Provider Perspectives on Quality Payment Programs Targeting Diabetes in Primary Care Settings

Stakeholder perspectives on payment reform in maternity care in the Netherlands: A Q-methodology study

Based on theoretical notions, there is consensus that alternative payment models to the common fee-for-service model have the potential to improve healthcare quality through increased collaboration and reduced under- and overuse. This is particularly relevant for maternity care in the Netherlands because perinatal mortality rates are relatively high in comparison to other Western countries. Therefore, an experiment with bundled payments for maternity care was initiated in 2017. However, the uptake of this alternative payment model remains low, as also seen in other countries, and fee-for-service models prevail. A deeper understanding of stakeholders' perspectives on payment reform in maternity care is necessary to inform policy makers about the obstacles to implementing alternative payment models and potential ways forward. We conducted a Q-methodology study to explore perspectives of stakeholders (postpartum care managers, midwives, gynecologists, managers, health insurers) in maternity care in the Netherlands on payment reform. Participants were asked to rank a set of statements relevant to payment reform in maternity care and explain their ranking during an interview. Factor analysis was used to identify patterns in the rankings of statements. We identified three distinct perspectives on payment reform in maternity care. One general perspective, broadly supported within the sector, focusing mainly on outcomes, and two complementary perspectives, one focusing more on equality and one focusing more on collaboration. This study shows there is consensus among stakeholders in maternity care in the Netherlands that payment reform is required. However, stakeholders have different views on the purpose and desired design of the payment reform and set different conditions. Working towards payment reform in co-creation with all involved parties may improve the general attitude towards payment reform, may enhance the level of trust among stakeholders, and may contribute to a higher uptake in practice.

Development of a Self-Assessment Audit Instrument to Support Climate-Conscious Community Pharmacy Practice and Education

Climate breakdown continues to occur at an alarming pace, and the need for all citizens and professionals to respond has never been so urgent. Healthcare work contributes significantly to greenhouse gas (GHG) emissions, representing an opportunity and responsibility for pharmacists to engage in more climate-conscious practices. A key informant interview-based qualitative research method was undertaken to identify options and strategies for community pharmacists to contribute positively to achieving climate-related carbon footprint reduction goals. A total of 10 thought leaders in climate-conscious pharmacy practice were interviewed using a semi-structured protocol, and a constant comparative data analysis method was used to identify common themes and priorities. A self-assessment audit instrument (SAAI) was identified as a positive first step to build awareness, knowledge, skills, and confidence amongst community pharmacists regarding actionable climate-conscious community pharmacy practice. The SAAI supported both self-reflection and self-assessment, while signposting additional resources that could be accessed by pharmacists to continue their learning and professional development. Further work in this area is required if community pharmacy is to contribute positively to climate reduction targets locally and globally.