1
|
Belotti L, Maito S, Vesga-Varela AL, de Almeida LY, da Silva MT, Haddad AE, da Costa Palacio D, Bonfim D. Activities of the oral health teams in primary health care: a time-motion study. BMC Health Serv Res 2024; 24:617. [PMID: 38730416 PMCID: PMC11088098 DOI: 10.1186/s12913-024-11053-5] [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: 01/15/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Efficient planning of the oral health workforce in Primary Health Care (PHC) is paramount to ensure equitable community access to services. This requires a meticulous examination of the population's needs, strategic distribution of oral health professionals, and effective human resource management. In this context, the average time spent on care to meet the needs of users/families/communities is the central variable in healthcare professional workforce planning methods. However, many time measures are solely based on professional judgment or experience. OBJECTIVE Calculate the average time parameters for the activities carried out by the oral health team in primary health care. METHOD This is a descriptive observational study using the time-motion method carried out in five Primary Health Care Units in the city of São Paulo, SP, Brazil. Direct and continuous observation of oral health team members occurred for 40 h spread over five days of a typical work week. RESULTS A total of 696.05 h of observation were conducted with 12 Dentists, three Oral Health Assistants, and five Oral Health Technicians. The Dentists' main activity was consultation with an average duration of 24.39 min, which took up 42.36% of their working time, followed by documentation with 12.15%. Oral Health Assistants spent 31.57% of their time on infection control, while Oral Health Technicians spent 22.37% on documentation. CONCLUSION The study establishes time standards for the activities performed by the dental care team and provides support for the application of workforce planning methods that allow for review and optimization of the work process and public policies.
Collapse
Affiliation(s)
- Lorrayne Belotti
- Albert Einstein Center for Studies, Research, and Practices in Primary Health Care and Networks, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil.
| | - Sofia Maito
- Albert Einstein Center for Studies, Research, and Practices in Primary Health Care and Networks, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Andrea Liliana Vesga-Varela
- Albert Einstein Center for Studies, Research, and Practices in Primary Health Care and Networks, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Leticia Yamawaka de Almeida
- Albert Einstein Center for Studies, Research, and Practices in Primary Health Care and Networks, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Maira Tamires da Silva
- Albert Einstein Center for Studies, Research, and Practices in Primary Health Care and Networks, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | | | - Danielle da Costa Palacio
- Albert Einstein Center for Studies, Research, and Practices in Primary Health Care and Networks, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| | - Daiana Bonfim
- Albert Einstein Center for Studies, Research, and Practices in Primary Health Care and Networks, Hospital Israelita Albert Einstein, Sao Paulo, SP, Brazil
| |
Collapse
|
2
|
Klinkner G, Bak L, Clements JN, Gonzales EH. Development of Quality Measures for Inpatient Diabetes Care and Education Specialists: A Call to Action. J Healthc Qual 2023; 45:297-307. [PMID: 37428949 DOI: 10.1097/jhq.0000000000000397] [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: 07/12/2023]
Abstract
ABSTRACT Diabetes and hyperglycemia are associated with an increased risk of in-hospital complications that lead to longer lengths of stay, increased morbidity, higher mortality, and risk of readmission. Diabetes care and education specialists (DCESs) working in hospital settings are uniquely prepared and credentialed to serve as content experts to facilitate change and implement processes and programs to improve glycemic-related outcomes. A recent survey of DCESs explored the topic of productivity and clinical metrics. Outcomes highlighted the need to better evaluate the impact and value of inpatient DCESs, advocate for the role, and to expand diabetes care and education teams to optimize outcomes. The purpose of this article was to recommend strategies and metrics that can be used to quantify the work of inpatient DCESs and describe how such metrics can help to show the value of the inpatient DCES and assist in making a business case for the role.
