1
|
Tomaschek R, Gemperli A, Essig S. Improving collaboration between specialists and general practitioners in services for individuals with chronic spinal cord injury living in rural areas of Switzerland: Baseline results from the SCI-Co study. J Spinal Cord Med 2024; 47:423-431. [PMID: 36441044 PMCID: PMC11044760 DOI: 10.1080/10790268.2022.2097996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
CONTEXT/OBJECTIVE Strategies to combine primary and specialized care are crucial to meet the needs of individuals with spinal cord injury (SCI) located in rural areas. We explored the collaboration between general practitioners (GPs) and SCI specialists who will participate in an intervention study to improve their collaboration. DESIGN A questionnaire survey from August to October 2020. SETTING Primary Care, Specialized SCI care. PARTICIPANTS Eight GPs and 13 SCI specialists. INTERVENTIONS Baseline results from the SCI-Co study. OUTCOME MEASURES N/A. RESULTS Overall, satisfaction ratings for the collaboration between GPs and SCI specialists were high, and all physicians agreed that they work together well. Especially, SCI specialists were satisfied in collaborating with GPs. Despite Switzerland's fragmented primary and secondary care system, only a few physicians reported about issues with delays and waiting lists. While GPs wanted to improve the quality of their referral, most SCI specialists reported being content with it. GPs were also discontent about discharge organization by specialists. CONCLUSION Satisfaction with collaboration was high, both in GPs and specialists. Areas for improvement include discharge and referral processes.
Collapse
Affiliation(s)
- Rebecca Tomaschek
- Center for Primary and Community Care, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Armin Gemperli
- Center for Primary and Community Care, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Stefan Essig
- Center for Primary and Community Care, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| |
Collapse
|
2
|
Zaccagnini M, Bussières A, Kim S, Nugus P, West A, Thomas A. What scholarly practice means to respiratory therapists: An interpretive description study. J Eval Clin Pract 2023; 29:1314-1325. [PMID: 37622229 DOI: 10.1111/jep.13917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 08/26/2023]
Abstract
RATIONALE Engagement in scholarly practice has been associated with professional empowerment, role satisfaction and improvements in care delivery and patient outcomes across many healthcare professions. However, in evolving professions like respiratory therapy, scholarly practice is excluded from competency frameworks, resulting in a gap in education and subsequent application of this competency in practice. An exploration of scholarly practice in respiratory therapy may provide insights into evolving professions that face tensions between meeting competency requirements as outlined in frameworks and providing quality healthcare to the populations they serve. AIMS AND OBJECTIVES The aim of the study was to explore what scholarly practice means, and how it manifests in practice from respiratory therapists' (RTs) perspectives. METHODS We used interpretive description methodology. We purposively sampled participants to obtain varied perspectives of scholarly practice in respiratory therapy. We conducted 26 semistructured interviews with RTs in different roles (clinicians, educators, researchers, leaders and managers) across Canada and analysed the data using inductive analysis. Data collection and analysis proceeded concurrently. RESULTS We developed five main themes: (i) the identity of a scholarly practitioner in RTs; (ii) factors influencing scholarly practice; (iii) one's impression of their professional self-image; (iv) scholarly practice as a vehicle for changing practice and (v) the complex interconnections between knowledges and practices. CONCLUSION Scholarly practice appears to be a multifaceted phenomenon encompassing a wide range of activities and skills including conducting research, reflective practice, application of research to practice, and contributing to the advancement of the profession and healthcare. Scholarly practice is influenced by organisational context and culture, available resources, intrinsic motivation and external political context. We identified similarities between professional identity and the description of the scholarly practitioner, suggesting that these two phenomena may be interconnected. Furthermore, participants believed that scholarly practice could enhance the image, credibility, legitimacy and professionalisation of the profession.
