direct patient work and driving accounted for the majority of activities performed by assistant nurses (48% and 29%, respectively) and assistant health workers (70% and 17%, respectively). (4) Conclusions: The demand for home care services is increasing in terms of both size and complexity. Simultaneously, there is a growing shortage of skilled staff. RNs is the group with the least face-to-face time with patients. To meet the patients' needs, it is necessary to discuss and modify existing home care service systems in order to use resources appropriately and effectively.
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Sørensen M, Garnweidner-Holme L. Hva er god kvalitet i behandling og oppfølging av personer med langtidssykdom? TIDSSKRIFT FOR OMSORGSFORSKNING 2021. [DOI: 10.18261/issn.2387-5984-2021-02-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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19
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Considerations Regarding the Professional Practicing Choice of the Students from the Medical Faculties in Romania. ACTA MEDICA TRANSILVANICA 2021. [DOI: 10.2478/amtsb-2021-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Analysing students’ options regarding the specialty and the country in which they want to practice, provides useful information in judicious planning of human resources in the health system, the factors that motivate the choice, being both personal, difficult to change, but also economic or social that can be influenced by legislation, so that the number of deficient specialties decreases, and the disparity of the ensuring the medical services in urban to rural areas is reduced. This paper is a qualitative study, with voluntary response, applied to students of public and private medical schools in Romania, that investigates the intention to the professional practicing choice after graduation and the reasons of their decisions. The results show the orientation towards the urban environment in a percentage of 100% or for migration - between 2.2% and 50%. Regarding the chosen specialties, the results show that the most frequently chosen specialties were as follows: cardiology, surgery, internal medicine, specialties considered deficient in 2020.(1)
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20
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Loussouarn C, Franc C, Videau Y, Mousquès J. Can General Practitioners Be More Productive? The Impact of Teamwork and Cooperation with Nurses on GP Activities. HEALTH ECONOMICS 2021; 30:680-698. [PMID: 33377283 DOI: 10.1002/hec.4214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/28/2020] [Accepted: 12/09/2020] [Indexed: 05/13/2023]
Abstract
The integration of primary care organizations and interprofessional cooperation is encouraged in many countries to both improve the productive and allocative efficiency of care provision and address the unequal geographical distribution of general practitioners (GPs). In France, a pilot experiment promoted the vertical integration of and teamwork between GPs and nurses. This pilot experiment relied on the staffing and training of nurses; skill mixing, including the authorization to shift tasks from GPs to nurses; and new remuneration schemes. This article evaluates the overall impact of this pilot experiment over the period 2010-2017 on GP activities based on the following indicators: number of working days, patients seen at least once, patients registered, and visits delivered. We control for endogeneity and reduce selection bias by using a case-control design combining coarsened exact matching and difference-in-differences estimates on panel data. We find a small positive impact on the number of GP working days (+1.2%) following enrollment and a more pronounced effect on the number of patients seen (+7.55%) or registered (+6.87%). However, we find no effect on the number of office and home visits. In this context, cooperation and teamwork between GPs and nurses seem to improve access to care for patients.
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Affiliation(s)
- Christophe Loussouarn
- ERUDITE (EA 437), FR TEPP CNRS 3435, University Paris-Est Créteil (UPEC), Créteil, France
- Institute for Research and Information in Health Economics (Irdes), Paris, France
| | - Carine Franc
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris Saclay, Université Paris-Sud, UVSQ, Villejuif, France
- Institute for Research and Information in Health Economics (Irdes), Paris, France
| | - Yann Videau
- ERUDITE (EA 437), FR TEPP CNRS 3435, University Paris-Est Créteil (UPEC), Créteil, France
| | - Julien Mousquès
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris Saclay, Université Paris-Sud, UVSQ, Villejuif, France
- Institute for Research and Information in Health Economics (Irdes), Paris, France
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Wensing M, Szecsenyi J, Laux G. Continuity in general practice and hospitalization patterns: an observational study. BMC FAMILY PRACTICE 2021; 22:21. [PMID: 33446104 PMCID: PMC7809859 DOI: 10.1186/s12875-020-01361-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/21/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND High continuity of care is a key feature of strong general practice. This study aimed to assess the effect of a programme for enhancing strong general practice care on the continuity of care in Germany. The second aim was to assess the effect of continuity of care on hospitalization patterns. METHODS We performed an observational study in Germany, involving patients who received a strong general practice care programme (n=1.037.075) and patients who did not receive this programme (n=723.127) in the year 2017. We extracted data from a health insurance database. The cohorts were compared with respect to three measures of continuity of care (Usual Provider Index, Herfindahl Index, and the Sequential Continuity Index), adjusted for patient characteristics. The effects of continuity in general practice on the rates of hospitalization, rehospitalization, and avoidable hospitalization were examined in multiple regression analyses. RESULTS Compared to the control cohort, continuity in general practice was higher in patients who received the programme (continuity measures were 12.47 to 23.76% higher, P< 0.0001). Higher continuity of care was independently associated with lowered risk of hospitalization, rehospitalization, and avoidable hospitalization (relative risk reductions between 2.45 and 9.74%, P< 0.0001). Higher age, female sex, higher morbidity (Charlson-index), and home-dwelling status (not nursing home) were associated with higher rates of hospitalization. CONCLUSION Higher continuity of care may be one of the mechanisms underlying lower hospitalization rates in patients who received strong general practice care, but further research is needed to examine the causality underlying the associations.
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Affiliation(s)
- Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Gunter Laux
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Cassou M, Mousquès J, Franc C. General practitioners' income and activity: the impact of multi-professional group practice in France. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2020; 21:1295-1315. [PMID: 33057977 DOI: 10.1007/s10198-020-01226-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
France has first experimented, in 2009, and then generalized a practice level add-on payment to promote Multi-Professional Primary Care Groups (MPCGs). Team-based practices are intended to improve both the efficiency of outpatient care supply and the attractiveness of medically underserved areas for healthcare professionals. To evaluate its financial attractiveness and thus the sustainability of MPCGs, we analyzed the evolution of incomes (self-employed income and wages) of General Practitioners (GPs) enrolled in a MPCG, compared with other GPs. We also studied the impacts of working in a MPCG on GPs' activity through both the quantity of medical services provided and the number of patients encountered. Our analyses were based on a quasi-experimental design, with a panel dataset over the period 2008-2014. We accounted for the selection into MPCG by using together coarsened exact matching and difference-in-differences (DID) design with panel-data regression models to account for unobserved heterogeneity. We show that GPs enrolled in MPCGs during the period exhibited an increase in income 2.5% higher than that of other GPs; there was a greater increase in the number of patients seen by the GPs' (88 more) without involving a greater increase in the quantity of medical services provided. A complementary cross-sectional analysis for 2014 showed that these changes were not detrimental to quality in terms of bonuses related to the French pay-for-performance program for the year 2014. Hence, our results suggest that labor and income concerns should not be a barrier to the development of MPCGs, and that MPCGs may improve patient access to primary care services.
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Affiliation(s)
- Matthieu Cassou
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, 16 Avenue Paul Vaillant Couturier, 94807 Cedex, Villejuif, France.
