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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 DOI: 10.1016/j.aprim.2024.103046] [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: 04/04/2024] [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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Laursen MG, Rahbaek MØ, Jensen SD, Praetorius T. Experiences of young people living with type 1 diabetes in transition to adulthood: The importance of care provider familiarity and support. Scand J Caring Sci 2024; 38:126-135. [PMID: 37726958 DOI: 10.1111/scs.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/03/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND During the developmental transition from childhood to adulthood, young people living with type 1 diabetes (T1D) are more likely to take less care of their chronic disease. Alongside the developmental transition, young people with T1D also experience an organisational transition in which the care responsibility changes from a family-based approach in paediatric care to an individualised approach in adult care. Little is known from the perspective of the young people about what their interactions with the healthcare providers mean during these transitions. AIM The aim of this study is to explore how young people living with T1D experience interactions with their care providers, and what it means for their developmental transition. METHOD Semi-structured interviews with 10 respondents aged 18-20 living with T1D who were recruited from a youth outpatient diabetes clinic in Denmark. Recorded audio data were transcribed and analysed using an interpretative phenomenological analysis approach. RESULTS Young people experience continuity in the relationship with the diabetes nurse from the paediatric clinic and a personal patient-provider relationship with their well-known and new care providers. This creates a feeling of familiarity and contributes to a seamless transition. The young people express that becoming more involved in diabetes treatment increases their willingness to take more responsibility for their own health. They also express that care providers should support them in managing their diabetes and talk about sensitive topics. CONCLUSION Continuity in the relationship with the diabetes nurse makes the transition from paediatric to adult care more satisfying and seamless. To support the developmental transition, care providers should gradually involve young people more in diabetes management and be supportive as they become more independent during the developmental transition.
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Affiliation(s)
| | - Marie Ørts Rahbaek
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Sissel Due Jensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Thim Praetorius
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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Fleury MJ, Rochette L, Gentil L, Grenier G, Lesage A. Predictors of Physician Follow-Up Care Among Patients Affected by an Incident Mental Disorder Episode in Quebec (Canada). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:100-115. [PMID: 37357714 PMCID: PMC10789227 DOI: 10.1177/07067437231182570] [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: 06/27/2023]
Abstract
OBJECTIVES This study identified predictors of prompt (1+ outpatient physician consultations/within 30 days), adequate (3+/90 days) and continuous (5+/365 days) follow-up care from general practitioners (GPs) or psychiatrists among patients with an incident mental disorder (MD) episode. METHODS Study data were extracted from the Quebec Integrated Chronic Disease Surveillance System (QICDSS), which covers 98% of the population eligible for health-care services under the Quebec (Canada) Health Insurance Plan. This observational epidemiological study investigating the QICDSS from 1 April 1997 to 31 March 2020, is based on a 23-year patient cohort including 12+ years old patients with an incident MD episode (n = 2,670,133). Risk ratios were calculated using Robust Poisson regressions to measure patient sociodemographic and clinical characteristics, and prior service use, which predicted patients being more or less likely to receive prompt, adequate, or continuous follow-up care after their last incident MD episode, controlling for previous MD episodes, co-occurring disorders, and years of entry into the cohort. RESULTS A minority of patients, and fewer over time, received physician follow-up care after an incident MD episode. Women; patients aged 18-64; with depressive or bipolar disorders, co-occurring MDs-substance-related disorders (SRDs) or physical illnesses; those receiving previous GP follow-up care, especially in family medicine groups; patients with higher prior continuity of GP care; and previous high users of emergency departments were more likely to receive follow-up care. Patients living outside the Montreal metropolitan area; those without prior MDs; patients with anxiety, attention deficit hyperactivity, personality, schizophrenia and other psychotic disorders, or SRDs were less likely to receive follow-up care. CONCLUSION This study shows that vulnerable patients with complex clinical characteristics and those with better previous GP care were more likely to receive prompt, adequate or continuous follow-up care after an incident MD episode. Overall, physician follow-up care should be greatly improved.
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Affiliation(s)
- Marie-Josée Fleury
- Douglas Hospital Research Centre, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Louis Rochette
- Institut National de Santé Publique du Québec, Quebec City, QC, Canada
| | - Lia Gentil
- Douglas Hospital Research Centre, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Montreal, QC, Canada
| | - Alain Lesage
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Département de Psychiatrie, Université de Montréal, Montréal, QC, Canada
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Kasanagottu K, Mukamal KJ, Landon BE. Predictors of treatment intensification in uncontrolled hypertension. J Hypertens 2024; 42:283-291. [PMID: 37889569 DOI: 10.1097/hjh.0000000000003598] [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: 10/28/2023]
Abstract
PURPOSE Prior studies have shown that treatment intensification for patients presenting with uncontrolled hypertension (HTN) rarely occurs, even during visits to the patient's own primary care physicians (PCPs). In this article, we identified predictors of treatment intensification for uncontrolled HTN. METHODS We conducted a cross-sectional study using nationally representative survey data on visits by patients aged 18 or above with uncontrolled HTN, defined as a recorded SBP at least 140 and/or a DBP at least 90 using data from the National Ambulatory Medical Care Survey (NAMCS) 2008-2018. Our outcome is treatment intensification defined as the addition of a new blood pressure medication. RESULTS We analyzed 22 559 visits to PCPs where uncontrolled HTN was noted, representing 801 023 786 visits nationally. Among these encounters, 2138 (10.3%) of the visits resulted in treatment intensification. Visits with the patient's own PCP had higher rates of treatment intensification than visits to another PCP (10.8 vs. 5.9%, P < 0.0001). Visits for patients previously on antihypertensive medications had lower rates of treatment intensification (11% for no medications, 10.4% for one medication, 6.6% for ≥2 medications, P < 0.0001), but there were no statistically significant differences in rates of intensification for those with relevant comorbidities (9.4% for no chronic conditions, 10.8% for one to two chronic conditions, 8.9% for at least three chronic conditions, P = 0.12). Multivariable adjusted results were similar to the unadjusted findings. CONCLUSION Visits for patients with uncontrolled HTN rarely result in treatment intensification. Substantial opportunity exists to improve management of HTN, particularly for patients on fewer medications or seen by a covering provider.
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Affiliation(s)
- Koushik Kasanagottu
- Division of General Medicine, Beth Israel Deaconess Medical Center, Brookline
- Department of Medicine
| | - Kenneth J Mukamal
- Division of General Medicine, Beth Israel Deaconess Medical Center, Brookline
- Department of Medicine
| | - Bruce E Landon
- Division of General Medicine, Beth Israel Deaconess Medical Center, Brookline
- Department of Healthcare Policy, Harvard Medical School, Boston, Massachusetts, USA
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Butler DC, Larkins S, Jorm L, Korda RJ. Does use of GP and specialist services vary across areas and according to individual socioeconomic position? A multilevel analysis using linked data in Australia. BMJ Open 2024; 14:e074624. [PMID: 38184309 PMCID: PMC10773367 DOI: 10.1136/bmjopen-2023-074624] [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: 04/12/2023] [Accepted: 12/07/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE Timely access to primary care and supporting specialist care relative to need is essential for health equity. However, use of services can vary according to an individual's socioeconomic circumstances or where they live. This study aimed to quantify individual socioeconomic variation in general practitioner (GP) and specialist use in New South Wales (NSW), accounting for area-level variation in use. DESIGN Outcomes were GP use and quality-of-care and specialist use. Multilevel logistic regression was used to estimate: (1) median ORs (MORs) to quantify small area variation in outcomes, which gives the median increased risk of moving to an area of higher risk of an outcome, and (2) ORs to quantify associations between outcomes and individual education level, our main exposure variable. Analyses were adjusted for individual sociodemographic and health characteristics and performed separately by remoteness categories. SETTING Baseline data (2006-2009) from the 45 and Up Study, NSW, Australia, linked to Medicare Benefits Schedule and death data (to December 2012). PARTICIPANTS 267 153 adults aged 45 years and older. RESULTS GP (MOR=1.32-1.35) and specialist use (1.16-1.18) varied between areas, accounting for individual characteristics. For a given level of need and accounting for area variation, low education-level individuals were more likely to be frequent users of GP services (no school certificate vs university, OR=1.63-1.91, depending on remoteness category) and have continuity of care (OR=1.14-1.24), but were less likely to see a specialist (OR=0.85-0.95). CONCLUSION GP and specialist use varied across small areas in NSW, independent of individual characteristics. Use of GP care was equitable, but specialist care was not. Failure to address inequitable specialist use may undermine equity gains within the primary care system. Policies should also focus on local variation.
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Affiliation(s)
- Danielle C Butler
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Rosemary J Korda
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
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Almalki ZS, Alahmari AK, Alajlan SAA, Alqahtani A, Alshehri AM, Alghamdi SA, Alanezi AA, Alawaji BK, Alanazi TA, Almutairi RA, Aldosari S, Ahmed N. Continuity of care in primary healthcare settings among patients with chronic diseases in Saudi Arabia. SAGE Open Med 2023; 11:20503121231208648. [PMID: 37915839 PMCID: PMC10617268 DOI: 10.1177/20503121231208648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Maintaining continuity of care is one of the most critical components of providing great care in primary health care. This study aimed to explore continuity of care and its predictors in primary healthcare settings among patients with chronic diseases in Saudi Arabia. Method Face-to-face cross-sectional interviews were conducted with patients with chronic diseases who had at least four visits to primary care facilities in Riyadh, Saudi Arabia, between November 1, 2022 and March 3, 2023. We determined patients' continuity of care levels using the Bice-Boxerman continuity of care index. A Tobit regression model was used to determine the effects of several factors on the continuity of care index. Results The interviews were conducted with 193 respondents with chronic diseases of interest. The mean continuity of care index of the entire sample was 0.54. Those with asthma had the highest median continuity of care index at 0.75 (interquartile range, 0.62-0.75), whereas those diagnosed with thyroid disease had a much lower continuity of care index (0.47) (interquartile range, 0.3-0.62). Tobit regression model findings showed that employed respondents with poorer general health had a negative effect on continuity of care index levels. By contrast, a higher continuity of care index was significantly associated with elderly respondents, urban residents, and those diagnosed with dyslipidemia, diabetes, hypertension, or asthma. Conclusions According to our findings, the continuity of care level in Saudi Arabia's primary healthcare setting is low. The data demonstrate how continuity of care varies among study group characteristics and that improving continuity of care among chronic disease patients in Saudi Arabia is multifaceted and challenging, necessitating a coordinated and integrated healthcare delivery approach.
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Affiliation(s)
- Ziyad S Almalki
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Abdullah K Alahmari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | | | - Abdulhadi Alqahtani
- Clinical Research Specialist, Clinical Research Department, Research Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Ahmed M Alshehri
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Saleh A Alghamdi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Adel A Alanezi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Basil K Alawaji
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Tareq A Alanazi
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Rawan A Almutairi
- Collage of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Saad Aldosari
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
| | - Nehad Ahmed
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Riyadh, Saudi Arabia
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Butler DC, Larkins S, Korda RJ. Association of individual-socioeconomic variation in quality-of-primary care with area-level service organisation: A multilevel analysis using linked data. J Eval Clin Pract 2023; 29:984-997. [PMID: 36894510 PMCID: PMC10946916 DOI: 10.1111/jep.13834] [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: 10/17/2022] [Revised: 02/11/2023] [Accepted: 02/17/2023] [Indexed: 03/11/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Ensuring equitable access to primary care (PC) contributes to reducing differences in health related to people's socioeconomic circumstances. However, there is limited data on system-level factors associated with equitable access to high-quality PC. We examine whether individual-level socioeconomic variation in general practitioner (GP) quality-of-care varies by area-level organisation of PC services. METHODS Baseline data (2006-2009) from the Sax Institute's 45 and Up Study, involving 267,153 adults in New South Wales, Australia, were linked to Medicare Benefits Schedule claims and death data (to December 2012). Small area-level measures of PC service organisation were GPs per capita, bulk-billing (i.e., no copayment) rates, out-of-pocket costs (OPCs), rates of after-hours and chronic disease care planning/coordination services. Using multilevel logistic regression with cross-level interaction terms we quantified the relationship between area-level PC service characteristics and individual-level socioeconomic variation in need-adjusted quality-of-care (continuity-of-care, long-consultations, and care planning), separately by remoteness. RESULTS In major cities, more bulk-billing and chronic disease services and fewer OPCs within areas were associated with an increased odds of continuity-of-care-more so among people of high- than low education (e.g., bulk-billing interaction with university vs. no school certificate 1.006 [1.000, 1.011]). While more bulk-billing, after-hours services and fewer OPCs were associated with long consultations and care planning across all education levels, in regional locations alone, more after-hours services were associated with larger increases in the odds of long consultations among people with low- than high education (0.970 [0.951, 0.989]). Area GP availability was not associated with outcomes. CONCLUSIONS In major cities, PC initiatives at the local level, such as bulk-billing and after-hours access, were not associated with a relative benefit for low- compared with high-education individuals. In regional locations, policies supporting after-hours access may improve access to long consultations, more so for people with low- compared with high-education.