Collapse
Affiliation(s)
- Marco Zaccagnini
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Québec, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Québec, Canada
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | - Sungha Kim
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Québec, Canada
| | - Peter Nugus
- Institute of Health Sciences Education, McGill University, Montréal, Québec, Canada
- Department of Family Medicine, McGill University, Montréal, Québec, Canada
| | - Andrew West
- The Canadian Society of Respiratory Therapists, St John, New Brunswick, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, Québec, Canada
- Institute of Health Sciences Education, McGill University, Montréal, Québec, Canada
| |
Collapse
|
3
|
Wolf F, Krause M, Meißner F, Rost L, Bleidorn J, Dierks MT, Kuschick D, Kuempel L, Toutaoui K, Riens B, Schmidt K, Heintze C, Döpfmer S. [Attitudes of general practitioners and medical practice assistants towards the delegation of medical services: Results of a survey in Berlin, Brandenburg and Thuringia]. DAS GESUNDHEITSWESEN 2023; 85:1115-1123. [PMID: 38081173 PMCID: PMC10713333 DOI: 10.1055/a-2158-8982] [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] [Indexed: 12/18/2023]
Abstract
INTRODUCTION The delegation of tasks and responsibilities from general practitioners (GPs) to medical practice assistants (MPAs) can contribute to ensuring primary care in Germany. The aim of the study was to collect and analyze attitudes and procedures of GPs and MPAs regarding the delegation of physician-related tasks and activities. METHODOLOGY A self-designed, piloted questionnaire was sent to all GPs listed within the regional Associations of Statutory Health Insurance Physicians (KV) in Thuringia, Berlin, and Brandenburg (n=5,516) and their MPAs. Participants were asked to indicate which physician-related activities were already delegated and on which occasions further delegations could be considered. RESULTS 890 GPs (response rate: 16.1%) and 566 MPAs participated in the written survey. The participants were predominantly female and most of them worked in urban areas. Numerous activities, such as medical history taking, triage, Disease Management Program (DMP) controls, vaccinations and home visits, have already been delegated. The willingness to delegate further tasks (e. g., follow-up prescriptions and referrals, independent takeover of simple consultations, assessing the necessity of physician consultation) was high. CONCLUSION The survey showed a high level of willingness of both occupational groups to delegate physician-related activities to MFAs. An expansion seems possible under certain conditions. Many activities have already been delegated to MPAs in primary care practices. Our survey provides suggestions regarding further tasks suitable for delegation, some of which go beyond the delegation agreement valid in Germany.
Collapse
Affiliation(s)
- Florian Wolf
- Institut für Allgemeinmedizin, Universitätsklinikum
Jena, Jena, Germany
| | - Markus Krause
- Institut für Allgemeinmedizin, Universitätsklinikum
Jena, Jena, Germany
| | - Franziska Meißner
- Institut für Allgemeinmedizin, Universitätsklinikum
Jena, Jena, Germany
| | - Liliana Rost
- Institut für Allgemeinmedizin, Universitätsklinikum
Jena, Jena, Germany
| | - Jutta Bleidorn
- Institut für Allgemeinmedizin, Universitätsklinikum
Jena, Jena, Germany
| | - Marius Tibor Dierks
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| | - Doreen Kuschick
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| | - Lisa Kuempel
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| | - Kahina Toutaoui
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| | - Burgi Riens
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| | - Konrad Schmidt
- Institut für Allgemeinmedizin, Universitätsklinikum
Jena, Jena, Germany
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| | - Christoph Heintze
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| | - Susanne Döpfmer
- Institut für Allgemeinmedizin, Charité
Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
4
|
Winkler K, Gerlach N, Donner-Banzhoff N, Berberich A, Jung-Henrich J, Schlößler K. Determinants of referral for suspected coronary artery disease: a qualitative study based on decision thresholds. BMC PRIMARY CARE 2023; 24:110. [PMID: 37131137 PMCID: PMC10152784 DOI: 10.1186/s12875-023-02064-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/18/2023] [Indexed: 05/04/2023]
Abstract