- Institute for Research and Information in Health Economics (IRDES), Paris, France.
| | - Julien Mousquès
- Institute for Research and Information in Health Economics (IRDES), Paris, France
| | - Carine Franc
- Centre for Research in Epidemiology and Population Health, French National Institute of Health and Medical Research (INSERM U1018), Université Paris-Saclay, Université Paris-Sud, UVSQ, 16 Avenue Paul Vaillant Couturier, 94807 Cedex, Villejuif, France
- Institute for Research and Information in Health Economics (IRDES), Paris, France
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Faraco EB, Guimarães L, Anderson C, Leite SN. The pharmacy workforce in public primary healthcare centers: promoting access and information on medicines. Pharm Pract (Granada) 2020; 18:2048. [PMID: 33224324 PMCID: PMC7672483 DOI: 10.18549/pharmpract.2020.4.2048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/25/2020] [Indexed: 12/04/2022] Open
Abstract
Background: Only few studies have analyzed the pharmaceutical workforce in primary
healthcare centers, and a global recommendation calls for better
understanding of the trends that shape workforce development and
capacity. Objective: To analyze the distribution of the pharmaceutical workforce in primary
healthcare centers in the national health system [Sistema Único de
Saúde (SUS)] in Brazil. Methods: The study was conducted using data from the National Survey on Access, Use
and Promotion of Rational Use of Medicines in Brazil. Secondary data
referring to the socioeconomic indicators of each municipality were obtained
from national public databases. Data stratification in geographic regions
was considered, and data on workers in the management of the municipal
pharmaceutical services and medicines dispensing centers were analyzed.
Crude and adjusted prevalence ratios were calculated by Poisson regression
in the study investigating the factors associated with low and high-density
pharmacists per 10,000 inhabitants. Results: The results showed that most Brazilian municipalities have a rate of 1 or
more pharmacist per 10,000 inhabitants in primary healthcare public
facilities, with a higher concentration of pharmacists in small
municipalities. Even in Brazilian municipalities with lower economic
capacity, the conditions of access to medicines and pertinent information on
medicines were directly related to the number of pharmacists available in
these centers. Conclusions: This study showed a high number of pharmacists in the public health system.
The higher density of pharmacists in primary healthcare public facilities
correlated to increased access to medicines information and better municipal
social development.
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Affiliation(s)
- Emilia B Faraco
- Postgraduate Program in Pharmacy, Federal University of Santa Catarina. Florianópolis, SC (Brasil).
| | - Luciano Guimarães
- Postgraduate Program in Epidemiology, Federal University of Rio Grande do Sul. Porto Alegre, RS (Brasil).
| | - Claire Anderson
- Professor of Social Pharmacy. Division of Pharmacy Practice and Policy, University of Nottingham. Nottingham (United Kingdom).
| | - Silvana N Leite
- Professor. Postgraduate Program in Pharmacy, Federal University of Santa Catarina. Florianópolis, SC (Brasil).
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Faraco EB, Guimarães L, Anderson C, Leite SN. The pharmacy workforce in public primary healthcare centers: promoting access and information on medicines. Pharm Pract (Granada) 2020; 18:2048. [PMID: 33224324 DOI: 10.18549/pharmpract.2020.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 10/25/2020] [Indexed: 05/22/2023] Open
Abstract
BACKGROUND Only few studies have analyzed the pharmaceutical workforce in primary healthcare centers, and a global recommendation calls for better understanding of the trends that shape workforce development and capacity. OBJECTIVE To analyze the distribution of the pharmaceutical workforce in primary healthcare centers in the national health system [Sistema Único de Saúde (SUS)] in Brazil. METHODS The study was conducted using data from the National Survey on Access, Use and Promotion of Rational Use of Medicines in Brazil. Secondary data referring to the socioeconomic indicators of each municipality were obtained from national public databases. Data stratification in geographic regions was considered, and data on workers in the management of the municipal pharmaceutical services and medicines dispensing centers were analyzed. Crude and adjusted prevalence ratios were calculated by Poisson regression in the study investigating the factors associated with low and high-density pharmacists per 10,000 inhabitants. RESULTS The results showed that most Brazilian municipalities have a rate of 1 or more pharmacist per 10,000 inhabitants in primary healthcare public facilities, with a higher concentration of pharmacists in small municipalities. Even in Brazilian municipalities with lower economic capacity, the conditions of access to medicines and pertinent information on medicines were directly related to the number of pharmacists available in these centers. CONCLUSIONS This study showed a high number of pharmacists in the public health system. The higher density of pharmacists in primary healthcare public facilities correlated to increased access to medicines information and better municipal social development.
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Affiliation(s)
- Emilia B Faraco
- Postgraduate Program in Pharmacy, Federal University of Santa Catarina. Florianópolis, SC (Brasil).
| | - Luciano Guimarães
- Postgraduate Program in Epidemiology, Federal University of Rio Grande do Sul. Porto Alegre, RS (Brasil).
| | - Claire Anderson
- Professor of Social Pharmacy. Division of Pharmacy Practice and Policy, University of Nottingham. Nottingham (United Kingdom).
| | - Silvana N Leite
- Professor. Postgraduate Program in Pharmacy, Federal University of Santa Catarina. Florianópolis, SC (Brasil).
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Beyer A, Stentzel U, Hoffmann W, van den Berg N. [Attitude of Parents Towards Pediatric Care and Interprofessional Task-Sharing in Regions Distant Versus Close to Care Facilities: Results of a Standardized Survey]. DAS GESUNDHEITSWESEN 2020; 83:516-522. [PMID: 32886938 DOI: 10.1055/a-1192-4840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM The aim of the study was to determine parents' views in regions distant to medical care (dtmc) vs. close to medical care (ctmc) on (1) the assessment of situation in pediatric care and (2) on delegation of medical tasks to qualified members of non-medical health professions. METHOD A self-developed questionnaire was sent to parents in kindergartens, who are either nearby (=close to the medical care provider, ctmc) or more than 20 km away from the nearest pediatric practice and a pediatrics department (=distant to the medical care provider, dtmc). The questions covered socio-demographic, pediatric-care-related aspects and attitudes to delegation of defined medical tasks to non-medical health professionals. RESULTS Of the n=407 evaluable questionnaires (response rate: 18%), 49% came from parents in ctmc-kindergartens and 51% from parents in dtmc-kindergartens. Significant differences were found in the number of children living in the household (ctmc: 21% with 3 or more children vs. dtmc:13%; p-value 0,044), years of education of parents (ctmc: 50% had more than 10 years vs. dtmc: 39%; p-value 0.026), the number of visits to doctor (ctmc: 50% presented her child 4 or more times to a doctor in the last 12 months vs. dtmc: 32%; p-value <0.001) and the kind of medical doctor present (dtmc: in 51% a pediatrician vs. ctmc: 87%; p-value <0.001). The distance to the doctor was significantly different (p-value <0.001) and parents in dtmc-kindergartens perceived more often problems in pediatric health care (dtmc: 61% confirmed problems vs. ctmc: 47%; p-value 0.032). Dtmc-kindergarten-parents more often approved delegation for all of the defined and proposed medical tasks. CONCLUSIONS The results show clear differences between the survey regions. To support pediatric care in regions distant to medical care facilities, innovative care concepts are needed. The positive attitude of the majority of parents on the subject of delegation forms a good basis for the development of concrete concepts and their practical testing in pilot projects.