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Affiliation(s)
- Danielle C. Butler
- National Centre for Epidemiology and Population HealthThe Australian National UniversityCanberraAustralia
| | - Sarah Larkins
- College of Medicine and DentistryJames Cook UniversityTownsvilleAustralia
| | - Rosemary J Korda
- National Centre for Epidemiology and Population HealthThe Australian National UniversityCanberraAustralia
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Wang W, Zhang J, Lu J, Wei X. Patient views of the good doctor in primary care: a qualitative study in six provinces in China. Glob Health Res Policy 2023; 8:24. [PMID: 37434267 DOI: 10.1186/s41256-023-00309-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 06/07/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND China has been striving to train primary care doctors capable of delivering high-quality service through general practitioner training programs and family doctor team reforms, but these initiatives have not adequately met patient needs and expectations. In order to guide further reform efforts to better meet patient expectations, this study generates a profile of the good doctor in primary care from the patient perspective. METHODS Semi-structured interviews were conducted in six provinces (Shandong, Zhejiang, Henan, Shaanxi, Shanxi, Heilongjiang) in China. A total of 58 interviewees completed the recorded interviews. Tape-based analysis was used to produce narrative summaries. Trained research assistants listened to the recordings of the interviews and summarized them by 30-s segments. Thematic analysis was performed on narrative summaries to identify thematic families. RESULTS Five domains and 18 attributes were generated from the analysis of the interview data. The domains of the good doctor in primary care from the patient perspective were: strong Clinical Competency (mentioned by 97% of participants) and Professionalism & Humanism (mentioned by 93% of participants) during service delivery, followed by Service Provision and Information Communication (mentioned by 74% and 62% of participants, respectively). Moreover, Chinese patients expect that primary care doctors have high educational attainment and a good personality (mentioned by 41% of participants). CONCLUSIONS This five-domain profile of the good doctor in primary care constitutes a foundation for further primary care workforce capacity building. Further primary care reform efforts should reflect the patient views and expectations, especially in the family physician competency framework and primary care performance assessment system development. Meanwhile, frontline primary care organizations also need to create supportive environments to assist competent doctors practice in primary care, especially through facilitating the learning of primary care doctors and improving their well-being.
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Affiliation(s)
- Wenhua Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Jinnan Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Jiao Lu
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, People's Republic of China
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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When is caring sharing? Primary care provider interdependence and continuity of care. JAAPA 2023; 36:32-40. [PMID: 36484712 DOI: 10.1097/01.jaa.0000902896.51294.47] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
ABSTRACT Efforts to improve access to high-quality, efficient primary care have highlighted the need for team-based care. Most primary care teams are designed to maintain continuity of care between patients and primary care providers (PCPs), because continuity of care can improve some patient outcomes. However, PCPs are interdependent because they care for, or share, patients. PCP interdependence, and its association with continuity of care, is not well described. This study describes a measure of PCP interdependence. We also evaluate the association between patient and panel characteristics, including PCP interdependence. Our results found that the extent of interdependence between PCPs in the same clinic varies widely. A range of patient and panel characteristics affect continuity of care, including patient complexity and PCP interdependence. These results suggest that continuity of care for complex patients is sensitive to panel characteristics, including PCP interdependence and panel size. This information can be used by primary care organizations for evidence-based team design.
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Kasenda S, Meland E, Hetlevik Ø, Mildestvedt T, Dullie L. Factors associated with self-rated health in primary care in the South-Western health zone of Malawi. BMC PRIMARY CARE 2022; 23:88. [PMID: 35439944 PMCID: PMC9016970 DOI: 10.1186/s12875-022-01686-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 04/04/2022] [Indexed: 11/30/2022]
Abstract
Background Self-rated health (SRH) is a single-item measure of current health, which is often used in community surveys and has been associated with various objective health outcomes. The prevalence and factors associated with SRH in Sub-Saharan Africa remain largely unknown. This study sought to investigate: (1) the prevalence of poor SRH, (2) possible associations between SRH, and socio-demographic and clinical parameters, and (3) associations between SRH and the patients’ assessment of the quality of primary care. Methods A cross-sectional study was conducted in 12 primary care facilities in Blantyre, Neno, and Thyolo districts of Malawi among 962 participants who sought care in these facilities. An interviewer-administered questionnaire containing the Malawian primary care assessment tool, and questions on socio-demographic characteristics and self-rated health was used for data collection. Descriptive statistics were used to determine the distribution of variables of interest and binary logistic regression was used to determine factors associated with poor SRH. Results Poor SRH was associated with female sex, increasing age, decreasing education, frequent health care attendance, and with reported disability. Patients content with the service provided and who reported higher scores of relational continuity from their health care providers reported better SRH as compared with others. Conclusion This study reports findings from a context where SRH is scarcely examined. The prevalence of poor SRH in Malawi is in line with findings from clinical populations in other countries. The associations between poor SRH and socio-demographic factors are also known from other populations. SRH might be improved by emphasizing continuity of care in primary care services.
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Continuity of Care and Healthcare Costs among Patients with Chronic Disease: Evidence from Primary Care Settings in China. Int J Integr Care 2022; 22:4. [PMID: 36310688 PMCID: PMC9562970 DOI: 10.5334/ijic.5994] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Though critical to primary care, continuity of care has rarely been examined in China. This study aims to assess the relationship between continuity of care and healthcare costs among patients with chronic diseases within primary care settings in China. Methods: In this cross-sectional study, we used a social health insurance claims dataset of 1406 patients with hypertension and/or diabetes in Yuhuan City, Zhejiang Province collected in 2017–2019. We measured continuity of care using the Bice-Boxerman Continuity of Care (COC) Index, Herfindahl Index (HI), Sequential Continuity of Care (SECON) Index, Usual Provider of Care (UPC), and a binary variable indicating whether a patient’s UPC was a primary care provider. We examined the associations between continuity of care and healthcare costs in the same period and the subsequent year, using ordinary least squares regression for the outpatient costs and two-part regression for the inpatient costs. Based on the regression coefficients, we predicted costs saved if each continuity measure was set to 1 from the status quo. Results: When optimum continuity were to be achieved, 7.12–27.29% of total outpatient costs and 55.38–73.35% of total inpatient costs could be saved compared to the status quo during the two-year study period. If optimum continuity were to be achieved in the first year, 7.47%–21.78% of total outpatient costs and 8.84–40.22% of total inpatient costs could be saved in the second-year. Conclusions: Care continuity indicators were consistently associated with reduced outpatient costs and hospitalization risks. Future health reform in China should further enhance continuity of care in primary care.
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Espinel-Flores V, Tiburcio-Lara G, Vargas I, Eguiguren P, Mogollón-Pérez AS, Ferreira-de-Medeiros-Mendes M, López-Vázquez J, Bertolotto F, Amarilla D, Vázquez ML. Relational Continuity of Chronic Patients with Primary and Secondary Care Doctors: A Study of Public Healthcare Networks of Six Latin American Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13008. [PMID: 36293587 PMCID: PMC9602030 DOI: 10.3390/ijerph192013008] [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: 09/01/2022] [Revised: 10/05/2022] [Accepted: 10/07/2022] [Indexed: 06/16/2023]
Abstract
Despite relational continuity (RC) with the doctor being key to care quality for chronic patients, particularly in fragmented healthcare systems, like many in Latin America (LA), little is known about RC and its attributes, particularly regarding specialists. Aim: We aim to analyse chronic patients' perceptions of RC with primary (PC) and secondary (SC) care doctors, and record changes between 2015 and 2017 in the public healthcare networks of six LA countries. An analysis of two cross-sectional studies applying the CCAENA questionnaire to chronic patients (N = 4881) was conducted in Argentina, Brazil, Chile, Colombia, Mexico, and Uruguay. The dependent variables of RC with PC and SC doctors were: consistency, trust, effective communication, and synthetic indexes based on RC attributes. Descriptive and multivariate analyses were performed. Although the RC index was high in 2015, especially in PC in all countries, and at both levels in Argentina and Uruguay, low perceived consistency of PC and SC doctors in Colombia and Chile and of SC doctors in Mexico revealed important areas for improvement. In 2017 the RC index of SC doctors increased in Chile and Mexico, while SC doctors' consistency in Colombia decreased. This study reveals important gaps in achieving RC with doctors, particularly in SC, which requires further structural and organisational reforms.
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Affiliation(s)
- Verónica Espinel-Flores
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, ES08022 Barcelona, Spain
| | - Gabriela Tiburcio-Lara
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, ES08022 Barcelona, Spain
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, ES08022 Barcelona, Spain
| | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Universidad de Chile, Independencia 939, Santiago de Chile, Chile
| | - Amparo-Susana Mogollón-Pérez
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Cra 24 No. 63C-69, Quinta Mutis, Bogotá 11001, Colombia
| | - Marina Ferreira-de-Medeiros-Mendes
- Grupo de Estudos de Gestão e Avaliação em Saúde, Instituto de Medicina Integral Professor Fernando Figueira, Rua Dos Coelhos No. 300, Boa Vista, Recife 50070-550, Brazil
| | - Julieta López-Vázquez
- Instituto de Salud Pública, Universidad Veracruzana, Av. Dr. Luis Castelazo Ayala s/n Col. Industrial Ánimas, Xalapa 91190, Mexico
| | - Fernando Bertolotto
- Facultad de Enfermería, Universidad de la República, Avenida 18 de Julio 124, Montevideo 11200, Uruguay
| | - Delia Amarilla
- Maestría en Salud Pública, Centro de Estudios Interdisciplinarios, Universidad Nacional de Rosario, Maipú 1065, Rosario 2000, Argentina
| | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avinguda Tibidabo 21, ES08022 Barcelona, Spain
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Smithman MA, Haggerty J, Gaboury I, Breton M. Improved access to and continuity of primary care after attachment to a family physician: longitudinal cohort study on centralized waiting lists for unattached patients in Quebec, Canada. BMC PRIMARY CARE 2022; 23:238. [PMID: 36114464 PMCID: PMC9482231 DOI: 10.1186/s12875-022-01850-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 09/08/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Having a regular family physician is associated with many benefits. Formal attachment – an administrative patient-family physician agreement – is a popular feature in primary care, intended to improve access to and continuity of care with a family physician. However, little evidence exists about its effectiveness. In Quebec, Canada, where over 20% of the population is unattached, centralized waiting lists help attach patients. This provides a unique opportunity to observe the influence of attachment in previously unattached patients. The aim was to evaluate changes in access to and continuity of primary care associated with attachment to a family physician through Quebec’s centralized waiting lists for unattached patients.
Methods
We conducted an observational longitudinal population cohort study, using medical services billing data from public health insurance in the province of Québec, Canada. We included patients attached through centralized waiting lists for unattached patients between 2012 and 2014 (n = 410,140). Our study was informed by Aday and Andersen’s framework for the study of access to health services. We compared outcomes during four 12-month periods: two periods before and two periods after attachment, with T0–2 years as the reference period. Outcome measures were number of primary care visits and Bice-Boxerman Concentration of Care Index at the physician and practice level (for patients with ≥2 visits in a given period). We included age, sex, region remoteness, medical vulnerability, and Charlson Comorbidity Index as covariates in regression models fitted with generalized estimating equations.
Results
The number of primary care visits increased by 103% in the first post attachment year and 29% in the second year (p < 0.001). The odds of having all primary care visits concentrated with a single physician increased by 53% in the first year and 22% (p < 0.001) in the second year after attachment. At the practice level, the odds of perfect concentration of care increased by 19% (p < 0.001) and 15% (p < 0.001) respectively, in first and second year after attachment.
Conclusion
Our results show an increase in patients’ number of primary care visits and concentration of care at the family physician and practice level after attachment to a family physician. This suggests that attachment may help improve access to and continuity of primary care.
