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Zhong C, Huang J, Li L, Luo Z, Liang C, Zhou M, Hu N, Kuang L. Relationship between patient-perceived quality of primary care and self-reported hospital utilisation in China: A cross-sectional study. Eur J Gen Pract 2024; 30:2308740. [PMID: 38407121 PMCID: PMC10898267 DOI: 10.1080/13814788.2024.2308740] [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: 06/21/2023] [Accepted: 01/15/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Reducing avoidable hospital admissions is a global healthcare priority, with optimal primary care recognised as pivotal for achieving this objective. However, in developing systems like China, where primary care is evolving without compulsory gatekeeping, the relationship between patient-perceived primary care quality and hospital utilisation remains underexplored. OBJECTIVES This study aimed to explore the association between patient-perceived primary care quality and self-reported hospital utilisation in China. METHODS Data were collected from 16 primary care settings. Patient-perceived quality of primary care was measured using the Assessment Survey of Primary Care scale across six domains (first-contact care, continuity, comprehensiveness, accessibility, coordination, and patient-centredness). Hospital utilisation included patient self-reported outpatient visits, hospital admissions, and emergency department (ED) visits in the last six months. Logistic regression analyses were examined associations between self-reported hospital utilisation and perceived primary care quality adjusted for potential confounders. RESULTS Of 1,185 patients recruited, 398 (33.6%) reported hospital utilisation. Logistic regression analyses showed that higher total scores for patient-perceived quality of primary care were associated with decreased odds of hospital utilisation (adjusted odds ratio(AOR): 0.417, 95% confidence interval (CI): 0.308-0.565), outpatient visits (AOR: 0.394, 95% CI: 0.275-0.566) and hospital admissions (AOR: 0.496, 95% CI: 0.276-0.891). However, continuity of care was positively associated with ED visits (AOR: 2.252, 95% CI: 1.051-4.825). CONCLUSION Enhanced patient-perceived quality of primary care in China is associated with a reduction in self-reported overall hospital utilisation, including outpatient visits and hospital admissions. However, better continuity of care may be associated with increased ED visits. Further research is warranted for precise insights and validation of these findings.
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Affiliation(s)
- Chenwen Zhong
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Junjie Huang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Lina Li
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhuojun Luo
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Cuiying Liang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Mengping Zhou
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Nan Hu
- Department of Family and Preventive Medicine, and Population Health Sciences, University of UT School of Medicine, Salt Lake City, UT, USA
| | - Li Kuang
- Department of Health Policy and Management, School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong, China
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López García A, Barber Pérez P. [Systematic review of the primary care quality assessment instruments used in the last 10 years]. Aten Primaria 2024; 56:103046. [PMID: 39018797 PMCID: PMC11305259 DOI: 10.1016/j.aprim.2024.103046] [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: 04/04/2024] [Revised: 06/04/2024] [Accepted: 06/11/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVE There are numerous instruments in the scientific literature for the evaluation of the quality of Primary Care (PC) and to know which of them are the most used and in which countries provides more information to make a well-founded decision. The aim is to determine which, between 2013 and 2023, have been the instruments used to assess the international quality of PC, its evolution and geographical distribution. DESIGN Systematic review. DATA SOURCES PubMed and Embase. From March to December 2023. INCLUSION CRITERIA 1) Validation studies of specific assessment instruments to measure the quality of PC and/or the satisfaction of patients, providers or managers. 2) carried out in the field of PC and 3) published between 1/01/2013 and 01/02/2023. 83 full-text articles were included. DATA EXTRACTION From each publication, an instrument used to evaluate the quality of the PC, attributes of the PC it evaluates, recipient of the evaluation, user, provider or manager, year, and country. RESULTS Fifteen PC assessment instruments were found. The most widely used is the Primary Care Assessing Tool (PCAT), with wide geographical distribution, versions in several languages, is more limited in Europe, except in Spain, and is mostly used in the Primary Care Assessing Tool (PCAT). CONCLUSIONS The PCAT, due to its cultural adaptability, availability in several languages, its ability to evaluate the fundamental principles of PC enunciated by the World Health Organization and to contemplate the perspectives of all health agents, is a complete, versatile, and consistent questionnaire for the evaluation of the quality of PC.
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Affiliation(s)
- Alberto López García
- Facultad de Ciencias Económicas, Campus de Tafira, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España.
| | - Patricia Barber Pérez
- Profesora titular de universidad, Departamento de Métodos Cuantitativos, Facultad de Ciencias Económicas, Campus de Tafira, Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Las Palmas, España
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Straand J, de Wit N. The transition of general practice into an academic discipline: tracing the origins through the first four professors in general practice/family medicine. Scand J Prim Health Care 2024; 42:483-492. [PMID: 38625547 PMCID: PMC11332283 DOI: 10.1080/02813432.2024.2335537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
Being the 'mother' of most clinical specialties, general practice is as old as medicine itself. However, as a recognized academic discipline within medical schools, general practice has a relatively short life span. A decisive step forward was taken in 1956 when the University of Edinburgh established its Department of General Practice, and appointed the world's inaugural professor in the field in 1963. During the 1960s, the pioneering move in Edinburgh was followed by universities in the Netherlands (University of Utrecht), Canada (Western University, Ontario), and Norway (University of Oslo), marking the beginning of global academic recognition for general practice/family medicine. Despite its critical role in healthcare, the academic evolution of general practice has been sparingly documented, with a notable absence of comprehensive accounts detailing its integration into medical schools as an independent discipline with university departments and academic professors. Last year (2023) marked the 60th anniversary of Dr. Richard Scott's historic appointment as the first professor of General Practice/Family Medicine. Through the lens of the first four professors appointed between 1963 and 1969, we explore the 'birth' of general practice to become an academic discipline. In most western countries of today, general practice has become a recognized medical discipline and an important part of the medical education. But many places, this development is lagging behind. The global shaping of general practice into an academic discipline is therefore definitively not completed.
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Affiliation(s)
- Jørund Straand
- General Practice Research Unit (AFE), Department of General Practice/Family Medicine, University of Oslo, Oslo, Norway
| | - Niek de Wit
- Department of General Practice, Julius Center of Health Sciences and Primary Care, University Medical Center (UMC) Utrecht, Utrecht, The Netherlands
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Galárraga O, Quijano-Ruiz A, Faytong-Haro M. The Effects of Mobile Primary Health Teams: Evidence from the Médico del Barrio Strategy in Ecuador. WORLD DEVELOPMENT 2024; 181:106659. [PMID: 38911668 PMCID: PMC11192489 DOI: 10.1016/j.worlddev.2024.106659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/25/2024]
Abstract
Starting in 2017, Ecuador gradually expanded its primary healthcare access program nationwide using mobile traveling healthcare teams through the Estrategia Médico del Barrio (EMB) [or Neighborhood Doctor Strategy]. EMB teams, composed of a primary care physician, a nurse, and a community health worker, made home visits in marginalized areas. We estimate the impact of the EMB on health and utilization outcomes using nationally representative household surveys for 2006 (N=55,666), 2012-13 (N=92,500) and 2018-19 (N=168,747). The treatment variable at the extensive margin is any exposure to EMB at the canton level. At the intensive margin, we use exposure in terms of weeks covered by EMB and the number and composition of EMB personnel per 1000 population. We identify outcomes of treated vs. non- or partially-treated cantons based on the random combination of the timing of the start of the program's implementation and the timing of the survey interview, which varied across cantons. We use difference-in-difference (DD) and difference-in-difference-in-difference (DDD) frameworks, the latter for cantons with high indigenous concentration. We find significant effects on the reported health problem and preventive care, but mixed results in terms of curative healthcare. The DDD specification shows that EMB improved health problem diagnoses and preventive healthcare utilization, including in highly indigenous cantons, yet it seemed to have had mixed results in terms of curative care use in Ecuador. Various alternative specifications and robustness tests do not qualitatively alter the main findings.
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Affiliation(s)
| | - Alonso Quijano-Ruiz
- Ecuadorian Development Research Lab, Guayaquil, Ecuador
- The Wang Yanan Institute for Studies in Economics, Xiamen University, Xiamen, China
| | - Marco Faytong-Haro
- Ecuadorian Development Research Lab, Guayaquil, Ecuador
- Pennsylvania State University, State College, PA, USA
- Universidad de Especialidades Espíritu Santo, Guayaquil, Ecuador
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5
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Wiedmeyer ML, Pedersen JS, Wakil Z, Hedden L. Equity in practice: Integrating cross cultural health brokers for culturally safe primary care for immigrants and refugees in British Columbia. Healthc Manage Forum 2024; 37:23S-27S. [PMID: 39194273 DOI: 10.1177/08404704241264426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
Umbrella Multicultural Health Co-op is a community health centre serving cultural communities of immigrants/refugees in British Columbia. It uses Cross Cultural Health Brokers (CCHBs), multicultural workers bridging patients and the healthcare system, to better meet the primary care needs of immigrant/refugee populations. Through the Team Primary Care initiative, Umbrella Co-op: (1) added new CCHBs alongside allied health practitioners; and (2) implemented team workshops and evaluation for quality improvement. The learning health system framework guided project activities. Comprehensive, culturally responsive primary care for immigrants and refugees benefits from a team-based approach that includes the integration of CCHBs. Team development activities improved team function. Co-developing evaluation with the interprofessional team enabled meaningful participation. Health system design for equity-oriented team-based primary care for immigrants and refugees should include resources for CCHBs and team development infrastructure.
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Affiliation(s)
- Mei-Ling Wiedmeyer
- Umbrella Multicultural Health Co-op, New Westminster, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeanette S Pedersen
- Umbrella Multicultural Health Co-op, New Westminster, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Zarghoona Wakil
- Umbrella Multicultural Health Co-op, New Westminster, British Columbia, Canada
| | - Lindsay Hedden
- Simon Fraser University, Burnaby, British Columbia, Canada
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Barber C, Beselt LJ, Alcantara J, Jaffer B, Bute-Seaton K, Chong W, Carver T, MacNeill H, Salami B, Sonnenberg LK, Rangel JC, LeBlanc C, Osei-Tutu K, Bouka A, Radhakrishnan A, Maniate JM. Advancing equity, diversity, inclusivity, and accessibility in primary care: The development of an integrated educational experience model. Healthc Manage Forum 2024; 37:371-376. [PMID: 39047148 PMCID: PMC11348623 DOI: 10.1177/08404704241264236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
This article presents the development of the Equity, Diversity, Inclusivity, and Accessibility (EDIA) Cross-Cutting Theme Project within the Team Primary Care (TPC) initiative, aimed at addressing systemic inequities through innovative educational strategies. Grounded in the social accountability of health professions framework, this project aims to equip primary care teams with the knowledge, skills, and attitudes necessary to promote health equity. The EDIA Integrated Educational Experience (IEE) model includes a self-assessment tool, digital learning space, and national mentorship network, providing a comprehensive approach for primary care teams to promote health equity. The IEE model utilizes a layered micro, meso, and macro approach to support cultural transformation within highly complex healthcare environments. Key lessons learned involve trust- and relationship-building processes to help dismantle historical silos and encourage open dialogue. Future efforts focus on implementation, ensuring adaptability, scalability, and sustainability, positioning the model as a catalyst for equitable primary care delivery.
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Affiliation(s)
| | | | | | - Bizav Jaffer
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | | | - Wendy Chong
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Tamara Carver
- Bruyère Research Institute, Ottawa, Ontario, Canada
- McGill University, Montreal, Quebec, Canada
| | - Heather MacNeill
- Bruyère Research Institute, Ottawa, Ontario, Canada
- University of Toronto, Toronto, Ontario, Canada
| | - Bukola Salami
- Bruyère Research Institute, Ottawa, Ontario, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Lyn K. Sonnenberg
- Bruyère Research Institute, Ottawa, Ontario, Canada
- University of Alberta, Edmonton, Alberta, Canada
| | - J. Cristian Rangel
- Bruyère Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Constance LeBlanc
- Bruyère Research Institute, Ottawa, Ontario, Canada
- Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kannin Osei-Tutu
- Bruyère Research Institute, Ottawa, Ontario, Canada
- University of Calgary, Calgary, Alberta, Canada
| | - Aimée Bouka
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Arun Radhakrishnan
- Bruyère Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
| | - Jerry M. Maniate
- Bruyère Research Institute, Ottawa, Ontario, Canada
- University of Ottawa, Ottawa, Ontario, Canada
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7
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Klunder JH, Heymans MW, van der Heide I, Verheij RA, Maarsingh OR, van Hout HP, Joling KJ. Predicting unplanned admissions to hospital in older adults using routinely recorded general practice data: development and validation of a prediction model. Br J Gen Pract 2024; 74:e628-e636. [PMID: 38724188 PMCID: PMC11349354 DOI: 10.3399/bjgp.2023.0350] [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: 07/13/2023] [Accepted: 02/26/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND Unplanned admissions to hospital represent a hazardous event for older people. Timely identification of high-risk individuals using a prediction tool may facilitate preventive interventions. AIM To develop and validate an easy-to-use prediction model for unplanned admissions to hospital in community-dwelling older adults using readily available data to allow rapid bedside assessment by GPs. DESIGN AND SETTING This was a retrospective study using the general practice electronic health records of 243 324 community-dwelling adults aged ≥65 years linked with national administrative data to predict unplanned admissions to hospital within 6 months. METHOD The dataset was geographically split into a development (n = 142 791/243 324, 58.7%) and validation (n = 100 533/243 324, 41.3%) sample to predict unplanned admissions to hospital within 6 months. The performance of three different models was evaluated with increasingly smaller selections of candidate predictors (optimal, readily available, and easy-to-use models). Logistic regression was used with backward selection for model development. The models were validated internally and externally. Predictive performance was assessed by area under the curve (AUC) and calibration plots. RESULTS In both samples, 7.6% (development cohort: n = 10 839/142 791, validation cohort: n = 7675/100 533) had ≥1 unplanned hospital admission within 6 months. The discriminative ability of the three models was comparable and remained stable after geographic validation. The easy-to-use model included age, sex, prior admissions to hospital, pulmonary emphysema, heart failure, and polypharmacy. Its discriminative ability after validation was AUC 0.72 (95% confidence interval = 0.71 to 0.72). Calibration plots showed good calibration. CONCLUSION The models showed satisfactory predictive ability. Reducing the number of predictors and geographic validation did not have an impact on predictive performance, demonstrating the robustness of the model. An easy-to-use tool has been developed in this study that may assist GPs in decision making and with targeted preventive interventions.