Collapse
|
3
|
Granja M, Alves L, Correia S. Access to General Practitioners during the COVID-19 pandemic in Portugal-A survey study of patient experiences in an urban setting. PLoS One 2023; 18:e0285899. [PMID: 37220164 DOI: 10.1371/journal.pone.0285899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/14/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND In 2020, Portugal had high levels of unmet health care needs. Primary Care was reported as the main source of unmet needs. OBJECTIVES To describe face-to-face and remote access to GPs in Portugal during the COVID-19 pandemic. To discover patient experiences and attitudes to access to care. To identify determinants of access to care. METHODS A survey of a random sample of 4,286 adults registered in a group of Family Practices was conducted in 2021. Paper questionnaires were sent by post to patients who had no e-mail address registered with the practice. Patients with an e-mail address were sent a link to an online questionnaire. Outcomes were reported waiting times for face-to-face and remote contacts with GPs, dichotomized to ascertain compliance with standards. Associations between participant characteristics and outcome variables were tested using logistic regression. RESULTS Waiting times for face-to-face consultations with GPs during the pandemic often exceeded the maximum waiting times (MWT) set by the National Health Service. Remote contacts were mostly conducted within acceptable standards. Waiting times for speaking with the GP over the phone were rated as 'poor' by 40% and 27% reported requests for these calls as unmet. The odds of getting care over MWT increased for participants who reported poorer digital skills. Participants were less likely to get non-urgent consultations over MWT if they found it easy to use the online patient portal to book appointments (odds ratio 0.24; 99% confidence intervals 0.09-0.61), request prescriptions (0.18; 0.04-0.74) or insert personal data (0.18; 0.04-0.95). CONCLUSION Patient reported access to GPs during the pandemic was uneven in Portugal. Obtaining non-urgent consultations and remote contacts over MWT affected mainly those patients with poor digital skills. Telephone access to GPs received the worse ratings. Access through traditional pathways must remain available, to prevent the widening of inequities.
Collapse
Affiliation(s)
- Mónica Granja
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Universidade do Porto, Porto, Portugal
| | - Luís Alves
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Universidade do Porto, Porto, Portugal
| | - Sofia Correia
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional, Universidade do Porto, Porto, Portugal
| |
Collapse
|
4
|
Granja M, Correia S, Alves L. Access to General Practitioners during the second year of the COVID-19 pandemic in Portugal: a nationwide survey of doctors. BMC PRIMARY CARE 2023; 24:46. [PMID: 36782109 PMCID: PMC9924884 DOI: 10.1186/s12875-023-01994-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The Portuguese National Health System (NHS) provides universal coverage and near-free health care, but the population has high out-of-pocket expenses and unmet care needs. This suggests impaired accessibility, a key dimension of primary care. The COVID-19 pandemic has further affected access to health care. Understanding General Practitioners' (GP) experiences during the pandemic is necessary to reconfigure post-pandemic service delivery and to plan for future emergencies. This study aimed to assess accessibility to GPs, from their perspective, evaluating determinants of accessibility during the second pandemic year in Portugal. METHODS All GPs working in NHS Family Practices in continental Portugal were invited to participate in a survey in 2021. A structured online self-administered anonymous questionnaire was used. Accessibility was assessed through waiting times for consultations and remote contacts and provision of remote access. NHS standards were used to assess waiting times. Descriptive statistics were used to characterize the study sample. Associations between categorical variables were tested using the χ2 statistic and the Student t-test was used to compare means of continuous variables. RESULTS A total of 420 GPs were included (7% of the target population). Median weekly working hours was 49.0 h (interquartile range 42.0-56.8), although only 14% reported a contracted weekly schedule over 40 h. Access to in-person consultations and remote contacts was reported by most GPs to occur within NHS time standards. Younger GPs more often reported waiting times over these standards. Most GPs considered that they do not have enough time for non-urgent consultations or for remote contacts with patients. CONCLUSIONS Most GPs reported compliance with standards for waiting times for most in-person consultations and remote contacts, but they do so at the expense of work overload. A persistent excess of regular and unpaid working hours by GPs needs confirmation. If unpaid overtime is necessary to meet the regular demands of work, then workload and specific allocated tasks warrant review. Future research should focus on younger GPs, as they seem vulnerable to restricted accessibility. GPs' preferences for more in-person care than was feasible during the pandemic must be considered when planning for the post-pandemic reconfiguration of service delivery.
