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Hawes EM, Page C, Galloway E, McClurg MR, Lombardi B. Pharmacists Colocated With Primary Care Physicians: Understanding Delivery of Interprofessional Primary Care. Med Care 2024; 62:87-92. [PMID: 38051204 DOI: 10.1097/mlr.0000000000001960] [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: 12/07/2023]
Abstract
BACKGROUND While evidence supports interprofessional primary care models that include pharmacists, the extent to which pharmacists are working in primary care and the factors associated with colocation is unknown. OBJECTIVES This study aimed to analyze the physical colocation of pharmacists with primary care providers (PCPs) and examine predictors associated with colocation. RESEARCH DESIGN This is a retrospective cross-sectional study of pharmacists and PCPs with individual National Provider Identifiers in the National Plan and Provider Enumeration System's database. Pharmacist and PCP practice addresses of the health care professionals were geocoded, and distances less than 0.1 miles were considered physically colocated. SUBJECTS In all, 502,373 physicians and 221,534 pharmacists were included. RESULTS When excluding hospital-based pharmacists, 1 in 10 (11%) pharmacists were colocated with a PCP. Pharmacists in urban settings were more likely to be colocated than those in rural areas (OR=1.32, CI: 1.26-1.38). Counties with the highest proportion of licensed pharmacists per 100,000 people in the county had higher colocation (OR=1.38, CI: 1.32-1.45). Colocation was significantly higher in states with an expanded scope of practice (OR 1.37, CI: 1.32-1.42) and those that have expanded Medicaid (OR 1.07, CI: 1.03-1.11). Colocated pharmacists more commonly worked in larger physician practices. CONCLUSION Although including pharmacists on primary care teams improves clinical outcomes, reduces health care costs, and enhances patient and provider experience, colocation appears to be unevenly dispersed across the United States, with lower rates in rural areas. As the integration of pharmacists in primary care continues to expand, knowing the prevalence and facilitators of growth will be helpful to policymakers, researchers, and clinical administrators.
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Affiliation(s)
- Emily M Hawes
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Cristen Page
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- University of North Carolina School of Medicine, Chapel Hill, NC
| | - Evan Galloway
- Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Mary Roth McClurg
- University of North Carolina Eshelman School of Pharmacy, Chapel Hill, NC
| | - Brianna Lombardi
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Health Workforce Research Center, Chapel Hill, NC
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Baskin C, Duncan F, Adams EA, Oliver EJ, Samuel G, Gnani S. How co-locating public mental health interventions in community settings impacts mental health and health inequalities: a multi-site realist evaluation. BMC Public Health 2023; 23:2445. [PMID: 38062427 PMCID: PMC10702025 DOI: 10.1186/s12889-023-17404-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 12/04/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Public mental health interventions are non-clinical services that aim to promote wellbeing and prevent mental ill health at the population level. In England, the health, social and community system is characterised by complex and fragmented inter-sectoral relationships. To overcome this, there has been an expansion in co-locating public mental health services within clinical settings, the focus of prior research. This study evaluates how co-location in community-based settings can support adult mental health and reduce health inequalities. METHODS A qualitative multi-site case study design using a realist evaluation approach was employed. Data collection took place in three phases: theory gleaning, parallel testing and refining of theories, and theory consolidation. We collected data from service users (n = 32), service providers (n = 32), funders, commissioners, and policy makers (n = 11), and members of the public (n = 10). We conducted in-depth interviews (n = 65) and four focus group discussions (n = 20) at six case study sites across England, UK, and two online multi-stakeholder workshops (n = 20). Interview guides followed realist-informed open-ended questions, adapted for each phase. The realist analysis used an iterative, inductive, and deductive data analysis approach to identify the underlying mechanisms for how community co-location affects public mental health outcomes, who this works best for, and understand the contexts in which co-location operates. RESULTS Five overarching co-location theories were elicited and supported. Co-located services: (1) improved provision of holistic and person-centred support; (2) reduced stigma by creating non-judgemental environments that were not associated with clinical or mental health services; (3) delivered services in psychologically safe environments by creating a culture of empathy, friendliness and trust where people felt they were being treated with dignity and respect; (4) helped to overcome barriers to accessibility by making service access less costly and more time efficient, and (5) enhance the sustainability of services through better pooling of resources. CONCLUSION Co-locating public mental health services within communities impacts multiple social determinants of poor mental health. It has a role in reducing mental health inequalities by helping those least likely to access services. Operating practices that engender inter-service trust and resource-sharing are likely to support sustainability.
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Affiliation(s)
- Cleo Baskin
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, UK
| | - Fiona Duncan
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle, NE2 4AX, UK.
| | - Emma A Adams
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle, NE2 4AX, UK
| | - Emily J Oliver
- Population Health Sciences Institute, Newcastle University, Baddiley-Clark Building, Newcastle, NE2 4AX, UK
| | - Gillian Samuel
- The McPin Foundation, 7-14 Great Dover Street, London, SE1 4YR, UK
| | - Shamini Gnani
- Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London, W6 8RP, UK
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Fleischmann M, Vaughan B, Bird A, Grace S, Fitzgerald K, McLeod G. Demographic, practice and clinical management characteristics of osteopaths referring to podiatrists: secondary analysis of a nationally representative sample of Australian osteopaths. BMC Health Serv Res 2022; 22:224. [PMID: 35180867 PMCID: PMC8855537 DOI: 10.1186/s12913-022-07520-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 11/25/2021] [Indexed: 11/30/2022] Open
Abstract
Background Interprofessional care is paramount in contemporary healthcare practice. How different professions interact, and the characteristics of those practitioners who practice in an interprofessional way are rarely described in the literature. The aim of the current work was to identify the demographic, practice and clinical management characteristics of Australian osteopaths who report referring to podiatrists. Methods The study was a secondary analysis of data from the Osteopathy Research and Innovation Network (ORION). Inferential statistics were generated to identify statistically significant demographic, practice and clinical management characteristics associated with referrals to podiatrists by Australian osteopaths. Results Nine-hundred and ninety-two Australian osteopaths responded to the questionnaire. Sending referrals to a podiatrist was reported by 651 participants (65.6%). Female Australian osteopaths were less likely to report referring to podiatrists compared to male osteopaths (OR 0.76, 95%CI 0.59–0.99). Australian osteopaths who reported referring to podiatrists were more likely to report receiving referrals from podiatrists (OR 9.75, 95%CI 6.98–13.61), use orthopaedic testing in patient assessment (OR 7.62, 95%CI 2.82–20.60), and often treat patients with postural disorders (OR 1.71, 95%CI 1.03–2.26), compared to osteopaths who do not refer to podiatrists. Conclusion This study provides initial evidence for the referral relationship between Australian osteopaths and podiatrists. Further work could explore the nature of these referrals, including the complaints resulting in referral and outcomes of care. This information will be useful to those involved in health policy development and the professions advocating for their role in the wider healthcare system.