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Affiliation(s)
- Jet H Klunder
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam; Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit; Methodology, Amsterdam Public Health, Public Health Research Institute, Amsterdam
| | - Iris van der Heide
- Netherlands Institute for Health Services Research (NIVEL); Department of Languages, Literature and Communication, Faculty of Humanities, Utrecht University, Utrecht
| | - Robert A Verheij
- NIVEL, Utrecht; Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg
| | - Otto R Maarsingh
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam; Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam
| | - Hein Pj van Hout
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam; Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam
| | - Karlijn J Joling
- Department of Medicine for Older People, Amsterdam UMC, Vrije Universiteit Amsterdam; Aging and Later Life, Amsterdam Public Health Research Institute, Amsterdam
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Wangler J, Jansky M. [Ensuring primary care in Germany-findings from a quantitative survey of general practitioners]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:998-1009. [PMID: 38862728 PMCID: PMC11349858 DOI: 10.1007/s00103-024-03896-4] [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: 02/08/2024] [Accepted: 05/13/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Given the risk of a shortage of general practitioners in private practice, the question arises as to which concepts can make an effective contribution. To date, there is a lack of studies that comprehensively shed light on how general practitioners, based on their professional experience, view different approaches to ensuring primary care in the long term. OBJECTIVES The aim of the study was to determine the positions, attitudes, and experiences of general practitioners with regard to ensuring primary care. METHODS Using an online survey, a total of 4176 general practitioners were surveyed between February and June 2023. In addition to the descriptive analysis, a t-test on independent samples was used to determine significant differences between two groups. RESULTS Of those surveyed, 42% reported a noticeable decline of general medical practices in their area. In addition, 53% saw a declining attractiveness of primary care for young doctors, which is attributed to three problem areas: 1) the position of primary care in the healthcare system, 2) requirements for training and further education, and 3) working conditions. In order to secure primary care, those surveyed were primarily in favor of the following approaches: establishing a primary care physician system (85%), increasing the promotion of interest and points of contact in training and further education (80%), strengthening multi-professional outpatient care centers (64%), restructuring curricula (56%) and admission criteria for medical studies (50%), and reforming general medical training (53%). CONCLUSIONS As the results show, general practitioners have their own suggestions and preferences that complement existing expert assessments. General practitioners should be more consistently involved in the planning, implementation, and evaluation of measures to stabilize primary care.
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Affiliation(s)
- Julian Wangler
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland.
| | - Michael Jansky
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland
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van Tilburg ML, Spin I, Pisters MF, Staal JB, Ostelo RW, van der Velde M, Veenhof C, Kloek CJ. Barriers and Facilitators to the Implementation of Digital Health Services for People With Musculoskeletal Conditions in the Primary Health Care Setting: Systematic Review. J Med Internet Res 2024; 26:e49868. [PMID: 39190440 DOI: 10.2196/49868] [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: 06/13/2023] [Revised: 12/01/2023] [Accepted: 04/10/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND In recent years, the effectiveness and cost-effectiveness of digital health services for people with musculoskeletal conditions have increasingly been studied and show potential. Despite the potential of digital health services, their use in primary care is lagging. A thorough implementation is needed, including the development of implementation strategies that potentially improve the use of digital health services in primary care. The first step in designing implementation strategies that fit the local context is to gain insight into determinants that influence implementation for patients and health care professionals. Until now, no systematic overview has existed of barriers and facilitators influencing the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. OBJECTIVE This systematic literature review aims to identify barriers and facilitators to the implementation of digital health services for people with musculoskeletal conditions in the primary health care setting. METHODS PubMed, Embase, and CINAHL were searched for eligible qualitative and mixed methods studies up to March 2024. Methodological quality of the qualitative component of the included studies was assessed with the Mixed Methods Appraisal Tool. A framework synthesis of barriers and facilitators to implementation was conducted using the Consolidated Framework for Implementation Research (CFIR). All identified CFIR constructs were given a reliability rating (high, medium, or low) to assess the consistency of reporting across each construct. RESULTS Overall, 35 studies were included in the qualitative synthesis. Methodological quality was high in 34 studies and medium in 1 study. Barriers (-) of and facilitators (+) to implementation were identified in all 5 CFIR domains: "digital health characteristics" (ie, commercial neutral [+], privacy and safety [-], specificity [+], and good usability [+]), "outer setting" (ie, acceptance by stakeholders [+], lack of health care guidelines [-], and external financial incentives [-]), "inner setting" (ie, change of treatment routines [+ and -], information incongruence (-), and support from colleagues [+]), "characteristics of the healthcare professionals" (ie, health care professionals' acceptance [+ and -] and job satisfaction [+ and -]), and the "implementation process" (involvement [+] and justification and delegation [-]). All identified constructs and subconstructs of the CFIR had a high reliability rating. Some identified determinants that influence implementation may be facilitators in certain cases, whereas in others, they may be barriers. CONCLUSIONS Barriers and facilitators were identified across all 5 CFIR domains, suggesting that the implementation process can be complex and requires implementation strategies across all CFIR domains. Stakeholders, including digital health intervention developers, health care professionals, health care organizations, health policy makers, health care funders, and researchers, can consider the identified barriers and facilitators to design tailored implementation strategies after prioritization has been carried out in their local context.
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Affiliation(s)
- Mark Leendert van Tilburg
- Innovation of Movement Care Research Group, Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Ivar Spin
- Innovation of Movement Care Research Group, Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
| | - Martijn F Pisters
- Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands
- Research Group Empowering Healthy Behaviour, Department of Health Innovations and Technology, Fontys University of Applied Sciences, Eindhoven, Netherlands
| | - J Bart Staal
- Musculoskeletal Rehabilitation Research Group, HAN University of Applied Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
- Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
| | - Raymond Wjg Ostelo
- Department of Health Sciences, Faculty of Science, VU University, Amsterdam Movement Sciences Research Institute, Amsterdam, Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Center, Location Vrije Universiteit, Amsterdam Movement Sciences Research Institute, Amsterdam, Netherlands
| | - Miriam van der Velde
- Innovation of Movement Care Research Group, Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
- Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Cindy Veenhof
- Innovation of Movement Care Research Group, Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
- Department of Rehabilitation, Physiotherapy Science and Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands
| | - Corelien Jj Kloek
- Innovation of Movement Care Research Group, Research Centre for Healthy and Sustainable Living, HU University of Applied Sciences Utrecht, Utrecht, Netherlands
- Center for Physical Therapy Research and Innovation in Primary Care, Julius Health Care Centers, Utrecht, Netherlands
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Gustafsson PE, Fonseca-Rodríguez O, San Sebastián M, Burström B, Mosquera PA. Evaluating the impact of the 2010 Swedish choice reform in primary health care on avoidable hospitalization and socioeconomic inequities: an interrupted time series analysis using register data. BMC Health Serv Res 2024; 24:972. [PMID: 39174988 PMCID: PMC11342640 DOI: 10.1186/s12913-024-11434-w] [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: 02/01/2024] [Accepted: 08/13/2024] [Indexed: 08/24/2024] Open
Abstract
BACKGROUND The Swedish Primary Health Care (PHC) system has, like in other European countries, undergone a gradual transition towards marketization and privatization, most distinctly through a 2010 choice reform. The reform led to an overall but regionally heterogenous expansion of private PHC providers in Sweden, and with evidence also pointing to possible inequities in various aspects of PHC provision. Evidence on the reform's impact on population-level primary health care performance and equity in performance remains scarce. The present study therefore aimed to examine whether the increase in private provision after the reform impacted on population-average rates of avoidable hospitalizations, as well as on corresponding socioeconomic inequities. METHODS This register-based study used a multiple-group interrupted time-series design for the study period 2001-2017, with the study population (N = 51 million observations) randomly drawn from the total Swedish population aged 18-85 years. High, medium, and low implementing comparison groups were classified by tertiles of increase in private PHC providers after the reform. PHC performance was measured by avoidable hospitalizations, and socioeconomic position by education and income. Interrupted time series analysis based on individual-level data was used to estimate the reform impact on avoidable hospitalization risk, and on inequities through the Relative Index of Inequality (RII). RESULTS All three comparisons groups displayed decreasing risk of avoidable hospitalizations but increasing socioeconomic inequities across the study period. Compared to regions with little change in provision after the reform, regions with large increase in private provision saw a steeper decrease in avoidable hospitalizations after the reform (relative risk (95%): 1.6% (1.1; 2.1)), but at the same time steeper increase in inequities (by education: 2.0% (0.1%; 4.0); by income: 2.2% (-0.1; 4.3)). CONCLUSIONS The study suggests that the increase in private health care centers, enabled by the choice reform, contributed to a small improvement when it comes to overall PHC performance, but simultaneously to increased socioeconomic inequities in PHC performance. This duality in the impact of the Swedish reform also reflects the arguments in the European health policy debate on patient choice PHC models, with hopes of improved performance but fears of increased inequities.
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Affiliation(s)
- Per E Gustafsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, 901 87, Sweden.
| | | | - Miguel San Sebastián
- Department of Epidemiology and Global Health, Umeå University, Umeå, 901 87, Sweden
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Paola A Mosquera
- Department of Epidemiology and Global Health, Umeå University, Umeå, 901 87, Sweden
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Rahman B, Babe G, Griffith LE, Price D, Lapointe-Shaw L, Costa AP. Patients report high information coordination between rostered primary care physicians and specialists: A cross-sectional study. PLoS One 2024; 19:e0307611. [PMID: 39172961 PMCID: PMC11340953 DOI: 10.1371/journal.pone.0307611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 07/02/2024] [Indexed: 08/24/2024] Open
Abstract
Our study aimed to describe patient experience of information coordination between their primary care physician and specialists and to examine the associations between their experience and their personal and primary care characteristics. We conducted a cross-sectional study of Ontario residents rostered to a primary care physician and visited a specialist physician in the previous 12 months by linking population-based health administrative data to the Health Care Experience Survey collected between 2013 and 2020. We described respondents' sociodemographic and health care utilization characteristics and their experience of information coordination between their primary care physician and specialists. We measured the adjusted association between patient-reported measures of information coordination before and after respondents received care from a specialist physician and their type of primary care model. 1,460 out 20,422 (weighted 7.5%) of the respondents reported that their specialist physician did not have basic medical information about their visit from their primary care physician in the previous 12 months. 2,298 out of 16,442 (weighted 14.9%) of the respondents reported that their primary care physician seemed uninformed about the care they received from the specialist. Females, younger individuals, those with a college or undergraduate level of education, and users of walk-in clinics had a higher likelihood of reporting a lack of information coordination between the primary care and specialist physicians. Only respondents rostered to an enhanced fee-for-service model had a higher odds of reporting that the specialist physician did not have basic medical information about their visit compared to those rostered to a Family Health Team (OR 1.22, 95% Cl 1.12-1.40). We found no significant association between respondent's type of primary care model and that their primary care physician was uninformed about the care received from the specialist physician. In this population-based health study, respondents reported high information coordination between their primary care physician and specialists. Except for respondents rostered to an enhanced fee-for-service model of care, we did not find any difference in information coordination across other primary care models.
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Affiliation(s)
- Bahram Rahman
- Physician and Provider Services Division, Ministry of Health, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - Glenda Babe
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
| | - Lauren E. Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
| | - David Price
- McMaster Family Health Team, Hamilton, Ontario, Canada
- Medical School, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lauren Lapointe-Shaw
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine and Geriatrics, University Health Network and Sinai Health System, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women’s College Institute for Health System Solutions and Virtual Care, Women’s College Hospital, Toronto, Ontario, Canada
| | - Andrew P. Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada
- ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- The Research Institute of St. Joe’s Hamilton, St. Joseph’s Healthcare Hamilton, Hamilton, Ontario, Canada
- Centre for Integrated Care, St. Joseph’s Health System, Hamilton, Ontario, Canada
- Schlegel Research Institute for Aging, Waterloo, Ontario, Canada
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Berget AM, Moen VP, Hustoft M, Assmus J, Strand LI, Skouen JS, Hetlevik Ø. Use of primary healthcare services before and after specialized rehabilitation and its relation to changes in health and functioning: a longitudinal cohort study. J Rehabil Med 2024; 56:jrm39912. [PMID: 39161992 PMCID: PMC11348576 DOI: 10.2340/jrm.v56.39912] [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: 01/19/2024] [Accepted: 07/18/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVE To examine patients' use of primary healthcare (PHC) before and after specialized rehabilitation and its relation with self-reported health and functioning. DESIGN Longitudinal cohort study. PARTICIPANTS 451 rehabilitation patients. METHODS Register data were used to measure the frequency of visits to the general practitioner (GP) and physiotherapist (PT) in PHC 3 years before and after rehabilitation. Patients reported health (EQ-VAS) and functioning (SF-36) before rehabilitation and at 1 and 3 years after. Data are described for the total study cohort and subgroups with musculoskeletal disease (MSD) and cardiovascular disease (CVD). RESULTS There was an increase in GP and PT visits preceding rehabilitation and a gradual decrease thereafter. An exception was GP visits among patients with CVD, with few diagnosis-specific visits before but an increase after. Lower levels of health and functioning tended to be related to more frequent GP and PT visits. An indication of clinically important improvement was found among those with frequent GP visits in the MSD subgroup, and among those with 1-2 GP visits in the CVD subgroup. CONCLUSIONS The diverse relationship between health and functioning, and the use of PHC services at follow-up, may imply that additional factors besides healthcare use explain long-term improvement following rehabilitation.
