1
|
Alyousef M, Naughton C, Bradley C, Savage E. Primary healthcare reform for chronic conditions in countries with high or very high human development index: A systematic review. Chronic Illn 2022; 18:469-487. [PMID: 34841923 PMCID: PMC9397395 DOI: 10.1177/17423953211059143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To address the growing burden of chronic disease globally, many countries have developed a national policy for primary healthcare reform. In some countries with high and very high human development index, evaluations of the implementation of these reforms have been published. To date, there has been no systematic review of these evaluations. The objectives of this review are to identify: (a) the vision for primary healthcare; (b) the features of primary healthcare reforms; and (c) evaluation findings of primary healthcare reforms. METHODS A systematic literature review was conducted guided by the PRISMA statement. We searched for academic articles and grey literature from 1 March 2008 to 1 September 2020. Screening and data extraction were conducted by two authors. Descriptive analysis and narrative synthesis were applied. RESULTS A vision for integrated primary healthcare shifting chronic disease management from specialist hospital services to primary care was found to require new organization and funding models such as collaborative primary healthcare networks and commissioning along with shared governance across health sectors. The need for general practitioner leadership and engagement to support primary healthcare reform was identified. Although there was evidence of barriers in progressing primary healthcare reform, evaluation results showed some positive outcomes, most notably shifts in services towards increased primary care access and utilization. DISCUSSION A challenge in undertaking the review was the heterogeneity of articles with little consistency in how primary healthcare reform was evaluated and reported on across countries. Evaluation of national health reforms involves complex system-wide projects and is an area that needs further exploration and discussion to determine the most appropriate methodologies for collecting and analysing large-scale data with consideration for service and health outcomes.
Collapse
Affiliation(s)
- Mohammed Alyousef
- School of Nursing and Midwifery, 8795University College Cork, Cork, Ireland.,Department of Health Services Administration and Hospitals, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Corina Naughton
- School of Nursing and Midwifery, 8795University College Cork, Cork, Ireland
| | - Colin Bradley
- The Department of General Practice, 8795University College Cork, Cork, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, 8795University College Cork, Cork, Ireland
| |
Collapse
|
2
|
Case management programs for people with complex needs: Towards better engagement of community pharmacies and community-based organisations. PLoS One 2021; 16:e0260928. [PMID: 34879101 PMCID: PMC8654230 DOI: 10.1371/journal.pone.0260928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 11/19/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction The objectives of this study were 1) to describe how case management programs engaged community pharmacies and community-based organisations in a perspective of integrated care for people with complex needs, and 2) to identify enablers, barriers and potential strategies for this engagement. Methods Using a descriptive qualitative design, individual interviews and focus groups with patients, healthcare providers and managers were analysed according to a mixed thematic analysis based on a deductive (Rainbow Model of Integrated Care) and an inductive approach. Results and discussion Participants highlighted the individualized service plan as a significant tool to foster a shared person-focused vision of care, information exchanges and concerted efforts. Openness to collaboration was also considered as an enabler for community stakeholders’ engagement. The lack of recognition of community-based organisations by certain providers and the time required to participate in individualized service plans were outlined as barriers to professional integration. Limited opportunities for community stakeholders to be involved in decision-making within case management programs were reported as another constraint to their engagement. Cultural differences between organisations regarding the focus of the intervention (psychosocial vs healthcare needs) and differences in bureaucratic structures and funding mechanisms may negatively affect community stakeholders’ engagement. Formal consultation mechanisms and improvement of communication channels between healthcare providers and community stakeholders were suggested as ways to overcome these barriers. Conclusion Efforts to improve care integration in case management programs should be directed toward the recognition of community stakeholders as co-producers of care and co-builders of social policies across the entire care continuum for people with complex needs.