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Affiliation(s)
- Angelika Beyer
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald
| | - Ulrike Stentzel
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald
| | - Wolfgang Hoffmann
- Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald
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Scaioli G, Schäfer WLA, Boerma WGW, Spreeuwenberg PMM, Schellevis FG, Groenewegen PP. Communication between general practitioners and medical specialists in the referral process: a cross-sectional survey in 34 countries. BMC FAMILY PRACTICE 2020; 21:54. [PMID: 32183771 PMCID: PMC7079351 DOI: 10.1186/s12875-020-01124-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 03/09/2020] [Indexed: 11/29/2022]
Abstract
Background The communication of relevant patient information between general practitioners (GPs) and medical specialists is important in order to avoid fragmentation of care thus achieving a higher quality of care and ensuring physicians’ and patients’ satisfaction. However, this communication is often not carried out properly. The objective of this study is to assess whether communication between GPs and medical specialists in the referral process is associated with the organisation of primary care within a country, the characteristics of the GPs, and the characteristics of the primary care practices themselves. Methods An analysis of a cross-sectional survey among GPs in 34 countries was conducted. The odds ratios of the features that were expected to relate to higher rates of referral letters sent and communications fed back to GPs were calculated using ordered logistic multilevel models. Results A total of 7183 GPs from 34 countries were surveyed. Variations between countries in referral letters sent and feedback communication received did occur. Little of the variance between countries could be explained. GPs stated that they send more referral letters, and receive more feedback communications from medical specialists, in countries where they act as gatekeepers, and when, in general, they interact more with specialists. GPs reported higher use of referral letters when they had a secretary and/or a nurse in their practice, used health information technologies, and had greater job satisfaction. Conclusions There are large differences in communication between GPs and medical specialists. These differences can partly be explained by characteristics of the country, the GP and the primary care practice. Further studies should also take the organisation of secondary care into account.
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Affiliation(s)
- Giacomo Scaioli
- Department of Public Health Sciences, University of Turin, Piazza Polonia, 94, 10126, Torino, Italy
| | - Willemijn L A Schäfer
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 633 N. St Clair Street, Chicago, IL, 60611, USA
| | - Wienke G W Boerma
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, Utrecht, 3500BN, The Netherlands
| | - Peter M M Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, Utrecht, 3500BN, The Netherlands
| | - François G Schellevis
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, Utrecht, 3500BN, The Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT, the Netherlands
| | - Peter P Groenewegen
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, Utrecht, 3500BN, The Netherlands. .,Department of Sociology and Department of Human Geography, Utrecht University, P.O. Box 80.115, Utrecht, 3508 TC, The Netherlands.
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Marchal S, Hollander M, Schoenmakers M, Schouwink M, Timmer JR, Bilo HJG, Schwantje O, van ’t Hof AWJ, Hoes AW. Design of the ZWOT-CASE study: an observational study on the effectiveness of an integrated programme for cardiovascular risk management compared to usual care in general practice. BMC FAMILY PRACTICE 2019; 20:149. [PMID: 31675925 PMCID: PMC6825359 DOI: 10.1186/s12875-019-1039-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 10/17/2019] [Indexed: 01/22/2023]
Abstract
BACKGROUND Cardiovascular diseases (CVD) contribute considerably to mortality and morbidity. Prevention of CVD by lifestyle change and medication is important and needs full attention. In the Netherlands an integrated programme for cardiovascular risk management (CVRM), based on the Chronic Care Model (CCM), has been introduced in primary care in many regions in recent years, but its effects are unknown. In the ZWOT-CASE study we will assess the effect of integrated care for CVRM in the region of Zwolle on two major cardiovascular risk factors: systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-cholesterol) in patients with or at high risk of CVD. METHODS This study is a pragmatic observational study comparing integrated care for CVRM with usual care among patients aged 40-80 years with CVD (n = 370) or with a high CVD risk (n = 370) within 26 general practices. After 1 yr follow-up, primary outcomes (SBP and LDL-cholesterol level) are measured. Secondary outcomes include lifestyle habits (smoking, dietary habits, alcohol use, physical activity), risk factor awareness, 10-year risk of cardiovascular morbidity or mortality, health care consumption, patient satisfaction and quality of life. CONCLUSION The ZWOT-CASE study will provide insight in the effects of integrated care for CVRM in general practice in patients with CVD or at high CVD risk. TRIAL REGISTRATION The ZWOlle Transmural Integrated Care for CArdiovaScular Risk Management Study; ClinicalTrials.gov ; Identifier: NCT03428061; date of registration: 09-02-2018; This study has been retrospectively registered.
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Affiliation(s)
- Suzanne Marchal
- Julius Center for Health Sciences and Primary Care/ University Medical Center Utrecht and Utrecht University, Huispost Str. 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Monika Hollander
- Julius Center for Health Sciences and Primary Care/ University Medical Center Utrecht and Utrecht University, Huispost Str. 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | | | - Michiel Schouwink
- Medrie, Dr. Klinkertweg 18, PO Box 40099, 8004 DB Zwolle, The Netherlands
| | - Jorik R. Timmer
- Isala, Dokter van Heesweg 2, PO Box 10400, 8000 GK Zwolle, The Netherlands
| | - Henk J. G. Bilo
- Center for Integrated Care, Dr. Spanjaardweg, 118025 BT Zwolle, The Netherlands
| | - Olof Schwantje
- General Practitioners Region Region of Zwolle, Zwolle, The Netherlands
| | - Arnoud W. J. van ’t Hof
- Isala, Dokter van Heesweg 2, PO Box 10400, 8000 GK Zwolle, The Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
- Zuyderland Medical Center, department of Cardiology, Heerlen, The Netherlands
| | - Arno W. Hoes
- Julius Center for Health Sciences and Primary Care/ University Medical Center Utrecht and Utrecht University, Huispost Str. 6.131, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Aakjær Andersen C, Jensen MBB, Toftegaard BS, Vedsted P, Harris M, Research Group Ö. Primary care physicians' access to in-house ultrasound examinations across Europe: a questionnaire study. BMJ Open 2019; 9:e030958. [PMID: 31575576 PMCID: PMC6773286 DOI: 10.1136/bmjopen-2019-030958] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The overall objective of this study was to examine the differences in ultrasound availability in primary care across Europe. DESIGN Cross-sectional study. SETTING Primary care. PARTICIPANTS Primary care physicians (PCPs). PRIMARY AND SECONDARY OUTCOMES MEASURES The primary aim was to describe the variation in in-house primary care ultrasonography availability across Europe using descriptive statistics. The secondary aim was to explore associations between in-house ultrasonography availability and the characteristics of PCPs and their clinics using a mixed-effects logistic regression model. RESULTS We collected data from 20 European countries. A total of 2086 PCPs participated, varying from 59 to 446 PCPs per country. The median response rate per country was 24.8%. The median (minimum-maximum) percentage of PCPs across Europe with access to in-house abdominal ultrasonography was 15.3% (0.0%-98.1%) and 12.1% (0.0%-30.8%) had access to in-house pelvic ultrasonography with large variations between countries. We found associations between in-house abdominal ultrasonography availability and larger clinics (OR 2.5, 95% CI 1.2 to 4.9) and clinics with medical doctors specialised in areas, which traditionally use ultrasonography (OR 2.1, 95% CI 1.1 to 3.8). Corresponding associations were found between in-house pelvic ultrasonography availability and larger clinics (OR 1.9, 95% CI 1.3 to 2.7) and clinics with medical doctors specialised in areas, which traditionally use ultrasonography (OR 3.0, 95% CI 1.8 to 5.1). Additionally, we found a negative association between urban clinics and in-house pelvic ultrasound availability (OR 0.5, 95% CI 0.2 to 0.9). CONCLUSIONS Across Europe, there is a large variation in PCPs' access to in-house ultrasonography and organisational aspects of primary care seem to determine this variation. If evidence continues to support ultrasonography as a front-line point-of-care test, implementation strategies for increasing its availability in primary care are needed. Future research should focus on facilitators and barriers that may affect the implementation process.