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Affiliation(s)
- Anne Mette Berget
- Centre of Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital, Bergen, Norway; Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Vegard Pihl Moen
- Centre of Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital, Bergen, Norway; Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Merethe Hustoft
- Centre of Habilitation and Rehabilitation in Western Norway, Haukeland University Hospital, Bergen, Norway; Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jörg Assmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Liv Inger Strand
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jan Sture Skouen
- Department of Physical Medicine and Rehabilitation, Haukeland University Hospital, Bergen, Norway
| | - Øystein Hetlevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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13
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Wang S, Buote R, Moritz LR, Lavergne MR, Marshall EG. Advice to future family physicians: findings from qualitative interviews with family medicine residents and early-career family physicians. BMC MEDICAL EDUCATION 2024; 24:897. [PMID: 39164702 PMCID: PMC11334307 DOI: 10.1186/s12909-024-05882-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/09/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND Canadians continue to report challenges accessing primary care. Practice choices made by primary care providers shape services available to Canadians. Although there is literature observing family medicine practice trends, there is less clarity on the reasoning underlying primary care providers' practice intentions. Advice offered by residents and early-career family physicians may reveal challenges they have experienced, how they have adapted to them, and strategies for new residents. In this paper, we examine advice family medicine residents and early-career family physicians would give to new family medicine residents. METHODS Sixty early-career family physicians and thirty residents were interviewed as part of a mixed-methods study of practice patterns of family medicine providers in Canada. During qualitative interviews, participants were asked, "what advice would you give [a new family medicine resident] about planning their career as a family physician?" We inductively analyzed responses to this question. RESULTS Advice consisted of understanding the current climate of family medicine (need for specialization, business management burden, physician burnout) and revealed reasons behind said challenges (lack of support for comprehensive clinic care, practical limitations of different practice models, and how payment models influence work-life balance). Subtheme analyses showed early-career family physicians being more vocal on understanding practical aspects of the field including practice logistics and achieving job security. CONCLUSION Most advice mirrored current changes and challenges as well as revealing strategies on how primary care providers are handling the realities of practicing family medicine. Multi-modal systemic interventions may be needed to support family physicians throughout the changing reality of family medicine and ensure family medicine is an appealing specialty.
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Affiliation(s)
- Sean Wang
- Primary Care Research Unit, Dalhousie Family Medicine, Dalhousie University, 1465 Brenton Street Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Richard Buote
- Primary Care Research Unit, Dalhousie Family Medicine, Dalhousie University, 1465 Brenton Street Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Lauren R Moritz
- Primary Care Research Unit, Dalhousie Family Medicine, Dalhousie University, 1465 Brenton Street Suite 402, Halifax, NS, B3J 3T4, Canada
| | - M Ruth Lavergne
- Primary Care Research Unit, Dalhousie Family Medicine, Dalhousie University, 1465 Brenton Street Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Emily Gard Marshall
- Primary Care Research Unit, Dalhousie Family Medicine, Dalhousie University, 1465 Brenton Street Suite 402, Halifax, NS, B3J 3T4, Canada.
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Rao KD, Bairwa M, Mehta A, Hyat S, Ahmed R, Rajapaksa L, Adams AM. Improving urban health through primary health care in south Asia. Lancet Glob Health 2024:S2214-109X(24)00121-9. [PMID: 39178875 DOI: 10.1016/s2214-109x(24)00121-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 02/19/2024] [Accepted: 03/06/2024] [Indexed: 08/26/2024]
Abstract
South Asia is rapidly urbanising. The strains of rapid urbanisation have profound implications for the health and equity of urban populations. This Series paper examines primary health care (PHC) in south Asian cities. Health and its social determinants vary considerably across south Asian cities and substantial socioeconomic inequities are present. Although cities offer easy geographical access to PHC services, financial hardship associated with health care use and low quality of care are a concern, particularly for low-income residents. Providing better PHC in south Asia requires a multi-sectoral response, with effective and resourced urban local bodies; increased public financing for health care; and new service delivery models aimed at low-income urban communities that involve strengthening public sector services, strengthening government engagement with private providers where necessary, and engaging with low-income communities and the PHC providers that serve them.
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Affiliation(s)
- Krishna D Rao
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Mohan Bairwa
- All India Institute of Medical Sciences, New Delhi, India
| | - Akriti Mehta
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Sana Hyat
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rushdia Ahmed
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Lalini Rajapaksa
- Department of Community Medicine, University of Colombo, Colombo, Sri Lanka
| | - Alayne M Adams
- Factor-Inwentash Faculty of Social Work, McGill University, Montreal, QC, Canada
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15
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Wong CL, Chan CWH, Zhang M, Cheung YT, Chow KM, Li CK, Li WHC, Brauer E, Chen Y. Care coordination models for transition and long-term follow-up among childhood cancer survivors: a scoping review. BMJ Open 2024; 14:e087343. [PMID: 39160096 PMCID: PMC11337698 DOI: 10.1136/bmjopen-2024-087343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 07/23/2024] [Indexed: 08/21/2024] Open
Abstract
OBJECTIVES Childhood cancer survivors may experience complex health issues during transition and long-term follow-up (LTFU); therefore, high-quality healthcare is warranted. Care coordination is one of the essential concepts in advanced healthcare. Care coordination models vary among childhood cancer survivors in transition and LTFU. This study aimed to identify care coordination models for childhood cancer survivors in transition and LTFU and synthesise essential components of the models. DESIGN This scoping review was guided by the methodological framework from Arksey and O'Malley and was reported with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A systematic literature search was conducted on six databases using possible combinations of terms relevant to childhood cancer survivors, transition/LTFU and care coordination model. Data were analysed by descriptive and content analysis. DATA SOURCES The literature search was first conducted in May 2023 and updated in May 2024. Six databases including Medline, PubMed, Embase, Web of Science, CINAHL and Cochrane Library were searched; meanwhile, a hand search was also conducted. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies relevant to describing any models, interventions or strategies about care coordination of transition or LTFU healthcare services among childhood cancer survivors were included. DATA EXTRACTION AND SYNTHESIS Two reviewers independently screened and included studies. Basic information as well as care coordination model-related data in the included studies were extracted. Descriptive summary and content analysis were used for data analysis. RESULTS In the 20 545 citations generated by the search strategy, seven studies were identified. The critical determinants of the models in the included studies were the collaboration of the multidisciplinary team, integration of the navigator role and the provision of patient-centred, family-involved, needs-oriented clinical services. The main functions of the models included risk screening and management, primary care-based services, psychosocial support, health education and counselling, and financial assistance. Models of care coordination were evaluated at patient and clinical levels. Based on this review, core concepts of successful care coordination models for childhood cancer survivors in transition or LTFU were synthesised and proposed as the '3 I' framework: individualisation, interaction and integration. CONCLUSION This scoping review summarised core elements of care coordination models for childhood cancer survivors' transition and LTFU. A proposed conceptual framework to support and guide the development of care coordination strategies for childhood cancer survivors' transition and LTFU care was developed. Future research is needed to test the proposed model and develop appropriate care coordination strategies for providing high-quality healthcare for childhood cancer survivors' transition and LTFU.
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Affiliation(s)
- Cho Lee Wong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Carmen Wing Han Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Mengyue Zhang
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Ka Ming Chow
- Chinese University of Hong Kong, New Territories, Hong Kong
| | - Chi Kong Li
- Deparment of Paediatrics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - William H C Li
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | | | - Yongfeng Chen
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong
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16
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Thomas RL, Millett C, Sousa Soares RD, Hone T. More doctors, better health? A generalised synthetic control approach to estimating impacts of increasing doctors under Brazil's Mais Medicos programme. Soc Sci Med 2024; 358:117222. [PMID: 39181082 DOI: 10.1016/j.socscimed.2024.117222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/10/2024] [Accepted: 08/09/2024] [Indexed: 08/27/2024]
Abstract
Worldwide, there are an insufficient number of primary care physicians to provide accessible, high-quality primary care services. Better knowledge on the health impacts of policies aimed at improving access to primary care physicians is important for informing future policies. Using a generalised synthetic control estimator (GSC), we estimate the effect of the increase in primary care physicians from the Programa Mais Médicos in Brazil. The GSC allows us to estimates a continuous treatment effects which are heterogenous by region. We exploit the variation in physicians allocated to each Brazilian microregion to identify the impact of an increasing Mais Médicos primary care physicians. We explore hospitalisations and mortality rates (both total and from ambulatory care sensitive conditions) as outcomes. Our analysis differs from previous work by estimating the impact of the increase in physician numbers, as opposed to the overall impact of programme participation. We examine the impact on hospitalisations and mortality rates and employ a panel dataset with monthly observations of all Brazilian microregion over the period 2008-2017. We find limited effects of an increase in primary care physicians impacting health outcomes - with no significant impact of the Programa Mais Médicos on hospitalisations or mortality rates. Potential explanations include substitution of other health professionals, impacts materialising over the longer-term, and poor within-region allocation of Mais Médicos physicians.
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Affiliation(s)
- Rhys Llewellyn Thomas
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
| | - Christopher Millett
- Public Health Policy Evaluation Unit, Imperial College London, London, UK; NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | | | - Thomas Hone
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
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Bracken K, Salerno J, Yang L. Physician-Led Synchronous Telemedicine Compared to Face-To-Face Care in Primary Care: A Systematic Review. Eval Health Prof 2024:1632787241273911. [PMID: 39140652 DOI: 10.1177/01632787241273911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024]
Abstract
The COVID-19 crisis rapidly introduced telemedicine as the predominate modality to deliver healthcare however this change has not received attention in primary care settings and the health-related impacts are unknown. The study's objective was to explore the effects of physician-led synchronous telemedicine compared to face-to-face care delivered in the primary care setting on healthcare system use and attributes of primary care as reported in recent studies. We performed a comprehensive literature search in five databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PsycInfo) and critical appraisal using the Joanna Briggs Institute tools. Of 6,247 studies identified, 157 studies underwent full text review, and 19 studies were included. Most studies were conducted in the U.S. (78.9%) and used video and telephone telemedicine (57.9%). An outcome-based qualitative description and narrative synthesis showed similar or fewer emergency department visits, hospital visits, and prescribing, and fewer diagnostic tests and imaging for telemedicine visits compared to face-to-face care. Our systematic review fills a gap in the literature on telemedicine in primary care settings however our results need to be interpreted cautiously given studies' susceptibility to selection bias, confounding, and limited applicability to other health systems and time periods.
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Affiliation(s)
- Keyna Bracken
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Canada
| | - Jennifer Salerno
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Canada
- Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Canada
| | - Ling Yang
- Department of Family Medicine, Faculty of Health Sciences, McMaster University, Canada
- Michael G. DeGroote School of Medicine, McMaster University, Canada
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18
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Wang W, Zhao R, Zhang J, Xu T, Lu J, Nicholas S, Wei X, Liu X, Yang H, Matiland E. Public expectations of good primary health care in China: a national qualitative study. Fam Pract 2024; 41:564-570. [PMID: 36573339 DOI: 10.1093/fampra/cmac149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND China is currently making efforts to transform the current hospital-centric service delivery system to people-centred primary health care (PHC)-based delivery system, with service delivery organized around the health needs and expectations of people. To help direct China's PHC reform efforts, a profile of high-quality PHC from the public's perspective is required. OBJECTIVES To profile high-quality PHC from the perspective of the Chinese public. METHODS Semistructured interviews were conducted in 6 provinces (Henan, Shandong, Zhejiang, Shaanxi, Shanxi, and Heilongjiang) in China. In total, 58 interviewees completed the recorded interview. For transcription, trained research assistant listened to the recording of the interviews, summarizing each 30-s segment in English. Next, thematic analysis was performed on the narrative summaries to identify thematic families. RESULTS Seven themes and 16 subthemes were generated from the analysis of our interview data. In order of their frequency, the interviewees expressed a high expectation for interpersonal communication and technical quality; followed by access, comprehensive care, cost, continuity, and coordination. CONCLUSIONS Using qualitative data from 6 provinces in China, knowledge was generated to reveal the public's views and expectations for high-quality PHC. Our results confirm the urgent need for quality improvement efforts to improve patient experience and technical quality. The government also needs to further improve the delivery system and medical training programme to better meet public expectation in these areas, especially in establishing an innovative integrated primary care model, and strengthening interpersonal and clinical competency training for family doctors.