Collapse
Affiliation(s)
- Mónica Granja
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal.
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal.
| | - Sofia Correia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
| | - Luís Alves
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
| |
Collapse
|
5
|
Abstract
Aim: To compare the competencies of primary care physicians (PCPs) with poor and good prescribing performance in frequently encountered indications. Background: Primary care centers are one of the mostly visited health facilities by the population for different health issues. Methods: In this cross-sectional study, we analyzed 6 125 487 prescriptions generated by 1431 PCPs which were selected by systematic sampling in 2016 in Istanbul. We defined PCPs as poor prescriber (n = 227) or good prescriber (n = 210) in terms of their prescribing performance per WHO/INRUD criteria. We compared solo diagnosis prescriptions of these two groups in ‘percentage of prescriptions in compliance with clinical guidelines’ and also rational prescribing indicators. Findings: Poor prescribers and good prescribers significantly differed in each of the prescribing indicators for their all solo diagnosis prescriptions. Hypertension had the highest difference of the average cost per encounter (Δ = 284.2%) between poor prescribers (US$43.99 ± 63.05) and good prescribers (US$11.45 ± 45.0), whereas headache had the highest difference between the groups in the percentage encounters with an antibiotic (14.9% vs. 1.5%). Detailed analysis of the prescribing performances showed significantly higher values of each WHO/INRUD indicators for all examined diagnoses. We found significantly higher percentages of guideline-compliant drugs in good prescribers compared to that in poor prescribers in hypertension (40.8% vs 34.8%), tonsillopharyngitis (57.9% vs 50.7%), and acute sinusitis (46.4% vs 43.6%). Conclusion: This study shows that the prescribing performances of PCPs are not rational enough in terms of drug selection and prescription content. Furthermore, even the physicians who have good prescribing practice appear as not satisfactorily rational in compliance with current pharmacotherapy competencies.
Collapse
|
6
|
Stobbe EJ, Groenewegen PP, Schäfer W. Job satisfaction of general practitioners: a cross-sectional survey in 34 countries. HUMAN RESOURCES FOR HEALTH 2021; 19:57. [PMID: 33906679 PMCID: PMC8077953 DOI: 10.1186/s12960-021-00604-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Job satisfaction of general practitioners (GPs) is important because of the consequences of low satisfaction for GPs, their patients and the health system, such as higher turnover, health problems for the physicians themselves, less satisfied patients, poor clinical outcomes and suboptimal health care delivery. In this study, we aim to explain differences in the job satisfaction of GPs within and between countries. METHODS We performed a secondary analysis of cross-sectional survey data, collected between 2010 and 2012 on 7379 GPs in 34 (mostly European) countries, as well as data on country and health system characteristics from public databases. Job satisfaction is measured through a composite score of six items about self-reported job experience. Operationalisation of the theoretical constructs includes variables, such as the range of services GPs provide, working hours, employment status, and feedback from colleagues. Data were analysed using linear multilevel regression analysis, with countries and GPs as levels. We developed hypotheses on the basis of the Social Production Function Theory, assuming that GPs 'produce' job satisfaction through stimulating work that provides a certain level of comfort, adds to their social status and provides behavioural confirmation. RESULTS Job satisfaction varies between GPs and countries, with high satisfaction in Denmark and Canada (on average 2.97 and 2.77 on a scale from 1-4, respectively) and low job satisfaction in Spain (mean 2.15) and Hungary (mean 2.17). One-third of the total variance is situated on the country level, indicating large differences between countries, and countries with a higher GDP per capita have more satisfied GPs. Health system characteristics are not related to GP job satisfaction. At the GP and practice level, performing technical procedures and providing preventive care, feedback from colleagues, and patient satisfaction are positively related to GP job satisfaction and working more hours is negatively related GP job satisfaction. CONCLUSION Overall and in terms of our theoretical approach, we found that GPs are able to 'produce' work-related well-being through activities and resources related to stimulation, comfort and behavioural confirmation, but not to status.