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Affiliation(s)
- Michael Fleischmann
- College of Health and Biomedicine, Victoria University, Melbourne, Australia. .,School of Public Health, University of Technology Sydney, Sydney, Australia.
| | - Brett Vaughan
- School of Public Health, University of Technology Sydney, Sydney, Australia.,Department of Medical Education, University of Melbourne, Melbourne, Australia.,School of Health and Human Sciences, Southern Cross University, Lismore, Australia
| | - Adam Bird
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Australia
| | - Sandra Grace
- School of Health and Human Sciences, Southern Cross University, Lismore, Australia
| | - Kylie Fitzgerald
- Department of Medical Education, University of Melbourne, Melbourne, Australia
| | - Gopi McLeod
- School of Public Health, University of Technology Sydney, Sydney, Australia.,School of Health and Human Sciences, Southern Cross University, Lismore, Australia
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Rurik I, Nánási A, Jancsó Z, Kalabay L, Lánczi LI, Móczár C, Semanova C, Schmidt P, Torzsa P, Ungvári T, Kolozsvári LR. Evaluation of primary care services in Hungary: a comprehensive description of provision, professional competences, cooperation, financing, and infrastructure, based on the findings of the Hungarian-arm of the QUALICOPC study. Prim Health Care Res Dev 2021; 22:e36. [PMID: 34193332 PMCID: PMC8278788 DOI: 10.1017/s1463423621000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/03/2020] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary health care provision in terms of quality, equity, and costs are different by countries. The Quality and Costs of Primary Care (QUALICOPC) study evaluated these domains and parameters in 35 countries, using uniformized method with validated questionnaires filled out by family physicians/general practitioners (GPs).This paper aims to provide data of the Hungarian-arm of the QUALICOPC study and to give an overview about the recent Hungarian primary care (PC) system. METHODS The questionnaires were completed in 222 Hungarian GP practices, delivered by fieldworkers, in a geographically representative distribution. Descriptive analysis was performed on the data. FINDINGS Financing is based mostly on capitation, with additional compensatory elements and minor financial incentives. The gate-keeping function is weak. The communication between GPs and specialists is often insufficient. The number of available devices and equipment are appropriate. Single-handed practices are predominant. Appointment instead of queuing is a new option and is becoming more popular, mainly among better-educated and urban patients. GPs are involved in the management of almost all chronic condition of all generations. Despite the burden of administrative tasks, half of the GPs estimate their job as still interesting, burn-out symptoms were rarely found. Among the evaluated process indicators, access, continuity, comprehensiveness, and coordination were rated as satisfactory, together with equity among health outcome indicators. Financing is insufficient; therefore, many GPs are involved in additional income-generating activities. The old age of the GPs and the lack of the younger GPs generation contributes to a shortage in manpower. Cooperation and communication between different levels of health care provision should be improved, focusing better on community orientation and on preventive services. Financing needs continuous improvement and appropriate incentives should be implemented. There is a need for specific PC-oriented guidelines to define properly the tasks and competences of GPs.
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Affiliation(s)
- Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anna Nánási
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Zoltán Jancsó
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Kalabay
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Csaba Móczár
- Irinyi Primary Care Health Center, Kecskemét, Hungary
| | - Csilla Semanova
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Péter Schmidt
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Tímea Ungvári
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - László Róbert Kolozsvári
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Nieves CI, Dannefer R, Zamula A, Fonseca A, Myers C, Brown-Dudley L, Manyindo N. A Qualitative Evaluation of A Community-Based Nutrition and Health Promotion Program. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2021. [DOI: 10.1080/19320248.2021.1898514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Christina I. Nieves
- New York City Department of Health and Mental Hygiene, Bureau of Harlem Neighborhood Health, Center for Health Equity and Community Wellness, New York, USA
| | - Rachel Dannefer
- New York City Department of Health and Mental Hygiene, Bureau of Harlem Neighborhood Health, Center for Health Equity and Community Wellness, New York, USA
| | - Arlen Zamula
- New York City Department of Health and Mental Hygiene, Bureau of Harlem Neighborhood Health, Center for Health Equity and Community Wellness, New York, USA
| | - Anthony Fonseca
- New York City Department of Health and Mental Hygiene, Bureau of Harlem Neighborhood Health, Center for Health Equity and Community Wellness, New York, USA
| | | | - La’Shawn Brown-Dudley
- New York City Department of Health and Mental Hygiene, Bureau of Harlem Neighborhood Health, Center for Health Equity and Community Wellness, New York, USA
| | - Noel Manyindo
- New York City Department of Health and Mental Hygiene, Bureau of Harlem Neighborhood Health, Center for Health Equity and Community Wellness, New York, USA
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Heilbrun A, Drossos T. Evidence for Mental Health Contributions to Medical Care in Diabetes Management: Economic and Professional Considerations. Curr Diab Rep 2020; 20:79. [PMID: 33247792 PMCID: PMC8647713 DOI: 10.1007/s11892-020-01337-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW This paper considers the potential contributions of behavioral health providers to interprofessional, collaborative treatment for diabetes. We have the following objectives: (1) review the behavioral health complications, risks, burdens, and costs associated with diabetes management and consider the role of behavioral health providers in treating mental health concerns specific to diabetes; (2) highlight two frameworks for incorporating behavioral health into diabetes treatment, and review the empirical support for each; and (3) consider the financial feasibility of integrating behavioral health services into diabetes medical care settings. RECENT FINDINGS The healthcare field is still in the nascent stages of integrating behavioral health services in endocrinology clinics, but there is growing evidence that integrated behavioral healthcare has the potential to improve disease management and psychological functioning for individuals with chronic medical conditions. Furthermore, as a result of recent changes to the billing structure for behavioral health services in a medical setting, reimbursement rates for behavioral health providers in this capacity have improved considerably. If delivered by qualified behavioral health providers using evidence-based guidelines, behavioral health integration has the potential to optimize health outcomes, improve quality of life, and decrease fragmentation of care for patients with diabetes. Future research should focus on developing a financially feasible, empirically supported model of integrated behavioral health and disseminating the model to medical providers treating patients with diabetes.