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Affiliation(s)
- Wenhua Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Ruixue Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Jinnan Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Tiange Xu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Jiao Lu
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Stephen Nicholas
- Australian National Institute of Management and Commerce, Sydney, Australia
- Research Institute for International Strategies, Guangdong University of Foreign Studies, Guangzhou, PR China
- School of Economics and School of Management, Tianjin Normal University, Tianjin, PR China
- Newcastle Business School, University of Newcastle, Newcastle, Australia
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Xiaoyun Liu
- China Centre for Health Development Studies, Peking University, Beijing, PR China
| | - Huiyun Yang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, PR China
| | - Elizabeth Matiland
- School of Management, University of Liverpool, Liverpool, United Kingdom
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19
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Dias HS, Pereira AMM, Nunes EDFPDA, Martins CP, Castilho M, Mendonça FDF, de Lima LD. Political factors and arrangements influencing primary health care financing and resource allocation: A scoping review protocol. PLoS One 2024; 19:e0308754. [PMID: 39121167 PMCID: PMC11315285 DOI: 10.1371/journal.pone.0308754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 07/30/2024] [Indexed: 08/11/2024] Open
Abstract
INTRODUCTION Primary health care is a key element in the structuring and coordination of health systems, contributing to overall coverage and performance. PHC financing is therefore central in this context, with variations in sufficiency and regularity depending on the "political dimension" of health systems. Research that systematically examines the political factors and arrangements influencing PHC financing is justified from a global and multidisciplinary perspective. The scoping review proposed here aims to systematically map the evidence on this topic in the current literature, identifying groups, institutions, priorities and gaps in the research. METHODS AND ANALYSIS A scoping review will be conducted following the method proposed by Arksey and O'Malley to answer the following question: What is known from the literature about political factors and arrangements and their influence on and repercussions for primary health care financing and resource allocation models? The review will include peer-reviewed papers in Portuguese, English or Spanish published between 1978 and 2023. Searches will be performed of the following databases: Medline (PubMed), Embase, BVS Salud, Web of Science, Scopus and Science Direct. The review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Inclusion and exclusion criteria will be used for literature screening and mapping. Screening and data charting will be conducted by a team of four reviewers. REGISTRATION This protocol is registered on the Open Science Framework (OSF) platform, available at https://doi.org/10.17605/OSF.IO/Q9W3P.
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Affiliation(s)
- Henrique Sant’Anna Dias
- Research and Innovation Vice-Direction, Sergio Arouca National School of Public Health, Rio de Janeiro, RJ, Brazil
| | - Adelyne Maria Mendes Pereira
- Department of Health Planning and Administration, Sergio Arouca National School of Public Health, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Marcela Castilho
- Department of Collective Health, Londrina State University, Londrina, Paraná, Brazil
| | | | - Luciana Dias de Lima
- Department of Health Planning and Administration, Sergio Arouca National School of Public Health, Rio de Janeiro, Rio de Janeiro, Brazil
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20
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Holzinger F, Kümpel L, Resendiz Cantu R, Alberter A, Möckel M, Heintze C. Emergency department visits as a potential opportunity to promote primary care attachment and modify utilization patterns - results of a pilot study in Berlin, Germany. BMC Emerg Med 2024; 24:142. [PMID: 39112973 PMCID: PMC11304799 DOI: 10.1186/s12873-024-01056-0] [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: 11/16/2023] [Accepted: 07/18/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Utilization by low acuity patients contributes to emergency department (ED) crowding. Both knowledge deficits about adequate care levels and access barriers in primary care are important promoters of such presentations. Concurrently, not having a general practitioner (GP) increases the likelihood of low-acuity ED utilization. This pilot study thus investigated feasibility, acceptance, and potential effects of an ED-delivered intervention for low-acuity patients with no regular primary care provider, consisting of an educational leaflet on acute care options and an optional GP appointment scheduling service. METHODS Low-acuity ED consulters not attached to a GP were given an information leaflet about alternative care offers for acute health problems and offered optional personal appointment scheduling at a local GP practice. Patients were surveyed on demographics, medical characteristics, health care utilization, valuation of the intervention, and reasons for not being attached to a GP and visiting the ED. A follow-up survey was conducted after twelve months. Trends in health and health care utilization were evaluated. RESULTS Between December 2020 and April 2022, n = 160 patients were enrolled, n = 114 were followed up. The study population was characterized by young age (mean 30.6 years) and predominantly good general health. Besides good health, personal mobility was a central reason for not being attached to a GP, but general preference for specialists and bad experiences with primary care were also mentioned. Most frequently stated motives for the ED consultation were subjective distress and anxiety, a belief in the superiority of the hospital, and access problems in primary care. The interventional offers were favorably valued, 52.5% (n = 84) accepted the GP appointment scheduling service offer. At follow-up, GP utilization had significantly increased, while there were no significant changes regarding utilization of other providers, including ED. An additional practice survey showed a 63.0% take-up rate for the appointment service. CONCLUSIONS With this pilot study, we were able to show that a personalized appointment scheduling service seems to be a promising approach to promote GP attachment and increase primary care utilization in patients without a regular GP in a highly urbanized setting. Further larger-scale studies are needed to investigate potential quantitative effects on ED visits. TRIAL REGISTRATION German Clinical Trials Register (DRKS00023480); date 2020/11/27.
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Affiliation(s)
- Felix Holzinger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany.
| | - Lisa Kümpel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
| | - Rebecca Resendiz Cantu
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine, Campus Mitte and Virchow, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Anja Alberter
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine, Campus Mitte and Virchow, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Martin Möckel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Division of Emergency Medicine, Campus Mitte and Virchow, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Christoph Heintze
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of General Practice, Charitéplatz 1, 10117, Berlin, Germany
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Ferguson J, Stringer G, Walshe K, Donnelly A, Grigoroglou C, Allen T, Kontopantelis E, Ashcroft DM. 'None of Them Know Me': A Qualitative Study of the Implications of Locum Doctor Working for Patient Experience. Health Expect 2024; 27:e14156. [PMID: 39087726 PMCID: PMC11292670 DOI: 10.1111/hex.14156] [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: 03/19/2024] [Revised: 07/10/2024] [Accepted: 07/11/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION There have been some concerns about the impact of temporary doctors, otherwise known as locums, on patient safety and the quality of care. Despite these concerns, research has paid little attention to the implications of locum working on patient experience. METHODS A qualitative semi-structured interview study was conducted with 130 participants including locums, people working with locums and patients with experience of being seen or treated by locums. Analysis was conducted using a reflexive thematic approach and abductive analysis to position themes against wider knowledge. RESULTS Three main themes were constructed through analysis: (1) Awareness and disclosure; patients were not always aware if their doctor was a locum, and there was some debate about whether patients had a right to know, particularly if locum working presented quality and safety risks. (2) Continuity and accessibility of care; access was regarded as priority for acute conditions, but for long-term or serious conditions, patients preferred to see a permanent doctor who knew their history, although it was acknowledged that locums could provide fresh perspectives. (3) Communication and practice; locums and patients described how consultations were approached differently when doctors worked as locums. Patients evaluated their interactions based on how safe they felt with practitioners. CONCLUSION Patients reported that they were unlikely to have continuity of care with any doctors delivering care, regardless of their contractual status. Locums sometimes provided new perspectives on care which could be beneficial for patient outcomes, but for patients with long-term, complex or serious conditions continuity of care was important, and these patients may avoid or delay seeking care when locums are the only available option. PATIENT OR PUBLIC CONTRIBUTION Patients and carers were involved in our study from inception to dissemination. Our Patient and Public Involvement (PPI) forum was involved throughout project design and planning and gave us feedback and guidance on research materials and outputs (e.g., study protocol, participant information sheets, survey tools, interview schedules, emerging findings). Our PPI forum co-produced our patient interview schedule, two members of our PPI forum led the patient focus groups and all were involved in analysis of patient interviews. Our PPI Chair was involved in the preparation of this manuscript.
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Affiliation(s)
- Jane Ferguson
- Health Services Management CentreThe University of BirminghamBirminghamUK
| | - Gemma Stringer
- Alliance Manchester Business SchoolThe University of ManchesterManchesterUK
| | - Kieran Walshe
- Alliance Manchester Business SchoolThe University of ManchesterManchesterUK
| | - Ailsa Donnelly
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services ResearchUniversity of ManchesterManchesterUK
| | - Christos Grigoroglou
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary CareThe University of ManchesterManchesterUK
| | - Thomas Allen
- Manchester Centre for Health Economics, Division of Population Health, Health Services Research and Primary CareThe University of ManchesterManchesterUK
- Danish Centre for Health EconomicsUniversity of Southern DenmarkOdenseDenmark
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care, Division of Population Health, Health Services Research and Primary CareThe University of ManchesterManchesterUK
- Division of Informatics, Imaging and Data ScienceUniversity of ManchesterManchesterUK
| | - Darren M. Ashcroft
- NIHR Greater Manchester Patient Safety Research Collaboration, Division of Pharmacy and Optometry, Faculty of Biology Medicine and HealthUniversity of ManchesterManchesterUK
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Santen SA, Gonzalez-Flores A, Coe CL, Partin M, Brenner JM, Nalin PM, Macerollo AA, Cangiarella J, Saavedra A, Leong SL. Return on Investment of Three-Year Accelerated Programs for Students, Medical Schools, Departments, and Community. MEDICAL SCIENCE EDUCATOR 2024; 34:919-925. [PMID: 39099855 PMCID: PMC11297223 DOI: 10.1007/s40670-024-02043-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/08/2024] [Indexed: 08/06/2024]
Abstract
Building on the initial accelerated pathway programs in the 1970s to increase workforce, nearly 30 schools have launched accelerated 3-year pathways (A3YP) during the past decade. The authors based on their educational roles, experiences, and scholarship with A3YP provide this perspective of the argument for A3YP and potential disadvantages for each group-students, schools, residencies, departments, and community. When schools consider innovations, they might consider A3YPs for multiple reasons; this perspective helps provide justification for the program and broadly considers return on investment (ROI). The ROI for students includes decreased debt, reduced costs and stress associated with the fourth-year residency applications, and a directed pathway with facilitated transition into a residency program with accompanying professional identity development. Disadvantages for students include early specialty commitment, risk of deceleration, and condensed curriculum. The ROI for schools includes recruiting and retaining students, who will then transition more easily into residency and stimulating innovation. Residency programs gain residents with known skills, who have been a part of the department for 3 years. In addition, fewer residency slots for interviewing leads to saving recruitment administrative costs and time. Finally, many programs are intended to increase the workforce, since students who come to the region for medical school and transition directly into residency are likely to stay in the region. Disadvantages include increased curricular complexity for the medical school, increased administrative support, and advising resources. Finally, several of the accelerated programs attract matriculants from diverse backgrounds contributing to the diversity of the medical school, residency program, and community workforce.
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Affiliation(s)
- Sally A. Santen
- Department of Emergency Medicine, University of Cincinnati, 231 Albert Sabin Way, ML 0769, Cincinnati, OH 45267-0769 USA
- Virginia Commonwealth University School of Medicine, Richmond, VA USA
| | - Alicia Gonzalez-Flores
- Department of Internal Medicine, University of California Davis School of Medicine, Davis, CA USA
| | - Catherine L. Coe
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC USA
| | - Michael Partin
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Hershey, PA USA
| | - Judith M. Brenner
- New York University Grossman Long Island School of Medicine, Mineola, NY USA
| | - Peter M. Nalin
- University of Minnesota School of Medicine, Minneapolis, MN USA
| | - Allison A. Macerollo
- Department of Family and Community Medicine, The Ohio State University College of Medicine, Columbus, OH USA
| | - Joan Cangiarella
- Department of Pathology, NYU Grossman School of Medicine, New York, NY USA
| | | | - Shou Ling Leong
- Department of Family and Community Medicine, Pennsylvania State University College of Medicine, Hershey, PA USA
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Tsuei SHT. Reflection on 30 years of Taiwanese national health insurance: Analysis of Taiwanese health system progress, challenges, and opportunities. J Formos Med Assoc 2024:S0929-6646(24)00350-4. [PMID: 39089963 DOI: 10.1016/j.jfma.2024.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 07/21/2024] [Accepted: 07/28/2024] [Indexed: 08/04/2024] Open
Abstract
On the eve of Taiwan's National Health Insurance's 30th birthday, this study reviews the policy and performance trajectory of the Taiwanese health system. Taiwan has controlled their health spending well and grown increasingly reliant on private financing. The floating-point global budget payment preferentially rewards outpatient-based services, but this has not affected the hospital-centric market composition, which persists despite several primary-care friendly developments. The outcomes suggest improving health care workforce and resource availability, good patient-centredness, respectable technical efficiency, and impressive patient care satisfaction. However, there are worrisome trends for financial barriers to access and allocative efficiency. Evidence on clinical quality suggests that hospitals are performing well though the primary care setting might not be. Overall, the public remains satisfied despite signs of lagging improvement in health outcomes, worsening maternal mortality rate, and persistently incomplete financial risk protection. Identifying what drives the worsening financial barriers of access and persistent financial risk is necessary for further discussions on potential financing adjustments. Improving allocative efficiency could draw on a combination of supporting the functions and quality of primary care alongside patient-oriented education and incentives. Further data on causes of slow health status improvement and rebounding maternal mortality rate is necessary.
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Affiliation(s)
- Sian Hsiang-Te Tsuei
- Faculty of Medicine, University of British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Canada.
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24
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Barbosa SDP, Martinez-Riera JR, Barroso TMMDDA, Hernadez-Caravaca I, Oliveira AC, González CIA, Racis M, Silva MAMD, Pinto DL, Campos ÁLF, Pio LM, Lana FCF. [National health systems, legislation, and social determinants: a comparative study of Brazil, Spain, Portugal, and Italy]. CAD SAUDE PUBLICA 2024; 40:e00169423. [PMID: 39082569 PMCID: PMC11290831 DOI: 10.1590/0102-311xpt169423] [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: 09/06/2023] [Revised: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 08/02/2024] Open
Abstract
This is a documentary, exploratory, descriptive study, which is part of a multicenter international study assessing the national health systems with a care model based on primary health care of Brazil, Spain, Italy, and Portugal, funded by the Brazilian National Research Council (CNPq, acronym in Portuguese). It aims to identify the basic health legislation, the right to health, and the doctrinal and organizational principles of each country with a focus on the impact of social determinants of health on the national health systems. The results showed these countries have similar legislation and doctrinal principles, with a constitutional right to health, based on primary health care, and with a care model of the family health type. The challenges identified were low birth rate and high life expectancy at birth in European countries and criteria for access to medication and care financing. Based on our findings, the countries with higher investment in a structural basis, ensuring more dignified, solid, and vigilant socioeconomic and sanitary conditions, provide an important differentiation in responsiveness and sustainability of the national health system and direct impact on the quality of life.