Collapse
Affiliation(s)
- Emiel J Stobbe
- Nivel - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands
- Trimbos Institute, Da Costakade 45, 3521VS, Utrecht, The Netherlands
| | - Peter P Groenewegen
- Nivel - Netherlands Institute for Health Services Research, PO Box 1568, 3500 BN, Utrecht, The Netherlands.
- Department of Sociology, Department of Human Geography, Utrecht University, Utrecht, The Netherlands.
| | - Willemijn Schäfer
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 633 N. St Clair Street, Chicago, IL, 60611, USA
| |
Collapse
|
7
|
Aguiar J, Ribeiro M, Pedro AR, Martins AP, da Costa FA. Awareness about barriers to medication adherence in cardiovascular patients and strategies used in clinical practice by Portuguese clinicians: a nationwide study. Int J Clin Pharm 2020; 43:629-636. [PMID: 33104948 DOI: 10.1007/s11096-020-01174-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although much is known about cardiovascular patients' medication adherence, the extent to which clinicians perceive non-adherence as a barrier in clinical practice is little explored. Objective To evaluate knowledge and awareness about potential barriers to medication adherence, and to evaluate strategies used in clinical practice by Portuguese clinicians on how to foster medication adherence of patients undergoing secondary cardiovascular prevention. Setting Nominal Group Technique (NGT) at the University of Lisbon; online survey addressed to physicians working in primary and secondary care in Portugal. Method A narrative literature review was conducted in Pubmed to identify studies describing interventions targeted at physicians to manage medication adherence. The NGT included 12 allied healthcare professionals with recognized expertise in medication adherence and was organised in four phases, resulting in survey development. The survey was used in a cross-sectional national study where clinicians reported their knowledge and perceptions about patients' medication adherence and their daily practice. Main outcome measures Knowledge and awareness about barriers to medication adherence; and practice patterns. Results A total of 296 papers were identified, 26 of which were included. Four main topics were selected to be used in the NGT: adherence determinants, detecting non-adherence, fostering adherence, and educating physicians. NGT resulted in a survey, reaching 451 physicians, mostly practicing in primary care. Most had specific education on medication adherence and considered patient interviews and prescription records the most useful assessment methods. Nonetheless, many recognised often using clinical judgement to evaluate adherence in practice. Barriers to medication adherence were perceived to occur often during implementation. Most perceived reasons for uncontrolled hypertension were non-adherence to lifestyle recommendations and to medication. Less than half the physicians asked their patients if medication was taken. More useful enabling strategies included reducing daily doses, reviewing therapeutic options and motivational interventions. Conclusions Clinicians seem well informed about the importance of medication adherence and aware of problems encountered in practice. Limited time during medical appointment may be a barrier for better patient support.
Collapse
Affiliation(s)
- João Aguiar
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal
| | - Manuel Ribeiro
- Environmental and Natural Resources Center (CERENA), University of Lisbon, Higher Technical Institute, Lisbon, Portugal
| | - Ana Rita Pedro
- National School of Public Health, Nova University of Lisbon, Research Group in Health Policy and Administration, Lisbon, Portugal
| | | | - Filipa Alves da Costa
- Research Institute for Medicines (iMED.ULisboa), Faculty of Pharmacy, University of Lisbon, Lisbon, Portugal. .,Interdisciplinary Research Center Egas Moniz (CiiEM), University Institute Egas Moniz (IUEM), Campus Universitário, Quinta da Granja, Monte da Caparica, 2829-511, Caparica, Portugal.