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Affiliation(s)
| | | | - Berit Skjødeberg Toftegaard
- Department of Emergency Medicine, the Regional Hospital in Horsens, Horsens, Denmark
- Research Unit for General Practice, Aarhus Universitet, Aarhus, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus Universitet, Aarhus, Denmark
| | - Michael Harris
- Department for Health, University of Bath, Bath, UK
- Berner Institut für Hausarztmedizin (BIHAM), Universität Bern, Bern, Switzerland
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Schäfer WL, Boerma WG, van den Berg MJ, De Maeseneer J, De Rosis S, Detollenaere J, Greß S, Heinemann S, van Loenen T, Murante AM, Pavlič DR, Seghieri C, Vainieri M, Willems S, Groenewegen PP. Are people's health care needs better met when primary care is strong? A synthesis of the results of the QUALICOPC study in 34 countries. Prim Health Care Res Dev 2019; 20:e104. [PMID: 32800009 PMCID: PMC6609545 DOI: 10.1017/s1463423619000434] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/25/2019] [Accepted: 04/27/2019] [Indexed: 11/06/2022] Open
Abstract
AIM This article synthesises the results of a large international study on primary care (PC), the QUALICOPC study. BACKGROUND Since the Alma Ata Declaration, strengthening PC has been high on the policy agenda. PC is associated with positive health outcomes, but it is unclear how care processes and structures relate to patient experiences. METHODS Survey data were collected during 2011-2013 from approximately 7000 PC physicians and 70 000 patients in 34, mainly European, countries. The data on the patients are linked to data on the PC physicians within each country and analysed using multilevel modelling. FINDINGS Patients had more positive experiences when their PC physician provided a broader range of services. However, a broader range of services is also associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries where patients had a continuous relationship with PC physicians. Additionally, patients with a long-term relationship with their PC physician were less likely to attend the emergency department. Capitation payment was associated with more positive patient experiences. Mono- and multidisciplinary co-location was related to improved processes in PC, but the experiences of patients visiting multidisciplinary practices were less positive. A stronger national PC structure and higher overall health care expenditures are related to more favourable patient experiences for continuity and comprehensiveness. The study also revealed inequities: patients with a migration background reported less positive experiences. People with lower incomes more often postponed PC visits for financial reasons. Comprehensive and accessible care processes are related to less postponement of care. CONCLUSIONS The study revealed room for improvement related to patient-reported experiences and highlighted the importance of core PC characteristics including a continuous doctor-patient relationship as well as a broad range of services offered by PC physicians.
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Affiliation(s)
- Willemijn L.A. Schäfer
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 633 N. St Clair Street, Chicago, IL 60611, USA
- NIVEL – Netherlands Institute for Health Services Research, PO box 1568, 3500BN Utrecht, The Netherlands
| | - Wienke G.W. Boerma
- NIVEL – Netherlands Institute for Health Services Research, PO box 1568, 3500BN Utrecht, The Netherlands
| | - Michael J. van den Berg
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, 22660, 1100 DD, Amsterdam
| | - Jan De Maeseneer
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium
| | - Sabina De Rosis
- Scuola Superiore Sant’Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy
| | - Jens Detollenaere
- KCE – Belgian Health Care Knowledge Centre, Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - Stefan Greß
- Department of Nursing and Health Sciences, University of Applied Sciences Fulda, Leipziger Str. 123, 36037 Fulda, Germany
| | - Stephanie Heinemann
- Department of Nursing and Health Sciences, University of Applied Sciences Fulda, Leipziger Str. 123, 36037 Fulda, Germany
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073 Göttingen, Germany
| | - Tessa van Loenen
- Pharos – Centre of Expertise on Health Disparities, PO box 13318, 3507 LH Utrecht, The Netherlands
| | - Anna Maria Murante
- Scuola Superiore Sant’Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy
| | - Danica R. Pavlič
- Department of Family Medicine, University of Ljubljana, Poljanski nasip 58, 1000 Ljubljana, Slovenia
| | - Chiara Seghieri
- Scuola Superiore Sant’Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy
| | - Milena Vainieri
- Scuola Superiore Sant’Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium
| | - Peter P. Groenewegen
- NIVEL – Netherlands Institute for Health Services Research, PO box 1568, 3500BN Utrecht, The Netherlands
- Department of Sociology and Department of Human Geography, Utrecht University, P.O. Box 80.115, 3508 TC Utrecht, The Netherlands
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Has the diffusion of primary care teams in France improved attraction and retention of general practitioners in rural areas? Health Policy 2019; 123:508-515. [DOI: 10.1016/j.healthpol.2019.03.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 02/19/2019] [Accepted: 03/01/2019] [Indexed: 11/19/2022]
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Josi R, De Pietro C. Skill mix in Swiss primary care group practices - a nationwide online survey. BMC FAMILY PRACTICE 2019; 20:39. [PMID: 30832589 PMCID: PMC6398248 DOI: 10.1186/s12875-019-0926-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/19/2019] [Indexed: 11/12/2022]
Abstract
BACKGROUND Increasing chronic conditions and multimorbidity is placing growing service pressures on health care, especially primary care services. This comes at a time when GP workforce shortages are starting to be felt across Switzerland, placing a threat on the sustainability of good access to primary care. By establishing multiprofessional teams in primary care, service capacity is increased and the pressures on the GP workforce can be alleviated. The roles of non-medical health professions in primary care are not established so far in Switzerland and the personnel composition of primary care group practices is not known. Therefore this study aims to provide insights into the current composition, educational background and autonomy of the these new professional roles in primary care. METHODS For this descriptive exploratory study a web-based online survey methodology was used. Group practices were defined as being a medical practice with any specialisation where at least three physicians work together in a team. Based on this restriction 240 eligible group practices were identified in Switzerland. The following four tertiary-level health professions were included in the study: nurses, physiotherapists, occupational therapists and dietitians. Additionally medical practice assistants with couselling competencies were included. RESULTS A total of 102 practices answered the questionnaire which is equivalent to an answer rate of 43%. The sample included data from 17 cantons. 46.1% of the practices employed non-physician health professionals. Among the tertiary-level health professions, physiotherapists were the most frequent profession with a total of 78 physiotherapists over all group practices, followed by nurses (43), dietitians (34) and occupational therapists (3). In practices which employ those professionals their average number per practice was 3.4. 25.5% of the practices had health professionals employed with advanced roles and competencies. CONCLUSION The results from this study demonstrate that while nearly 50% of groups practices have established non-physician professionals, only 25% of practices integrate these professionals with advanced roles. Compared with other countries, there would appear to be significant scope to extent and broaden the uptake of non-physician professionals in primary care in Switzerland. Clear policy direction along with supporting regulation and financing arrangements are required.