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Kasenda S, Meland E, Hetlevik Ø, Mildestvedt T, Dullie L. Factors associated with self-rated health in primary care in the South-Western health zone of Malawi. BMC PRIMARY CARE 2022; 23:88. [PMID: 35439944 PMCID: PMC9016970 DOI: 10.1186/s12875-022-01686-y#citeas] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Self-rated health (SRH) is a single-item measure of current health, which is often used in community surveys and has been associated with various objective health outcomes. The prevalence and factors associated with SRH in Sub-Saharan Africa remain largely unknown. This study sought to investigate: (1) the prevalence of poor SRH, (2) possible associations between SRH, and socio-demographic and clinical parameters, and (3) associations between SRH and the patients' assessment of the quality of primary care. METHODS A cross-sectional study was conducted in 12 primary care facilities in Blantyre, Neno, and Thyolo districts of Malawi among 962 participants who sought care in these facilities. An interviewer-administered questionnaire containing the Malawian primary care assessment tool, and questions on socio-demographic characteristics and self-rated health was used for data collection. Descriptive statistics were used to determine the distribution of variables of interest and binary logistic regression was used to determine factors associated with poor SRH. RESULTS Poor SRH was associated with female sex, increasing age, decreasing education, frequent health care attendance, and with reported disability. Patients content with the service provided and who reported higher scores of relational continuity from their health care providers reported better SRH as compared with others. CONCLUSION This study reports findings from a context where SRH is scarcely examined. The prevalence of poor SRH in Malawi is in line with findings from clinical populations in other countries. The associations between poor SRH and socio-demographic factors are also known from other populations. SRH might be improved by emphasizing continuity of care in primary care services.
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Affiliation(s)
- Stephen Kasenda
- grid.512477.2Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Eivind Meland
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Øystein Hetlevik
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Thomas Mildestvedt
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway
| | - Luckson Dullie
- grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, 5020 Bergen, Norway ,Partners in health, Neno, Malawi
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Are primary care and continuity of care associated with asthma-related acute outcomes amongst children? A retrospective population-based study. BMC PRIMARY CARE 2022; 23:5. [PMID: 35172739 PMCID: PMC8759282 DOI: 10.1186/s12875-021-01605-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 12/01/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Having a primary care provider and a continuous relationship may be important for asthma outcomes. In this study, we sought to determine the association between 1) having a usual provider of primary care (UPC) and asthma-related emergency department (ED) visits and hospitalization in Québec children with asthma and 2) UPC continuity of care and asthma outcomes. METHODS Population-based retrospective cohort study using Québec provincial health administrative data, including children 2-16 years old with asthma (N = 39, 341). Exposures and outcomes were measured from 2010-2011 and 2012-2013, respectively. Primary exposure was UPC stratified by the main primary care models in Quebec (team-based Family Medicine Groups, family physicians not in Family Medicine Groups, pediatricians, or no assigned UPC). For those with an assigned UPC the secondary exposure was continuity of care, measured by the UPC Index (high, medium, low). Four multivariate logistic regression models examined associations between exposures and outcomes (ED visits and hospitalizations). RESULTS Overall, 17.4% of children had no assigned UPC. Compared to no assigned UPC, having a UPC was associated with decreased asthma-related ED visits (pediatrician Odds Ratio (OR): 0.80, 95% Confidence Interval (CI) [0.73, 0.88]; Family Medicine Groups OR: 0.84, 95% CI [0.75,0.93]; non-Family Medicine Groups OR: 0.92, 95% CI [0.83, 1.02]) and hospital admissions (pediatrician OR: 0.66, 95% CI [0.58, 0.75]; Family Medicine Groups OR: 0.82, 95% CI [0.72, 0.93]; non-Family Medicine Groups OR: 0.76, 95% CI [0.67, 0.87]). Children followed by a pediatrician were more likely to have high continuity of care. Continuity of care was not significantly associated with asthma-related ED visits. Compared to low continuity, medium and high continuity of care decreased asthma-related hospital admissions, but none of these associations were significant. CONCLUSION Having a UPC was associated with reduced asthma-related ED visits and hospital admissions. However, continuity of care was not significantly associated with outcomes. The current study provides ongoing evidence for the importance of primary care in children with asthma.
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Galvao TF, Tiguman GMB, Pereira Nunes B, Correia da Silva AT, Tolentino Silva M. Continuity of Primary Care in the Brazilian Amazon: A Cross-Sectional Population-Based Study. Int J Prev Med 2021; 12:57. [PMID: 34447499 PMCID: PMC8356987 DOI: 10.4103/ijpvm.ijpvm_440_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 09/26/2020] [Indexed: 11/04/2022] Open
Abstract
Background Few studies have evaluated the continuity of primary care in universal health care systems, especially in underserved areas. Methods This was a cross-sectional study with 4,001 adults (≥18 years old) living in the Manaus Metropolitan Region in 2015. Interviews were conducted in households selected with probabilistic sampling. City and neighborhood variables were collected from databanks. Prevalence ratios (PR) of the continuity of care (defined as using a primary care service and having been previously registered in the Family Health Strategy program) and 95% confidence intervals (CIs) were calculated with multilevel Poisson regression analysis. Results A total of 20.6% (95%CI 19.4-21.9%) of the participants reported continuity of primary care. Women (PR = 1.38; 95%CI 1.18-1.61), nonwhite individuals (PR = 1.13; 95%CI 1.05-1.21), and poorer people (PR = 1.55; 95%CI 1.19-2.02) had higher levels of continuity, whereas health insurance holders had lower levels of continuity (PR = 0.46; 95%CI 0.34-0.62). Individuals with continuity of care had more physician consultations (PR = 1.06; 95%CI 1.02-1.10), dentist consultations (PR = 1.16; 95%CI 1.05-1.28), fewer depressive (PR = 0.59; 95%CI 0.44-0.79) and anxiety symptoms (PR = 0.64; 95%CI 0.48-0.85), and a higher quality of life (β = 0.033; 95%CI 0.011-0.054) than those without continuity. Conclusions Continuity of care was attained by two-tenths of the population and the level of continuity was high among socioeconomically disadvantaged people. Good outcomes and health services usage increased with continuity of care.
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Affiliation(s)
- Tais Freire Galvao
- Faculty of Pharmaceutical Sciences, State University of Campinas, Campinas, Brazil
| | | | - Bruno Pereira Nunes
- Department of Nursing in Public Health, Federal University of Pelotas, Pelotas, Brazil
| | - Andrea Tenorio Correia da Silva
- Department of Preventive Medicine, Universidade de São Paulo, São Paulo, Brazil.,Coordinator, Primary Care Research Group, Faculdade de Medicina Santa Marcelina, São Paulo, Brazil
| | - Marcus Tolentino Silva
- Post-Graduation Program of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, Brazil
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Graif C, Meurer J, Fontana M. An Ecological Model to Frame the Delivery of Pediatric Preventive Care. Pediatrics 2021; 148:s13-s20. [PMID: 34210842 PMCID: PMC8312252 DOI: 10.1542/peds.2021-050693d] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
Screening and surveillance are integral aspects of child health promotion and disease prevention. The American Academy of Pediatrics recommends that primary care clinicians screen children and adolescents for a broad array of conditions, conduct surveillance of growth and development, identify social determinants of health, and identify protective and risk factors that might impact health over time. However, access to and outcomes of preventive services vary based on features of children’s social ecology, including family and community contexts. The proposed five-stage socio-ecological model considers multiple contextual dimensions of pediatric screening: (1) individual, (2) interpersonal, (3) organizational, (4) community/population, and (5) public policy. Incorporating this model into routine care might improve outcomes at the individual and population level. Future endeavors should focus on integration of this model with validated risk screening tools as part of a supportive electronic health record, culture, and incentive structure. Further research assessing the contributors and outcomes of differences in beliefs, resources, practices, and opportunities among individuals, families, providers, primary care organizations, communities, health systems, and policy partners will be essential in advancing knowledge and policies to improve preventive services delivery.
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Affiliation(s)
- Corina Graif
- Department of Sociology and Criminology, College of the Liberal Arts and Population Research Institute, Pennsylvania State University, University Park, Pennsylvania
| | - John Meurer
- Division of Community Health, Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Margherita Fontana
- Department of Cariology, Restorative Sciences, and Endodontics, School of Dentistry, University of Michigan, Ann Arbor, Michigan
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Palapar L, Kerse N, Wilkinson-Meyers L, Lumley T, Blom JW. Primary Care Variation in Rates of Unplanned Hospitalizations, Functional Ability, and Quality of Life of Older People. Ann Fam Med 2021; 19:318-331. [PMID: 34264838 PMCID: PMC8282304 DOI: 10.1370/afm.2687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 10/13/2020] [Accepted: 01/04/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To investigate variability in older people's outcomes according to general practitioner (GP) and practice characteristics in New Zealand and the Netherlands. METHODS We used data from 2 primary care-based, cluster-randomized, controlled trials to separately fit mixed models of unplanned admission rates, functional ability, and quality of life (QOL) and examine variation according to GP- and practice-level characteristics after adjusting for participant-level characteristics. For the New Zealand sample (n = 3,755 aged 75+ years in 60 practices), we modeled 36-month unplanned admission rates, Nottingham Extended Activities of Daily Living (NEADL) scale, and QOL domain ratings from the brief version of the World Health Organization Quality of Life assessment tool. For the Netherlands sample (n = 3,141 aged 75+ years in 59 practices), we modeled 12-month unplanned admission rates, Groningen Activity Restriction Scale scores, and EuroQOL 5 dimensions (EQ-5D) summary index. RESULTS None of the GP or practice characteristics were significantly associated with rates of unplanned admissions in the New Zealand sample, but we found greater rates of admission in larger practices (incidence rate ratio [IRR], 1.45; 95% CI, 1.15-1.81) and practices staffed with a practice nurse (IRR, 1.74; 95% CI, 1.20-2.52) in the Netherlands sample. In both samples, differences were consistently small where there were significant associations with function (range, -0.26 to 0.19 NEADL points in the New Zealand sample; no associations in the Netherlands sample) and QOL (range, -1.64 to 0.97 QOL points in New Zealand; -0.01 EQ-5D points in the Netherlands). CONCLUSIONS In the absence of substantial differences in older people's function and QOL, it remains unclear whether intriguing GP- or practice-related variations in admission rates represent low- or high-quality practice.
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Affiliation(s)
- Leah Palapar
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Ngaire Kerse
- Department of General Practice and Primary Health Care, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Laura Wilkinson-Meyers
- Health Systems Section, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Thomas Lumley
- Department of Statistics, Faculty of Science, University of Auckland, Auckland, New Zealand
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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Is continuity of primary care declining in England? Practice-level longitudinal study from 2012 to 2017. Br J Gen Pract 2021; 71:e432-e440. [PMID: 33947666 PMCID: PMC8103927 DOI: 10.3399/bjgp.2020.0935] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/03/2020] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Continuity of care is a core principle of primary care related to improved patient outcomes and reduced healthcare costs. Evidence suggests continuity of care in England is declining. AIM To confirm reports of declining continuity of care, explore differences in decline according to practice characteristics, and examine associations between practice populations or appointment provision and changes in continuity of care. DESIGN AND SETTING Longitudinal design on GP Patient Survey data reported annually in June or July from 2012 to 2017, whereby the unit of analysis was English general practices that existed in 2012. METHOD Linear univariable and bivariable multilevel models were used to determine decline in average annual percentage of patients having a preferred GP and seeing this GP 'usually' according to practicelevel continuity of care, rural/urban location, and deprivation. Associations between percentage of patients having a preferred GP or seeing this GP usually and patients' experiences with the appointment system and practice population characteristics were modelled. RESULTS In 2012, 56.7% of patients had a preferred GP, which had declined by 9.4 percentage points (pp) (95% CI = -9.6 to -9.2) by 2017. Of patients with a preferred GP, 66.4% saw that GP 'usually' in 2012; this had declined by 9.7 pp (95% CI = -10.0 to -9.4) by 2017. This decline was visible in all types of practices, irrespective of baseline continuity, rural/urban location, or level of deprivation. At practice level, an increase over time in the percentage of patients reporting good overall experience of making appointments was associated with an increase in both the percentage of patients having a preferred GP and those able to see that GP 'usually'. CONCLUSION Patients reported a steady decline in continuity of care over time, which should concern clinicians and policymakers. Ability of practices to offer patients a satisfactory appointment system could partly counteract this decline.