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Affiliation(s)
- Anna Heilbrun
- The University of Chicago, 5801 S Ellis Ave, Chicago, IL 60637, USA
| | - Tina Drossos
- The University of Chicago, 5801 S Ellis Ave, Chicago, IL 60637, USA
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7
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Role of Occupational Therapy in Primary Care. Am J Occup Ther 2020; 74:7413410040p1-7413410040p16. [DOI: 10.5014/ajot.2020.74s3001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Abstract
The American Occupational Therapy Association (AOTA) affirms that occupational therapy practitioners1 are well prepared to contribute to interprofessional collaborative care teams addressing the primary care needs of individuals across the life course. Because of an increased focus on preventive population health and social determinants of health by health care organizations, synergy between primary care and occupational therapy is growing, with support for client-centered,2 comprehensive whole-person care, health promotion and prevention, disease self-management, and quality of life (Halle et al., 2018). Occupational therapy practitioners’ distinct knowledge of the significant impact that roles, habits, and routines have on health and wellness makes their contribution to primary care valuable (AOTA, 2020b). Occupational therapy’s focus on meaningful engagement in occupations is relevant and vital to participation in individual, family, and community life (AOTA, 2020c). In addition, occupational therapy practitioners’ holistic and population perspectives allow them to be effective both as interprofessional health care team members and as direct care providers to support client, family, and community needs in primary care delivery models (Leland et al., 2017). The purposes of this position paper are to define primary care and to describe occupational therapy’s evolving and advancing role in primary care, including expansion of services into specialty primary care areas such as pediatric primary care and obstetrics and gynecology (AOTA, 2018).
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Merryman MB, Synovec C. Integrated Care: Provider referrer perceptions of occupational therapy services for homeless adults in an integrated primary care setting. Work 2020; 65:321-330. [PMID: 32007976 DOI: 10.3233/wor-203084] [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: 11/15/2022] Open
Abstract
BACKGROUND Occupational therapists have a long history of addressing community performance and participation challenges faced by individuals with complex, chronic conditions, including those with serious mental illnesses (SMI) and cognitive issues that present with a traumatic brain injury (TBI). Healthcare reform has shifted incentives to support practices that promote successful community life for people with complex medical conditions. Community based care models emphasizing integrated primary care, such as Federally Qualified Health Centers (FQHC) are emerging, and a generalist role for occupational therapy is being defined. Those with complex comorbid conditions such as mental illness, substance abuse and traumatic brain injury are at risk for negative health outcomes that are further compounded by homelessness. There is a critical need to understand effective treatment options for this population to reduce the negative effects of chronic health conditions. As occupational therapists further define a role serving traditional clients in less traditional settings, such as the FQHC, it is helpful to explore the perceptions of the utility of OT services on the part of provider referrers. OBJECTIVE This study explored provider referrer perceptions of a new occupational therapy service for homeless adults in an FQHC to assist effective allocation of scarce resources. METHODS Twelve provider referrers at an FQHC were interviewed regarding their perception of the role and utility of occupational therapy in this setting. Interviews were then coded for themes. RESULTS Providers identified the unique value of occupational therapy, emphasizing critical information gleaned from the performance-based assessment of functional cognition, and the positive impact on team interactions and subsequent care decisions. CONCLUSION Occupational therapy provides a distinct perspective on client performance in FQHC settings indicating benefit for inclusion of services.
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Affiliation(s)
- M Beth Merryman
- Department of Occupational Therapy & Occupational Science, Towson University, Towson, MD, USA
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Timpel P, Lang C, Wens J, Contel JC, Schwarz PEH. The Manage Care Model - Developing an Evidence-Based and Expert-Driven Chronic Care Management Model for Patients with Diabetes. Int J Integr Care 2020; 20:2. [PMID: 32346360 PMCID: PMC7181948 DOI: 10.5334/ijic.4646] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/25/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Most current care models are disease- or symptom-focused and mostly do not account for the individual needs of patients with chronic diseases. The aim of this study was to develop an innovative, evidence-based and expert-based practice model for the management of patients with type 2 diabetes mellitus. METHOD An iterative approach was used combining systematic literature search with qualitative methods, including a standardised survey of experts in chronic care (n = 92), an expert workshop of professionals (n = 22) and a multilingual online survey (n = 659). Using three consensus meetings involving researchers, policy makers and experts in chronic care, a limited number of core components and care recommendations was set up to develop a new chronic care model. RESULTS The developed 'MANAGE CARE MODEL' includes aspects of the health and social care system, resources derived from the living environment, aspects of health promotion and prevention, as well as an expanded understanding of improved outcomes as an integral part of chronic care. CONCLUSION The MANAGE CARE MODEL provides guidance for the development and implementation of chronic care programs, regional networks and national strategies. Future research is needed to validate the model as an instrument of regional chronic care management.