BACKGROUND Chest pain is a frequent consultation issue in primary care, with coronary artery disease (CAD) being a serious potential cause. Primary care physicians (PCPs) assess the probability for CAD and refer patients to secondary care if necessary. Our aim was to explore PCPs' referral decisions, and to investigate determinants which influenced those decisions. METHODS PCPs working in Hesse, Germany, were interviewed in a qualitative study. We used 'stimulated recall' with participants to discuss patients with suspected CAD. With a sample size of 26 cases from nine practices we reached inductive thematic saturation. Interviews were audio-recorded, transcribed verbatim and analyzed by inductive-deductive thematic content analysis. For the final interpretation of the material, we used the concept of decision thresholds proposed by Pauker and Kassirer. RESULTS PCPs reflected on their decisions for or against a referral. Aside from patient characteristics determining disease probability, we identified general factors which can be understood as influencing the referral threshold. These factors relate to the practice environment, to PCPs themselves and to non-diagnostic patient characteristics. Proximity of specialist practice, relationship with specialist colleagues, and trust played a role. PCPs sometimes felt that invasive procedures were performed too easily. They tried to steer their patients through the system with the intent to avoid over-treatment. Most PCPs were unaware of guidelines but relied on informal local consensus, largely influenced by specialists. As a result, PCPs gatekeeping role was limited. CONCLUSIONS We could identify a large number of factors that impact referral for suspected CAD. Several of these factors offer possibilities to improve care at the clinical and system level. The threshold model proposed by Pauker and Kassirer was a useful framework for this kind of data analysis.
Collapse
Affiliation(s)
- Katja Winkler
- Department of General Practice/Family Medicine, University Marburg, Karl-Von-Frisch-Str. 4, 35043, Marburg, Germany.
| | - Navina Gerlach
- Department of General Practice/Family Medicine, University Marburg, Karl-Von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Norbert Donner-Banzhoff
- Department of General Practice/Family Medicine, University Marburg, Karl-Von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Anika Berberich
- Department of General Practice/Family Medicine, University Marburg, Karl-Von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Jutta Jung-Henrich
- Department of General Practice/Family Medicine, University Marburg, Karl-Von-Frisch-Str. 4, 35043, Marburg, Germany
| | - Kathrin Schlößler
- Department of General Practice/Family Medicine, University Marburg, Karl-Von-Frisch-Str. 4, 35043, Marburg, Germany
- Institute of General Practice and Family Medicine (AM RUB), Ruhr University, Bochum, Germany
| |
Collapse
|
5
|
Lalji R, Hofstetter L, Kongsted A, von Wyl V, Puhan MA, Hincapié CA. The Swiss chiropractic practice-based research network: a population-based cross-sectional study to inform future musculoskeletal research. Sci Rep 2023; 13:5655. [PMID: 37024506 PMCID: PMC10078089 DOI: 10.1038/s41598-023-32437-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 03/28/2023] [Indexed: 04/08/2023] Open
Abstract
The Swiss chiropractic practice-based research network (PBRN) is a nationwide project developed in collaboration with patients, clinicians, and academic stakeholders to advance musculoskeletal epidemiologic research. The aim of this study was to describe the clinician population recruited and representativeness of this PBRN to inform future collaboration. A population-based cross-sectional study was performed. PBRN clinician characteristics were described and factors related to motivation (operationalised as VAS score ≥ 70) to participate in a subsequent patient cohort pilot study were assessed. Among 326 eligible chiropractors, 152 enrolled in the PBRN (47% participation). The PBRN was representative of the larger Swiss chiropractic population with regards to age, language, and geographic distribution. Of those enrolled, 39% were motivated to participate in a nested patient cohort pilot study. Motivation was associated with age 40 years or older versus 39 years or younger (OR 2.3, 95% CI 1.0-5.2), and with a moderate clinic size (OR 2.4, 95% CI 1.1-5.7) or large clinic size (OR 2.8, 95% CI 1.0-7.8) versus solo practice. The Swiss chiropractic PBRN has enrolled almost half of all Swiss chiropractors and has potential to facilitate collaborative practice-based research to improve musculoskeletal health care quality.Trial registration: Swiss chiropractic PBRN (ClinicalTrials.gov identifier: NCT05046249); Swiss chiropractic cohort (Swiss ChiCo) pilot study (ClinicalTrials.gov identifier: NCT05116020).