| |
Collapse
|
8
|
Schäfer WLA, van den Berg MJ, Groenewegen PP. The association between the workload of general practitioners and patient experiences with care: results of a cross-sectional study in 33 countries. HUMAN RESOURCES FOR HEALTH 2020; 18:76. [PMID: 33066776 PMCID: PMC7565810 DOI: 10.1186/s12960-020-00520-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The workload of general practitioners (GPs) and dissatisfaction with work have been increasing in various Western countries over the past decades. In this study, we evaluate the relation between the workload of GPs and patients' experiences with care. METHODS We collected data through a cross-sectional survey among 7031 GPs and 67,873 patients in 33 countries. Dependent variables are the patient experiences on doctor-patient communication, accessibility, continuity, and comprehensiveness of care. Independent variables concern the workload measured as the GP-reported work hours per week, average consultation times, job satisfaction (an indicator of subjective workload), and the difference between the workload measures of every GP and the average in their own country. Finally, we evaluated interaction effects between workload measures and what patients find important in a country and the presence of a patient-list system. Relationships were determined through multilevel regression models. RESULTS Patients of GPs who are happier with their work were found to experience better communication, continuity, access, and comprehensiveness. When GPs are more satisfied compared to others in their country, patients also experience better quality. When GPs work more hours per week, patients also experience better quality of care, but not in the area of accessibility. A longer consultation time, also when compared to the national average, is only related to more comprehensive care. There are no differences in the relationships between countries with and without a patient list system and in countries where patients find the different quality aspects more important. CONCLUSIONS Patients experience better care when their GP has more work hours, longer consultation times, and especially, a higher job satisfaction.
Collapse
Affiliation(s)
- Willemijn L. A. Schäfer
- Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611 USA
| | | | - Peter P. Groenewegen
- NIVEL, the Netherlands Institute for Health Services Research, Utrecht, The Netherlands
- Department of Human Geography, Utrecht University, Utrecht, The Netherlands
- Department of Sociology, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
9
|
Morken T, Rebnord IK, Maartmann-Moe K, Hunskaar S. Workload in Norwegian general practice 2018 - an observational study. BMC Health Serv Res 2019; 19:434. [PMID: 31253160 PMCID: PMC6599272 DOI: 10.1186/s12913-019-4283-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/19/2019] [Indexed: 11/21/2022] Open
Abstract
Background Rising workload in general practice has been a recent cause for concern in several countries; this is also the case in Norway. Long working hours and heavy workload seem to affect recruitment and retention of regular general practitioners (RGPs). We investigated Norwegian RGPs’ workload in terms of time used on patient-related office work, administrative work, municipality tasks and other professional activities in relation to RGPs, and gender, age, employment status and size of municipality. Methods In early 2018, an electronic survey was sent to all 4716 RGPs in Norway. In addition to demographic background, the RGP reported minutes per day used on various tasks in the RGP practice prospectively during 1 week. Working time also included additional tasks in the municipality, other professional work and on out-of-hours primary health care. Differences were analysed by chi square test, independent t-tests, and one-way ANOVA. Results Among 1876 RGPs (39.8%), the mean total working hours per week was 55.6, while the mean for regular number of working hours was 49.0 h weekly. Men worked 1.5 h more than women (49.7 vs. 48.2 h, p = 0.010). Self-employed RGPs work more than salaried RGPs (49.3 vs. 42.5 h, p < 0.001), and RGPs age 55–64 years worked more than RGPs at age 30–39 (51.1 vs. 47.3 h, p < 0.001). 54.1% of the regular working hours was used on face-to-face patient work. Conclusions Norwegian RGPs have long working hours compared to recommended regular working hours in Norway, with small gender differences. Only half of the working time is used on face-to-face consultations. There seems to be a trend of increasing workload among Norwegian GPs, at the cost of direct patient contact. Further research should address identifying factors that can reduce long working hours. Electronic supplementary material The online version of this article (10.1186/s12913-019-4283-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tone Morken
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, NO-5018, Bergen, Norway.