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20
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Dambha-Miller H, Day A, Kinmonth AL, Griffin SJ. Primary care experience and remission of type 2 diabetes: a population-based prospective cohort study. Fam Pract 2021; 38:141-146. [PMID: 32918549 PMCID: PMC8006762 DOI: 10.1093/fampra/cmaa086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Remission of Type 2 diabetes is achievable through dietary change and weight loss. In the UK, lifestyle advice and referrals to weight loss programmes predominantly occur in primary care where most Type 2 diabetes is managed. OBJECTIVE To quantify the association between primary care experience and remission of Type 2 diabetes over 5-year follow-up. METHODS A prospective cohort study of adults with Type 2 diabetes registered to 49 general practices in the East of England, UK. Participants were followed-up for 5 years and completed the Consultation and Relational Empathy measure (CARE) on diabetes-specific primary care experiences over the first year after diagnosis of the disease. Remission at 5-year follow-up was measured with HbA1c levels. Univariable and multivariable logistic regression models were constructed to quantify the association between primary care experience and remission of diabetes. RESULTS Of 867 participants, 30% (257) achieved remission of Type 2 diabetes at 5 years. Six hundred twenty-eight had complete data at follow-up and were included in the analysis. Participants who reported higher CARE scores in the 12 months following diagnosis were more likely to achieve remission at 5 years in multivariable models; odds ratio = 1.03 (95% confidence interval = 1.01-1.05, P = 0.01). CONCLUSION Primary care practitioners should pay greater attention to delivering optimal patient experiences alongside clinical management of the disease as this may contribute towards remission of Type 2 diabetes. Further work is needed to examine which aspects of the primary care experience might be optimized and how these could be operationalized.
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Affiliation(s)
- Hajira Dambha-Miller
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Division of Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Alexander Day
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Ann Louise Kinmonth
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Simon J Griffin
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
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21
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Can Continuity of Care Reduce Hospitalization Among Community-dwelling Older Adult Veterans Living With Dementia? Med Care 2020; 58:988-995. [PMID: 32925470 DOI: 10.1097/mlr.0000000000001386] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Hospitalization is a difficult experience, especially for patients with dementia. Understanding whether better continuity of care (COC) reduces hospitalizations can indicate interventions that might help curb hospitalizations. OBJECTIVE To estimate the causal impact of COC on hospitalizations and different reasons for hospitalization among community-dwelling older veterans with dementia. RESEARCH DESIGN Population-based observational study using nationwide Veterans Health Administration data linked to Medicare claims in Fiscal Years (FYs) 2014-2015. To account for unobserved confounders we used an instrumental variable for COC-whether veteran changed residence by more than 10 miles. SUBJECTS Community-dwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (n=105,528). MEASURES Bice-Boxerman Continuity of Care (BBC) index (0-worst to 1-best COC); binary indicators of any hospitalization for all causes, for ambulatory care sensitive conditions (ACSCs) and for reasons grouped by major diagnostic category. RESULTS The mean BBC in FY 2014 was 0.32 (SD, 0.23). In FY 2015 43.3% of the cohort veterans were hospitalized. A 0.1 higher BBC resulted in 2.4% (95% confidence interval, 0.5%-4.4%) lower probability of hospitalization for all causes. BBC was not associated with hospitalization for ACSCs. Grouped by major diagnostic category, a 0.1 higher BBC resulted in 3.8% (95% confidence interval, 2.1%-5.4%) lower probability of hospitalization for neuropsychiatric diseases/disorders, with no impact on hospitalizations for circulatory, respiratory, infectious, kidney and urinary, digestive, musculoskeletal, and endocrine-metabolic diseases/disorders. CONCLUSIONS Among community-dwelling older veterans with dementia, better COC resulted in less hospitalizations, and this effect was primarily due to less hospitalization for neuropsychiatric diseases/disorders but not hospitalization for ACSCs, or other hospitalization reasons.
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22
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Riffin C, Wolff JL, Pillemer KA. Assessing and Addressing Family Caregivers' Needs and Risks in Primary Care. J Am Geriatr Soc 2020; 69:432-440. [PMID: 33217776 DOI: 10.1111/jgs.16945] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/18/2020] [Accepted: 09/20/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To characterize current practices, barriers, and facilitators to assessing and addressing family caregivers' needs and risks in primary care. DESIGN Cross-sectional, national mail-based survey. SETTING American Medical Association Masterfile database. PARTICIPANTS U.S. primary care physicians (N = 106), including general internists (n = 44) and geriatricians (n = 62). MEASUREMENTS Approaches to assessing and addressing family caregivers' needs and risks; barriers and facilitators to conducting caregiver assessments. RESULTS Few respondents reported conducting a formal caregiver assessment using a standardized instrument in the past year (10.5%). Informal, unstructured discussions about caregivers' needs and risks were common and encompassed a range of issues, most frequently caregivers' management of patients' safety (41.0%), ability to provide assistance (40.0%), and need for support (40.0%). To address caregiver needs, most respondents endorsed referring patients to services (e.g., adult day care, home care) (69.8%), assessing the appropriateness of the patient's living situation (67.9%), and referring caregivers to community agencies (63.2%). Lack of time was the most frequently cited barrier to assessing caregivers' needs (81.1%). The most commonly endorsed facilitators were access to better referral options (67.0%) and easier referral mechanisms (65.1%). Practice patterns, barriers, and facilitators to caregiver assessment did not differ by physician type. CONCLUSIONS Primary care physicians use informal, unstructured discussions rather than standardized instruments to assess caregivers' needs and risks. There is heterogeneity in the topics discussed and types of referrals made. Findings indicate the lack of translation of caregiver assessment tools from research to practice.
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Affiliation(s)
- Catherine Riffin
- Division of Geriatrics & Palliative Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jennifer L Wolff
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Karl A Pillemer
- Department of Human Development, Cornell University, Ithaca, New York, USA
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23
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Lei L, Intrator O, Conwell Y, Fortinsky RH, Cai S. Continuity of care and health care cost among community-dwelling older adult veterans living with dementia. Health Serv Res 2020; 56:378-388. [PMID: 32812658 DOI: 10.1111/1475-6773.13541] [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] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To estimate the causal impact of continuity of care (COC) on total, institutional, and noninstitutional cost among community-dwelling older veterans with dementia. DATA SOURCES Combined Veterans Health Administration (VHA) and Medicare data in Fiscal Years (FYs) 2014-2015. STUDY DESIGN FY 2014 COC was measured by the Bice-Boxerman Continuity of Care (BBC) index on a 0-1 scale. FY 2015 total combined VHA and Medicare cost, institutional cost of acute inpatient, emergency department [ED], long-/short-stay nursing home, and noninstitutional long-term care (LTC) cost for medical (like skilled-) and social (like unskilled-) services were assessed controlling for covariates. An instrumental variable for COC (change of residence by more than 10 miles) was used to account for unobserved health confounders. DATA COLLECTION Community-dwelling veterans with dementia aged 66 and older, enrolled in Traditional Medicare (N = 102 073). PRINCIPAL FINDINGS Mean BBC in FY 2014 was 0.32; mean total cost in FY 2015 was $35 425. A 0.1 higher BBC resulted in (a) $4045 lower total cost; (b) $1597 lower acute inpatient cost, $119 lower ED cost, $4368 lower long-stay nursing home cost; (c) $402 higher noninstitutional medical LTC and $764 higher noninstitutional social LTC cost. BBC had no impact on short-stay nursing home cost. CONCLUSIONS COC is an effective approach to reducing total health care cost by supporting noninstitutional care and reducing institutional care.
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Affiliation(s)
- Lianlian Lei
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan.,Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, New York
| | - Orna Intrator
- Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, New York.,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Yeates Conwell
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Richard H Fortinsky
- Center on Aging, University of Connecticut School of Medicine, Farmington, Connecticut
| | - Shubing Cai
- Geriatrics & Extended Care Data Analysis Center (GECDAC), Canandaigua VA Medical Center, Canandaigua, New York.,Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, Rochester, New York
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Staykov E, Qureshi D, Scott M, Talarico R, Hsu AT, Howard M, Costa AP, Fung C, Ip M, Liddy C, Tanuseputro P. Do Patients Retain their Family Physicians after Long-Term Care Entry? A Retrospective Cohort Study. J Am Med Dir Assoc 2020; 21:1951-1957. [PMID: 32586719 DOI: 10.1016/j.jamda.2020.04.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/17/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Older adults value and benefit from the long-standing relationship they have with their family physicians. This dynamic has not been researched in a long-term care (LTC, ie, nursing home) setting. We sought to determine the proportion of LTC residents who retain their community family physician within the first 180 days of LTC, and the resident, physician, and LTC home factors that may influence retention. DESIGN Population-based retrospective cohort study. SETTING AND PARTICIPANTS Individuals from Ontario, Canada, aged 60 years or older who were newly admitted to a LTC home between April 1, 2014 and March 31, 2017. METHODS Residents were indexed upon LTC admission, and their data was linked across ICES databases. Residents were matched to their rostered family physician, and physician retention was defined as having at least 1 visit by their matched physician within 0 to 90 days and 90 to 180 days of LTC admission. RESULTS Out of 50,089 LTC residents, 12.1% retained their family physicians post-LTC admission. Resident factors associated with reduced odds of retention included physical impairment [odds ratio OR (95% confidence interval, CI) = 0.59 (0.42‒0.83)], cognitive impairment [0.39 (0.33‒0.47)], and a dementia diagnosis [0.80 (0.74‒0.86)]. Physician factors associated with lower retention included a greater distance from the LTC home to the family physician's clinic [30+ kilometers 0.41 (0.35‒0.48)], having a physician who is female [0.90 (0.83‒0.98)], an international medical graduate [0.89 (0.81‒0.97)] or someone who practices in a capitation-based Family Health Organization [0.86 (0.78‒0.95)]. Factors associated with greater odds of retention were residing in a rural LTC home [2.23 (1.78‒2.79)], having a rural family physician [1.70 (1.52‒1.90)], or a family physician who has billed LTC fee codes in the past year [2.64 (2.45‒2.85)]. CONCLUSIONS AND IMPLICATIONS Few LTC residents retained their family physician post-LTC admission, underscoring this healthcare transition as a breakdown point in relational continuity. Factors that influenced retention included resident health, LTC home geography, and family physician demographics and practice patterns.
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Affiliation(s)
- Emiliyan Staykov
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Danial Qureshi
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Mary Scott
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Robert Talarico
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; ICES uOttawa, Ottawa, Ontario, Canada
| | - Amy T Hsu
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Michelle Howard
- ICES McMaster, Hamilton, Ontario, Canada; Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Celeste Fung
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada; St. Patrick's Home of Ottawa, Ottawa, Ontario, Canada
| | - Michael Ip
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Clare Liddy
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
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Management in primary care at the time of a suicide attempt and its impact on care post-suicide attempt: an observational study in the French GP sentinel surveillance system. BMC FAMILY PRACTICE 2020; 21:55. [PMID: 32213164 PMCID: PMC7098086 DOI: 10.1186/s12875-020-01126-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 03/11/2020] [Indexed: 11/17/2022]
Abstract
Background We aimed to describe primary care management at the time of a suicide attempt (SA) and after the SA. Methods An observational (cross-sectional) study was conducted among 166 sentinel GPs within France (a non-gatekeeping country) between 2013 and 2017 for all GP’s patients who attempted suicide. Measurements: frequency of patients 1) managed by the GP at the time of the SA, 2) addressed to an emergency department (ED), 3) without care at the time of the SA, and 4) managed by the GP after the SA and factors associated with GP management at the time of and after the SA. Results Three hundred twenty-one SAs were reported, of which N = 95 (29.6%) were managed by the GP at the time of the SA, N = (70.5%) were referred to an ED, and N = (27.4%) remained at home. Forty-eight (14.9%) patients did not receive any care at the time of the SA and 178 (55.4%) were managed directly by an ED. GPs were more likely to be involved in management of the patient at the time of the SA if they were younger (39.2% for patients < 34 years old; 22.9% for those 35 to 54 years old, and 30.3% for those more than 55 years old p = 0.02) or the SA involved a firearm or self-cutting (51.9%) versus those involving drugs (23.7%); p = 0.006). After the SA, GPs managed 174 patients (54.2%), more often (60%) when they provided care at home at the time of the SA, p = 0.04; 1.87 [1.07; 3.35]. No other factor was associated with management by GPs after the SA. Conclusions The study faced limitations: data were not available for patients managed solely by specialists during their SA and results may not be generalisable to countries with a stronger gatekeeping system. We concluded that GPs are involved in the management of patients at the time of a SA for a third of patients. EDs are the major provider of care at that time. Half patients consulted GPs after the SA and connections between GPs and ED upon discharge should be improved.