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Affiliation(s)
- Patrick Timpel
- Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, DE
| | - Caroline Lang
- Department of General Practice, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, DE
| | - Johan Wens
- Department of Primary and Interdisciplinary Care Antwerp, University of Antwerp, Antwerp, BE
| | - Juan Carlos Contel
- Chronic Care Program, Department of Health, Integrated Health and Social Care Plan, Generalitat de Catalunya, ES
| | - Peter E. H. Schwarz
- Prevention and Care of Diabetes, Department of Medicine III, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, DE
- Paul Langerhans Institut Dresden, German Center for Diabetes Research (DZD), Dresden, DE
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Duckett S. What should primary care look like after the COVID-19 pandemic? Aust J Prim Health 2020; 26:207-211. [DOI: 10.1071/py20095] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 11/23/2022]
Abstract
The response to COVID-19 transformed primary care: new telehealth items were added to the Medicare Benefits Schedule, and their use quickly escalated, general practices and community health centres developed new ways of working and patients embraced the changes. As new coronavirus infections plummet and governments contemplate lifting spatial distancing restrictions, attention should turn to the transition out of pandemic mode. Some good things happened during the pandemic, including the rapid introduction of the new telehealth items. The post-pandemic health system should learn from the COVID-19 changes and create a new normal.
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The Neighborhood as a Unit of Change for Health: Early Findings from the East Harlem Neighborhood Health Action Center. J Community Health 2019; 45:161-169. [PMID: 31451987 PMCID: PMC6954892 DOI: 10.1007/s10900-019-00712-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 07/09/2019] [Accepted: 07/25/2019] [Indexed: 11/01/2022]
Abstract
Place-based approaches have been promoted as one way to reduce health inequities by addressing community-level factors that shape health, such as housing quality, healthcare systems, the built environment, and social capital. In 2016-2017, the NYC Health Department's Center for Health Equity launched three Neighborhood Health Action Centers (Action Centers), which use a place-based approach to improve health in neighborhoods with disproportionate burdens of premature mortality. We describe this approach and the genesis of the Action Centers. We then describe the East Harlem Action Center, which was the first to open, and share findings from qualitative interviews with the East Harlem Action Center's Governance Council, a group comprised of Action Center staff and co-located partners and programs which supports Action Center coordination. Interviewees felt that collaboration, being responsive to community needs, and being community based were essential elements of the Action Center. Interviewees recognized the complex dynamic of a large city agency serving as the host for the Action Center while simultaneously aiming to establish more equitable relationships with partners. Governance Council members' expectations and hopes for the East Harlem Action Center were consistent with the overall vision and model for the Action Centers, which may facilitate implementation.
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12
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Schäfer WL, Boerma WG, van den Berg MJ, De Maeseneer J, De Rosis S, Detollenaere J, Greß S, Heinemann S, van Loenen T, Murante AM, Pavlič DR, Seghieri C, Vainieri M, Willems S, Groenewegen PP. Are people's health care needs better met when primary care is strong? A synthesis of the results of the QUALICOPC study in 34 countries. Prim Health Care Res Dev 2019; 20:e104. [PMID: 32800009 PMCID: PMC6609545 DOI: 10.1017/s1463423619000434] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 01/25/2019] [Accepted: 04/27/2019] [Indexed: 11/06/2022] Open
Abstract
AIM This article synthesises the results of a large international study on primary care (PC), the QUALICOPC study. BACKGROUND Since the Alma Ata Declaration, strengthening PC has been high on the policy agenda. PC is associated with positive health outcomes, but it is unclear how care processes and structures relate to patient experiences. METHODS Survey data were collected during 2011-2013 from approximately 7000 PC physicians and 70 000 patients in 34, mainly European, countries. The data on the patients are linked to data on the PC physicians within each country and analysed using multilevel modelling. FINDINGS Patients had more positive experiences when their PC physician provided a broader range of services. However, a broader range of services is also associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries where patients had a continuous relationship with PC physicians. Additionally, patients with a long-term relationship with their PC physician were less likely to attend the emergency department. Capitation payment was associated with more positive patient experiences. Mono- and multidisciplinary co-location was related to improved processes in PC, but the experiences of patients visiting multidisciplinary practices were less positive. A stronger national PC structure and higher overall health care expenditures are related to more favourable patient experiences for continuity and comprehensiveness. The study also revealed inequities: patients with a migration background reported less positive experiences. People with lower incomes more often postponed PC visits for financial reasons. Comprehensive and accessible care processes are related to less postponement of care. CONCLUSIONS The study revealed room for improvement related to patient-reported experiences and highlighted the importance of core PC characteristics including a continuous doctor-patient relationship as well as a broad range of services offered by PC physicians.
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Affiliation(s)
- Willemijn L.A. Schäfer
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 633 N. St Clair Street, Chicago, IL 60611, USA
- NIVEL – Netherlands Institute for Health Services Research, PO box 1568, 3500BN Utrecht, The Netherlands
| | - Wienke G.W. Boerma
- NIVEL – Netherlands Institute for Health Services Research, PO box 1568, 3500BN Utrecht, The Netherlands
| | - Michael J. van den Berg
- Amsterdam UMC, University of Amsterdam, Department of Public Health, Amsterdam Public Health Research Institute, 22660, 1100 DD, Amsterdam
| | - Jan De Maeseneer
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium
| | - Sabina De Rosis
- Scuola Superiore Sant’Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy
| | - Jens Detollenaere
- KCE – Belgian Health Care Knowledge Centre, Kruidtuinlaan 55, 1000 Brussels, Belgium
| | - Stefan Greß
- Department of Nursing and Health Sciences, University of Applied Sciences Fulda, Leipziger Str. 123, 36037 Fulda, Germany
| | - Stephanie Heinemann
- Department of Nursing and Health Sciences, University of Applied Sciences Fulda, Leipziger Str. 123, 36037 Fulda, Germany
- Department of General Practice, University Medical Center Göttingen, Humboldtallee 38, 37073 Göttingen, Germany
| | - Tessa van Loenen
- Pharos – Centre of Expertise on Health Disparities, PO box 13318, 3507 LH Utrecht, The Netherlands