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Affiliation(s)
| | | | | | | | | | | | - Manuela Racis
- Azienda Socio-sanitaria del Medio Campidano, Sanluri, Italia
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25
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Li M, Zhang X, Tang H, Zheng H, Long R, Cheng X, Cheng H, Dong J, Wang X, Zhang X, Geldsetzer P, Liu X. Quality of primary health care for chronic diseases in low-resource settings: Evidence from a comprehensive study in rural China. PLoS One 2024; 19:e0304294. [PMID: 39052549 PMCID: PMC11271947 DOI: 10.1371/journal.pone.0304294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 07/10/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND There is a paucity of evidence regarding the definition of the quality of primary health care (PHC) in China. This study aims to evaluate the PHC quality for chronic diseases in rural areas based on a modified conceptual framework tailored to the context of rural China. METHODS This comprehensive study, involving a patient survey, a provider survey and chart abstraction, and second-hand registered data, was set in three low-resource counties in rural China from 2021 to 2022. Rural patients with hypertension or type 2 diabetes, and health care workers providing care on hypertension or diabetes were involved. The modified PHC quality framework encompasses three core domains: a competent PHC system (comprehensiveness, accessibility, continuity, and coordination), effective clinical care (assessment, diagnosis, treatment, disease management, and provider competence), and positive user experience (information sharing, shared decision-making, respect for patient's preferences, and family-centeredness). Standardized PHC quality score was generated by arithmetic means or Rasch models of Item Response Theory. RESULTS This study included 1355 patients, 333 health care providers and 2203 medical records. Ranging from 0 (the worst) to 1 (the best), the average quality score for the PHC system was 0.718, with 0.887 for comprehensiveness, 0.781 for accessibility, 0.489 for continuity, and 0.714 for coordination. For clinical care, average quality was 0.773 for disease assessment, 0.768 for diagnosis, 0.677 for treatment, 0.777 for disease management, and 0.314 for provider competence. The average quality for user experience was 0.727, with 0.933 for information sharing, 0.657 for shared decision-making, 0.936 for respect for patients' preferences, and 0.382 for family-centeredness. The differences in quality among population subgroups, although statistically significant, were small. CONCLUSION The PHC quality in rural China has shown strengths and limitations. We identified large gaps in continuity of care, treatment, provider competence, family-centeredness, and shared decision-making. Policymakers should invest more effort in addressing these gaps to improve PHC quality.
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Affiliation(s)
- Mingyue Li
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
| | - Xiaotian Zhang
- School of Health Policy & Management, Nanjing Medical University, Nanjing, China
| | - Haoqing Tang
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Huixian Zheng
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Ren Long
- Department of Health Policy and Management, School of Public Health, Peking University, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Xiaoran Cheng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Haozhe Cheng
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Jiajia Dong
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Xiaohui Wang
- Department of Cardiology, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Xiaoyan Zhang
- Department of Social and Behavioral Sciences, School of Global Public Health, New York University, New York, New York, United States of America
| | - Pascal Geldsetzer
- Division of Primary Care and Population Health, Department of Medicine, Stanford University, Stanford, California, United States of America
- Chan Zuckerberg Biohub, San Francisco, San Francisco, California, United States of America
| | - Xiaoyun Liu
- China Center for Health Development Studies, Peking University, Beijing, China
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26
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Kim JH, Cisneros T, Nguyen A, van Meijgaard J, Warraich HJ. Geographic Disparities in Access to Cardiologists in the United States. J Am Coll Cardiol 2024; 84:315-316. [PMID: 38986673 DOI: 10.1016/j.jacc.2024.04.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/25/2024] [Accepted: 04/26/2024] [Indexed: 07/12/2024]
Affiliation(s)
- Jeong Hwan Kim
- Brigham and Women's Hospital, Boston, Massachusetts, USA; VA Boston Healthcare System, Boston, Massachusetts, USA
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27
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Mira JJ, Carratala-Munuera C, Vicente MA, Astier-Peña MP, García-Torres D, Soriano C, Sánchez-García A, Chilet-Rosell E, Gil-Guillén VF, López-Pineda A, Pérez-Jover V. Gender Disparities in Adverse Events Resulting From Low-Value Practices in Family Practice in Spain: A Retrospective Cohort Study. Int J Public Health 2024; 69:1607030. [PMID: 39081783 PMCID: PMC11286494 DOI: 10.3389/ijph.2024.1607030] [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: 12/28/2023] [Accepted: 07/03/2024] [Indexed: 08/02/2024] Open
Abstract
Objectives: This study aimed to evaluate gender-based disparities in preventable adverse events due to low-value practices (LVPs) in primary care. Methods: A retrospective cohort study in Alicante, Spain. Results: A total of 1,516 patient records were examined, finding that older individuals and women experienced more LVP-related events. Female patients faced a higher volume of such events than males with the same health issue. Interaction analysis revealed patients treated by male physicians had more severe events, while those attended by females experienced milder ones. Adverse events were more frequent in LVPs associated with gender-based reasons. Conclusion: These results highlight the need for tailored healthcare professional awareness programs on overuse's impact on safety. Addressing outcome differences between male and female patients should inform awareness campaigns.
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Affiliation(s)
- José Joaquín Mira
- Alicante-Sant Joan Health District, Alicante, Spain
- ATENEA Research, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), San Juan de Alicante, Spain
- Health Psychology Department, Miguel Hernandez University of Elche, Elche, Spain
- RICAPPS—Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Sant Joan Alacant, Spain
| | - Concepción Carratala-Munuera
- RICAPPS—Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Sant Joan Alacant, Spain
- Clinical Medicine Department, Miguel Hernandez University of Elche, Elche, Spain
| | | | - Maria Pilar Astier-Peña
- Universitas Health Centre, Zaragoza, Spain
- Public Health Service of Aragon, University of Zaragoza, Grupo de Investigación en Bioética de Aragón, Instituto de Investigación Sanitaria de Aragón, Aragón, Spain
| | - Daniel García-Torres
- Alicante-Sant Joan Health District, Alicante, Spain
- ATENEA Research, Foundation for the Promotion of Health and Biomedical Research of Valencia Region (FISABIO), San Juan de Alicante, Spain
| | | | | | - Elisa Chilet-Rosell
- Public Health, History of Medicine and Gynecology Department, Miguel Hernandez University of Elche, Elche, Spain
| | - Vicente F. Gil-Guillén
- RICAPPS—Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Sant Joan Alacant, Spain
- Clinical Medicine Department, Miguel Hernandez University of Elche, Elche, Spain
| | - Adriana López-Pineda
- RICAPPS—Red de Investigación en Cronicidad, Atención Primaria y Prevención y Promoción de la Salud, Sant Joan Alacant, Spain
- Clinical Medicine Department, Miguel Hernandez University of Elche, Elche, Spain
| | - Virtudes Pérez-Jover
- Health Psychology Department, Miguel Hernandez University of Elche, Elche, Spain
- Calitè Research, Applied Psychology Research Centre, Miguel Hernández University, Elche, Spain
- Hospital Psychology Research Group, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Hospital General Universitario de Alicante, Alicante, Spain
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28
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Aubrey-Basler K, Bursey K, Pike A, Penney C, Furlong B, Howells M, Al-Obaid H, Rourke J, Asghari S, Hall A. Interventions to improve primary healthcare in rural settings: A scoping review. PLoS One 2024; 19:e0305516. [PMID: 38990801 PMCID: PMC11239038 DOI: 10.1371/journal.pone.0305516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/01/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND Residents of rural areas have poorer health status, less healthy behaviours and higher mortality than urban dwellers, issues which are commonly addressed in primary care. Strengthening primary care may be an important tool to improve the health status of rural populations. OBJECTIVE Synthesize and categorize studies that examine interventions to improve rural primary care. ELIGIBILITY CRITERIA Experimental or observational studies published between January 1, 1996 and December 2022 that include an historical or concurrent control comparison. SOURCES OF EVIDENCE Pubmed, CINAHL, Cochrane Library, Embase. CHARTING METHODS We extracted and charted data by broad category (quality, access and efficiency), study design, country of origin, publication year, aim, health condition and type of intervention studied. We assigned multiple categories to a study where relevant. RESULTS 372 papers met our inclusion criteria, divided among quality (82%), access (20%) and efficiency (13%) categories. A majority of papers were completed in the USA (40%), Australia (15%), China (7%) or Canada (6%). 35 (9%) papers came from countries in Africa. The most common study design was an uncontrolled before-and-after comparison (32%) and only 24% of studies used randomized designs. The number of publications each year has increased markedly over the study period from 1-2/year in 1997-99 to a peak of 49 papers in 2017. CONCLUSIONS Despite substantial inequity in health outcomes associated with rural living, very little attention is paid to rural primary care in the scientific literature. Very few studies of rural primary care use randomized designs.
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Affiliation(s)
- Kris Aubrey-Basler
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Krystal Bursey
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Andrea Pike
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Carla Penney
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Bradley Furlong
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Mark Howells
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Harith Al-Obaid
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - James Rourke
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Shabnam Asghari
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Amanda Hall
- Discipline of Family Medicine, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Division of Public Health and Applied Health Sciences, Faculty of Medicine, Memorial University, St. John's, Newfoundland and Labrador, Canada
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Kioko P, De Meijer F, Lusambili A, Gathu C. Implementing a community rotation to the internship training in Kenya: barriers and enablers. EDUCATION FOR PRIMARY CARE 2024:1-10. [PMID: 38989546 DOI: 10.1080/14739879.2024.2370537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/17/2024] [Indexed: 07/12/2024]
Abstract
Community placements among trainee doctors have proven beneficial in understanding community problems, the role of primary care in health, and increasing the likelihood of pursuing a primary care career, albeit with some challenges. In 2020, Kenya started community rotations as part of the mandatory internship programme. This study aimed to describe the experiences among medical interns and their educational supervisors during the rotation from which insights on how to improve the community rotation may be drawn. A qualitative analysis of 13 in-depth interviews carried out among medical interns and their supervisors was undertaken in the first year of the implementation of the community rotation. Factors that enabled a successful rotation were an increased awareness amongst interns about patient health in the context of the community, presence of existing primary care structures, and the use of technology for patient follow-up during the COVID-19 pandemic. Conversely, challenges experienced by participants included insufficient communication prior to implementing the community health rotation, limited community health exposure among medical graduates before the internship, and fear of contracting or spreading COVID-19. The study identified opportunities to improve the community rotation through stakeholder engagement, timely government communication, and strengthening undergraduate medical training in community health competencies.
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Affiliation(s)
- Peter Kioko
- Family Medicine Department, Aga Khan University, Nairobi, Kenya
| | - Fleur De Meijer
- Family Medicine Department, Aga Khan University, Nairobi, Kenya
| | | | - Catherine Gathu
- Family Medicine Department, Aga Khan University, Nairobi, Kenya
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30
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Peterson CL. Inequality and health: Can medical practice address the consequences of inequalities? J Eval Clin Pract 2024. [PMID: 38975616 DOI: 10.1111/jep.14067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 05/24/2024] [Accepted: 06/09/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND The extent to which governments provide socioeconomic supports has been highlighted by their spending during the COVID-19 pandemic. This has implications for patterns of inequality, in particular on exacerbating unequal health and well-being. RESULTS Inequity has expanded due to neoliberalism, a market-based approach that has endured for more than four decades. Together with COVID-19, it has developed and exposed many structural governance differences. DISCUSSION There are a number of examples presented of the effects of inequalities on health and well-being. The role of general practice in addressing these is discussed and challenges are highlighted, especially those relating to payment systems and workforce constraints.
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Affiliation(s)
- Chris L Peterson
- Department of Social Inquiry, La Trobe University, Bundoora, Australia
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31
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Almaqhawi A. Knowledge and Competence Regarding the Management of Chronic Kidney Disease among Family Medicine Professionals in the Eastern Province of Saudi Arabia: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:880. [PMID: 39063457 PMCID: PMC11276965 DOI: 10.3390/ijerph21070880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/17/2024] [Accepted: 06/26/2024] [Indexed: 07/28/2024]
Abstract
Diabetes is a significant risk factor for chronic kidney disease (CKD) and a primary cause of global morbidity and mortality, resulting in significant costs to healthcare systems. The management of diabetic CKD in the primary care setting remains an ongoing challenge despite the current best practices in the quality of care. This study evaluated family medicine physicians' knowledge and confidence regarding managing CKD in the Eastern Province of Saudi Arabia. A self-administered online questionnaire was distributed to physicians through various social media sites and email lists. The largest number of participants reported a full confidence in knowing kidney disease stages, blood pressure targets and the importance of urine albumin-creatinine ratio testing. Overall, 71.8% of physicians reported a high confidence level, followed by 23.9% reporting average and 4.2% reporting low confidence. Being younger and working at PHC were identified as significant predictors of increased confidence. Although most of the physicians reported a high confidence in managing CKD patients, the need for improvement was evident. Age and workplace institutions were the greater contributors to physicians' confidence. Continuous education among healthcare practitioners is crucial to updating knowledge and providing optimum quality of care among this group of patients.