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Abstract
BACKGROUND Recent reports of increased national estimates of pediatric psychiatric emergency department (ED) visits and psychiatric hospitalizations emphasize the need to research these utilization patterns. OBJECTIVES To assess the patient-provider continuity of care (CoC) and compare the risk of psychiatric ED visits or hospitalization according to the CoC level. RESEARCH DESIGN A cohort design was applied to Medicaid administrative claims data (2007-2014) for 3-16-year olds with a first psychiatric diagnosis between 2009 and 2013 (n=38,825). SUBJECTS Continuously enrolled youths with (1) ≥1 outpatient psychiatric visits and (2) ≥4 pediatric outpatient visits in the prior 24 months. MEASURES The authors assessed CoC in the 24 months before the first psychiatric outpatient visit and quantified CoC using the Alpha Index. The authors assessed patient-provider CoC before first psychiatric diagnosis and the odds of psychiatric ED visits or psychiatric hospitalizations in the year after diagnosis. RESULTS Of the 38,825 youths, 88.9% received a first psychiatric diagnosis by age 14. The odds of ED visits were significantly higher among youths with low CoC [6.63%, adjusted odds ratio (AOR), 1.27; 95% confidence interval (CI), 1.13-1.41] or moderate CoC (5.76%; AOR, 1.14; 95% CI, 1.02-1.27) compared with those with high CoC (4.96%). Greater odds of psychiatric hospitalization related to low (7.53%; AOR, 1.17; 95% CI, 1.06-1.29) or moderate CoC (7.01%; AOR, 1.15; 95% CI, 1.03-1.27) compared with high CoC (6.06%). CONCLUSIONS The odds of potentially disruptive clinical management and costly psychiatric ED visits or hospitalizations were lower for youths with high CoC. The findings support the need to research the impact of CoC on long-term pediatric mental health service use.
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Shrivastava R, Couturier Y, Simard-Lebel S, Girard F, Aguirre NVB, Torrie J, Emami E. Relational continuity of oral health care in Indigenous communities: a qualitative study. BMC Oral Health 2019; 19:287. [PMID: 31865901 PMCID: PMC6927186 DOI: 10.1186/s12903-019-0986-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/11/2019] [Indexed: 11/23/2022] Open
Abstract
Background The relational continuity of care is an essential function of primary health care. This study reports on the perspectives of Cree communities and their primary health care providers regarding the barriers and enablers of relational continuity of oral health care integrated at a primary health care organization. Methods A multiple case study design within a qualitative approach and developmental evaluation methodology were used to conduct this research study in Cree communities of Northern Québec. Maximum variation sampling and snowball techniques were used to recruit the participants. Data collection consisted of individual interviews and focus group discussions. Thematic analysis was conducted which included transcription, debriefing, codification, data display, and interpretation. The consolidated criteria for reporting qualitative studies (COREQ) were used to guide the reporting of study findings. Results A total of six focus group discussions and 36 individual interviews were conducted. Five major themes emerged from the thematic analyses for barriers (two) and enablers (three). Themes for barriers included impermanence and lack of effective communication, whereas themes for enablers included culturally competent professionals, working across professional boundaries, and proactive organizational engagement. Conclusions Based on these findings, relational continuity can be empowered by effective strategies for overcoming barriers and encouraging enablers, such as recruitment of permanent professionals, organizing cultural competency training, development of a Cree language dental glossary, encouraging inter-professional collaboration, and promoting the organization’s efforts.
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Affiliation(s)
- Richa Shrivastava
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, H3C 3J7, Canada
| | - Yves Couturier
- School of Social Work, Université de Sherbrooke, Sherbrooke, J1H 4C4, Québec, Canada
| | | | - Felix Girard
- Faculty of Dentistry, Université de Montréal, Montréal, Québec, H3C 3J7, Canada
| | | | - Jill Torrie
- Director of Specialised Services, Cree Board of Health and Social Services of James Bay, Mistissini, Québec, G0W 1C0, Canada
| | - Elham Emami
- Faculty of Dentistry, McGill University, Montréal, Québec, H3A 1G1, Canada.
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James S, McInnes S, Halcomb E, Desborough J. Lifestyle risk factor communication by nurses in general practice: Understanding the interactional elements. J Adv Nurs 2019; 76:234-242. [DOI: 10.1111/jan.14221] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 08/19/2019] [Accepted: 09/25/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Sharon James
- School of Nursing University of Wollongong Bega NSW Australia
| | - Susan McInnes
- School of Nursing University of Wollongong Wollongong NSW Australia
| | | | - Jane Desborough
- Department of Health Services Research and Policy Research School of Population Health College of Medicine, Biology and the Environment Australian National University Canberra ACT Australia
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Tammes P, Payne RA, Salisbury C, Chalder M, Purdy S, Morris RW. The impact of a named GP scheme on continuity of care and emergency hospital admission: a cohort study among older patients in England, 2012-2016. BMJ Open 2019; 9:e029103. [PMID: 31548353 PMCID: PMC6773345 DOI: 10.1136/bmjopen-2019-029103] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To investigate whether the introduction of a named general practitioner (GP, family physician) improved patients' healthcare for patients aged 75 and over in England. SETTING Random sample of 27 500 patients aged 65 to 84 in 2012 within 139 English practices from the Clinical Practice Research Datalink linked with Hospital Episode Statistics. DESIGN Prospective cohort approach, measuring patients' GP consultations and emergency hospital admissions 2 years before/after the intervention. Patients were grouped in (i) aged over 74 and (ii) younger than 75 in both periods in order to compare who were or were not subject to the intervention. Adjusted associations between the named GP scheme, continuity of care and emergency hospital admission were examined using multilevel modelling. INTERVENTION National Health Service policy to introduce a named accountable GP for patients aged over 74 in April 2014. MAIN OUTCOME MEASURES (A) Continuity of care index-score, (B) risk of emergency hospital admissions, (C) number of emergency hospital admissions. RESULTS The intervention was associated with a decrease in continuity index-scores of -0.024 (95% CI -0.030 to -0.018, p<0.001); there were no differences in the decrease between the two age groups (-0.005, 95% CI -0.014 to 0.005). In the pre-intervention and post-intervention periods, respectively, 15.4% and 19.4% patients had an emergency admission. The probability of an emergency hospital admission increased after the intervention (OR 1.156, 95% CI 1.064 to 1.257, p=0.001); this increase was bigger for patients over 74 (relative OR 1.191, 95% CI 1.066 to 1.330, p=0.002). The average number of emergency hospital admissions increased after the intervention (rate ratio (RR) 1.178, 95% CI 1.103 to 1.259, p<0.001); this increase was greater for patients over 74 (relative RR 1.143, 95% CI 1.052 to 1.242, p=0.001). CONCLUSION The introduction of the named GP scheme was not associated with improvements in either continuity of care or rates of unplanned hospitalisation.
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Affiliation(s)
- Peter Tammes
- Bristol Medical School: Population Health Sciences, Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Rupert A Payne
- Bristol Medical School: Population Health Sciences, Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Chris Salisbury
- Bristol Medical School: Population Health Sciences, Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Melanie Chalder
- Bristol Medical School: Population Health Sciences, Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Sarah Purdy
- Bristol Medical School: Population Health Sciences, Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Richard W Morris
- Bristol Medical School: Population Health Sciences, Centre for Academic Primary Care, University of Bristol, Bristol, UK
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Li YC. Continuity of care for newly diagnosed diabetic patients: A population-based study. PLoS One 2019; 14:e0221327. [PMID: 31437219 PMCID: PMC6705849 DOI: 10.1371/journal.pone.0221327] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 08/06/2019] [Indexed: 12/05/2022] Open
Abstract
This study explores whether continuity of care is associated with health care outcomes and medical care use among patients with newly diagnosed diabetes. A retrospective cohort analysis was performed using the Taiwanese National Health Insurance database, and cases were followed up from January 2010 to December 2012. Four thousand and seven patients with newly diagnosed diabetes were followed for 3 years. The continuity of care was measured using the continuity of care index (COCI) and the usual provider continuity score (UPCS) with high and low dichotomous categories. The probabilities of dementia, hospitalization, emergency room visits, and death were used as health care outcomes. Medical care use was defined as the number of hospital admissions, length of hospital stays, and number of emergency room visits. Adjusted odds ratios (ORs) were obtained using multivariate logistic regression; adjusted ORs for the probabilities of dementia, hospital admissions, and emergency room visits in the higher COCI patient group were 0.582 (p < 0.05), 0.623 (p < 0.001), and 0.650 (p < 0.001), respectively. Negative binomial regression models for medical resource use indicated that the group with higher COCI scores used fewer medical resources compared with the group with lower COCI scores. The findings of UPCS analysis showed that those in the high COCI group also fell into the high UPCS group. In this study, continuity of care was associated with favorable health care outcomes and less medical care uses among newly diagnosed diabetic patients. Long-term relationships between patients and health care providers should be enhanced to provide improved continuity of care.
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Affiliation(s)
- Ying-Chun Li
- Institute of Health Care Management, National Sun Yat-sen University, Kaohsiung, Taiwan
- * E-mail:
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Dullie L, Meland E, Hetlevik Ø, Mildestvedt T, Kasenda S, Kantema C, Gjesdal S. Performance of primary care in different healthcare facilities: a cross-sectional study of patients' experiences in Southern Malawi. BMJ Open 2019; 9:e029579. [PMID: 31324683 PMCID: PMC6661549 DOI: 10.1136/bmjopen-2019-029579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/31/2019] [Accepted: 06/07/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE In most African countries, primary care is delivered through a district health system. Many factors, including staffing levels, staff experience, availability of equipment and facility management, affect the quality of primary care between and within countries. The purpose of this study was to assess the quality of primary care in different types of public health facilities in Southern Malawi. STUDY DESIGN This was a cross-sectional quantitative study. SETTING The study was conducted in 12 public primary care facilities in Neno, Blantyre and Thyolo districts in July 2018. PARTICIPANTS Patients aged ≥18 years, excluding the severely ill, were selected to participate in the study. PRIMARY OUTCOMES We used the Malawian primary care assessment tool to conduct face-to-face interviews. Analysis of variance at 0.05 significance level was performed to compare primary care dimension means and total primary care scores. Linear regression models at 95% CI were used to assess associations between primary care dimension scores, patients' characteristics and healthcare setting. RESULTS The final number of respondents was 962 representing 96.1% response rate. Patients in Neno hospitals scored 3.77 points higher than those in Thyolo health centres, and 2.87 higher than those in Blantyre health centres in total primary care performance. Primary care performance in health centres and in hospital clinics was similar in Neno (20.9 vs 19.0, p=0.608) while in Thyolo, it was higher at the hospital than at the health centres (19.9 vs 15.2, p<0.001). Urban and rural facilities showed a similar pattern of performance. CONCLUSION These results showed considerable variation in experiences among primary care users in the public health facilities in Malawi. Factors such as funding, policy and clinic-level interventions influence patients' reports of primary care performance. These factors should be further examined in longitudinal and experimental settings.
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Affiliation(s)
- Luckson Dullie
- Global Public Health and Primary Care, Universitetet i Bergen Det medisinsk-odontologiske fakultet, Bergen, Norway
| | - Eivind Meland
- Department of Family Medicine, School of Family Medicine and Public Health, University of Malawi, Malawi
| | | | - Thomas Mildestvedt
- Department of Family Medicine, School of Family Medicine and Public Health, University of Malawi, Malawi
| | - Stephen Kasenda
- Department of Health, Blantyre District Health Office, Blantyre, Malawi
| | - Constance Kantema
- Department of Education, Lilongwe Urban Education Office, Lilongwe, Malawi
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Singh J, Dahrouge S, Green ME. The impact of the adoption of a patient rostering model on primary care access and continuity of care in urban family practices in Ontario, Canada. BMC FAMILY PRACTICE 2019; 20:52. [PMID: 30999868 PMCID: PMC6474046 DOI: 10.1186/s12875-019-0942-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 04/02/2019] [Indexed: 01/07/2024]
Abstract
BACKGROUND Greater continuity and access to primary care results in improved patient health, satisfaction, and reduced healthcare costs. Although patient rostering is considered to be a cornerstone of a high performing primary care system and is believed to improve continuity and access, few studies have examined these relationships. This study examined the impact of the adoption of a patient rostering enhanced fee-for-service model (eFFS) on continuity, coordination of specialized care, and access. METHOD A population-based longitudinal study was conducted using health administrative data from urban family practices in Ontario, Canada. Family physicians that transitioned from traditional FFS (tFFS) to eFFS between 2004 and 2013 were followed overtime. Physicians providing comprehensive primary care that had at least 4 years of pre-transition and 2 years of post-transition data were eligible. Patients were attributed to physicians on an annual basis by determining the provider that billed the largest dollar amount over a 2 year period. Outcomes of interest were the usual provider of care index (UPC), a referral index (RI) (% of total primary care referrals for a physician's roster made by the main provider), and emergency department (ED) visits for family practice sensitive conditions (FPSCs). Mixed-effects segmented linear and logistic regressions were used to examine changes in outcomes while controlling for patient and provider contextual factors. RESULTS Prior to transitioning, UPC was decreasing at a rate of 0.27%/year (95% CI: -0.34 to - 0.21, p < 0.0001). Following the transition, UPC began decreasing by an additional 0.59%/year (95% CI: -0.69 to - 0.49, p < 0.0001) relative to the pre-transition rate. RI decreased by an additional 0.34%/year (95% CI: -0.43 to - 0.24, p < 0.0001) relative to the pre-transition period, where it had been stable. The transition had minimal impact on FPSC ED visits. CONCLUSION Continuity and coordination of specialized care slightly decreased upon transition from tFFS to eFFS. This is likely due to physicians working in groups and sharing patients following the transition to the eFFS model. Adoption of an enrolment model with after-hours care did not decrease non-urgent ED use, which may reflect the small impact that primary care access has on these types of ED visits.