| | - Anna Maria Murante
- Scuola Superiore Sant’Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy
| | - Danica R. Pavlič
- Department of Family Medicine, University of Ljubljana, Poljanski nasip 58, 1000 Ljubljana, Slovenia
| | - Chiara Seghieri
- Scuola Superiore Sant’Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy
| | - Milena Vainieri
- Scuola Superiore Sant’Anna, Institute of Management, Laboratorio Management e Sanità, piazza Martiti della Libertà 33, Pisa 56127, Italy
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Corneel Heymanslaan 10, Ghent, Belgium
| | - Peter P. Groenewegen
- NIVEL – Netherlands Institute for Health Services Research, PO box 1568, 3500BN Utrecht, The Netherlands
- Department of Sociology and Department of Human Geography, Utrecht University, P.O. Box 80.115, 3508 TC Utrecht, The Netherlands
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13
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Zhang Y, Yu M, Song D. Meta-Analysis the Quality of General Practitioners Management for Elderly Patients with Hypertension in China. Health (London) 2019. [DOI: 10.4236/health.2019.1110108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Reform der Primärversorgung in Österreich. Wien Med Wochenschr 2018; 168:406-414. [DOI: 10.1007/s10354-017-0613-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/16/2017] [Indexed: 11/25/2022]
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15
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Mazzi MA, Rimondini M, van der Zee E, Boerma W, Zimmermann C, Bensing J. Which patient and doctor behaviours make a medical consultation more effective from a patient point of view. Results from a European multicentre study in 31 countries. PATIENT EDUCATION AND COUNSELING 2018; 101:1795-1803. [PMID: 29891103 DOI: 10.1016/j.pec.2018.05.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 05/07/2018] [Accepted: 05/25/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess European patients' preferences regarding seven aspects of doctor-patient communication. METHODS 6049 patients from 31 European countries evaluated 21 doctor and 12 patient behaviours, through a patient-generated questionnaire (PCVq). Multilevel models explored the effects of patient characteristics, contextual and cultural dimensions on preferences. RESULTS Patients attributed more responsibility to doctors, by giving greater importance to doctor than to patient factors, in particular to Treating the patient as a partner and as a person and Continuity of care. Gender, age, education, the presence of chronic illness and two of Hofstede's cultural dimensions, Individualism and Indulgence, showed differential evaluations among patients. Women gave greater importance to all seven communication aspects, older patients to being prepared for the consultation, lower educated patients to Treating patient as a person and Thoughtful planning. Patients from countries with an indulgent background rated all seven communication aspects of greater importance. A more individualistic orientation was related to lower importance regarding the four doctor's factors and the patient factor Open and Honest. CONCLUSIONS Treating the patient as a person and providing continuity of care emerged as universal values. PRACTICE IMPLICATIONS The findings should represent a landmark for the adaptation of patient-generated communication guidelines and programs in Europe.
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Affiliation(s)
- Maria Angela Mazzi
- University of Verona, Department of Neurosciences, Biomedicine and Movement Sciences, Italy.
| | - Michela Rimondini
- University of Verona, Department of Neurosciences, Biomedicine and Movement Sciences, Italy
| | | | - Wienke Boerma
- NIVEL, Netherlands Institute for Health Services Research, The Netherlands
| | - Christa Zimmermann
- University of Verona, Department of Neurosciences, Biomedicine and Movement Sciences, Italy
| | - Jozien Bensing
- NIVEL, Netherlands Institute for Health Services Research, The Netherlands
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16
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Li A, Cronin S, Bai YQ, Walker K, Ammi M, Hogg W, Wong ST, Wodchis WP. Assessing the representativeness of physician and patient respondents to a primary care survey using administrative data. BMC FAMILY PRACTICE 2018; 19:77. [PMID: 29848292 PMCID: PMC5977493 DOI: 10.1186/s12875-018-0767-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 05/18/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND QUALICOPC is an international survey of primary care performance. QUALICOPC data have been used in several studies, yet the representativeness of the Canadian QUALICOPC survey is unknown, potentially limiting the generalizability of findings. This study examined the representativeness of QUALICOPC physician and patient respondents in Ontario using health administrative data. METHODS This representativeness study linked QUALICOPC physician and patient respondents in Ontario to health administrative databases at the Institute for Clinical Evaluative Sciences. Physician respondents were compared to other physicians in their practice group and all Ontario primary care physicians on demographic and practice characteristics. Patient respondents were compared to other patients rostered to their primary care physicians, patients rostered to their physicians' practice groups, and a random sample of Ontario residents on sociodemographic characteristics, morbidity, and health care utilization. Standardized differences were calculated to compare the distribution of characteristics across cohorts. RESULTS QUALICOPC physician respondents included a higher proportion of younger, female physicians and Canadian medical graduates compared to other Ontario primary care physicians. A higher proportion of physician respondents practiced in Family Health Team models, compared to the provincial proportion for primary care physicians. QUALICOPC patient respondents were more likely to be older and female, with significantly higher levels of morbidity and health care utilization, compared with the other patient groups examined. However, when looking at the QUALICOPC physicians' whole rosters, rather than just the patient survey respondents, the practice profiles were similar to those of the other physicians in their practice groups and Ontario patients in general. CONCLUSIONS Comparisons revealed some differences in responding physicians' demographic and practice characteristics, as well as differences in responding patients' characteristics compared to the other patient groups tested, which may have resulted from the visit-based sampling strategy. Ontario QUALICOPC physicians had similar practice profiles as compared to non-participating physicians, providing some evidence that the participating practices are representative of other non-participating practices, and patients selected by visit-based sampling may also be representative of visiting patients in other practices. Those using QUALICOPC data should understand this limited representativeness when generalizing results, and consider the potential for bias in their analyses.
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Affiliation(s)
- Allanah Li
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada. .,Department of Family & Community Medicine, University of Toronto, Toronto, Canada.