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Affiliation(s)
- Abdullah Almaqhawi
- Department of Family and Community Medicine, College of Medicine, King Faisal University, Al Hofuf P.O. Box 400, Saudi Arabia
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32
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Pfarrwaller E, Maisonneuve H, Laurent C, Abbiati M, Sommer J, Baroffio A, Haller DM. Dynamics of Students' Career Choice: a Conceptual Framework-Based Qualitative Analysis Focusing on Primary Care. J Gen Intern Med 2024; 39:1544-1555. [PMID: 38102409 PMCID: PMC11254893 DOI: 10.1007/s11606-023-08567-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Increasing primary care's attractiveness as a career choice is an important task of socially accountable medical schools. Research has broadly studied influences on medical students' career choice. However, a deeper understanding of the processes behind career decision-making could support medical schools in their efforts to promote primary care careers. OBJECTIVE To explore the dynamics of career choice during medical school with a focus on primary care, based on a previously developed conceptual framework. APPROACH Qualitative study using a phenomenological, inductive-deductive approach DESIGN AND PARTICIPANTS: Individual interviews were conducted from May 2019 to January 2020 with 14 first-year postgraduate trainee physicians, graduates of the Faculty of Medicine in Geneva, Switzerland, purposively sampled based on their interest in primary care during undergraduate studies. The interview guide was developed to elicit narratives about career-related decision-making. Two authors coded the transcripts. Thematic analysis alternated with data collection until thematic saturation was reached. Emerging themes were discussed and refined within the research team. KEY RESULTS Two main themes emerged: (1) developing professional identity, expressed as a changing professional image from unprecise and idealistic to concrete and realistic; priorities changed from content-based to lifestyle-based preferences; (2) individual trajectories of career-related decision-making, determined by different stages of refining professional interests; students navigated this process by employing various strategies, ranging from active exploration to passive behaviors. CONCLUSIONS This study's narrative approach illustrates the dynamic nature of career choice and refines elements of a conceptual framework previously developed by the authors. Its findings underline the importance of exploration, for which personal experiences and observations of physicians' work are crucial. To advance efforts to make primary care a more attractive career, students must be sufficiently exposed to primary care in a safe and individualized environment and should be supported in all stages of their career choice process.
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Affiliation(s)
- Eva Pfarrwaller
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Hubert Maisonneuve
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- University College of General Medicine, Faculty of Medicine, University Claude Bernard Lyon 1, Lyon, France
| | - Camille Laurent
- University College of General Medicine, Faculty of Medicine, University Claude Bernard Lyon 1, Lyon, France
| | - Milena Abbiati
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Johanna Sommer
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Anne Baroffio
- Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dagmar M Haller
- University Institute for Primary Care, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Burch P, Whittaker W, Bower P, Checkland K. Has the NHS national extended access scheme delivered its policy aims? A case study of two large scale extended access providers. J Health Serv Res Policy 2024; 29:191-200. [PMID: 37978850 PMCID: PMC11151702 DOI: 10.1177/13558196231216657] [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: 11/19/2023]
Abstract
OBJECTIVES In 2018, NHS England mandated that all patients in England should be able to access general practice services outside of ordinary hours. While some patients would access additional hours at their own practice, others would need supra-practice level provision - that is, they would be seen in a different location and by a different care team. The policy aim was to enhance patient access to care, with a particular focus on those who work during the day. This study examines (a) how supra-practice level provision of extended access appointments for general medical problems are operationalised and (b) whether the aims of the policy are being met. METHODS This study presents qualitative comparative case studies of two contrasting service providers offering extended access. The data collected included 30 hours of clinician-patient observations, 25 interviews with staff, managers, and commissioners, 20 interviews with patients, organisational protocols/documentation, and routinely collected appointment data. Thematic analysis ran concurrently with data gathering and facilitated the iterative adaptation of data collection. RESULTS Three cross-cutting themes were identified: extended access is being used to bolster a struggling primary care system, extended access provides a different service to in-hours general practice, and it is difficult for extended access to provide seamless care. CONCLUSIONS Supra-practice access models can provide effective care for most patients with straightforward issues. When ongoing management of complex problems is required, this model of patient care can be problematic.
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Affiliation(s)
- Patrick Burch
- PhD Fellow, Centre for Primary Care, University of Manchester, Manchester, UK
| | - William Whittaker
- Senior Lecturer, Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Peter Bower
- Professor, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Katherine Checkland
- Professor, Centre for Primary Care, University of Manchester, Manchester, UK
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Steele Gray C, Ramachandran M, Brinton C, Forte M, Loganathan M, Walsh R, Callaghan J, Upshur R, Wiljer D. Digitally mediated relationships: How social representation in technology influences the therapeutic relationship in primary care. Soc Sci Med 2024; 353:116962. [PMID: 38908092 DOI: 10.1016/j.socscimed.2024.116962] [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: 06/14/2023] [Revised: 03/21/2024] [Accepted: 05/09/2024] [Indexed: 06/24/2024]
Abstract
Relationships, built on trust, knowledge, regard, and loyalty, have been demonstrated to be fundamental to health care delivery. Strong relationships between patients and providers have been linked to more compassionate care delivery, and better patient experience and outcomes, and may be particularly important in primary care. The rapid adoption of digital technologies since the onset of COVID-19 has led health care systems to seriously consider a "digital-first" primary care delivery model. Questions remain regarding what impact this transformation will have on the therapeutic relationship. Using a rapid ethnographic approach this study explores how patient and provider understandings of therapeutic relationships and digital health technologies may influence relationship-building or maintenance between patients with complex care needs and their care providers. Three team-based primary care sites in Toronto, Ontario, Canada were included in the study. Across the three sites 9 patients with chronic health conditions, 1 caregiver, and 10 healthcare providers (including family physicians, family medicine residents, social workers, and nurse practitioners) participated. Interviews were conducted with all participants and 8 observations of virtual clinical encounters (phone and video visits) were conducted. Using social representation theory as a lens, analysis revealed that participants' constructions of therapeutic relationships and digital technologies were informed by their identities, experiences, and expectations. For participants to see technologies as enabling to the therapeutic relationship, there needed to be alignment between how participants viewed the role of technology in care and in their lives, and how they recognized (or constructed) a good therapeutic relationship. This exploratory work suggests the need to think about how both patients' and providers' views of technology may determine whether digital technologies can be leveraged to meet patient needs while maintaining, or building, strong therapeutic relationships.
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Affiliation(s)
- Carolyn Steele Gray
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Canada; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada.
| | - Meena Ramachandran
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Canada; School of Physical and Occupational Therapy, McGill University, Canada
| | - Christopher Brinton
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Canada; Michael G. DeGroote School of Medicine, McMaster University, Canada
| | - Milena Forte
- Mount Sinai Hospital, Canada; Department of Family and Community Medicine, University of Toronto, Canada
| | - Mayura Loganathan
- Mount Sinai Hospital, Canada; Department of Family and Community Medicine, University of Toronto, Canada
| | | | - Julie Callaghan
- Community Health and Quality, Unison Health and Community Services, Canada
| | - Ross Upshur
- Department of Family and Community Medicine, University of Toronto, Canada
| | - David Wiljer
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Canada; Department of Psychiatry, University of Toronto, Canada; Continuing Professional Development, Temerty Faculty of Medicine, University of Toronto, Canada; The Centre for Addiction and Mental Health, Canada; Education Technology Innovation, University Health Network, Canada
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Tilhou AS, Burns M, Chachlani P, Chen Y, Dague L. How Does Telehealth Expansion Change Access to Healthcare for Patients With Different Types of Substance Use Disorders? SUBSTANCE USE & ADDICTION JOURNAL 2024; 45:473-485. [PMID: 38494728 PMCID: PMC11179974 DOI: 10.1177/29767342241236028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
BACKGROUND Patients with substance use disorders (SUDs) exhibit low healthcare utilization despite high medical need. Telehealth could boost utilization, but variation in uptake across SUDs is unknown. METHODS Using Wisconsin Medicaid enrollment and claims data from December 1, 2018, to December 31, 2020, we conducted a cohort study of telemedicine uptake in the all-ambulatory and the primary care setting during telehealth expansion following the COVID-19 public health emergency (PHE) onset (March 14, 2020). The sample included continuously enrolled (19 months), nonpregnant, nondisabled adults aged 19 to 64 years with opioid (OUD), alcohol (AUD), stimulant (StimUD), or cannabis (CannUD) use disorder or polysubstance use (PSU). Outcomes: total and telehealth visits in the week, and fraction of visits in the week completed by telehealth. Linear and fractional regression estimated changes in in-person and telemedicine utilization. We used regression coefficients to calculate the change in telemedicine utilization, the proportion of in-person decline offset by telemedicine uptake ("offset"), and the share of visits completed by telemedicine ("share"). RESULTS The cohort (n = 16 756) included individuals with OUD (34.8%), AUD (30.1%), StimUD (9.5%), CannUD (9.5%), and PSU (19.7%). Total and telemedicine utilization varied by group post-PHE. All-ambulatory: total visits dropped for all, then rose above baseline for OUD, PSU, and AUD. Telehealth expansion was associated with visit increases: OUD: 0.489, P < .001; PSU: 0.341, P < .001; StimUD: 0.160, P < .001; AUD: 0.132, P < .001; CannUD: 0.115, P < .001. StimUD exhibited the greatest telemedicine share. Primary care: total visits dropped for all, then recovered for OUD and CannUD. Telemedicine visits rose most for PSU: 0.021, P < .001; OUD: 0.019, P < .001; CannUD: 0.011, P < .001; AUD: 0.010, P < .001; StimUD: 0.009, P < .001. PSU and OUD exhibited the greatest telemedicine share, while StimUD exhibited the lowest. Telemedicine fully offset declines for OUD only. CONCLUSIONS Telehealth expansion helped maintain utilization for OUD and PSU; StimUD and CannUD showed less responsiveness. Telehealth expansion could widen gaps in utilization by SUD type.
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Affiliation(s)
- Alyssa Shell Tilhou
- Department of Family Medicine, Boston University Medical Center, Boston, MA, USA
| | - Marguerite Burns
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Preeti Chachlani
- Institute for Research on Poverty, University of Wisconsin-Madison, Madison, WI, USA
| | - Ying Chen
- Department of Risk and Insurance, Wisconsin School of Business, University of Wisconsin-Madison, Madison, WI, USA
| | - Laura Dague
- The Bush School of Government and Public Service, Texas A&M University, College Station, TX, USA
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Rajan D, Jakab M, Schmets G, Azzopardi-Muscat N, Winkelmann J, Peiris D, Di Ruggiero E, Naledi T, Jantsch AG, Trindade T, Gitahi N, Lessof S, Khalid F, Dalil S, Figueras J. Political economy dichotomy in primary health care: bridging the gap between reality and necessity. THE LANCET REGIONAL HEALTH. EUROPE 2024; 42:100945. [PMID: 39070750 PMCID: PMC11281911 DOI: 10.1016/j.lanepe.2024.100945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 05/14/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Dheepa Rajan
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - Melitta Jakab
- WHO European Centre for Primary Health Care, Almaty, Kazakhstan
| | - Gerard Schmets
- World Health Organization Headquarters, Geneva, Switzerland
| | | | | | - David Peiris
- The George Institute for Global Health, Sydney, Australia
| | | | | | | | | | | | - Suszy Lessof
- European Observatory on Health Systems and Policies, Brussels, Belgium
| | - Faraz Khalid
- World Health Organization Headquarters, Geneva, Switzerland
| | - Suraya Dalil
- World Health Organization Headquarters, Geneva, Switzerland
| | - Josep Figueras
- European Observatory on Health Systems and Policies, Brussels, Belgium
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Matthews S, Qureshi N, Levin JS, Eberhart NK, Breslau J, McBain RK. Financial Interventions to Improve Screening in Primary Care: A Systematic Review. Am J Prev Med 2024; 67:134-146. [PMID: 38484900 DOI: 10.1016/j.amepre.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 06/23/2024]
Abstract
INTRODUCTION Although health screenings offer timely detection of health conditions and enable early intervention, adoption is often poor. How might financial interventions create the necessary incentives and resources to improve screening in primary care settings? This systematic review aimed to answer this question. METHODS Peer-reviewed studies published between 2000 and 2023 were identified and categorized by the level of intervention (practice or individual) and type of intervention, specifically alternative payment models (APMs), fee-for-service (FFS), capitation, and capital investments. Outcomes included frequency of screening, performance/quality of care (e.g., patient satisfaction, health outcomes), and workflow changes (e.g., visit length, staffing). RESULTS Of 51 included studies, a majority focused on practice-level interventions (n=32), used APMs (n=41) that involved payments for achieving key performance indicators (KPIs; n=31) and were of low or very low strength of evidence based on GRADE criteria (n=42). Studies often included screenings for cancer (n=32), diabetes care (n=18), and behavioral health (n=15). KPI payments to both practices and individual providers corresponded with increased screening rates, whereas capitation and provider-level FFS models yielded mixed results. A large majority of studies assessed changes in screening rates (n=48) with less focus on quality of care (n=11) or workflow changes (n=4). DISCUSSION Financial mechanisms can enhance screening rates with evidence strongest for KPI payments to both practices and individual providers. Future research should explore the relationship between financial interventions and quality of care, in terms of both clinical processes and patient outcomes, as well as the role of these interventions in shaping care delivery.