| | - Ingrid Keilegavlen Rebnord
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, NO-5018, Bergen, Norway
| | | | - Steinar Hunskaar
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Kalfarveien 31, NO-5018, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| |
Collapse
|
10
|
Jakob J, Cohidon C, Cornuz J, Selby K. Participation in medical activities beyond standard consultations by Swiss general practitioners: a cross-sectional study. BMC FAMILY PRACTICE 2018; 19:52. [PMID: 29724171 PMCID: PMC5934800 DOI: 10.1186/s12875-018-0738-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Accepted: 04/18/2018] [Indexed: 11/21/2022]
Abstract
Background Few data exist to support the observation that general practitioners (GPs) occupy many important positions in our communities or to characterize which GPs devote more of their time to such activities. We sought to characterize community-based complementary medical activities performed by GPs in the canton Vaud, Switzerland. Methods All GPs in a region were invited to participate in a cross-sectional study (n = 600) examining engagement in complementary activities beyond standard ambulatory consultations. Categories included teaching, care giving in specific structures, roles as medical experts or company doctors, community care giving, and others completed by the GP. GPs were asked the number of hours devoted monthly to each activity and whether or not they are remunerated for this work. Results One hundred and sixty-eight GPs responded (28%), with 149 (92%) reporting that they were engaged in at least one activity beyond their in-office consultations, including 117 (72%) in community care-giving (ex: care for addictions or refugees). Altogether, GPs spend on average 5.8 h a week on these activities. One-hundred and twenty-three GPs (82%) were remunerated for at least one of their complementary engagements. Predictors of participation in a larger number of complementary activities were working in a rural area (IRR 1.29, 95% CI 1.05 to 1.57) and having a higher weekly workload (IRR 1.01 for each additional hour, 95% CI 1.01 to 1.02). Conclusion The vast majority of GPs engage in activities beyond their standard clinic tasks and they are typically reimbursed. GPs in rural areas and those who work more hours per week are more likely to engage in complementary activities. Electronic supplementary material The online version of this article (10.1186/s12875-018-0738-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Julian Jakob
- Department of Ambulatory Care and Community Medicine, Lausanne University, Rue du Bugnon 44, 1011, Lausanne, Switzerland. .,Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland. .,Policlinique Médicale Universitaire, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland.
| | - Christine Cohidon
- Department of Ambulatory Care and Community Medicine, Lausanne University, Rue du Bugnon 44, 1011, Lausanne, Switzerland.,Institute of Family Medicine, Department of ambulatory care and community medicine, University of Lausanne, Lausanne, Switzerland
| | - Jacques Cornuz
- Department of Ambulatory Care and Community Medicine, Lausanne University, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - Kevin Selby
- Department of Ambulatory Care and Community Medicine, Lausanne University, Rue du Bugnon 44, 1011, Lausanne, Switzerland.,Kaiser Permanente Division of Research, 2000 Broadway, Oakland, USA
| |
Collapse
|
11
|
Perelman J, Chaves P, Gago J, Leuschner A, Lourenço A, Mestre R, Pisco L, Paixão I, de Carvalho Á, Caldas de Almeida J. Sistema português de saúde mental: avaliação crítica do modelo de pagamento aos prestadores. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2018. [DOI: 10.1159/000486052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
12
|
Irving G, Neves AL, Dambha-Miller H, Oishi A, Tagashira H, Verho A, Holden J. International variations in primary care physician consultation time: a systematic review of 67 countries. BMJ Open 2017; 7:e017902. [PMID: 29118053 PMCID: PMC5695512 DOI: 10.1136/bmjopen-2017-017902] [Citation(s) in RCA: 364] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To describe the average primary care physician consultation length in economically developed and low-income/middle-income countries, and to examine the relationship between consultation length and organisational-level economic, and health outcomes. DESIGN AND OUTCOME MEASURES This is a systematic review of published and grey literature in English, Chinese, Japanese, Spanish, Portuguese and Russian languages from 1946 to 2016, for articles reporting on primary care physician consultation lengths. Data were extracted and analysed for quality, and linear regression models were constructed to examine the relationship between consultation length and health service outcomes. RESULTS One hundred and seventy nine studies were identified from 111 publications covering 28 570 712 consultations in 67 countries. Average consultation length differed across the world, ranging from 48 s in Bangladesh to 22.5 min in Sweden. We found that 18 countries representing about 50% of the global population spend 5 min or less with their primary care physicians. We also found significant associations between consultation length and healthcare spending per capita, admissions to hospital with ambulatory sensitive conditions such as diabetes, primary care physician density, physician efficiency and physician satisfaction. CONCLUSION There are international variations in consultation length, and it is concerning that a large proportion of the global population have only a few minutes with their primary care physicians. Such a short consultation length is likely to adversely affect patient healthcare and physician workload and stress.