| | - Shawna Cronin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Yu Qing Bai
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Kevin Walker
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Mehdi Ammi
- School of Public Policy & Administration, Carleton University, Ottawa, Canada
| | - William Hogg
- Department of Family Medicine, University of Ottawa, Ottawa, Canada.,Bruyere Research Institute, Ottawa, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada.,Toronto Rehabilitation Institute, Toronto, Canada
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17
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A Research Program on Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH): An International Collaboration. Int J Integr Care 2018; 18:11. [PMID: 30127695 PMCID: PMC6095069 DOI: 10.5334/ijic.4160] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Health and social care systems across western developed nations are being challenged to meet the needs of an increasing number of people aging with multiple complex health and social needs. Community based primary health care (CBPHC) has been associated with more equitable access to services, better population level outcomes and lower system level costs. Itmay be well suited to the increasingly complex needs of populations; however the implementation of CBPHC models of care faces many challenges. This paper describes a program of research by an international, multi-university, multidisciplinary research team who are seeking to understand how to scale up and spread models of Integrated CBPHC (ICBPHC). The key question being addressed is “What are the steps to implementing innovative integrated community-based primary health care models that address the health and social needs of older adults with complex care needs?” and will be answered in three phases. In the first phase we identify and describe exemplar models of ICBPHC and their context in relation to relevant policies and performance across the three jurisdictions (New Zealand, Ontario and Québec, Canada). The second phase involves a series of theory-informed, mixed methods case studies from which we shall develop a conceptual framework that captures not only the attributes of successful innovative ICBPHC models, but also how these models are being implemented. In the third phase, we aim to translate our research into practice by identifying emerging models of ICBPHC in advance, and working alongside policymakers to inform the development and implementation of these models in each jurisdiction. The final output of the program will be a comprehensive guide to the design, implementation and scaling-up of innovative models of ICBPHC.
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Bonciani M, Schäfer W, Barsanti S, Heinemann S, Groenewegen PP. The benefits of co-location in primary care practices: the perspectives of general practitioners and patients in 34 countries. BMC Health Serv Res 2018; 18:132. [PMID: 29466980 PMCID: PMC5822600 DOI: 10.1186/s12913-018-2913-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background There is no clear evidence as to whether the co-location of primary care professionals in the same facility positively influences their way of working and the quality of healthcare as perceived by patients. The aim of this study was to identify the relationships between general practitioner (GP) co-location with other GPs and/or other professionals and the GP outcomes and patients’ experiences. Methods We wanted to test whether GP co-location is related to a broader range of services provided, the use of clinical governance tools and inter-professional collaboration, and whether the patients of co-located GPs perceive a better quality of care in terms of accessibility, comprehensiveness and continuity of care with their GPs. The source of data was the QUALICOPC study (Quality and Costs of Primary Care in Europe), which involved surveys of GPs and their patients in 34 countries, mostly in Europe. In order to study the relationships between GP co-location and both GPs’ outcomes and patients’ experience, multilevel linear regression analysis was carried out. Results The GP questionnaire was filled in by 7183 GPs and the patient experience questionnaire by 61,931 patients. Being co-located with at least one other professional is the most common situation of the GPs involved in the study. Compared with single-handed GP practices, GP co-location are positively associated with the GP outcomes. Considering the patients’ perspective, comprehensiveness of care has the strongest negative relationship of GP co-location of all the dimensions of patient experiences analysed. Conclusions The paper highlights that GP mono- and multi-disciplinary co-location is related to positive outcomes at a GP level, such as a broader provision of technical procedures, increased collaboration among different providers and wider coordination with secondary care. However, GP co-location, particularly in a multidisciplinary setting, is related to less positive patient experiences, especially in countries with health systems characterised by a weak primary care structure.
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Affiliation(s)
- M Bonciani
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - W Schäfer
- Netherlands Institute for Health Services Research-NIVEL, Utrecht, The Netherlands
| | - S Barsanti
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - S Heinemann
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany.,Department of Nursing and Health Sciences, University of Applied Sciences Fulda, Fulda, Germany
| | - P P Groenewegen
- Netherlands Institute for Health Services Research-NIVEL, Utrecht, The Netherlands.,Department of Sociology, Department of Human Geography, Utrecht University, Utrecht, The Netherlands
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19
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Delivery of adjuvant chemotherapy among stage III colon cancer patients at a public versus private hospital in New York City. Cancer Causes Control 2017; 29:253-260. [PMID: 29250702 DOI: 10.1007/s10552-017-0996-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 12/13/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE Prior studies of timeliness of adjuvant chemotherapy (AC) initiation in stage III colon cancer have suggested longer time to AC at public compared with private hospitals. Few studies have explored differences in AC completion. We investigated whether timely initiation and completion of AC differed between a public and private hospital, affiliated with the same academic institution in a large, urban setting. METHODS We conducted a retrospective cohort study of stage III colon cancer patients who had surgery and AC at the same medical center between 2008 and 2015, either at its affiliated public hospital (n = 43) or private hospital (n = 79). We defined timely initiation as receiving AC within 60 days postoperatively, and completion as receiving ≥ 75% of planned AC. Univariate and stepwise multivariable logistic regressions were used to identify factors associated with AC delivery. RESULTS Median number of days to AC was significantly greater among patients at the public (53, range 31-231) compared with the private hospital (43, range 25-105; p = 0.002). However, the percentage of patients with timely AC initiation did not differ substantially by hospital (74 vs 81%, p = 0.40). In multivariable analysis, age (OR 0.95/year, 95% CI 0.91-0.99) and laparoscopic versus open surgery (OR 5.65, 95% CI 1.92-16.62) were significant factors associated with timely AC initiation. Moreover, AC completion did not differ significantly between public (83.7%) and private (89.9%) hospital patients (p = 0.32). CONCLUSIONS The proportions of patients with timely initiation and completion of AC were similar at a public and private hospital affiliated with a large, urban medical center. Future research should investigate how specific system-level factors help alleviate this expected difference in timely care delivery.