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Affiliation(s)
| | | | | | | | | | - Ryan K McBain
- Department of Medicine, Brigham & Women's Hospital, Boston, Massachusetts; RAND Corporation, Arlington, Virginia
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Tripathy S, Mohapatra S, Preethika A. Breast cancer awareness among women of reproductive age- a questionnaire based study. Eur J Obstet Gynecol Reprod Biol 2024; 298:153-157. [PMID: 38761530 DOI: 10.1016/j.ejogrb.2024.05.014] [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: 09/25/2023] [Revised: 03/26/2024] [Accepted: 05/12/2024] [Indexed: 05/20/2024]
Abstract
INTRODUCTION Breast cancer is the most frequent cancer in women worldwide, and its prevalence is rising among younger women of reproductive age. The study aims to investigate their awareness of breast cancer risk factors, warning indicators, and preventive methods. The study also aimed to assess participants' knowledge of breast self-examination (BSE) and their practices with this crucial screening method. METHODOLOGY To achieve these goals, we used a cross-sectional survey employing a structured questionnaire. The questionnaire included multiple-choice and open-ended items about breast cancer awareness, knowledge, and practices. RESULTS There were 400 questionnaires given out to female patients attending the out-patient department, and 290 of them were completed and returned. The majority of responders to our poll, 88 %, were aware that breast cancer is the most frequent cancer in women. The fact that 57 % of the individuals never examined their own breasts is a worrying result. There was a statistically significant difference between knowledge and family history (X2 = 13.8, P < 0.001) and knowledge and schooling (X2 = 6.4,P < 0.001). Both the practise of BSE and knowledge of BC were good in respondents under the age of 45, however they differed statistically significantly (X2-2.8,P = 0.041 and X2-2.6, P = 0.001, respectively). CONCLUSION Understanding the extent of breast cancer awareness and knowledge gaps in this population is critical for planning targeted interventions and educational efforts. By identifying areas where knowledge is weak, healthcare practitioners and governments can implement policies to encourage early detection practices, reduce delays in seeking medical aid, and ultimately improve breast cancer outcomes.
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Affiliation(s)
- Saswati Tripathy
- Professor, Department of OBG, SRM Medical College Hospital and Research Center, Kattankulathur, Tamil Nadu 603203, India
| | - Satyajit Mohapatra
- Director, Center for Clinical Trials and Research, SRM Medical College Hospital and Research Center, Kattankulathur, Tamil Nadu 603203, India
| | - A Preethika
- Assistant Professor, Centre for Clinical Trials and Research, SRM Medical College Hospital and Research Center, Kattankulathur, Tamil Nadu 603203, India.
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Fogarty CT, Strayer SM, Lord RW, Baltierra DA, Jame PA, Hoff T. Making the Future of Family Medicine Brighter by Breaking it First…. Ann Fam Med 2024; 22:358-360. [PMID: 39038985 PMCID: PMC11268694 DOI: 10.1370/afm.3156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2024] Open
Affiliation(s)
- Colleen T Fogarty
- (Department of Family Medicine, University of Rochester Medical Center)
| | - Scott M Strayer
- (Virginia Commonwealth University School of Medicine, Department of Family Medicine and Population Health)
| | - Richard W Lord
- (Department of Family and Community Medicine, Wake Forest University School of Medicine)
| | - David A Baltierra
- (Department of Family Medicine, WVU School of Medicine - Eastern Division; UHA-East Family Medicine, WVU Medicine, University Healthcare Associates)
| | - Paul A Jame
- (Department of Family Medicine, University of Washington)
| | - Timothy Hoff
- (Management, Healthcare Systems, and Health Policy, D'Amore-McKim School of Business, School of Public Policy and Urban Affairs, Northeastern University; Associate Fellow, Green-Templeton College, University of Oxford)
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Morgan ZJ, Bazemore AW, Peterson LE, Phillips RL, Dai M. The Disproportionate Impact of Primary Care Disruption and Telehealth Utilization During COVID-19. Ann Fam Med 2024; 22:294-300. [PMID: 39038984 PMCID: PMC11268690 DOI: 10.1370/afm.3134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/25/2024] [Accepted: 04/12/2024] [Indexed: 07/24/2024] Open
Abstract
PURPOSE The COVID-19 pandemic not only exacerbated existing disparities in health care in general but likely worsened disparities in access to primary care. Our objective was to quantify the nationwide decrease in primary care visits and increase in telehealth utilization during the pandemic and explore whether certain groups of patients were disproportionately affected. METHODS We used a geographically diverse primary care electronic health record data set to examine the following 3 outcomes: (1) change in total visit volume, (2) change in in-person visit volume, and (3) the telehealth conversion ratio defined as the number of pandemic telehealth visits divided by the total number of prepandemic visits. We assessed whether these outcomes were associated with patient characteristics including age, gender, race, ethnicity, comorbidities, rurality, and area-level social deprivation. RESULTS Our primary sample included 1,652,871 patients from 408 practices. During the pandemic we observed decreases of 7% and 17% in total and in-person visit volume and a 10% telehealth conversion ratio. The greatest decreases in visit volume were observed among pediatric patients (-24%), Asian patients (-11%), and those with more comorbidities (-9%). Telehealth usage was greatest among Hispanic or Latino patients (17%) and those living in urban areas (12%). CONCLUSIONS Decreases in primary care visit volume were partially offset by increasing telehealth use for all patients during the COVID-19 pandemic, but the magnitude of these changes varied significantly across all patient characteristics. These variations have implications not only for the long-term consequences of the COVID-19 pandemic, but also for planners seeking to ready the primary care delivery system for any future systematic disruptions.
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Affiliation(s)
| | - Andrew W Bazemore
- American Board of Family Medicine, Lexington, Kentucky
- The Center for Professionalism and Value in Health Care, Washington, DC
| | - Lars E Peterson
- American Board of Family Medicine, Lexington, Kentucky
- Department of Family and Community Medicine, University of Kentucky, Lexington, Kentucky
| | - Robert L Phillips
- American Board of Family Medicine, Lexington, Kentucky
- The Center for Professionalism and Value in Health Care, Washington, DC
| | - Mingliang Dai
- American Board of Family Medicine, Lexington, Kentucky
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Schut T, van de Meeberg B, Lucassen P, Etz RS, van den Muijsenbergh M, Akkermans RP, Hartman TO. Dutch Translation and Psychometric Evaluation of the Person-Centered Primary Care Measure. Ann Fam Med 2024; 22:288-293. [PMID: 39038965 PMCID: PMC11268680 DOI: 10.1370/afm.3135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 03/20/2024] [Accepted: 04/12/2024] [Indexed: 07/24/2024] Open
Abstract
PURPOSE Person-centered care is foundational to good quality primary care and has positive effects on health outcomes and patient satisfaction. The Person-Centered Primary Care Measure (PCPCM) is a recently developed, patient-reported survey able to assess person-centeredness and has demonstrated strong validity and reliability. Little is known, however, about the feasibility of the PCPCM in non-English-speaking settings. We aimed to translate the questionnaire into Dutch, psychometrically evaluate the translated version, and ensure its feasibility for patients in Dutch primary care. METHODS We translated the PCPCM into Dutch using forward-backward translations. We conducted psychometric evaluations to ensure its feasibility among Dutch-speaking primary care patients, with special attention to low literacy populations. Next, we assessed structural validity, convergent validity using the Quality of Care Through the Patient's Eyes (QUOTE) questionnaire, and internal consistency in a cross-sectional study in primary care. RESULTS Translation and adaptation for low literacy populations required 4 iterations. In 4 general practices, 205 patients completed the survey. Confirmatory factor analyses could not confirm the 1-factor solution. The 3-factor solution was found to be a more optimal fit: comprehensiveness of care, personal relation, and contextual care. Internal reliability was high (Cronbach's α were 0.82, 0.73, and 0.86, respectively). We found a strong correlation between the total PCPCM and QUOTE scores (Spearman's ρ = 0.65, P <.001), indicating good convergent validity. CONCLUSION The Dutch version of the PCPCM has acceptable validity and reliability for measuring person-centeredness in primary care among Dutch-speaking populations including those with low literacy.
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Affiliation(s)
- Talitha Schut
- Department of Primary and Community Care, Radboud Institute for Health Services, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bernard van de Meeberg
- Department of Primary and Community Care, Radboud Institute for Health Services, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care, Radboud Institute for Health Services, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rebecca S Etz
- Department of Family Medicine and Population Health, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud Institute for Health Services, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Reinier P Akkermans
- Department of Primary and Community Care, Radboud Institute for Health Services, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tim Olde Hartman
- Department of Primary and Community Care, Radboud Institute for Health Services, Radboud University Medical Center, Nijmegen, The Netherlands
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Satterwhite S, Nguyen MLT, Honcharov V, McDermott AM, Sarkar U. "Good Care Is Slow Enough to Be Able to Pay Attention": Primary Care Time Scarcity and Patient Safety. J Gen Intern Med 2024; 39:1575-1582. [PMID: 38360962 PMCID: PMC11255151 DOI: 10.1007/s11606-024-08658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 01/24/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND There is growing, widespread recognition that expectations of US primary care vastly exceed the time and resources allocated to it. Little research has directly examined how time scarcity contributes to harm or patient safety incidents not readily capturable by population-based quality metrics. OBJECTIVE To examine near-miss events identified by primary care physicians in which taking additional time improved patient care or prevented harm. DESIGN Qualitative study based on semi-structured interviews. PARTICIPANTS Twenty-five primary care physicians practicing in the USA. APPROACH Participants completed a survey that included demographic questions, the Ballard Organizational Temporality Scale and the Mini-Z scale, followed by a one hour qualitative interview over video-conference (Zoom). Iterative thematic qualitative data analysis was conducted. KEY RESULTS Primary care physicians identified several types of near-miss events in which taking extra time during visits changed their clinical management. These were evident in five types of patient care episodes: high-risk social situations, high-risk medication regimens requiring patient education, high acuity conditions requiring immediate workup or treatment, interactions of physical and mental health, and investigating more subtle clinical suspicions. These near-miss events highlight the ways in which unreasonably large patient panels and packed schedules impede adequate responses to patient care episodes that are time sensitive and intensive or require flexibility. CONCLUSIONS Primary care physicians identify and address patient safety issues and high-risk situations by spending more time than allotted for a given patient encounter. Current quality metrics do not account for this critical aspect of primary care work. Current healthcare policy and organization create time scarcity. Interventions to address time scarcity and to measure its prevalence and implications for care quality and safety are urgently needed.
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Affiliation(s)
- Shannon Satterwhite
- Department of Family and Community Medicine, UC Davis Health, Sacramento, CA, USA
| | - Michelle-Linh T Nguyen
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Vlad Honcharov
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Aoife M McDermott
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
- Aston University, Birmingham, UK
| | - Urmimala Sarkar
- Division of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
- UCSF Pride Hall, San Francisco, CA, USA.
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Arsenault C, Mebratie AD, Gelaw SK, Shamebo D. Routine data in a primary care performance dashboard, Ethiopia. Bull World Health Organ 2024; 102:465-475A. [PMID: 38933476 PMCID: PMC11197649 DOI: 10.2471/blt.23.291122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 02/13/2024] [Accepted: 02/26/2024] [Indexed: 06/28/2024] Open
Abstract
Objective To explore the feasibility of building a primary care performance dashboard using DHIS2 data from Ethiopia's largest urban (Addis Ababa), agrarian (Oromia) and pastoral (Somali) regions. Methods We extracted 26 data elements reported by 12 062 health facilities to DHIS2 for the period 1 July 2022 to 30 June 2023. Focusing on indicators of effectiveness, safety and user experience, we built 14 indicators of primary care performance covering reproductive, maternal and child health, human immunodeficiency virus, tuberculosis, noncommunicable disease care and antibiotic prescription. We assessed data completeness by calculating the proportion of facilities reporting each month, and examined the presence of extreme outliers and assessed external validity. Findings At the regional level, average completeness across all data elements was highest in Addis Ababa (82.9%), followed by Oromia (66.2%) and Somali (52.6%). Private clinics across regions had low completeness, ranging from 38.6% in Somali to 58.7% in Addis Ababa. We found only a few outliers (334 of 816 578 observations) and noted that external validity was high for 11 of 14 indicators of primary care performance. However, the 12-month antiretroviral treatment retention rate and proportions of patients with controlled diabetes or hypertension exhibited poor external validity. Conclusion The Ethiopian DHIS2 contains information for measuring primary care performance, using simple analytical methods, at national and regional levels and by facility type. Despite remaining data quality issues, the health management information system is an important data source for generating health system performance assessment measures on a national scale.
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Affiliation(s)
- Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, 950 New Hampshire Ave, NW Washington, DC20052, United States of America
| | - Anagaw Derseh Mebratie
- Department of Health Systems Management and Health Policy, Addis Ababa University School of Public Health, Addis Ababa, Ethiopia
| | | | - Dessalegn Shamebo
- Department of Development Economics, Ethiopian Civil Service University, Addis Ababa, Ethiopia
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Becker B. Primary Care: Its Pokemon Moment. Am J Med 2024; 137:577-581. [PMID: 38556037 DOI: 10.1016/j.amjmed.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/08/2024] [Accepted: 03/08/2024] [Indexed: 04/02/2024]
Abstract
Primary care in the United States is undergoing bursts of evolution in response to health system stresses, changing demographics, and expansion of risk and value-based reimbursement structures. The impact of primary care remains substantive and associated with improved population health. However, the spectrum of services, the nature of the physicians involved and new ways of including the patient in her, or his own care suggests that a new definition of primary care be considered, and patient expectations be heeded and understood. Evolutionary bursts yield new traits and in primary care, they are spawning new care models with significant implications for general internal medicine, internal medicine/pediatrics trained individuals and medicine subspecialties given the focus of these models on Medicare Advantage. Ultimately, changes in reimbursement and creative incentives will be two factors among many that will solidify the next stage of primary care in the United States.
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Affiliation(s)
- Bryan Becker
- Department of Medicine, Anne Burnett Marion School of Medicine, Texas Christian University, Fort Worth, Tex.