Collapse
Affiliation(s)
- Greg Irving
- Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Ana Luisa Neves
- Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), University of Porto, Porto, Portugal
- Centre for Health Policy, Institute Global Health Innovation, Imperial College London, London, UK
| | - Hajira Dambha-Miller
- Primary Care Unit, University of Cambridge, Cambridge, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford
| | - Ai Oishi
- The Usher Institute of Population Health and Informatics, University of Edinburgh, Edinburgh, UK
| | | | - Anistasiya Verho
- The University of Helsinki, Finland
- National Institutefor Health and Welfare (THL)
| | | |
Collapse
|
13
|
Laranjo L, Rodolfo I, Pereira AM, de Sá AB. Characteristics of Innovators Adopting a National Personal Health Record in Portugal: Cross-Sectional Study. JMIR Med Inform 2017; 5:e37. [PMID: 29021125 PMCID: PMC5658640 DOI: 10.2196/medinform.7887] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/21/2017] [Accepted: 09/03/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Personal health records (PHRs) are increasingly being deployed worldwide, but their rates of adoption by patients vary widely across countries and health systems. Five main categories of adopters are usually considered when evaluating the diffusion of innovations: innovators, early adopters, early majority, late majority, and laggards. OBJECTIVE We aimed to evaluate adoption of the Portuguese PHR 3 months after its release, as well as characterize the individuals who registered and used the system during that period (the innovators). METHODS We conducted a cross-sectional study. Users and nonusers were defined based on their input, or not, of health-related information into the PHR. Users of the PHR were compared with nonusers regarding demographic and clinical variables. Users were further characterized according to their intensity of information input: single input (one single piece of health-related information recorded) and multiple inputs. Multivariate logistic regression was used to model the probability of being in the multiple inputs group. ArcGis (ESRI, Redlands, CA, USA) was used to create maps of the proportion of PHR registrations by region and district. RESULTS The number of registered individuals was 109,619 (66,408/109,619, 60.58% women; mean age: 44.7 years, standard deviation [SD] 18.1 years). The highest proportion of registrations was observed for those aged between 30 and 39 years (25,810/109,619, 23.55%). Furthermore, 16.88% (18,504/109,619) of registered individuals were considered users and 83.12% (91,115/109,619) nonusers. Among PHR users, 32.18% (5955/18,504) engaged in single input and 67.82% (12,549/18,504) in multiple inputs. Younger individuals and male users had higher odds of engaging in multiple inputs (odds ratio for male individuals 1.32, CI 1.19-1.48). Geographic analysis revealed higher proportions of PHR adoption in urban centers when compared with rural noncoastal districts. CONCLUSIONS Approximately 1% of the country's population registered during the first 3 months of the Portuguese PHR. Registered individuals were more frequently female aged between 30 and 39 years. There is evidence of a geographic gap in the adoption of the Portuguese PHR, with higher proportions of adopters in urban centers than in rural noncoastal districts.