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20
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Bonciani M, Barsanti S, Murante AM. Is the co-location of GPs in primary care centres associated with a higher patient satisfaction? Evidence from a population survey in Italy. BMC Health Serv Res 2017; 17:248. [PMID: 28376886 PMCID: PMC5379750 DOI: 10.1186/s12913-017-2187-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 03/24/2017] [Indexed: 12/24/2022] Open
Abstract
Background Several countries have co-located General Practitioners (GPs) in Primary Care Centres (PCCs) with other health and social care professionals in order to improve integrated care. It is not clear whether the co-location of a multidisciplinary team actually facilitates a positive patient experience concerning GP care. The aim of this study was to verify whether the co-location of GPs in PCCs is associated positively with patient satisfaction with their GP when patients have experience of a multidisciplinary team. We also investigated whether patients who frequently use health services, due to their complex needs, benefitted the most from the co-location of a multidisciplinary team. Methods The study used data from a population survey carried out in Tuscany (central Italy) at the beginning of 2015 to evaluate the patients’ experience and satisfaction with their GPs. Multilevel linear regression models were implemented to verify the relationship between patient satisfaction and co-location. This key explanatory variable was measured by considering both the list of GPs working in PCCs and the answers of surveyed patients who had experienced the co-location of their GP in a multidisciplinary team. We also explored the effect modification on patient satisfaction due to the use of hospitalisation, access to emergency departments and visits with specialists, by performing the multilevel modelling on two strata of patient data: frequent and non-frequent health service users. Results A sample of 2025 GP patients were included in the study, 757 of which were patients of GPs working in a PCC. Patient satisfaction with their GP was generally positive. Results showed that having a GP working within a PCC and the experience of the co-located multidisciplinary team were associated with a higher satisfaction (p < 0.01). For non-frequent users of health services on the other hand, the co-location of multidisciplinary team in PCCs was not significantly associated with patient satisfaction, whereas for frequent users, the strength of relationships identified in the overall model increased (p < 0.01). Conclusion The co-location of GPs with other professionals and their joint working as experienced in PCCs seems to represent a greater benefit for patients, especially for those with complex needs who use primary care, hospitals, emergency care and specialized care frequently.
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Affiliation(s)
- Manila Bonciani
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy.
| | - Sara Barsanti
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Anna Maria Murante
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Pisa, Italy
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Scheele CE, Vrangbæk K. Co-location as a Driver for Cross-Sectoral Collaboration with General Practitioners as Coordinators: The Case of a Danish Municipal Health Centre. Int J Integr Care 2016; 16:15. [PMID: 28316555 PMCID: PMC5354220 DOI: 10.5334/ijic.2471] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/22/2016] [Indexed: 11/28/2022] Open
Abstract
The issue of integrated care and inter-sectoral collaboration is on the health policy agenda in many countries. Yet, there is limited knowledge about the effects of the different policy instruments used to achieve this. This paper studies co-location as a driver for cross-sectoral collaboration with general practitioners (GPs) acting as coordinators in a municipal health centre. The purpose of the health centre, which is staffed by health professionals from municipal, regional and private sectors, is to provide primary health services to the citizens of the municipality. Co-locating these professionals is supposed to benefit e.g., elder citizens and patients with chronic diseases who frequently require services from health professionals across administrative sectors. Methodologically, the analysis is based on qualitative data in the form of semi-structured interviews with the health professionals employed at the health centre and with administrative managers from municipal and regional government levels. The study finds that co-location does not function as a driver for cross-sectoral collaboration in a health centre when GPs act as coordinators. Cross-sectoral collaboration is hampered by the general practitioners' work routines and professional identity, by organisational factors and by a lack of clarity concerning the content of collaboration with regard to economic and professional incentives.
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Affiliation(s)
- Christian Elling Scheele
- University of Copenhagen, Department of Public Health, Centre for Healthy Aging, Centre for Health Economics, DK
| | - Karsten Vrangbæk
- University of Copenhagen, Department of Public Health, Centre for Healthy Aging, Centre for Health Economics, DK
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22
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Do primary care professionals agree about progress with implementation of primary care teams: results from a cross sectional study. BMC FAMILY PRACTICE 2016; 17:163. [PMID: 27875994 PMCID: PMC5120534 DOI: 10.1186/s12875-016-0541-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 05/21/2016] [Indexed: 11/16/2022]
Abstract
Background Primary care is the cornerstone of healthcare reform with policies across jurisdictions promoting interdisciplinary team working. The effective implementation of such health policies requires understanding the perspectives of all actors. However, there is a lack of research about health professionals’ views of this process. This study compares Primary Healthcare Professionals’ perceptions of the effectiveness of the Primary Care Strategy and Primary Care Team (PCT) implementation in Ireland. Methods Design and Setting: e-survey of (1) General Practitioners (GPs) associated with a Graduate Medical School (N = 100) and (2) Primary Care Professionals in 3 of 4 Health Service Executive (HSE) regions (N = 2309). After piloting, snowball sampling was used to administer the survey. Descriptive analysis was carried out using SPSS. Ratings across groups were compared using non-parametric tests. Results There were 569 responses. Response rates varied across disciplines (71 % for GPs, 22 % for other Primary Healthcare Professionals (PCPs). Respondents across all disciplines viewed interdisciplinary working as important. Respondents agreed on lack of progress of implementation of formal PCTs (median rating of 2, where 1 is no progress at all and 5 is complete implementation). GPs were more negative about the effectiveness of the Strategy to promote different disciplines to work together (median rating of 2 compared to 3 for clinical therapists and 3.5 for nurses, P = 0.001). Respondents identified resources and GP participation as most important for effective team working. Protected time for meetings and capacity to manage workload for meetings were rated as very important factors for effective team working by GPs, clinical therapists and nurses. A building for co-location of teams was rated as an important factor by nurses and clinical therapists though GPs rated it as less important. Payment to attend meetings and contractual arrangements were considered important factors by GPs but not by nurses or clinical therapists. Conclusion PCPs and GPs agree there is limited PCT implementation. GPs are most negative about this implementation. There is some disagreement about which resources are most important for effective PCT working. These findings provide valuable data for clinicians and policy makers about implementation of interdisciplinary teams in primary care. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0541-9) contains supplementary material, which is available to authorized users.