Collapse
Affiliation(s)
- Rahim Lalji
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Léonie Hofstetter
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Alice Kongsted
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
| | - Viktor von Wyl
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Cesar A Hincapié
- EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland.
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
- University Spine Centre Zurich (UWZH), Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
6
|
Granja M, Correia S, Alves L. Access to General Practitioners during the second year of the COVID-19 pandemic in Portugal: a nationwide survey of doctors. BMC PRIMARY CARE 2023; 24:46. [PMID: 36782109 PMCID: PMC9924884 DOI: 10.1186/s12875-023-01994-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 01/23/2023] [Indexed: 02/15/2023]
Abstract
BACKGROUND The Portuguese National Health System (NHS) provides universal coverage and near-free health care, but the population has high out-of-pocket expenses and unmet care needs. This suggests impaired accessibility, a key dimension of primary care. The COVID-19 pandemic has further affected access to health care. Understanding General Practitioners' (GP) experiences during the pandemic is necessary to reconfigure post-pandemic service delivery and to plan for future emergencies. This study aimed to assess accessibility to GPs, from their perspective, evaluating determinants of accessibility during the second pandemic year in Portugal. METHODS All GPs working in NHS Family Practices in continental Portugal were invited to participate in a survey in 2021. A structured online self-administered anonymous questionnaire was used. Accessibility was assessed through waiting times for consultations and remote contacts and provision of remote access. NHS standards were used to assess waiting times. Descriptive statistics were used to characterize the study sample. Associations between categorical variables were tested using the χ2 statistic and the Student t-test was used to compare means of continuous variables. RESULTS A total of 420 GPs were included (7% of the target population). Median weekly working hours was 49.0 h (interquartile range 42.0-56.8), although only 14% reported a contracted weekly schedule over 40 h. Access to in-person consultations and remote contacts was reported by most GPs to occur within NHS time standards. Younger GPs more often reported waiting times over these standards. Most GPs considered that they do not have enough time for non-urgent consultations or for remote contacts with patients. CONCLUSIONS Most GPs reported compliance with standards for waiting times for most in-person consultations and remote contacts, but they do so at the expense of work overload. A persistent excess of regular and unpaid working hours by GPs needs confirmation. If unpaid overtime is necessary to meet the regular demands of work, then workload and specific allocated tasks warrant review. Future research should focus on younger GPs, as they seem vulnerable to restricted accessibility. GPs' preferences for more in-person care than was feasible during the pandemic must be considered when planning for the post-pandemic reconfiguration of service delivery.
Collapse
Affiliation(s)
- Mónica Granja
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal.
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal.
| | - Sofia Correia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
| | - Luís Alves
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Rua das Taipas, N° 135, 4050-600, Porto, Portugal
| |
Collapse
|
7
|
Zaccagnini M, Bussières A, Mak S, Boruff J, West A, Thomas A. Scholarly practice in healthcare professions: findings from a scoping review. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2022:10.1007/s10459-022-10180-0. [PMID: 36456756 DOI: 10.1007/s10459-022-10180-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/16/2022] [Indexed: 06/17/2023]
Abstract
Scholarly practitioners are broadly defined as healthcare professionals that address critical practice problems using theory, scientific evidence, and practice-based knowledge. Though scholarly practice is included in most competency frameworks, it is unclear what scholarly practice is, how it develops and how it is operationalized in clinical practice. The aim of this review was to determine what is known about scholarly practice in healthcare professionals. We conducted a scoping review and searched MEDLINE, EMBASE, CINAHL from inception to May 2020. We included papers that explored, described, or defined scholarly practice, scholar or scholarly practitioner, and/or related concepts in healthcare professionals. We included a total of 90 papers. Thirty percent of papers contained an explicit definition of scholarly practice. Conceptualizations of scholarly practice were organized into three themes: the interdependent relationship between scholarship and practice; advancing the profession's field; and core to being a healthcare practitioner. Attributes of scholarly practitioners clustered around five themes: commitment to excellence in practice; collaborative nature; presence of virtuous characteristics; effective communication skills; and adaptive change ethos. No single unified definition of scholarly practice exists within the literature. The variability in terms used to describe scholarly practice suggests that it is an overarching concept rather than a definable entity. There are similarities between scholarly practitioners and knowledge brokers regarding attributes and how scholarly practice is operationalized. Individuals engaged in the teaching, research and/or assessment of scholarly practice should make explicit their definitions and expectations for healthcare professionals.