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Affiliation(s)
- Jatinderpreet Singh
- Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada. .,Department of Family Medicine, Queen's University, 220 Bagot St, Kingston, ON, K7L 3G2, Canada.
| | - Simone Dahrouge
- Department of Family Medicine, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Michael E Green
- Department of Public Health Sciences, Queen's University, 62 Fifth Field Company Lane, Kingston, ON, K7L 3N6, Canada.,Institute for Clinical Evaluative Sciences, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.,Department of Family Medicine, Queen's University, 220 Bagot St, Kingston, ON, K7L 3G2, Canada
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Kailasam M, Guo W, Hsann YM, Yang KS. Prevalence of care fragmentation among outpatients attending specialist clinics in a regional hospital in Singapore: a cross-sectional study. BMJ Open 2019; 9:e022965. [PMID: 30898796 PMCID: PMC6475441 DOI: 10.1136/bmjopen-2018-022965] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To measure the extent of multispecialty care fragmentation among outpatients receiving specialist care and identify associated risk factors for fragmented care. DESIGN A retrospective cross-sectional study. SETTING Specialist outpatient clinics (SOCs) in a Singapore regional hospital. PARTICIPANTS A total of 40 333 patients aged 21 and above with at least two SOC visits in the year 2016. Data for 146 792 physician consultation visits were used in the analysis and visits for allied health services and medical procedures were excluded. OUTCOME MEASURES The Fragmentation of Care Index (FCI) was used to measure care fragmentation for specialist outpatients. Log-linear regression with stepwise selection was used to investigate the association between FCI and patient age, gender, race and Most Frequently Visited Specialty (MFVS), controlling for number of different specialities seen. RESULTS About 36% experienced fragmented care (FCI >0) and their mean FCI was 0.70 (SD=0.20). FCI was found to be positively associated with age (p<0.001). Patients who most frequently visited Haematology, Endocrinology and Anaesthesiology specialities were associated with more fragmented care while those who most frequently visited Medical Oncology, Ophthalmology and Orthopaedics Surgery specialities were associated with less fragmented care. CONCLUSION Multispecialty care fragmentation was found to be moderately high in the outpatient specialist clinics and was found to be associated with patients' age and certain medical specialties. With an ageing population and a rising prevalence of multimorbidity, healthcare providers should seek to eliminate unnecessary referrals to reduce the extent of care fragmentation.
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Affiliation(s)
| | - Wenjia Guo
- Epidemiology, Ng Teng Fong General Hospital, Singapore
| | - Yin Maw Hsann
- Epidemiology, Ng Teng Fong General Hospital, Singapore
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Abstract
BACKGROUND Having a "personal" physician is a critical element to care continuity. Little is known about which older adults are more likely to lack personal physicians and if their care experiences differ from those with a personal physician. OBJECTIVE The objective of this study was to describe care experiences and characteristics associated with not having a personal physician. RESEARCH DESIGN We compare rates of lacking a personal physician across subgroups. Using doubly robust propensity-score-weighted regression, we compare patient experience among beneficiaries with and without a personal physician. SUBJECTS A total of 272,463 nationally representative beneficiaries age 65+ responding to the 2012 Medicare CAHPS survey. MEASURES Beneficiary characteristics, having a personal physician, 4 patient experience measures. RESULTS Five percent of respondents reported no personal physician. Lacking a personal physician was more common for men, racial/ethnic minorities (eg, 16% of American Indian/Alaska Natives), and the younger and less educated. Those without a personal physician reported substantially poorer experiences on 4 measures (P<0.001); these differences are larger than those observed by key demographic characteristics. Beneficiaries without a personal physician were more than 3 times as likely to have not seen any health care provider in the last 6 months. CONCLUSIONS Even with the access provided by Medicare, a small but nontrivial proportion of seniors report having no personal physician. Those without a personal physician report substantially worse patient experiences and lacking a personal physician is more common for some vulnerable groups. This may underlie some previously observed disparities. Efforts should be made to encourage and help seniors without personal physicians to select one.
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Sagsveen E, Rise MB, Grønning K, Westerlund H, Bratås O. Respect, trust and continuity: A qualitative study exploring service users' experience of involvement at a Healthy Life Centre in Norway. Health Expect 2018; 22:226-234. [PMID: 30472770 PMCID: PMC6433315 DOI: 10.1111/hex.12846] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/28/2018] [Accepted: 10/18/2018] [Indexed: 11/30/2022] Open
Abstract
Background To meet the challenges caused by non‐communicable diseases, Norway has established Healthy Life Centres within primary care to encourage a healthy lifestyle. To promote people's health and ensure high‐quality services, user involvement in contemporary health care is regarded as essential. Objective To explore the experience of user involvement among Healthy Life Centre users participating in individual health consultations, followed by physical activity groups and/or diet courses. Methods This was a qualitative study based on twenty semi‐structured individual interviews conducted between September 2015 and May 2016 at a Healthy Life Centre in Norway. Data were analysed using systematic text condensation. Results Being respected and having a trustworthy relationship with the professionals were found to be essential for the service users’ involvement. Building a trustworthy relationship was disrupted for some service users by a lack of relational continuity. This lack of continuity jeopardized the continuation of professionals’ awareness of the service users’ challenges and personal goals. The service users’ preferred levels of user involvement varied. Some service users did not always want to play an active part and instead wanted the professionals, as “experts,” to decide. Conclusions The findings imply that the professionals need to assess each service user's desires for involvement and consider how these can be met. Thus, user involvement cannot be understood without considering the particular setting and each individual service user's preferences for involvement. Relational continuity is needed to maintain the service users’ challenges and goals throughout the services and to promote health behaviour changes.
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Affiliation(s)
- Espen Sagsveen
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit B Rise
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - Kjersti Grønning
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Heidi Westerlund
- KBT Mid-Norway (Resource Centre for Service User Experience and Service Development), Trondheim, Norway
| | - Ola Bratås
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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Ball LE, Barnes KA, Crossland L, Nicholson C, Jackson C. Questionnaires that measure the quality of relationships between patients and primary care providers: a systematic review. BMC Health Serv Res 2018; 18:866. [PMID: 30453957 PMCID: PMC6245854 DOI: 10.1186/s12913-018-3687-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 11/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background International guidance on models of care stress the importance of good quality, continuous patient-provider relationships to support high quality and efficient care and hospital avoidance. However, assessing the quality of patient-provider relationships is challenging due to its experiential nature. The aim of this study was to undertake a systematic review to identify questionnaires previously developed or used to assess the quality of continuous relationships between patients and their provider in primary care. Methods MEDLINE, PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and SCOPUS databases were searched for English language studies published between 2009 and 2017. Key terms used identified studies conducted in the primary care setting examining relationships between patients and providers. Studies that focused on the conceptualisation, development, testing or review of a questionnaire, or studies that used a questionnaire for assessing the quality of continuous relationships between patients and providers were eligible. Studies that did not assess quality via a questionnaire, only assessed single aspects of relationships, only assessed single encounters, assessed transitions between settings or assessed relationships using an index were excluded. Information on validity testing of each relevant questionnaire identified from articles was reviewed to inform recommendations for future research and evaluation. Results Twenty-seven studies met the eligibility criteria, including 14 unique questionnaires. The questionnaires were diverse in length, scope, focus and level of validity testing. Five questionnaires were considered not feasible for future use due to size and lack of development work. Three questionnaires were considered strongest candidates for use in future work based on being relevant to the topic and primary care setting, freely available in English and not needing additional pilot work prior to use. These three questionnaires were the Care Continuity Across Levels of Care Scale, the Nijmegan Continuity Questionnaire and the Patient-Doctor Depth of Relationship Tool. Conclusions This study provides an overview of 14 unique questionnaires that have been used to assess the quality of continuous relationships between patients and primary care providers. The decision to use one of the questionnaires in future work requires careful consideration, including the scope, length, validation testing, accessibility of the questionnaires and their alignment with the initiative being evaluated.
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Affiliation(s)
- Lauren E Ball
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia. .,Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia.
| | - Katelyn A Barnes
- Menzies Health Institute Queensland, Griffith University, Parklands Drive, Southport, Gold Coast, QLD, 4222, Australia
| | - Lisa Crossland
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia
| | - Caroline Nicholson
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia
| | - Claire Jackson
- Centre for Health System Reform and Integration, UQ-Mater Research Institute, Brisbane, Australia
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Cross DA, Cohen GR, Lemak CH, Adler-Milstein J. Outcomes For High-Needs Patients: Practices With A Higher Proportion Of These Patients Have An Edge. Health Aff (Millwood) 2018; 36:476-484. [PMID: 28264949 DOI: 10.1377/hlthaff.2016.1309] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
High-value primary care for high-needs patients-those with multiple physical, mental, or behavioral health conditions-is critical to improving health system performance. However, little is known about what types of physician practices perform best for high-needs patients. We examined two scale-related characteristics that could predict how well physician practices delivered care to this population: the proportion of patients in the practice that were high-needs and practice size (number of physicians). Using four years of data on commercially insured, high-needs patients in Michigan primary care practices, we found lower spending and utilization among practices with a higher proportion of high-needs patients (more than 10 percent of the practice's panel) compared to practices with smaller proportions. Small practices (those with one or two physicians) had lower overall spending, but not less utilization, compared to large practices. However, practices with a substantial proportion of high-needs patients, as well as small practices, performed slightly worse on a composite measure of process quality than their associated reference group. Practices that treat a high proportion of high-needs patients might have structural advantages or have developed specialized approaches to serve this population. If so, this raises questions about how best to make use of this knowledge to foster high-value care for high-needs patients.
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Affiliation(s)
- Dori A Cross
- Dori A. Cross is a doctoral candidate in the Department of Health Management and Policy, School of Public Health, University of Michigan, in Ann Arbor
| | - Genna R Cohen
- Genna R. Cohen is a researcher at Mathematica Policy Research in Washington, D.C
| | - Christy Harris Lemak
- Christy Harris Lemak is chair of and a professor in the Department of Health Services Administration at the University of Alabama at Birmingham
| | - Julia Adler-Milstein
- Julia Adler-Milstein is an associate professor of information in the School of Information and an associate professor of health management and policy in the Department of Health Management and Policy, School of Public Health, both at the University of Michigan
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Waibel S, Vargas I, Coderch J, Vázquez ML. Relational continuity with primary and secondary care doctors: a qualitative study of perceptions of users of the Catalan national health system. BMC Health Serv Res 2018; 18:257. [PMID: 29631622 PMCID: PMC5891958 DOI: 10.1186/s12913-018-3042-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 03/20/2018] [Indexed: 11/10/2022] Open
Abstract
Background In the current context of increasingly fragmented healthcare systems where patients are seen by multiple doctors in different settings, patients’ relational continuity with one doctor is regaining relevance; however little is known about relational continuity with specialists. The aim of this study is to explore perceptions of relational continuity with primary care and secondary care doctors, its influencing factors and consequences from the viewpoint of users of the Catalan national health system (Spain). Methods We conducted a descriptive-interpretative qualitative study using a two-stage theoretical sample; (i) contexts: three healthcare areas in the Catalan national health system with differing characteristics; (ii) informants: users 18 years or older attended to at both care levels. Sample size (n = 49) was reached by saturation. Data were collected by individual semi-structured interviews, which were audio recorded and transcribed. A thematic content analysis was carried out segmenting data by study area, and leaving room for new categories to emerge from the data. Results Patients across the areas studied generally experienced consistency of primary care doctors (PCD), alongside some inconsistency of specialists. Consistency of specialists did not seem to be relevant to some patients when their clinical information was shared and used. Patients who experienced consistency and frequent visits with the same PCD or specialist described and valued having established an ongoing relationship characterised by personal trust and mutual accumulated knowledge. Identified consequences were diverse and included, for example, facilitated diagnosis or improved patient-doctor communication. The ascription to a PCD, a health system-related factor, facilitated relational continuity with the PCD, whereas organizational factors (for instance, the size of the primary care centre) favoured consistency of PCD and specialists. Doctor-related factors (for example, high technical competence or commitment to patient care) particulary fostered the development of an ongoing relationship. Conclusions Consistency of doctors differs depending on the care level as does the relevance attributed to it. Most influencing factors can be applied to both care levels and might be addressed by healthcare managers to foster relational continuity. More research is needed to fully understand the relevance patients assign to relational continuity with specialists. Electronic supplementary material The online version of this article (10.1186/s12913-018-3042-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sina Waibel
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Av. Tibidabo 21, 08022, Barcelona, Spain. .,Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Av. de Can Domènech 737, 08193, Bellaterra (Cerdanyola de Vallès), Spain.