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Sandelowsky H, Hylander I, Krakau I, Modin S, Ställberg B, Nager A. Time pressured deprioritization of COPD in primary care: a qualitative study. Scand J Prim Health Care 2016; 34:55-65. [PMID: 26849465 PMCID: PMC4911027 DOI: 10.3109/02813432.2015.1132892] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify factors that hinder discussions regarding chronic obstructive pulmonary disease (COPD) between primary care physicians (PCPs) and their patients in Sweden. SETTING Primary health care centres (PHCCs) in Stockholm, Sweden. SUBJECTS A total of 59 PCPs. DESIGN Semi-structured individual and focus-group interviews between 2012 and 2014. Data were analysed inspired by grounded theory methods (GTM). RESULTS Time-pressured patient-doctor consultations lead to deprioritization of COPD. During unscheduled visits, deprioritization resulted from focusing only on acute health concerns, while during routine care visits, COPD was deprioritized in multi-morbid patients. The reasons PCPs gave for deprioritizing COPD are: "Not becoming aware of COPD", "Not becoming concerned due to clinical features", "Insufficient local routines for COPD care", "Negative personal attitudes and views about COPD", "Managing diagnoses one at a time", and "Perceiving a patient's motivation as low''. CONCLUSIONS De-prioritization of COPD was discovered during PCP consultations and several factors were identified associated with time constraints and multi-morbidity. A holistic consultation approach is suggested, plus extended consultation time for multi-morbid patients, and better documentation and local routines. KEY POINTS Under-diagnosis and insufficient management of chronic obstructive pulmonary disease (COPD) are common in primary health care. A patient-doctor consultation offers a key opportunity to identify and provide COPD care. Time pressure, due to either high number of patients or multi-morbidity, leads to omission or deprioritization of COPD during consultation. Deprioritization occurs due to lack of awareness, concern, and local routines, negative personal views, non-holistic consultation approach, and low patient motivation. Better local routines, extended consultation time, and a holistic approach are needed when managing multi-morbid patients with COPD.
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Affiliation(s)
- Hanna Sandelowsky
- NVS, Section for Family Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
- CONTACT Hanna Sandelowsky Karolinska Institutet, NVS, Section for Family Medicine, Alfred Nobels Allé 12, S-14183 Huddinge, Stockholm, Sweden
| | - Ingrid Hylander
- NVS, Section for Family Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Ingvar Krakau
- NVS, Section for Family Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Sonja Modin
- NVS, Section for Family Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Björn Ställberg
- Department of Public Health and Caring Science, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Anna Nager
- NVS, Section for Family Medicine, Karolinska Institutet, Huddinge, Stockholm, Sweden
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Hoffmann K, George A, Dorner TE, Süß K, Schäfer WLA, Maier M. Primary health care teams put to the test a cross-sectional study from Austria within the QUALICOPC project. BMC FAMILY PRACTICE 2015; 16:168. [PMID: 26572224 PMCID: PMC4647311 DOI: 10.1186/s12875-015-0384-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 11/10/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multidisciplinary Primary Health Care Teams (PHCT) provide a comprehensive approach to address the social and health needs of communities. It was the aim of this analysis to assess the number of PHCT in Austria, a country with a weak PHC system, and to compare preventive activities, psychosocial care, and work satisfaction between GPs who work and those who do not work in PHCT. METHOD Within the QUALICOPC study, data collection was performed between November 2011 and May 2012, utilizing a standardized questionnaire for GPs. A stratified sample of GPs from across Austria was invited. Statistical analyses included descriptive statistics and tests. RESULTS Data from 171 GPs questionnaires were used for this analysis. Of these, 61.1 % (n = 113) had a mono-disciplinary office, 26.3 % (n = 45) worked in an office consisting of GP, receptionist and one additional primary care profession, and 7.6 % (n = 13) worked in a larger PHCT. GPs that worked in larger PHCT were younger and more involved in psychosocial and preventive care. No differences were found with regard to work satisfaction or workload. CONCLUSIONS This study gives insight into the structures of PHC in Austria. The results indicate a low number of PHCT; however, the overall return rate in our sample was low with more male GPs, more GPs from urban areas and more GPs working in offices together with other physicians than the national average. Younger GPs demonstrate a greater tendency to implement this primary care practice model in their practices, which seems to be associated with an emphasis in psychosocial and preventive care. If Austria is to increase the number of PHC teams, the country should embrace the work of young GPs and should offer relevant support for PHCT. Future developments could be guided by considering effective models of good practice and governmental support as in other countries.
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Affiliation(s)
- Kathryn Hoffmann
- Department of General Practice, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, 1090, Vienna, Austria.
| | - Aaron George
- Department of Community and Family Medicine, Duke Medical Center, Durham, NC, USA.
| | - Thomas E Dorner
- Institute for Social Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria.
| | - Katharina Süß
- Department of General Practice, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, 1090, Vienna, Austria.
| | - Willemijn L A Schäfer
- NIVEL, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
| | - Manfred Maier
- Department of General Practice, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1st floor, 1090, Vienna, Austria.
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Hoffmann K, Peersman W, George A, Dorner TE. Associations and Synergistic Effects for Psychological Distress and Chronic Back Pain on the Utilization of Different Levels of Ambulatory Health Care. A Cross-Sectional Study from Austria. PLoS One 2015; 10:e0134136. [PMID: 26218661 PMCID: PMC4517760 DOI: 10.1371/journal.pone.0134136] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 07/06/2015] [Indexed: 11/18/2022] Open
Abstract
The aim of this analysis was to assess the impact of chronic back pain and psychological distress on the utilization of primary and secondary levels of care in the ambulatory health care sector in Austria - a country without a gatekeeping system. Additionally, we aimed to determine if the joint effect of chronic back pain and psychological distress was higher than the impact of the sum of the two single conditions. The database used for this analysis was the Austrian Health Interview Survey, with data from 15,474 individuals. Statistical methods used were descriptive tests, regression models and the calculation of synergistic effects. Both chronic back pain and psychological distress had a positive association with the utilization of the primary (OR for chronic back pain 1.53 and psychological distress 1.33) and secondary (OR for chronic back pain 1.32 and psychological distress 1.24) levels of the health care sector. In the fully adjusted model, the synergistic effect of chronic back pain and psychological distress was significant for the secondary level of care (S 1.99, PAF 0.20), but not for the primary level of care (S 1.16, PAF 0.07). Synergistic effects and associations for chronic back pain and psychological distress on the utilization of both the primary and secondary levels of the ambulatory health care sector were observed, particularly for the secondary level of care. Our results demonstrate the utilization of health care services settings by individuals with these conditions, and offer opportunities to consider reorganization and structuring of the Austrian health care system.
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Affiliation(s)
- Kathryn Hoffmann
- Department of General Practice, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Wim Peersman
- Department of Family Medicine and Primary Care, Ghent University, Ghent, Belgium
| | - Aaron George
- Department of Community and Family Medicine, Duke Medical Center, Durham, NC, United States of America
| | - Thomas Ernst Dorner
- Institute for Social Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
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