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Affiliation(s)
- Renata Josi
- University of Applied Sciences of Southern Switzerland, Department of Business Economics, Health and Social Care, Via Violino 11, Manno, 6928 Switzerland
| | - Carlo De Pietro
- University of Applied Sciences of Southern Switzerland, Department of Business Economics, Health and Social Care, Via Violino 11, Manno, 6928 Switzerland
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Sheiman I, Shishkin S, Shevsky V. The evolving Semashko model of primary health care: the case of the Russian Federation. Risk Manag Healthc Policy 2018; 11:209-220. [PMID: 30464661 PMCID: PMC6220729 DOI: 10.2147/rmhp.s168399] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
This paper addresses the major developments in primary care in the Russian Federation under the evolving Semashko model. The overview of the original model and its current version indicates some positive characteristics, including the financial accessibility of care, focus on prevention, patient lists, and gatekeeping by primary-care providers. However, in practice these characteristics do not work according to expectations. The current primary-care system is inefficient and has low quality of care by international standards. The major reasons for the gap between the positive characteristics of the model and the actual developments are discussed, including the excessive specialization of primary care, weak health-workforce policy, the delay in the shift to a general practitioner model, and the dominance of the multispecialty polyclinic, which does not prove advantageous over alternative models. Government attempts to strengthen primary care cover a wide range of activities, but they are not enough to improve the system and cannot do this without more a systematic and consistent approach. The major lesson learnt is that the lack of generalists and coordination cannot be compensated for by the growing number of specialists in the staff of primary-care facilities. Big multispecialty settings (polyclinics in the Russian context) have the potential for more integrated service delivery, but to make it happen, action is needed. Simple decisions, like merging polyclinics, do not help much.
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Affiliation(s)
- Igor Sheiman
- Center for Health Policy, National Research University Higher School of Economics, Moscow, Russia,
| | - Sergey Shishkin
- Center for Health Policy, National Research University Higher School of Economics, Moscow, Russia,
| | - Vladimir Shevsky
- Center for Health Policy, National Research University Higher School of Economics, Moscow, Russia,
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Primary care workforce development in Europe: An overview of health system responses and stakeholder views. Health Policy 2018; 122:1055-1062. [PMID: 30100528 DOI: 10.1016/j.healthpol.2018.07.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 07/25/2018] [Accepted: 07/27/2018] [Indexed: 11/20/2022]
Abstract
Better primary care has become a key strategy for reforming health systems to respond effectively to increases in non-communicable diseases and changing population needs, yet the primary care workforce has received very little attention. This article aligns primary care policy and workforce development in European countries. The aim is to provide a comparative overview of the governance of workforce innovation and the views of the main stakeholders. Cross-country comparisons and an explorative case study design are applied. We combine material from different European projects to analyse health system responses to changing primary care workforce needs, transformations in the general practitioner workforce and patient views on workforce changes. The results reveal a lack of alignment between primary care reform policies and workforce policies and high variation in the governance of primary care workforce innovation. Transformations in the general practitioner workforce only partly follow changing population needs; countries vary considerably in supporting and achieving the goals of integration and community orientation. Yet patients who have experienced task shifting in their care express overall positive views on new models. In conclusion, synthesising available evidence from different projects contributes new knowledge on policy levers and reveals an urgent need for health system leadership in developing an integrated people-centred primary care workforce.
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Laurant M, van der Biezen M, Wijers N, Watananirun K, Kontopantelis E, van Vught AJAH. Nurses as substitutes for doctors in primary care. Cochrane Database Syst Rev 2018; 7:CD001271. [PMID: 30011347 PMCID: PMC6367893 DOI: 10.1002/14651858.cd001271.pub3] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Current and expected problems such as ageing, increased prevalence of chronic conditions and multi-morbidity, increased emphasis on healthy lifestyle and prevention, and substitution for care from hospitals by care provided in the community encourage countries worldwide to develop new models of primary care delivery. Owing to the fact that many tasks do not necessarily require the knowledge and skills of a doctor, interest in using nurses to expand the capacity of the primary care workforce is increasing. Substitution of nurses for doctors is one strategy used to improve access, efficiency, and quality of care. This is the first update of the Cochrane review published in 2005. OBJECTIVES Our aim was to investigate the impact of nurses working as substitutes for primary care doctors on:• patient outcomes;• processes of care; and• utilisation, including volume and cost. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), part of the Cochrane Library (www.cochranelibrary.com), as well as MEDLINE, Ovid, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and EbscoHost (searched 20.01.2015). We searched for grey literature in the Grey Literature Report and OpenGrey (21.02.2017), and we searched the International Clinical Trials Registry Platform (ICTRP) and ClinicalTrials.gov trial registries (21.02.2017). We did a cited reference search for relevant studies (searched 27.01 2015) and checked reference lists of all included studies. We reran slightly revised strategies, limited to publication years between 2015 and 2017, for CENTRAL, MEDLINE, and CINAHL, in March 2017, and we have added one trial to 'Studies awaiting classification'. SELECTION CRITERIA Randomised trials evaluating the outcomes of nurses working as substitutes for doctors. The review is limited to primary healthcare services that provide first contact and ongoing care for patients with all types of health problems, excluding mental health problems. Studies which evaluated nurses supplementing the work of primary care doctors were excluded. DATA COLLECTION AND ANALYSIS Two review authors independently carried out data extraction and assessment of risk of bias of included studies. When feasible, we combined study results and determined an overall estimate of the effect. We evaluated other outcomes by completing a structured synthesis. MAIN RESULTS For this review, we identified 18 randomised trials evaluating the impact of nurses working as substitutes for doctors. One study was conducted in a middle-income country, and all other studies in high-income countries. The nursing level was often unclear or varied between and even within studies. The studies looked at nurses involved in first contact care (including urgent care), ongoing care for physical complaints, and follow-up of patients with a particular chronic conditions such as diabetes. In many of the studies, nurses could get additional support or advice from a doctor. Nurse-doctor substitution for preventive services and health education in primary care has been less well studied.Study findings suggest that care delivered by nurses, compared to care delivered by doctors, probably generates similar or better health outcomes for a broad range of patient conditions (low- or moderate-certainty evidence):• Nurse-led primary care may lead to slightly fewer deaths among certain groups of patients, compared to doctor-led care. However, the results vary and it is possible that nurse-led primary care makes little or no difference to the number of deaths (low-certainty evidence).• Blood pressure outcomes are probably slightly improved in nurse-led primary care. Other clinical or health status outcomes are probably similar (moderate-certainty evidence).• Patient satisfaction is probably slightly higher in nurse-led primary care (moderate-certainty evidence). Quality of life may be slightly higher (low-certainty evidence).We are uncertain of the effects of nurse-led care on process of care because the certainty of this evidence was assessed as very low.The effect of nurse-led care on utilisation of care is mixed and depends on the type of outcome. Consultations are probably longer in nurse-led primary care (moderate-certainty evidence), and numbers of attended return visits are slightly higher for nurses than for doctors (high-certainty evidence). We found little or no difference between nurses and doctors in the number of prescriptions and attendance at accident and emergency units (high-certainty evidence). There may be little or no difference in the number of tests and investigations, hospital referrals and hospital admissions between nurses and doctors (low-certainty evidence).We are uncertain of the effects of nurse-led care on the costs of care because the certainty of this evidence was assessed as very low. AUTHORS' CONCLUSIONS This review shows that for some ongoing and urgent physical complaints and for chronic conditions, trained nurses, such as nurse practitioners, practice nurses, and registered nurses, probably provide equal or possibly even better quality of care compared to primary care doctors, and probably achieve equal or better health outcomes for patients. Nurses probably achieve higher levels of patient satisfaction, compared to primary care doctors. Furthermore, consultation length is probably longer when nurses deliver care and the frequency of attended return visits is probably slightly higher for nurses, compared to doctors. Other utilisation outcomes are probably the same. The effects of nurse-led care on process of care and the costs of care are uncertain, and we also cannot ascertain what level of nursing education leads to the best outcomes when nurses are substituted for doctors.