Collapse
Affiliation(s)
- Marco Zaccagnini
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montréal, QC, H3G 1Y5, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, QC, Canada
| | - André Bussières
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montréal, QC, H3G 1Y5, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, QC, Canada
- Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Susanne Mak
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montréal, QC, H3G 1Y5, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, QC, Canada
- Institute of Health Sciences Education, McGill University, Montréal, QC, Canada
| | - Jill Boruff
- Schulich Library of Physical Sciences, Life Sciences, and Engineering, McGill University, Montréal, QC, Canada
| | - Andrew West
- The Canadian Society of Respiratory Therapists, Saint John, NB, Canada
| | - Aliki Thomas
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir William Osler, Montréal, QC, H3G 1Y5, Canada.
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montréal, Montréal, QC, Canada.
- Institute of Health Sciences Education, McGill University, Montréal, QC, Canada.
| |
Collapse
|
8
|
Meier R, Chmiel C, Valeri F, Muheim L, Senn O, Rosemann T. The Effect of Financial Incentives on Quality Measures in the Treatment of Diabetes Mellitus: a Randomized Controlled Trial. J Gen Intern Med 2022; 37:556-564. [PMID: 33904045 PMCID: PMC8858366 DOI: 10.1007/s11606-021-06714-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/09/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Financial incentives are often used to improve quality of care in chronic care patients. However, the evidence concerning the effect of financial incentives is still inconclusive. OBJECTIVE To test the effect of financial incentives on quality measures (QMs) in the treatment of patients with diabetes mellitus in primary care. We incentivized a clinical QM and a process QM to test the effect of financial incentives on different types of QMs and to investigate the spill-over effect on non-incentivized QMs. DESIGN/PARTICIPANTS Parallel cluster randomized controlled trial based on electronic medical records database involving Swiss general practitioners (GPs). Practices were randomly allocated. INTERVENTION All participants received a bimonthly feedback report. The intervention group additionally received potential financial incentives on GP level depending on their performance. MAIN MEASURES Between-group differences in proportions of patients fulfilling incentivized QM (process QM of annual HbA1c measurement and clinical QM of blood pressure level below 140/95 mmHg) after 12 months. KEY RESULTS Seventy-one GPs (median age 52 years, 72% male) from 43 different practices and subsequently 3838 patients with diabetes mellitus (median age 70 years, 57% male) were included. Proportions of patients with annual HbA1c measurements remained unchanged (intervention group decreased from 79.0 to 78.3%, control group from 81.5 to 81.0%, OR 1.09, 95% CI 0.90-1.32, p = 0.39). Proportions of patients with blood pressure below 140/95 improved from 49.9 to 52.5% in the intervention group and decreased from 51.2 to 49.0% in the control group (OR 1.16, 95% CI 0.99-1.36, p = 0.06). Proportions of non-incentivized process QMs increased significantly in the intervention group. CONCLUSION GP level financial incentives did not result in more frequent HbA1c measurements or in improved blood pressure control. Interestingly, we could confirm a spill-over effect on non-incentivized process QMs. Yet, the mechanism of spill-over effects of financial incentives is largely unclear. TRIAL REGISTRATION ISRCTN13305645.