Collapse
|
3
|
Does Integrated Care Carry the Gene of Bureaucracy? Lessons from the Case of Québec. Int J Integr Care 2021; 21:13. [PMID: 34824562 PMCID: PMC8588895 DOI: 10.5334/ijic.5658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 08/04/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Demographic and epidemiological transitions of industralized countries mean health systems have to integrate health and social services to respond to the changing needs of their populations. Efforts to integrate care involve important policy and structural changes. This paper examines whether integration efforts are lost in translation during the bureaucratic appropriation of models, or, in an allegorical way, do they reveal genes of bureaucracy? Description: Since the 1960s, the health system of Québec has undergone four major structural and progressively integrative transformations, characterized as – modernization, shock of reality, explicit integration, and centralization phases. Discussion: Although integration efforts progressively transformed Québec’s health and social services system, embedded bureaucracies impeded the realisation of these projects. Notably, inadequate change management strategies and lack of integrated funding models hindered integration efforts. Furthermore, there was variability in government prioritisation and support of different aspects of the model by making some components happen, helping others happen and letting others happen. Conclusion: Drawing insights from bureaucratic obstacles to integration efforts may improve implementation strategies. This paper highlights important policy and administrative challenges that have to be taken into consideration in improving the implementation of integrated care initiatives in a real-life context.
Collapse
|
4
|
Breton M, Deville-Stoetzel N, Gaboury I, Smithman MA, Kaczorowski J, Lussier MT, Haggerty J, Motulsky A, Nugus P, Layani G, Paré G, Evoy G, Arsenault M, Paquette JS, Quinty J, Authier M, Mokraoui N, Luc M, Lavoie ME. Telehealth in Primary Healthcare: A Portrait of its Rapid Implementation during the COVID-19 Pandemic. Healthc Policy 2021; 17:73-90. [PMID: 34543178 PMCID: PMC8437249 DOI: 10.12927/hcpol.2021.26576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE This study documents the adoption of telehealth by various types of primary healthcare (PHC) providers working in teaching PHC clinics in Quebec during the COVID-19 pandemic. It also identifies the perceived advantages and disadvantages of telehealth. METHOD A cross-sectional study was conducted between May and August 2020. The e-survey was completed by 48/50 teaching primary care clinics representing 603/1,357 (44%) PHC providers. RESULTS Telephone use increased the most, becoming the principal virtual modality of consultation, during the pandemic. Video consultations increased, with variations by type of PHC provider: between 2% and 16% reported using it "sometimes." The main perceived advantages of telehealth were minimizing the patient's need to travel, improved efficiency and reduction in infection transmission risk. The main disadvantages were the lack of physical exam and difficulties connecting with some patients. CONCLUSION The variation in telehealth adoption by type of PHC provider may inform strategies to maximize the potential of telehealth and help create guidelines for its use in more normal times.
Collapse
Affiliation(s)
- Mylaine Breton
- Associate Professor, Department of Community Health Sciences, Université de Sherbrooke Longueuil, QC
| | - Nadia Deville-Stoetzel
- Research Professional, Université de Sherbrooke, Longueuil, QC; Doctoral Student, Department of Sociology, Université du Québec à Montréal, Montréal, QC
| | - Isabelle Gaboury
- Professor, Department of Family and Emergency Medicine, Université de Sherbrooke, Longueuil, QC
| | - Mélanie Ann Smithman
- Doctoral Student, Department of Community Health Sciences, Université de Sherbrooke, Sherbrooke, QC
| | - Janusz Kaczorowski
- Professor, Department of Family and Emergency Medicine, Université de Montréal, Montréal, QC
| | - Marie-Thérèse Lussier
- Director, Réseau de recherche en soins primaires de l'Université de Montréal (RRSPUM); Professor, Department of Family and Emergency Medicine, Université de Montréal, Montréal, QC
| | - Jeannie Haggerty
- Professor, Department of Family Medicine, McGill University, Montreal, QC
| | - Aude Motulsky
- Adjunct Professor, Department of Management Evaluation and Health Policy, School of Public Health of the Université de Montréal, Montréal, QC
| | - Peter Nugus
- Associate Professor, Department of Family Medicine, McGill University, Montreal, QC
| | - Géraldine Layani
- Clinical Adjunct Professor, Department of Family and Emergency Medicine, Université de Montréal, Montréal, QC
| | - Guy Paré
- Professor, Department of Information Technologies, HEC Montréal, Montréal, QC
| | - Gabrielle Evoy
- Student of Medicine, Université de Sherbrooke, Sherbrooke, QC
| | - Mylène Arsenault