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Av. Tibidabo 21, 08022, Barcelona, Spain
| | - Jordi Coderch
- Grup de Recerca en Serveis Sanitaris i Resultats en Salut, Serveis de Salut Integrats Baix Empordà, Carrer Hospital 17-19 Edifici Fleming, 17230, Palamós, Spain
| | - María-Luisa Vázquez
- Grup de Recerca en Serveis Sanitaris i Resultats en Salut, Serveis de Salut Integrats Baix Empordà, Carrer Hospital 17-19 Edifici Fleming, 17230, Palamós, Spain
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Lee A, Kennett S, Khera S, Ross S. Perceptions, practice, and "ownership:" experiences in continuity of the patient-doctor relationship in a family medicine residency. CANADIAN MEDICAL EDUCATION JOURNAL 2017; 8:e74-e85. [PMID: 29354200 PMCID: PMC5766222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The objective of this mixed-methods study was to determine interpersonal continuity (the ongoing therapeutic relationship between patient and health care provider) experiences of family medicine residents and preceptors, and explore their perceptions of interpersonal continuity. METHODS Quantitative data on resident and preceptor encounters were extracted from the electronic medical record (EMR). Opportunities for developing interpersonal continuity were determined using the Usual Provider Continuity (UPC) Index. A qualitative descriptive research method was used for the qualitative portion. Semi-structured interviews were conducted and constant comparative analysis was used to determine emerging themes. RESULTS Residents were found to have low UPC rates; preceptor rates were higher. Qualitative findings showed variable experiences with interpersonal continuity not apparent from UPC rates. Both preceptors and residents expressed perception of "ownership" of patients as a significant barrier to interpersonal continuity. CONCLUSION This study suggests that a perceived lack of individual "ownership" of a patient panel was a significant barrier to developing interpersonal continuity. This might conflict with current changes towards team-based health care delivery. Understanding perceptions and changing them through a multi-faceted approach including resident teaching and faculty development might help improve interpersonal continuity which are core to both family medicine curricula and current models of health care delivery.
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Affiliation(s)
- Ann Lee
- Department of Family Medicine, University of Alberta, Alberta, Canada
| | - Sandra Kennett
- Faculty of Nursing, University of Alberta, Alberta, Canada
| | - Sheny Khera
- Department of Family Medicine, University of Alberta, Alberta, Canada
| | - Shelley Ross
- Department of Family Medicine, University of Alberta, Alberta, Canada
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Vargas I, Garcia-Subirats I, Mogollón-Pérez AS, De Paepe P, da Silva MRF, Unger JP, Aller MB, Vázquez ML. Patient perceptions of continuity of health care and associated factors. Cross-sectional study in municipalities of central Colombia and north-eastern Brazil. Health Policy Plan 2017; 32:549-562. [PMID: 28104694 DOI: 10.1093/heapol/czw168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2016] [Indexed: 12/11/2022] Open
Abstract
Despite the fragmentation of healthcare provision being considered one of the main obstacles to attaining effective health care in Latin America, very little is known about patients' perceptions. This paper analyses the level of continuity of health care perceived by users and explores influencing factors in two municipalities of Colombia and Brazil, by means of a cross-sectional study based on a survey of a multistage probability sample of people who had suffered at least one health problem within the previous three months (2163 in Colombia; 2167 in Brazil). An adapted and validated version of the CCAENA© (Questionnaire of care continuity across levels of health care) was applied. Logistic regression models were generated to assess the relationship between perceptions of the different types of health care continuity and sociodemographic characteristics, health needs, and organizational factors. The results show lower levels of continuity across care levels in information transfer and care coherence and higher levels for the ongoing patient-doctor relationship, albeit with differences between the two countries. They also show greater consistency of doctors in the Brazilian study areas, especially in primary care. Consistency of doctors was not only positively associated with the patient-doctor ongoing relationship in the study areas of both countries, but also with information transfer and care coherence across care levels. The study area and health needs (the latter negatively for patients with poor self-rated health and positively for those with at least one chronic condition) were associated with all types of continuity of care. The influence of the sex or income varied depending on the country. The influence of the insurance scheme in the Colombian sample was not statistically significant. Both countries should implement policies to improve coordination between care levels, especially regarding information transfer and job stability for primary care doctors, both key factors to guarantee quality of care.
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Affiliation(s)
- Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, Barcelona, Spain
| | - Irene Garcia-Subirats
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, Barcelona, Spain
| | - Amparo Susana Mogollón-Pérez
- Escuela de Medicina y Ciencias de la Salud. Universidad del Rosario, Carrera 24, Número 63C-69, Bogotá, Colombia
| | - Pierre De Paepe
- The Prince Leopold Institute of Tropical Medicine, Nationalestraat 15, Antwerpen, Belgium
| | | | - Jean-Pierre Unger
- The Prince Leopold Institute of Tropical Medicine, Nationalestraat 15, Antwerpen, Belgium
| | - M B Aller
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, Barcelona, Spain
| | - María Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, Barcelona, Spain
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Tammes P, Purdy S, Salisbury C, MacKichan F, Lasserson D, Morris RW. Continuity of Primary Care and Emergency Hospital Admissions Among Older Patients in England. Ann Fam Med 2017; 15:515-522. [PMID: 29133489 PMCID: PMC5683862 DOI: 10.1370/afm.2136] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 05/11/2017] [Accepted: 06/05/2017] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Secondary health care services have been under considerable pressure in England as attendance rates increase, resulting in longer waiting times and greater demands on staff. This study's aim was to examine the association between continuity of care and risk of emergency hospital admission among older adults. METHODS We analyzed records from 10,000 patients aged 65 years and older in 2012 within 297 English general practices obtained from the Clinical Practice Research Datalink and linked with Hospital Episode Statistics. We used the Bice and Boxerman (BB) index and the appointed general practitioner index (last general practitioner consulted before hospitalization) to quantify patient-physician continuity. The BB index was used in a prospective cohort approach to assess impact of continuity on risk of admission. Both indices were used in a separate retrospective nested case-control approach to test the effect of changing physician on the odds of hospital admission in the following 30 days. RESULTS In the prospective cohort analysis, the BB index showed a graded, non-significant inverse relationship of continuity of care with risk of emergency hospital admission, although the hazard ratio for patients experiencing least continuity was 2.27 (95% CI, 1.37-3.76) compared with those having complete continuity. In the retrospective nested case-control analysis, we found a graded inverse relationship between continuity of care and emergency hospital admission for both BB and appointed general practitioner indices: for the latter, the odds ratio for those experiencing least continuity was 2.32 (95% CI, 1.48-3.63) relative to those experiencing most continuity. CONCLUSIONS Marked discontinuity of care might contribute to increased unplanned hospital admissions among patients aged 65 years and older. Schemes to enhance continuity of care have the potential to reduce hospital admissions.
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Affiliation(s)
- Peter Tammes
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Sarah Purdy
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Fiona MacKichan
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Daniel Lasserson
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.,Department of Gerontology, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, Oxford, United Kingdom
| | - Richard W Morris
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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Von Pressentin KB, Mash RJ, Baldwin-Ragaven L, Botha RPG, Govender I, Steinberg WJ. The bird’s-eye perspective: how do district health managers experience the impact of family physicians within the South African district health system? A qualitative study. S Afr Fam Pract (2004) 2017. [DOI: 10.1080/20786190.2017.1348047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- KB Von Pressentin
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - RJ Mash
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - L Baldwin-Ragaven
- Department of Family Medicine, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - RPG Botha
- Department of Family Medicine, University of Pretoria, Pretoria, South Africa
| | - I Govender
- Department of Family Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - WJ Steinberg
- Department of Family Medicine, University of the Free State, Bloemfontein, South Africa
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Mokienko A, Wangen KR. Disenrollment from general practitioners among chronic patients: a register-based longitudinal study of Norwegian claims data. BMC FAMILY PRACTICE 2016; 17:170. [PMID: 27978811 PMCID: PMC5159957 DOI: 10.1186/s12875-016-0571-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 12/02/2016] [Indexed: 11/19/2022]
Abstract
Background Norwegian general practitioners (GPs) consult on a variety of conditions with a mix of patient types. Patients with chronic diseases benefit from appropriate continuity of care and generally visit their GPs more often than the average patient. Our aim was to study disenrollment patterns among patients with chronic diseases in Norway, because such patterns could indicate otherwise unobserved GP quality. For instance, higher quality GPs could have both a greater share of patients with chronic diseases and lower disenrollment rates. Methods Data on 384,947 chronic patients and 3,974 GPs for the years 2009–2011 were obtained from national registers, including patient and GP characteristics, disenrollment data, and patient list composition. The birth cohorts from 1940 and 1970 (146,906 patients) were included for comparison. Patient and GP characteristics, comorbidity, and patient list composition were analyzed using descriptive statistics. Patients’ voluntary disenrollment was analyzed using logistic regression models. Results The GPs’ proportion of patients with a given chronic disease varied more than expected when the allocation was purely random. The proportions of patients with different chronic diseases were positively correlated, partly due to comorbidity. Patients tended to have lower disenrollment rates from GPs who had higher shares of patients with the same chronic disease. Disenrollment rates were generally lower from GPs with higher shares of patients with arthritis or depression, and higher from GPs who had higher shares of patients with diabetes type 1 and schizophrenia. This was the same in the comparison group. Conclusion Patients with a chronic disease appeared to prefer GPs who have higher shares of patients with the same disease. High shares of patients with some diseases were also negatively associated with disenrollment for all patient groups, while other diseases were positively associated. These findings may reflect the GPs’ general quality, but could alternatively result from the GPs’ specialization in particular diseases. The supportive findings for the comparison group make it more plausible that high shares of chronic patients could indicate GP quality.
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Affiliation(s)
- Anastasia Mokienko
- Department of Health Management and Health Economics, University of Oslo, P.O. Box 1089, Blindern, Oslo, 0318, Norway.
| | - Knut Reidar Wangen
- Department of Health Management and Health Economics, University of Oslo, P.O. Box 1089, Blindern, Oslo, 0318, Norway
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Li H, Sun Y, Qian D. Can integrated health services delivery have an impact on hypertension management? A cross-sectional study in two cities of China. Int J Equity Health 2016; 15:193. [PMID: 27899153 PMCID: PMC5129601 DOI: 10.1186/s12939-016-0485-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 11/21/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Policy makers require information regarding performance of different primary care delivery models in managing hypertension, which can be helpful for better hypertension management. This study aims to compare continuity of care among hypertensive patients between Direct Management (DM) Model of community health centers (CHCs) in Wuhan and Loose Collaboration (LC) Model in Nanjing. METHODS A cross-sectional questionnaire survey was conducted. Four CHCs in each city were randomly selected as study settings. 386 patients in Nanjing and 396 in Wuhan completed face-to-face interview surveys and were included in the final analysis. The relational continuity and coordination continuity (including both information continuity and management continuity) were measured and analyzed. Binary or multinomial logistic regression models were used for comparison between the two cities. RESULTS Participants from Nanjing had better relational continuity with primary care providers as compared with those from Wuhan, including more likely to be familiar with a CHC physician (OR = 2.762; 95%CI: 1.878 to 4.061), taken care of by the same CHC physician (OR = 1.846; 95%CI: 1.262 to 2.700), and known well by a CHC physician (OR = 1.762; 95%CI: 1.206 to 2.572). Multinomial logistic regression analyses showed there were significant differences between the two cities in reported frequency of communications between hospital and CHC physicians (P = 0.001), whether hospital and CHC physicians gave same treatment suggestions (P = 0.016), as well as how treatment strategy was formulated (P < 0.001). Participants in Wuhan were less likely than those in Nanjing to consider there was continuum regarding health services provided by hospital and CHC physicians (OR = 3.932; 95%CI: 2.394 to 6.459). CONCLUSIONS Our study shows that continuity of care is better for LC Model in Nanjing than DM Model in Wuhan. Our study suggests there is room for improvement regarding relational and information continuity in both cities.