Collapse
Affiliation(s)
- Rahel Meier
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland. .,University Hospital Zurich, Zürich, Switzerland.
| | - Corinne Chmiel
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.,University Hospital Zurich, Zürich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.,University Hospital Zurich, Zürich, Switzerland
| | - Leander Muheim
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.,University Hospital Zurich, Zürich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.,University Hospital Zurich, Zürich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091, Zurich, Switzerland.,University Hospital Zurich, Zürich, Switzerland
| |
Collapse
|
9
|
Rachamin Y, Meier R, Valeri F, Rosemann T, Muheim L. Physician-dispensing as a determinant of clinical and process measurements in patients at increased cardiovascular risk: A cross-sectional study in Swiss general practice. Health Policy 2021; 125:1305-1310. [PMID: 34392960 DOI: 10.1016/j.healthpol.2021.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 07/14/2021] [Accepted: 07/30/2021] [Indexed: 12/17/2022]
Abstract
AIMS In some healthcare systems, physicians are allowed to dispense drugs; in others, drug-dispensing is restricted to pharmacists. Whether physician-dispensing affects patient health is unknown. Thus, we aimed to investigate associations between physician-dispensing and clinical and process measurements in patients with selected long-term conditions indicating increased cardiovascular risk. METHODS Retrospective cross-sectional study in 2018 based on data from electronic medical records of 22405 patients (73.6% physician-dispensing) in Switzerland with medications for diabetes mellitus, arterial hypertension, or lipid-related disorders. We used multilevel regression models to determine the associations between physician-dispensing and clinical measurements (glycated hemoglobin [HbA1c], systolic blood pressure [sBP], low-density lipoprotein cholesterol [LDL-C]) or process measurements (number of annual clinical measurements, consultations, and drug prescriptions). RESULTS Median (interquartile range) HbA1c value was 6.8% (6.3-7.5) both for the physician-dispensing and pharmacist-dispensing group, sBP was 137 (126-150) and 136 mmHg (126-149), and LDL-C was 2.3 (1.8-3.0) and 2.5 mmol/L (1.9-3.2). After adjustments, the physician-dispensing group had 4% lower LDL-C levels (p = 0.041), 12% more frequent HbA1c measurements (p = 0001), 16% higher annual consultation rates (p < 0.05 for all conditions), and equal number of different drugs, compared to the pharmacist-dispensing group. CONCLUSIONS We found no relevant differences in selected clinical measurements between physician- and pharmacist-dispensing, and mixed results in process measurements. Our results do not indicate that one drug-dispensing channel is superior to the other.
Collapse
Affiliation(s)
- Yael Rachamin
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland.
| | - Rahel Meier
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| | - Leander Muheim
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland
| |
Collapse
|
10
|
Li KD, Hakam N, Sadighian MJ, Holler JT, Nabavizadeh B, Amend GM, Fang R, Meeks W, Makarov D, Breyer BN. Evaluating Quality Improvement and Patient Safety Amongst Practicing Urologists: Analysis of the 2018 American Urological Association Census. Urology 2021; 156:117-123. [PMID: 34331999 DOI: 10.1016/j.urology.2021.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 06/17/2021] [Accepted: 07/18/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe factors associated with Quality improvement and patient safety (QIPS) participation using 2018 American Urological Association Census data. QIPS have become increasingly important in medicine. However, studies about QIPS in urology suggest low levels of participation, with little known about factors predicting non-participation. METHODS Results from 2339 census respondents were weighted to estimate 12,660 practicing urologists in the United States. Our primary outcome was participation in QIPS. Predictor variables included demographics, practice setting, rurality, fellowship training, QIPS domains in practice, years in practice, and non-clinical/clinical workload. RESULTS QIPS participants and non-participants significantly differed in distributions of age (P = .0299), gender (P = .0013), practice setting (P <.0001), employment (employee vs partner vs owner vs combination; P <.0001), and fellowship training (P <.0001). QIPS participants reported fewer years in practice (21.3 vs 25.9, P = .018) and higher clinical (45.2 vs 39.2, P = .022) and non-clinical (8.76 vs 5.28, P = .002) work hours per week. Non-participation was associated with male gender (OR = 2.68, 95% CI 1.03-6.95) and Asian race (OR = 2.59, 95% CI 1.27-5.29) for quality programs and private practice settings (ORs = 8.72-27.8) for patient safety initiatives. CONCLUSION QIPS was associated with academic settings. Interventions to increase rates of quality and safety participation should target individual and system-level factors, respectively. Future work should discern barriers to QIPS engagement and its clinical benefits.