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Affiliation(s)
- Miranda Laurant
- Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical CenterPO Box 9101NijmegenNetherlands6500 HB
- HAN University of Applied SciencesFaculty of Health and Social StudiesNijmegenNetherlands
| | - Mieke van der Biezen
- Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical CenterPO Box 9101NijmegenNetherlands6500 HB
| | | | - Kanokwaroon Watananirun
- Faculty of Medicine, Siriraj Hospital, Mahidol UniversityDepartment of Obstetrics and GynaecologyMahidolThailand
| | - Evangelos Kontopantelis
- The University of ManchesterCentre for Health Informatics, Institute of Population HealthWilliamson Building, 5th FloorOxford RoadManchesterGreater ManchesterUKM13 9PL
| | - Anneke JAH van Vught
- HAN University of Applied SciencesFaculty of Health and Social StudiesNijmegenNetherlands
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Kuhlmann E, Batenburg R, Wismar M, Dussault G, Maier CB, Glinos IA, Azzopardi-Muscat N, Bond C, Burau V, Correia T, Groenewegen PP, Hansen J, Hunter DJ, Khan U, Kluge HH, Kroezen M, Leone C, Santric-Milicevic M, Sermeus W, Ungureanu M. A call for action to establish a research agenda for building a future health workforce in Europe. Health Res Policy Syst 2018; 16:52. [PMID: 29925432 PMCID: PMC6011393 DOI: 10.1186/s12961-018-0333-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 06/05/2018] [Indexed: 11/30/2022] Open
Abstract
The importance of a sustainable health workforce is increasingly recognised. However, the building of a future health workforce that is responsive to diverse population needs and demographic and economic change remains insufficiently understood. There is a compelling argument to be made for a comprehensive research agenda to address the questions. With a focus on Europe and taking a health systems approach, we introduce an agenda linked to the 'Health Workforce Research' section of the European Public Health Association. Six major objectives for health workforce policy were identified: (1) to develop frameworks that align health systems/governance and health workforce policy/planning, (2) to explore the effects of changing skill mixes and competencies across sectors and occupational groups, (3) to map how education and health workforce governance can be better integrated, (4) to analyse the impact of health workforce mobility on health systems, (5) to optimise the use of international/EU, national and regional health workforce data and monitoring and (6) to build capacity for policy implementation. This article highlights critical knowledge gaps that currently hamper the opportunities of effectively responding to these challenges and advising policy-makers in different health systems. Closing these knowledge gaps is therefore an important step towards future health workforce governance and policy implementation. There is an urgent need for building health workforce research as an independent, interdisciplinary and multi-professional field. This requires dedicated research funding, new academic education programmes, comparative methodology and knowledge transfer and leadership that can help countries to build a people-centred health workforce.
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Affiliation(s)
- Ellen Kuhlmann
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, OE 5410, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
- Karolinska Institutet, Medical Management Centre, LIME, Tomtebodavagen 18a, 171 77 Stockholm, Sweden
| | - Ronald Batenburg
- Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 Utrecht, The Netherlands
| | - Matthias Wismar
- European Observatory on Health Systems and Policies, Place Victor Horta/Victor Hortaplein, 40/10, 1060 Brussels, Brussels Belgium
| | - Gilles Dussault
- Global Health and Tropical Medicine & WHO Collaborating Center on Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine-NOVA University of Lisbon, Rua da Junqueira 100, 1349-008 Lisbon, Portugal
| | - Claudia B. Maier
- Department of Healthcare Management, Technische Universität Berlin, Strasse des 17. Juni 135, 10623 Berlin, Germany
| | - Irene A. Glinos
- European Observatory on Health Systems and Policies, Place Victor Horta/Victor Hortaplein, 40/10, 1060 Brussels, Brussels Belgium
| | - Natasha Azzopardi-Muscat
- Department of Health Services Management, Faculty of Health Science & WHO Collaborating Centre for Health Systems and Policy in Small States at the Islands and Small States Institute, University of Malta, Msida, MSD 2080 Malta
- European Public Health Association (EUPHA), Utrecht, Netherlands
| | - Christine Bond
- Christine Bond, Institute of Applied Health Sciences, University of Aberdeen, Foresterhill, Aberdeen, AB25 ZD United Kingdom
| | - Viola Burau
- Department of Public Health, University of Aarhus, Bartholins Allé 2, 8000 Aarhus C, Denmark
| | - Tiago Correia
- ISCTE-Instituto Universitário de Lisboa, School of Sociology and Public Policies, Avenida das Forcas Armadas, 1649-026 Lisbon, Portugal
| | - Peter P. Groenewegen
- Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 Utrecht, The Netherlands
- Department of Sociology, Utrecht University, Heidelberglaan 2, 3584 CS Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, Heidelberglaan 2, 3584 CS Utrecht, The Netherlands
| | - Johan Hansen
- Netherlands Institute for Health Services Research, Otterstraat 118-124, 3513 Utrecht, The Netherlands
| | - David J. Hunter
- Institute of Health and Society, Newcastle University, Newcastle, United Kingdom
| | - Usman Khan
- European Health Management Association (EHMA), Rue Belliard 15-17, 1040 Brussels, Belgium
| | - Hans H. Kluge
- Division of Health Systems and Public Health, WHO Regional Office for Europe, Marmorvej 51, 2100 Copenhagen, Denmark
| | - Marieke Kroezen
- Department of General Practice, Erasmus University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Claudia Leone
- Florence Nightingale Faculty of Nursing and Midwifery, King’s College London, 57 Waterloo Road, SE1 8WA London, United Kingdom
| | - Milena Santric-Milicevic
- Institute of Social Medicine, Faculty of Medicine University of Belgrade, Dr Subotica, Belgrade, 15 11000 Serbia
| | - Walter Sermeus
- KU Leuven Institute for Healthcare Policy, Kapucijnenvoer 35 blok d – box 7001, 3000 Leuven, Belgium
| | - Marius Ungureanu
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babeș-Bolyai University, 7 Pandurilor Street, 400376 Cluj-Napoca, Romania