Collapse
Affiliation(s)
- Liliana Laranjo
- Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
- Public Health Research Center (CISP/UNL), Portuguese School of Public Health, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Inês Rodolfo
- NOVA-LINCS - Faculdade de Ciências e Tecnologia, Faculty of Science and Technology, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Ana Marta Pereira
- Faculty of Human and Social Sciences, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Armando Brito de Sá
- Institute of Preventive Medicine, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| |
Collapse
|
14
|
The historical development of the Dutch Sentinel General Practice Network from a paper-based into a digital primary care monitoring system. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0753-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
15
|
Schäfer W, van den Berg M, Groenewegen P. De werkbelasting van huisartsen in internationaal perspectief. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s12445-016-0065-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
16
|
Lynn AM, Shih TC, Hung CH, Lin MH, Hwang SJ, Chen TJ. Characteristics of ambulatory care visits to family medicine specialists in Taiwan: a nationwide analysis. PeerJ 2015; 3:e1145. [PMID: 26290798 PMCID: PMC4540008 DOI: 10.7717/peerj.1145] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/11/2015] [Indexed: 12/20/2022] Open
Abstract
Although family medicine (FM) is the most commonly practiced specialty among all the medical specialties, its practice patterns have seldom been analyzed. Looking at data from Taiwan's National Health Insurance Research Database, the current study analyzed ambulatory visits to FM specialists nationwide. From a sample dataset that randomly sampled one out of every 500 cases among a total of 309,880,000 visits in 2012, it was found that 18.8% (n = 116, 551) of the 619,760 visits in the dataset were made to FM specialists. Most of the FM services were performed by male FM physicians. Elderly patients above 80 years of age accounted for only 7.1% of FM visits. The most frequent diagnoses (22.8%) were associated acute upper respiratory infections (including ICD 460, 465 and 466). Anti-histamine agents were prescribed in 25.6% of FM visits. Hypertension, diabetes and dyslipidemia were the causes of 20.7% of the ambulatory visits made to FM specialists of all types, while those conditions accounted for only 10.6% of visits to FM clinics. The study demonstrated the relatively low proportion of chronic diseases that was managed in FM clinics in Taiwan, and our detailed results could contribute to evidence-based discussions on healthcare policymaking and residency training.
Collapse
Affiliation(s)
- An-Min Lynn
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Chien Shih
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Hao Hung
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Hwai Lin
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| |
Collapse
|
17
|
Sobral D, Rosenbaum M, Figueiredo-Braga M. Computer use in primary care and patient-physician communication. PATIENT EDUCATION AND COUNSELING 2015; 98:S0738-3991(15)30013-6. [PMID: 26215571 DOI: 10.1016/j.pec.2015.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 06/25/2015] [Accepted: 07/05/2015] [Indexed: 02/28/2024]
Abstract
OBJECTIVES This study evaluated how physicians and patients perceive the impact of computer use on clinical communication, and how a patient-centered orientation can influence this impact. METHODS The study followed a descriptive cross-sectional design and included 106 family physicians and 392 patients. An original questionnaire assessed computer use, participants' perspective of its impact, and patient centered strategies. RESULTS Physicians reported spending 42% of consultation time in contact with the computer. A negative impact of computer in patient-physician communication regarding the consultation length, confidentiality, maintaining eye contact, active listening to the patient, and ability to understand the patient was reported by physicians, while patients reported a positive effect for all the items. Physicians considered that the usual computer placement in their consultation room was significantly unfavorable to patient-physician communication. CONCLUSIONS Physicians perceive the impact of computer use on patient-physician communication as negative, while patients have a positive perception of computer use on patient-physician communication. PRACTICE IMPLICATIONS Consultation support can represent a challenge to physicians who recognize its negative impact in patient centered orientation. Medical education programs aiming to enhance specific communication skills and to better integrate computer use in primary care settings are needed.
Collapse
Affiliation(s)
- Dilermando Sobral
- Family Health Unit of Ramalde, Health Centres Grouping of Porto Ocidental, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Medical Psychology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Marcy Rosenbaum
- Department of Family Medicine, University of Iowa Carver College of Medicine, Iowa City, USA
| | - Margarida Figueiredo-Braga
- Department of Clinical Neurosciences and Mental Health, Medical Psychology Unit, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|