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Affiliation(s)
- Haitao Li
- School of Medicine, Shenzhen University, Shenzhen, China
| | - Ying Sun
- The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Dongfu Qian
- School of Health Policy and Management, Nanjing Medical University, Hanzhong Road 140, Nanjing, 210029, Jiangsu Province, China.
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Hu R, Liao Y, Du Z, Hao Y, Liang H, Shi L. Types of health care facilities and the quality of primary care: a study of characteristics and experiences of Chinese patients in Guangdong Province, China. BMC Health Serv Res 2016; 16:335. [PMID: 27484465 PMCID: PMC4969734 DOI: 10.1186/s12913-016-1604-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Accepted: 07/29/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In China, most people tend to use hospitals rather than health centers for their primary care generally due to the perception that quality of care provided in the hospital setting is superior to that provided at the health centers. No studies have been conducted in China to compare the quality of primary care provided at different health care settings. The purpose of this study is to compare the quality of primary care provided in different types of health care facilities in China. METHODS A cross-sectional survey with patients was conducted in Guangdong province of China, using the validated Chinese Primary Care Assessment Tool (PCAT). ANOVA was performed to compare the overall and 10 domains of primary care quality for patients in tertiary, secondary, and primary health care settings. Multivariate analyses were used to assess the association between types of facility and quality of primary care attributes while controlling for sociodemographic and health care characteristics. RESULTS The final number of respondents was 864 including 161 from county hospitals, 190 from rural community health centers (CHCs), 164 from tertiary hospitals, 80 from secondary hospitals, and 269 from urban CHCs. Type of health care facilities was significantly associated with total PCAT score and domain scores. CHC was associated with higher total PCAT score and scores for first contact-access, ongoing care, comprehensiveness-services available, and community orientation than secondary and/or tertiary hospitals, after controlling for patients' demographic and health characteristics. Higher PCAT score was associated with greater satisfaction with primary care received. CHC patients were more likely to report satisfactory experiences compared to patients from secondary and tertiary facilities. CONCLUSIONS The study demonstrated that CHCs provided better quality primary care when compared with secondary and tertiary health care facilities, justifying CHCs as a model of primary care delivery.
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Affiliation(s)
- Ruwei Hu
- School of Public Health of Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou, China
| | - Yu Liao
- School of Public Health of Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou, China
| | - Zhicheng Du
- School of Public Health of Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou, China
| | - Yuantao Hao
- School of Public Health of Sun Yat-sen University, 74 Zhongshan Road II, Guangzhou, China
| | - Hailun Liang
- Johns Hopkins Primary Care Policy Center, Baltimore, 624 N. Broadway, Baltimore, Maryland, 21205, USA
| | - Leiyu Shi
- Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, Maryland, 21205, USA.
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Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study. Br J Gen Pract 2016; 66:e531-9. [PMID: 27324627 DOI: 10.3399/bjgp16x686101] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 04/26/2016] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Although continuity of care is a widely accepted core principle of primary care, the evidence about its benefits is still weak. AIM To investigate whether continuity of care in general practice is associated with better survival in older people. DESIGN AND SETTING Data were derived from the Longitudinal Aging Study Amsterdam, an ongoing cohort study in older people in the Netherlands. The study sample consisted of 1712 older adults aged ≥60 years, with 3-year follow-up cycles up to 17 years (1992-2009), and mortality follow-up until 2013. METHOD Continuity of care was defined as the duration of the ongoing therapeutic relationship between patient and GP. The Herfindahl-Hirschman Index was used to calculate the continuity of care (COC). A COC index value of 1 represented maximum continuity. COC index values <1 were divided into tertiles, with a fourth category for participants with maximum COC. Cox regression analysis was used to investigate the association between COC and survival time. RESULTS Seven hundred and forty-two participants (43.3%) reported a maximum COC. Among the 759 participants surviving 17 years, 251 (33.1%) still had the same GP. The lowest COC category (index >0-0.500) showed significantly greater mortality than those in the maximum COC category (hazard ratio (HR) = 1.20, 95% CI = 1.01 to 1.42). There were no confounders that affected this HR. CONCLUSION This study demonstrates that low continuity of care in general practice is associated with a higher risk of mortality, strengthening the case for encouragement of continuity of care.
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Pu C, Chou YJ. The impact of continuity of care on emergency room use in a health care system without referral management: an instrumental variable approach. Ann Epidemiol 2016; 26:183-8. [PMID: 26851825 DOI: 10.1016/j.annepidem.2015.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 12/14/2015] [Accepted: 12/24/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of the study was to determine whether continuity of care (COC) is beneficial in national health care systems without referral management by controlling for endogeneity of COC. METHODS We used National Health Insurance (Taiwan) claims data from 2008, encompassing approximately 23 million people, to determine whether COC is associated with reduced emergency room (ER) use by hypertension and diabetic patients in 2009. We used an instrumental variable approach to account for endogeneity associated with patients' COC levels. RESULTS After controlling for endogeneity, the marginal effect of COC on ER use probability when the COC score increased from 0 to 1 was 7.6% (P < .001) and 14.8% (P < .001) for hypertension and diabetic patients, respectively. CONCLUSIONS We determined that COC is more effective for reducing ER use than are models that assume that COC is exogenous. It has been argued that in many countries, health care systems without referral management encourage physician shopping and hinder physician-patient communication. However, there are benefits to disease-specific COC. Because current estimations have failed to take endogeneity biases into account, COC is more effective than is currently assumed.
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Affiliation(s)
- Christy Pu
- Department of Public Health, National Yang-Ming University, Taipei, Taiwan ROC.
| | - Yiing-Jenq Chou
- Department of Public Health, National Yang-Ming University, Taipei, Taiwan ROC
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Rural-to-Urban Migrants' Experiences with Primary Care under Different Types of Medical Institutions in Guangzhou, China. PLoS One 2015; 10:e0140922. [PMID: 26474161 PMCID: PMC4608723 DOI: 10.1371/journal.pone.0140922] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 10/01/2015] [Indexed: 11/29/2022] Open
Abstract
Objectives China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Migrants are in a vulnerable state when they attempt to access to primary care services. This study was designed to explore rural-to-urban migrants’ experiences in primary care, comparing their quality of primary care experiences under different types of medical institutions in Guangzhou, China. Methods The study employed a cross-sectional survey of 736 rural-to-urban migrants in Guangzhou, China in 2014. A validated Chinese version of Primary Care Assessment Tool—Adult Short Version (PCAT-AS), representing 10 primary care domains was used to collect information on migrants’ quality of primary care experiences. These domains include first contact (utilization), first contact (accessibility), ongoing care, coordination (referrals), coordination (information systems), comprehensiveness (services available), comprehensiveness (services provided), family-centeredness, community orientation and culturally competent. These measures were used to assess the quality of primary care performance as reported from patients’ perspective. Analysis of covariance was conducted for comparison on PCAT scores among migrants accessing primary care in tertiary hospitals, municipal hospitals, community health centers/community health stations, and township health centers/rural health stations. Multiple linear regression models were used to explore factors associated with PCAT total scores. Results After adjustments were made, migrants accessing primary care in tertiary hospitals (25.49) reported the highest PCAT total scores, followed by municipal hospitals (25.02), community health centers/community health stations (24.24), and township health centers/rural health stations (24.18). Tertiary hospital users reported significantly better performance in first contact (utilization), first contact (accessibility), coordination (information system), comprehensiveness (service available), and cultural competence. Community health center/community health station users reported significantly better experience in the community orientation domain. Township health center/rural health station users expressed significantly better experience in the ongoing care domain. There were no statistically significant differences across settings in the ongoing care, comprehensiveness (services provided), and family-centeredness domains. Multiple linear regression models showed that factors positively associated with higher PCAT total scores also included insurance covering parts of healthcare payment (P<0.001). Conclusions This study highlights the need for improvement in primary care provided by primary care institutions for rural-to-urban migrants. Relevant policies related to medical insurance should be implemented for providing affordable healthcare services for migrants accessing primary care.
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Tousignant P, Diop M, Fournier M, Roy Y, Haggerty J, Hogg W, Beaulieu MD. Validation of 2 new measures of continuity of care based on year-to-year follow-up with known providers of health care. Ann Fam Med 2014; 12:559-67. [PMID: 25384820 PMCID: PMC4226779 DOI: 10.1370/afm.1692] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE In a primary care context favoring group practices, we assessed the validity of 2 new continuity measures (both versions of known provider continuity, KPC) that capture the concentration of care over time from multiple physicians (multiple provider continuity, KPC-MP) or from the physician seen most often (personal provider continuity, KPC-PP). METHODS Patients with diabetes or cardiovascular disease (N = 765) were approached in the waiting rooms of 28 primary care clinics in 3 regions of the province of Quebec, Canada; answered a survey questionnaire measuring relational continuity, interpersonal communication, coordination within the clinic, coordination with specialists, and overall coordination; and gave permission for their medical records to be reviewed and their medical services utilization data for the previous 2 years to be accessed to measure KPC. Using generalized linear mixed models, we assessed the association between KPC and the patients' responses. RESULTS Among the 5 different patient-reported measures or their combination, KPC-MP was significantly related with overall coordination of care: for high continuity, the odds ratio (OR) = 2.02 (95% CI, 1.33-3.07), and for moderate continuity, OR = 1.61 (95% CI, 1.06-2.46). KPC-MP was also related with the combined continuity score: for high continuity, OR = 1.52 (95% CI, 1.11-2.09), and for moderate continuity, OR = 1.48 (95% CI, 1.10-2.00). KPC-PP was not significantly associated with any of the survey measures. CONCLUSIONS The KPC-MP measure, based on readily available administrative data, is associated with patient-perceived overall coordination of care among multiple physicians. KPC measures are potentially a valuable and low-cost way to follow the effects of changes favoring group practice on continuity of care for entire populations. They are easy to replicate over time and across jurisdictions.
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Affiliation(s)
- Pierre Tousignant
- Population Health and Health Services Team of the Montreal Health and Social Services Agency, Public Health Department, and the Quebec National Public Health Institute, Department of Health Systems Analysis and Evaluation, Montreal, Quebec The Department of Epidemiology, Biostatistics and Occupational Health, McGill University Montreal, Quebec
| | - Mamadou Diop
- Population Health and Health Services Team of the Montreal Health and Social Services Agency, Public Health Department, and the Quebec National Public Health Institute, Department of Health Systems Analysis and Evaluation, Montreal, Quebec
| | - Michel Fournier
- Montreal Health and Social Services Agency, Public Health Department
| | - Yves Roy
- Population Health and Health Services Team of the Montreal Health and Social Services Agency, Public Health Department, and the Quebec National Public Health Institute, Department of Health Systems Analysis and Evaluation, Montreal, Quebec
| | - Jeannie Haggerty
- Department of Family Medicine, McGill University, Montreal, Quebec
| | - William Hogg
- Department of Family Medicine, University of Ottawa, Ottawa, Ontario
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Price M, Lau FY. Provider connectedness and communication patterns: extending continuity of care in the context of the circle of care. BMC Health Serv Res 2013; 13:309. [PMID: 23941179 PMCID: PMC3751828 DOI: 10.1186/1472-6963-13-309] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 08/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Continuity is an important aspect of quality of care, especially for complex patients in the community. We explored provider perceptions of continuity through a system's lens. The circle of care was used as the system. METHODS Soft systems methodology was used to understand and improve continuity for end of life patients in two communities. PARTICIPANTS Physicians, nurses, pharmacists in two communities in British Columbia, involved in end of life care. Two debates/discussion groups were completed after the interviews and initial analysis to confirm findings. Interview recordings were qualitatively analyzed to extract components and enablers of continuity. RESULTS 32 provider interviews were completed. Findings from this study support the three types of continuity described by Haggerty and Reid (information, management, and relationship continuity). This work extends their model by adding features of the circle of care that influence and enable continuity: Provider Connectedness the sense of knowing and trust between providers who share care of a patient; a set of ten communication patterns that are used to support continuity across the circle of care; and environmental factors outside the circle that can indirectly influence continuity. CONCLUSIONS We present an extended model of continuity of care. The components in the model can support health planners consider how health care is organized to promote continuity and by researchers when considering future continuity research.
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Affiliation(s)
- Morgan Price
- School of Health Information Science, University of Victoria, 3800 Finnerty Road Victoria, V8P 5C2 Victoria, British Columbia, Canada
- Department of Family Practice, University of British Columbia, Vancouver, Canada
- Medical Science Building, University of Victoria, PO Box 1700, STN CSC, Victoria BC V8W 2Y2 Canada
| | - Francis Y Lau
- School of Health Information Science, University of Victoria, 3800 Finnerty Road Victoria, V8P 5C2 Victoria, British Columbia, Canada
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