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Busse R, van Ginneken E. Cross-country comparative research – Lessons from advancing health system and policy research on the occasion of the European Observatory on Health Systems and Policies’ 20th anniversary. Health Policy 2018; 122:453-456. [DOI: 10.1016/j.healthpol.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Bonciani M, Schäfer W, Barsanti S, Heinemann S, Groenewegen PP. The benefits of co-location in primary care practices: the perspectives of general practitioners and patients in 34 countries. BMC Health Serv Res 2018; 18:132. [PMID: 29466980 PMCID: PMC5822600 DOI: 10.1186/s12913-018-2913-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is no clear evidence as to whether the co-location of primary care professionals in the same facility positively influences their way of working and the quality of healthcare as perceived by patients. The aim of this study was to identify the relationships between general practitioner (GP) co-location with other GPs and/or other professionals and the GP outcomes and patients’ experiences. Methods We wanted to test whether GP co-location is related to a broader range of services provided, the use of clinical governance tools and inter-professional collaboration, and whether the patients of co-located GPs perceive a better quality of care in terms of accessibility, comprehensiveness and continuity of care with their GPs. The source of data was the QUALICOPC study (Quality and Costs of Primary Care in Europe), which involved surveys of GPs and their patients in 34 countries, mostly in Europe. In order to study the relationships between GP co-location and both GPs’ outcomes and patients’ experience, multilevel linear regression analysis was carried out. Results The GP questionnaire was filled in by 7183 GPs and the patient experience questionnaire by 61,931 patients. Being co-located with at least one other professional is the most common situation of the GPs involved in the study. Compared with single-handed GP practices, GP co-location are positively associated with the GP outcomes. Considering the patients’ perspective, comprehensiveness of care has the strongest negative relationship of GP co-location of all the dimensions of patient experiences analysed. Conclusions The paper highlights that GP mono- and multi-disciplinary co-location is related to positive outcomes at a GP level, such as a broader provision of technical procedures, increased collaboration among different providers and wider coordination with secondary care. However, GP co-location, particularly in a multidisciplinary setting, is related to less positive patient experiences, especially in countries with health systems characterised by a weak primary care structure.
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Affiliation(s)
- M Bonciani
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - W Schäfer
- Netherlands Institute for Health Services Research-NIVEL, Utrecht, The Netherlands
| | - S Barsanti
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - S Heinemann
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.,Department of Nursing and Health Sciences, University of Applied Sciences Fulda, Fulda, Germany
| | - P P Groenewegen
- Netherlands Institute for Health Services Research-NIVEL, Utrecht, The Netherlands.,Department of Sociology, Department of Human Geography, Utrecht University, Utrecht, The Netherlands
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Managing multimorbidity: Profiles of integrated care approaches targeting people with multiple chronic conditions in Europe. Health Policy 2018; 122:44-52. [DOI: 10.1016/j.healthpol.2017.10.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 09/27/2017] [Accepted: 10/13/2017] [Indexed: 11/23/2022]
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Klemenc-Ketiš Z, Švab I, Poplas Susič A. Implementing Quality Indicators for Diabetes and Hypertension in Family Medicine in Slovenia. Zdr Varst 2017; 56:211-219. [PMID: 29062395 PMCID: PMC5639810 DOI: 10.1515/sjph-2017-0029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 07/06/2017] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION A new form of family practices was introduced in 2011 through a pilot project introducing nurse practitioners as members of team and determining a set of quality indicators. The aim of this article was to assess the quality of diabetes and hypertension management. METHODS We included all family medicine practices that were participating in the project in December 2015 (N=584). The following data were extracted from automatic electronic reports on quality indicators: gender and specialisation of the family physician, status (public servant/self-contracted), duration of participation in the project, region of Slovenia, the number of inhabitants covered by a family medicine practice, the name of IT provider, and levels of selected quality indicators. RESULTS Out of 584 family medicine practices that were included in this project at the end of 2015, 568 (97.3%) had complete data and could be included in this analysis. The highest values were observed for structure quality indicator (list of diabetics) and the lowest for process and outcome quality indicators. The values of the selected quality indicators were independently associated with the duration of participation in the project, some regions of Slovenia where practices were located, and some IT providers of the practices. CONCLUSION First, the analysis of data on quality indicators for diabetes and hypertension in this primary care project pointed out the problems which are currently preventing higher quality of chronic patient management at the primary health care level.
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Affiliation(s)
- Zalika Klemenc-Ketiš
- University of Maribor, Faculty of Medicine, Department of Family Medicine, Taborska 8, 2000Maribor, Slovenia
| | - Igor Švab
- University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000Ljubljana, Slovenia
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Williams D, Thomas S. The impact of austerity on the health workforce and the achievement of human resources for health policies in Ireland (2008-2014). HUMAN RESOURCES FOR HEALTH 2017; 15:62. [PMID: 28893248 PMCID: PMC5594546 DOI: 10.1186/s12960-017-0230-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/07/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The global economic crisis saw recessionary conditions in most EU countries. Ireland's severe recession produced pro-cyclical health spending cuts. Yet, human resources for health (HRH) are the most critical of inputs into a health system and an important economic driver. The aim of this article is to evaluate how the Irish health system coped with austerity in relation to HRH and whether austerity allowed and/or facilitated the implementation of HRH policy. METHODS The authors employed a quantitative longitudinal trend analysis over the period 2008 to 2014 with Health Service Executive (HSE) staff database as the principal source. For the purpose of this study, heath service employment is defined as directly employed whole-time equivalent public service staffing in the HSE and other government agencies. The authors also examined the heath sector pay bill and sought to establish linkages between the main staff database and pay expenditure, as given in the HSE Annual Accounts and Financial Statements (AFS), and key HRH policies. RESULTS The actual cut in total whole-time equivalent (WTE) of directly employed health services human resources over the period 2008 to 2014 was 8027 WTE, a reduction of 7.2% but substantially less than government claims. There was a degree of relative protection for frontline staffing decreasing by 2.9% between 2008 and 2014 and far less than the 18.5% reduction in other staff. Staff exempted from the general moratorium also increased by a combined 12.6%. Counter to stated policy, the decline in staffing of non-acute care was over double than in acute care. Further, the reduction in directly employed staff was to a great extent matched by a marked increase in agency spending. CONCLUSIONS The cuts forced substantial HRH reductions and yet there was some success in pursuing policy goals, such as increasing the frontline workforce while reducing support staff and protection of some cadres. Nevertheless, other policies failed such as moving staff away from acute settings and the claimed financial savings were substantially offset by overtime payments and the need to hire more expensive agency workers. There was also substantial demotivation of staff as a consequence of the changes.