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Jibril MB, Sambo MN, Sulaiman H, Musa HS, Musa A, Shuaibu ZB, Aminu L, Wada YH, Ahmed A. Optimizing primary healthcare experience: assessing client satisfaction in Kaduna State, Northwest Nigeria. BMC PRIMARY CARE 2024; 25:231. [PMID: 38926674 PMCID: PMC11210089 DOI: 10.1186/s12875-024-02481-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Client satisfaction is a multidimensional construct focusing on clients' perceptions and evaluations of the treatment and care received. It is one of the factors affecting the outcomes of healthcare and the use of health services. Therefore, we aimed to assess clients' satisfaction with PHC services in Kaduna State, Northwest Nigeria. METHODOLOGY A cross-sectional descriptive study was conducted in Kaduna State, Northwest, Nigeria which evaluate the satisfaction of clients and caregivers accessing healthcare in PHC centres. A sample size of 217 was determined using Fisher's formula, with a multi-stage sampling technique used to randomly select eligible respondents, who have accessed at least a PHC service in any of the PHCs in the State were included in the study, A semi-structured, interviewer-administered questionnaire was administered, and the data collected was analyzed using SPSS version 23.0. Appropriate statistical tests were used to examine the association between dependent and independent variables, while predictor variables that showed significant association with the outcome variables were further subjected to logistic regression analysis, to determine factors that affect clients' satisfaction with PHC services. Statistical significance was determined at an alpha level set at 0.05 at a 95% confidence interval. RESULTS Thirty-one percent of the respondents were satisfied with PHC services in Kaduna State with a mean composite satisfaction score of 3.78 ± 0.67. Age, ethnicity, level of education, and occupational status were factors affecting clients' satisfaction with PHC services among the respondents. On multivariate analysis, age, ethnicity, educational status, and occupational status were significant factors affecting clients' satisfaction with PHC services. Clients of Hausa/Fulani extraction are one and a half times less likely to be satisfied with PHC services when compared to clients from other tribes [aOR = 1.5, 95% CI (1.21-4.67); p = 0.003]. In terms of educational status, clients with formal education are one and a one-third times more likely to be satisfied [aOR = 1.3, 95% CI (0.17-0.94)] with PHC service when compared with their counterparts with informal education (p = 0.034). CONCLUSION Clients' satisfaction with PHC services in Kaduna State, Northwest Nigeria was sub-optimal. Healthcare providers were recommended to improve their attitude bearing in mind clients' peculiarities.
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Huang R, Li W, Shi B, Su H, Hao J, Zhao C, Chai J. Evaluating China's primary healthcare services' efficiency and spatial correlation: a three-stage DEA-Malmquist model. Front Public Health 2024; 12:1366327. [PMID: 38962768 PMCID: PMC11220123 DOI: 10.3389/fpubh.2024.1366327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2024] [Accepted: 04/23/2024] [Indexed: 07/05/2024] Open
Abstract
Introduction Enhancing the efficiency of primary healthcare services is essential for a populous and developing nation like China. This study offers a systematic analysis of the efficiency and spatial distribution of primary healthcare services in China. It elucidates the fundamental landscape and regional variances in efficiency, thereby furnishing a scientific foundation for enhancing service efficiency and fostering coordinated regional development. Methods Employs a three-stage DEA-Malmquist model to assess the efficiency of primary healthcare services across 31 provincial units in mainland China from 2012 to 2020. Additionally, it examines the spatial correlation of efficiency distribution using the Moran Index. Results The efficiency of primary healthcare services in China is generally suboptimal with a noticeable declining trend, highlighting significant potential for improvement in both pure technical efficiency and scale efficiency. There is a pronounced efficiency gap among provinces, yet a positive spatial correlation is evident. Regionally, efficiency ranks in the order of East > Central > West. Factors such as GDP per capita and population density positively influence efficiency enhancements, while urbanization levels and government health expenditures appear to have a detrimental impact. Discussion The application of the three-stage DEA-Malmquist model and the Moran Index not only expands the methodological framework for researching primary healthcare service efficiency but also provides scientifically valuable insights for enhancing the efficiency of primary healthcare services in China and other developing nations.
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Affiliation(s)
- Rui Huang
- Department of Management, School of Management, Minzu University of China, Beijing, China
| | - Wan Li
- Department of Management, School of Management, Minzu University of China, Beijing, China
| | - Baoguo Shi
- Department of Economics, School of Economics, Minzu University of China, Beijing, China
| | - Hao Su
- Department of Management, School of Management, Minzu University of China, Beijing, China
| | - Jing Hao
- Department of Management, School of Management, Minzu University of China, Beijing, China
| | - Chuanjun Zhao
- Department of National Security, School of National Security, Minzu University of China, Beijing, China
| | - Juhong Chai
- Department of Management, School of Management, Minzu University of China, Beijing, China
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Kazi S, Starling C, Milicia A, Buckley B, Grisham R, Gruber E, Miller K, Arem H. Barriers and facilitators to screen for and address social needs in primary care practices in Maryland: a qualitative study. FRONTIERS IN HEALTH SERVICES 2024; 4:1380589. [PMID: 38952646 PMCID: PMC11215188 DOI: 10.3389/frhs.2024.1380589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 05/21/2024] [Indexed: 07/03/2024]
Abstract
Background Social needs screening can help modify care delivery to meet patient needs and address non-medical barriers to optimal health. However, there is a need to understand how factors that exist at multiple levels of the healthcare ecosystem influence the collection of these data in primary care settings. Methods We conducted 20 semi-structured interviews involving healthcare providers and primary care clinic staff who represented 16 primary care practices. Interviews focused on barriers and facilitators to awareness of and assistance for patients' social needs in primary care settings in Maryland. The interviews were coded to abstract themes highlighting barriers and facilitators to conducting social needs screening. The themes were organized through an inductive approach using the socio-ecological model delineating individual-, clinic-, and system-level barriers and facilitators to identifying and addressing patients' social needs. Results We identified several individual barriers to awareness, including patient stigma about verbalizing social needs, provider frustration at eliciting needs they were unable to address, and provider unfamiliarity with community-based resources to address social needs. Clinic-level barriers to awareness included limited appointment times and connecting patients to appropriate community-based organizations. System-level barriers to awareness included navigating documentation challenges on the electronic health record. Conclusions Overcoming barriers to effective screening for social needs in primary care requires not only practice- and provider-level process change but also an alignment of community resources and advocacy of policies to redistribute community assets to address social needs.
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Affiliation(s)
- Sadaf Kazi
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC, United States
| | - Claire Starling
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, Hyattsville, MD, United States
| | - Arianna Milicia
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC, United States
| | - Bryan Buckley
- National Committee for Quality Assurance, Washington, DC, United States
| | - Rachel Grisham
- Maryland Primary Care Program, Maryland Department of Health, Baltimore, MD, United States
| | - Emily Gruber
- Maryland Primary Care Program, Maryland Department of Health, Baltimore, MD, United States
| | - Kristen Miller
- National Center for Human Factors in Healthcare, MedStar Health Research Institute, Washington, DC, United States
- Department of Emergency Medicine, Georgetown University School of Medicine, Washington, DC, United States
| | - Hannah Arem
- Implementation Science, Healthcare Delivery Research Program, MedStar Health Research Institute, Hyattsville, MD, United States
- Department of Oncology, Georgetown University School of Medicine, Washington, DC, United States
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Patel KH, Chrisinger B. Effectiveness of primary care interventions in conjointly treating comorbid chronic pain and depression: a systematic review and meta-analysis. Fam Pract 2024; 41:234-245. [PMID: 37530738 DOI: 10.1093/fampra/cmad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Chronic pain and depression are highly comorbid, but the lack of consensus on the best treatment strategies puts patients at high risk of suboptimal care-coordination as well as health and social complications. Therefore, this study aims to quantitatively assesses how effective different primary care interventions have been in treating the comorbid state of chronic pain and depression. In particular, this study evaluates both short-term outcomes-based specifically on measures of chronic pain and depression during an intervention itself-and long-term outcomes or measures of pain and depression in the months after conclusion of the formal study intervention. METHODS This study is a systematic review and meta-analysis of randomised-controlled trials (RCTs) enrolling patients with concurrent chronic pain and depression. Intensity and severity of pain and depression symptoms were the primary outcomes. The main inclusion criteria were RCTs that: (i) enrolled patients diagnosed with depression and chronic pain, (ii) occurred in primary care settings, (iii) reported baseline and post-intervention outcomes for chronic pain and depression, (iv) lasted at least 8 weeks, and (v) used clinically validated outcome measures. Risk of bias was appraised with the Risk of Bias 2 tool, and GRADE guidelines were used to evaluate the quality of evidence. RESULTS Of 692 screened citations, 7 multicomponent primary care interventions tested across 891 patients were included. Meta-analyses revealed significant improvements in depression at post-intervention (SMD = 0.44, 95% CI [0.17, 0.71], P = 0.0014) and follow-up (SMD = 0.41, 95% CI [0.01, 0.81], P = 0.0448). Non-significant effects were observed for chronic pain at post-intervention (SMD = 0.27, 95% CI [-0.08, 0.61], P = 0.1287) and follow-up (SMD = 0.13, 95% CI [-0.3, 0.56], P = 0.5432). CONCLUSIONS Based on the results of the meta-analysis, primary care interventions largely yielded small to moderate positive effects for depressive symptoms and no significant effects on pain. In one study, stepped-care to be more effective in treatment of comorbid chronic pain and depression than other interventions both during the intervention and upon post-intervention follow-up. As such, depression appears more amenable to treatment than pain, but the number of published RCTs assessing both conditions is limited. More research is needed to further develop optimal treatment strategies.
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Affiliation(s)
- Krishna H Patel
- Department of Social Policy Intervention, University of Oxford, Oxford, United Kingdom
- Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
| | - Benjamin Chrisinger
- Department of Social Policy Intervention, University of Oxford, Oxford, United Kingdom
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O'Shea AMJ, Haraldsson B, Augustine MR, Shahnazi A, Mulligan K, Kaboli PJ. Impact of a Remote Primary Care Telehealth Staffing Model on Primary Care Access in the Veterans Health Administration. J Gen Intern Med 2024:10.1007/s11606-024-08835-2. [PMID: 38867100 DOI: 10.1007/s11606-024-08835-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/21/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND The Veterans Health Administration (VHA) implemented the Clinical Resource Hub (CRH) program to fill staffing gaps in primary care (PC) clinics via telemedicine and maintain veterans' healthcare access. OBJECTIVE To evaluate PC wait times before and after CRH implementation. DESIGN Comparative interrupted time series analysis among a retrospective observational cohort of PC clinics who did and did not use CRH during pre-implementation (October 2018-September 2019) and post-implementation (October 2019-February 2020) periods. PARTICIPANTS Clinics completing ≥10 CRH visits per month for 2 consecutive months and propensity matched control clinics. MAIN MEASURES Two measures of patient access (i.e., established, and new patient wait times) and one measure of clinic capacity (i.e., third next available appointment) were assessed. Clinics using CRH were 1:1 propensity score matched across clinical and demographic characteristics. Comparative interrupted time series models used linear mixed effects regression with random clinic-level intercepts and triple interaction (i.e., CRH use, pre- vs. post-implementation, and time) for trend and point estimations. KEY RESULTS PC clinics using CRH (N = 79) were matched to clinics not using CRH (N = 79). In the 12-month pre-implementation, third next available time increased in CRH clinics (0.16 days/month; 95% CI = [0.07, 0.25]), and decreased in the 5 months post-implementation (-0.58 days/month; 95% CI = [-0.90, -0.27]). Post-implementation third next available time also decreased in control clinics (-0.48 days/month; 95% CI = [-0.81, -0.17]). Comparative differences remained non-significant. There were no statistical differences in established or new patient wait times by CRH user status, CRH implementation, or over time. CONCLUSIONS In a national VHA telemedicine program developed to provide gap coverage for PC clinics, no wait time differences were observed between clinics using and not using CRH services. This hub-and-spoke telemedicine service is an effective model to provide gap coverage while maintaining access. Further investigation of quality and long-term access remains necessary.
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Affiliation(s)
- Amy M J O'Shea
- Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA
- Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Bjarni Haraldsson
- Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA
| | - Matthew R Augustine
- Geriatric Research Education and Clinical Center, James J Peters VA Medical Center, Bronx, NY, USA
- Department of Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ariana Shahnazi
- Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA.
| | - Kailey Mulligan
- Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA
- Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, Iowa City, IA, USA
- Department of Biostatistics, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Peter J Kaboli
- Center for Access and Delivery Research and Evaluation (CADRE) at the Iowa City VA Healthcare System, Iowa City, IA, USA
- Veterans Rural Health Resource Center-Iowa City, VA Office of Rural Health, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Allen LN, Hatefi A, Kak M, Herbst CH, Mallender J, Karem G. A rapid mixed-methods assessment of Libya's primary care system. BMC Health Serv Res 2024; 24:721. [PMID: 38862953 PMCID: PMC11167861 DOI: 10.1186/s12913-024-11121-w] [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: 03/22/2023] [Accepted: 05/19/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Libya has experienced decades of violent conflict that have severely disrupted health service delivery. The Government of National Unity is committed to rebuilding a resilient health system built on a platform of strong primary care. AIM Commissioned by the government, we set out to perform a rapid assessment of the system as it stands and identify areas for improvement. DESIGN AND SETTING We used a rapid applied policy explanatory-sequential mixed-methods design, working with Libyan data and Libyan policymakers, with supporting interview data from other primary care policymakers working across the Middle East and North Africa region. METHOD We used the Primary Health Care Performance Initiative framework to structure our assessment. Review of policy documents and secondary analysis of WHO and World Bank survey data informed a series of targeted policymaker interviews. We used deductive framework analysis to synthesise our findings. RESULTS We identified 11 key documents and six key policymakers to interview. Libya has strong policy commitments to providing good quality primary care, and a high number of health staff and facilities. Access to services and trust in providers is high. However, a third of facilities are non-operational; there is a marked skew towards axillary and administrative staff; and structural challenges with financing, logistics, and standards has led to highly variable provision of care. CONCLUSION In reforming the primary care system, the government should consolidate leadership, clarify governance structures and systems, and focus on setting national standards for human resources for health, facilities, stocks, and clinical care.
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Affiliation(s)
- Luke N Allen
- University of Oxford Centre for Global Primary Care, Oxford, UK.
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