- Family Physician, UFM-G Herzl Family Practice Centre; Assistant Professor, Department of Family Medicine, McGill University, Montreal, QC
| | - Jean-Sébastien Paquette
- Co-Director, Réseau de recherche axé sur les pratiques de première ligne de l'Université Laval; Associate Clinical Professor, Département médecine familiale et de médecine d'urgence (DMFMU), Université Laval, Québec City, QC
| | - Julien Quinty
- Adjunct Professor, Department of Family Medicine and Emergency Medicine, Université Laval, Québec City, QC
| | - Marie Authier
- Research Facilitator, Réseau de recherche en soins primaires de l'Université de Montréal (RRSPUM), Montreal, QC
| | - Nadjib Mokraoui
- Research Facilitator and Coordinator, McGill Practice-Based Research Network (PBRN), Montreal, QC
| | - Mireille Luc
- Deputy Director, Department of Family and Emergency Medicine, Practice-Based Research Network, Université de Sherbrooke, Sherbrooke, QC
| | - Marie-Eve Lavoie
- Scientific Coordinator and Research Facilitator, Réseau de recherche en soins primaires de l'Université de Montréal (RRSPUM), Montreal, QC
| |
Collapse
|
5
|
Akmal A, Gauld R. What components are important for effective healthcare alliance governance? Findings from a modified Delphi study in New Zealand. Health Policy 2020; 125:239-245. [PMID: 33390279 DOI: 10.1016/j.healthpol.2020.12.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 09/15/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022]
Abstract
Alliance governance is a form of governance developed in industry settings and more recently applied to healthcare. The core idea behind alliance governance is to involve the many stakeholders in the system to collaboratively develop a joint programme that promotes an integrated and whole of systems approach to care. Little is known about the model in healthcare, nor what those involved in an alliance should be focused upon. Using a modified Delphi method, this research presents a set of components that research participants agreed should underpin development of an effective alliance governance arrangement. These characteristics include a systems perspective-a truly shared governance protocol based on a shared vision and a common purpose; performance measurement-collecting and using real-time data that depicts the realities of an end-to-end system to establish better and more achievable goals based on alliance performance; a relational perspective to promote trust, respect and collaboration amongst alliance members, who historically have been competing for contracts and resources; structural changes that enable and promote a shared governance system; and, finally, equity and inclusion to ensure a diverse alliance which promotes diversity of ideas, and involvement of all stakeholders in the decision making process. This research is relevant to policymakers seeking to develop effective alliance-type arrangements as well as to those involved in the practice of alliance governance.
Collapse
Affiliation(s)
- Adeel Akmal
- Centre for Health Systems and Technology, Otago Business School, University of Otago, 60 Clyde Street, Dunedin 9016, New Zealand.
| | - Robin Gauld
- Centre for Health Systems and Technology, Otago Business School, University of Otago, 60 Clyde Street, Dunedin 9016, New Zealand.
| |
Collapse
|
6
|
Meurk C, Harris M, Wright E, Reavley N, Scheurer R, Bassilios B, Salom C, Pirkis J. Systems levers for commissioning primary mental healthcare: a rapid review. Aust J Prim Health 2019; 24:29-53. [PMID: 29338836 DOI: 10.1071/py17030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 09/23/2017] [Indexed: 11/23/2022]
Abstract
Primary Health Networks (PHNs) are a new institution for health systems management in the Australian healthcare system. PHNs will play a key role in mental health reform through planning and commissioning primary mental health services at a regional level, specifically adopting a stepped care approach. Selected PHNs are also trialling a healthcare homes approach. Little is known about the systems levers that could be applied by PHNs to achieve these aims. A rapid review of academic and grey literature published between 2006 and 2016 was undertaken to describe the use of systems levers in commissioning primary care services. Fifty-six documents met the inclusion criteria, including twelve specific to primary mental healthcare. Twenty-six levers were identified. Referral management, contracts and tendering processes, and health information systems were identified as useful levers for implementing stepped care approaches. Location, enrolment, capitation and health information systems were identified as useful in implementing a healthcare homes approach. Other levers were relevant to overall health system functioning. Further work is needed to develop a robust evidence-base for systems levers. PHNs can facilitate this by documenting and evaluating the levers that they deploy, and making their findings available to researchers and other commissioning bodies.