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Affiliation(s)
- Des Williams
- Workforce Planning, Analytics & Informatics, National HR Directorate, Health Service Executive, Swords Business Campus, Balheary Road Swords, Dublin, Ireland.
| | - Steve Thomas
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland
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van der Biezen M, Derckx E, Wensing M, Laurant M. Factors influencing decision of general practitioners and managers to train and employ a nurse practitioner or physician assistant in primary care: a qualitative study. BMC FAMILY PRACTICE 2017; 18:16. [PMID: 28173766 PMCID: PMC5297134 DOI: 10.1186/s12875-017-0587-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/19/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Due to the increasing demand on primary care, it is not only debated whether there are enough general practitioners (GPs) to comply with these demands but also whether specific tasks can be performed by other care providers. Although changing the workforce skill mix care by employing Physician Assistants (PAs) and Nurse Practitioners (NPs) has proven to be both effective and safe, the implementation of those professionals differs widely between and within countries. To support policy making regarding PAs/NPs in primary care, the aim of this study is to provide insight into factors influencing the decision of GPs and managers to train and employ a PA/NP within their organisation. METHODS A qualitative study was conducted in 2014 in which 7 managers of out-of-hours primary care services and 32 GPs who owned a general practice were interviewed. Three main topic areas were covered in the interviews: the decision-making process in the organisation, considerations and arguments to train and employ a PA/NP, and the tasks and responsibilities of a PA/NP. RESULTS Employment of PAs/NPs in out-of-hours services was intended to substitute care for minor ailments in order to decrease GPs' caseload or to increase service capacity. Mangers formulated long-term planning and role definitions when changing workforce skill mix. Lastly, out-of-hours services experienced difficulties with creating team support among their members regarding the employment of PAs/NPs. In general practices during office hours, GPs indented both substitution and supplementation for minor ailments and/or target populations through changing the skill mix. Supplementation was aimed at improving quality of care and extending the range of services to patients. The decision-making in general practices was accompanied with little planning and role definition. The willingness to employ PAs/NPs was highly influenced by an employees' motivation to start the master's programme and GPs' prior experience with PAs/NPs. Knowledge about the PA/NP profession and legislations was often lacking. CONCLUSIONS Role standardisations, long-term political planning and support from professional associations are needed to support policy makers in implementing skill mix in primary care.
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Affiliation(s)
- Mieke van der Biezen
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Scientific Center for Quality of Healthcare, P.O. Box 910, Nijmegen, 6500 HB, The Netherlands.
| | - Emmy Derckx
- Foundation for Development of Quality Care in General Practice, Tilburgseweg-West 100, Eindhoven, 5652 NP, The Netherlands
| | - Michel Wensing
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Scientific Center for Quality of Healthcare, P.O. Box 910, Nijmegen, 6500 HB, The Netherlands.,Department of General Practice and Health Services Research, Heidelberg University, INF- Marsilius Arkaden, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany
| | - Miranda Laurant
- Radboud university medical center, Radboud Institute for Health Sciences, IQ healthcare, Scientific Center for Quality of Healthcare, P.O. Box 910, Nijmegen, 6500 HB, The Netherlands.,HAN University of Applied Sciences, Faculty of Health and Social Studies, P.O. Box 6960, Nijmegen, 6503 GL, The Netherlands
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Kelly N, Garvey J, Palcic D. Health policy and the policymaking system: A case study of primary care in Ireland. Health Policy 2016; 120:913-9. [PMID: 27342835 DOI: 10.1016/j.healthpol.2016.06.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 05/25/2016] [Accepted: 06/08/2016] [Indexed: 11/25/2022]
Abstract
In 2001 the Irish government published a reforming policy intended to modernise and expand the delivery of primary care in Ireland. Fifteen years later, the Irish health system remains beset by problems indicative of a fragmented and underdeveloped primary care system. This case study examines the formation and implementation of the 2001 primary care policy and identifies key risk categories within the policymaking process itself that inhibited the timely achievement of policy objectives. Our methodology includes a directed content analysis of the policy formation and implementation documents and the influencing academic literature, as well as semi-structured interviews with key personnel involved in the process. We identify three broad risk categories - power, resources and capability - within the policymaking process that strongly influenced policy formation and implementation. We additionally show that the disjoint between policy formation and policy implementation was a contested issue among those involved in the policy process and provided space for these risks to critically undermine Ireland's primary care policy.
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Affiliation(s)
- Niall Kelly
- Kemmy Business School, University of Limerick, Limerick, Ireland.
| | - John Garvey
- Kemmy Business School, University of Limerick, Limerick, Ireland.
| | - Dónal Palcic
- Kemmy Business School, University of Limerick, Limerick, Ireland.
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Pavlič DR, Sever M, Klemenc-Ketiš Z, Švab I. Process quality indicators in family medicine: results of an international comparison. BMC FAMILY PRACTICE 2015; 16:172. [PMID: 26631138 PMCID: PMC4667500 DOI: 10.1186/s12875-015-0386-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/20/2015] [Indexed: 11/29/2022]
Abstract
Background The aim of our study was to describe variability in process quality in family medicine among 31 European countries plus Australia, New Zealand, and Canada. The quality of family medicine was measured in terms of continuity, coordination, community orientation, and comprehensiveness of care. Methods The QUALICOPC study (Quality and Costs of Primary Care in Europe) was carried out among family physicians in 31 European countries (the EU 27 except for France, plus Macedonia, Iceland, Norway, Switzerland, and Turkey) and three non-European countries (Australia, Canada, and New Zealand). We used random sampling when national registers of practitioners were available. Regional registers or lists of facilities were used for some countries. A standardized questionnaire was distributed to the physicians, resulting in a sample of 6734 participants. Data collection took place between October 2011 and December 2013. Based on completed questionnaires, a three-dimensional framework was established to measure continuity, coordination, community orientation, and comprehensiveness of care. Multilevel linear regression analysis was performed to evaluate the variation of quality attributable to the family physician level and the country level. Results None of the 34 countries in this study consistently scored the best or worst in all categories. Continuity of care was perceived by family physicians as the most important dimension of quality. Some components of comprehensiveness of care, including medical technical procedures, preventive care and health care promotion, varied substantially between countries. Coordination of care was identified as the weakest part of quality. We found that physician-level characteristics contributed to the majority of variation. Conclusions A comparison of process quality indicators in family medicine revealed similarities and differences within and between countries. The researchers found that the major proportion of variation can be explained by physicians’ characteristics. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0386-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danica Rotar Pavlič
- Department of Family Medicine, University of Ljubljana, Medical Faculty, Poljanski nasip 58, 1000, Ljubljana, Slovenia.
| | - Maja Sever
- Statistical Office of the Republic of Slovenia, Litostrojska 54, 1000, Ljubljana, Slovenia.
| | - Zalika Klemenc-Ketiš
- Department of Family Medicine, University of Ljubljana, Medical Faculty, Poljanski nasip 58, 1000, Ljubljana, Slovenia. .,Department of Family Medicine, Medical Faculty, University of Maribor, Taborska 8, 2000, Maribor, Slovenia.
| | - Igor Švab
- Department of Family Medicine, University of Ljubljana, Medical Faculty, Poljanski nasip 58, 1000, Ljubljana, Slovenia.
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