Collapse
Affiliation(s)
- Carla Meurk
- The University of Queensland, School of Public Health, Corner Herston Road and Wyndham Street, Herston, Qld 4006, Australia
| | - Meredith Harris
- The University of Queensland, School of Public Health, Corner Herston Road and Wyndham Street, Herston, Qld 4006, Australia
| | - Eryn Wright
- The University of Queensland, School of Public Health, Corner Herston Road and Wyndham Street, Herston, Qld 4006, Australia
| | - Nicola Reavley
- The University of Melbourne, Melbourne School of Population and Global Health, Vic. 3010, Australia
| | - Roman Scheurer
- The University of Queensland, School of Public Health, Corner Herston Road and Wyndham Street, Herston, Qld 4006, Australia
| | - Bridget Bassilios
- The University of Melbourne, Melbourne School of Population and Global Health, Vic. 3010, Australia
| | - Caroline Salom
- Policy and Epidemiology Group, Queensland Centre for Mental Health Research, Locked Bag 500, Archerfield, Qld 4108, Australia
| | - Jane Pirkis
- The University of Melbourne, Melbourne School of Population and Global Health, Vic. 3010, Australia
| |
Collapse
|
7
|
Smithman MA, Brousselle A, Touati N, Boivin A, Nour K, Dubois CA, Loignon C, Berbiche D, Breton M. Area deprivation and attachment to a general practitioner through centralized waiting lists: a cross-sectional study in Quebec, Canada. Int J Equity Health 2018; 17:176. [PMID: 30509274 PMCID: PMC6277998 DOI: 10.1186/s12939-018-0887-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Access to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada, socio-economically disadvantaged patients are more likely to be unattached (i.e. not have a regular GP). In the province of Quebec, where over 30% of the population is unattached, centralized waiting lists were implemented to help patients find a GP. Our objectives were to examine the association between social and material deprivation and 1) likelihood of attachment, and 2) wait time for attachment to a GP through centralized waiting lists. METHODS A cross-sectional study was conducted in five local health networks in Quebec, Canada, using clinical administrative data of patients attached to a GP between June 2013 and May 2015 (n = 24, 958 patients) and patients remaining on the waiting list as of May 2015 (n = 49, 901), using clinical administrative data. Social and material area deprivation indexes were used as proxies for patients' socio-economic status. Multiple regressions were carried out to assess the association between deprivation indexes and 1) likelihood of attachment to a GP and 2) wait time for attachment. Analyses controlled for sex, age, local health network and variables related to health needs. RESULTS Patients from materially medium, disadvantaged and very disadvantaged areas were underrepresented on the centralized waiting lists, while patients from socially disadvantaged and very disadvantaged areas were overrepresented. Patients from very materially advantaged and advantaged areas were less likely to be attached to a GP than patients from very disadvantaged areas. With the exception of patients from socially disadvantaged areas, all other categories of social deprivation were more likely to be attached to a GP compared to patients from very disadvantaged areas. We found a pro-rich gradient in wait time for attachment to a GP, with patients from more materially advantaged areas waiting less than those from disadvantaged areas. CONCLUSION Our findings suggest that there are socio-economic inequities in attachment to a GP through centralized waiting lists. Policy makers should take these findings into consideration to adjust centralized waiting list processes to avoid further exacerbation of health inequities.
Collapse
Affiliation(s)
- Mélanie Ann Smithman
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Astrid Brousselle
- School of Public Administration, University of Victoria, 3800 Finnerty Rd, Suite A302, Victoria, British Columbia, V8P 5C2, Canada
| | - Nassera Touati
- Centre de recherche sur la gouvernance, École nationale d'administration publique, 4750, Avenue Henri-Julien, Office 5117, Montreal, Quebec, H2T 3E5, Canada
| | - Antoine Boivin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Université de Montréal, 900 Rue Saint-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Kareen Nour
- Direction de santé publique, Centre intégré de santé et des services sociaux - Montérégie-Centre, 1255 rue Beauregard, Longueuil, Quebec, J4K 2M3, Canada
| | - Carl-Ardy Dubois
- Faculty of Nursing, Université de Montréal, 2375, chemin de la Côte Ste-Catherine, Office 5103, Montreal, Quebec, H3T 1A8, Canada
| | - Christine Loignon
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Djamal Berbiche
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada
| | - Mylaine Breton
- Centre de recherche Charles-Le Moyne - Saguenay Lac-St-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Suite 200, Longueuil, Quebec, J4K 0A8, Canada.
| |
Collapse
|
8
|
Thomas P. London Journal of Primary Care - a PAUSE. LONDON JOURNAL OF PRIMARY CARE 2018; 10:39-40. [PMID: 30042800 PMCID: PMC6055944 DOI: 10.1080/17571472.2018.1465636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
9
|
Wankah P, Guillette M, Dumas S, Couturier Y, Gagnon D, Belzile L, Mosbah Y, Breton M. Reorganising health and social care in Québec: a journey towards integrating care through mergers. LONDON JOURNAL OF PRIMARY CARE 2018; 10:48-53. [PMID: 30042802 PMCID: PMC6055938 DOI: 10.1080/17571472.2018.1453957] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Context Two reforms (2014, 2015) characterised by the merger of public health care establishments profoundly shaped the current organisation of Quebec’s healthcare system. In 2015, 22 megastructures called Integrated Health and Social Services Centres/Integrated University Health and Social Services Centres (IHSSC/IUHSSC), were created and mandated to organise care delivery to their local populations. Objective To describe the service configuration of the 2015 healthcare system reforms, emphasising on how it shaped the organisation of primary health care (PHC) in Quebec. Results With the creation of IHSSCs/IUHSSCs, Quebec’s healthcare system passed from three to two levels of governance, leading to a centralisation of decision-making powers. Most health services are delivered by the new organisations, while most PHC is delivered by semi-private medical practices, mainly Family Medicine Groups (FMGs). The FMG model is the preferred strategy to develop interdisciplinary team-work and inter-organizational collaborations with other PHC services. Conclusion mechanisms through which centralised healthcare systems achieve community oriented integrated care (COIC) need to be properly understood in order to improve meaningful clinical outcomes. Mergers may not sufficiently achieve integration of services in all its dimensions. These reforms should be monitored and evaluated on their capacity to mobilise all providers as well as physicians to participate in COIC.
Collapse
Affiliation(s)
- Paul Wankah
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil, Canada
| | - Maxime Guillette
- Centre de Recherche sur le vieillissement du CIUSS-CHUS de l'Estrie, Université de Sherbrooke, Sherbrooke, Canada
| | - Sophie Dumas
- Centre de Recherche sur le vieillissement du CIUSS-CHUS de l'Estrie, Université de Sherbrooke, Sherbrooke, Canada
| | - Yves Couturier
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil, Canada
| | | | | | - Yahya Mosbah
- Centre de Recherche sur le vieillissement du CIUSS-CHUS de l'Estrie, Université de Sherbrooke, Sherbrooke, Canada
| | - Mylaine Breton
- Centre de recherche Charles-Le Moyne - Saguenay-Lac-Saint-Jean sur les innovations en santé, Université de Sherbrooke, Longueuil, Canada
| |
Collapse
|
10
|
Thomas P. Collaborating sites for community-oriented integrated care and health promotion. LONDON JOURNAL OF PRIMARY CARE 2017; 9:2-6. [PMID: 28356918 PMCID: PMC5361748 DOI: 10.1080/17571472.2016.1271491] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
London Journal of Primary Care wishes to develop a network of collaborating sites to better understand how to achieve community-oriented integrated care and health promotion in different contexts. A collaborating site can do more than submit papers. It can develop its own domain on the LJPC website, contribute to the development of LJPC policy, and stimulate discussions with other collaborating sites. At any time a collaborating site can opt out. In addition to securing papers for publication, a site might nurture a network of supporters, teach people to use multiple research and quality improvement methods, develop a system of governance for locally led inquiries, develop case studies of community-oriented integrated care and health promotion and facilitate within-site and between-site learning and change.
Collapse
|
11
|
While A. Form and function: integrated care. Br J Community Nurs 2015; 20:258. [PMID: 25993378 DOI: 10.12968/bjcn.2015.20.5.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Alison While
- Emeritus Professor of Community Nursing, King's College London, Florence Nightingale Faculty of Nursing and Midwifery and Fellow of the QNI
| |
Collapse
|