Collapse
Affiliation(s)
- Kevin D Li
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Nizar Hakam
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Michael J Sadighian
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Jordan T Holler
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Behnam Nabavizadeh
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Gregory M Amend
- Department of Urology, University of California San Francisco, San Francisco, CA
| | - Raymond Fang
- Department of Data Management and Statistical Analysis, American Urological Association, Linthicum, MD
| | - William Meeks
- Department of Data Management and Statistical Analysis, American Urological Association, Linthicum, MD
| | - Danil Makarov
- Population Health and Health Policy, New York University School of Medicine Veterans Affairs New York Harbor Healthcare System-Brooklyn, Brooklyn, NY
| | - Benjamin N Breyer
- Department of Urology, University of California San Francisco, San Francisco, CA; Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, CA.
| |
Collapse
|
11
|
Jungo KT, Meier R, Valeri F, Schwab N, Schneider C, Reeve E, Spruit M, Schwenkglenks M, Rodondi N, Streit S. Baseline characteristics and comparability of older multimorbid patients with polypharmacy and general practitioners participating in a randomized controlled primary care trial. BMC FAMILY PRACTICE 2021; 22:123. [PMID: 34157981 PMCID: PMC8220761 DOI: 10.1186/s12875-021-01488-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 06/09/2021] [Indexed: 11/15/2022]
Abstract
Objectives Recruiting general practitioners (GPs) and their multimorbid older patients for trials is challenging for multiple reasons (e.g., high workload, limited mobility). The comparability of study participants is important for interpreting study findings. This manuscript describes the baseline characteristics of GPs and patients participating in the ‘Optimizing PharmacoTherapy in older multimorbid adults In primary CAre’ (OPTICA) trial, a study of optimization of pharmacotherapy for multimorbid older adults. The overall aim of this study was to determine if the GPs and patients participating in the OPTICA trial are comparable to the real-world population in Swiss primary care. Design Analysis of baseline data from GPs and patients in the OPTICA trial and a reference cohort from the FIRE (‘Family medicine ICPC Research using Electronic medical records’) project. Setting Primary care, Switzerland. Participants Three hundred twenty-three multimorbid (≥ 3 chronic conditions) patients with polypharmacy (≥ 5 regular medications) aged ≥ 65 years and 43 GPs recruited for the OPTICA trial were compared to 22,907 older multimorbid patients with polypharmacy and 227 GPs from the FIRE database. Methods We compared the characteristics of GPs and patients participating in the OPTICA trial with other GPs and other older multimorbid adults with polypharmacy in the FIRE database. We described the baseline willingness to have medications deprescribed of the patients participating in the OPTICA trial using the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire. Results The GPs in the FIRE project and OPTICA were similar in terms of sociodemographic characteristics and their work as a GP (e.g. aged in their fifties, ≥ 10 years of experience, ≥ 60% are self-employed, ≥ 80% work in a group practice). The median age of patients in the OPTICA trial was 77 years and 45% of trial participants were women. Patients participating in the OPTICA trial and patients in the FIRE database were comparable in terms of age, certain clinical characteristics (e.g. systolic blood pressure, body mass index) and health services use (e.g. selected lab and vital data measurements). More than 80% of older multimorbid patients reported to be willing to stop ≥ 1 of their medications if their doctor said that this would be possible. Conclusion The characteristics of patients and GPs recruited into the OPTICA trial are relatively comparable to characteristics of a real-world Swiss population, which indicates that recruiting a generalizable patient sample is possible in the primary care setting. Multimorbid patients in the OPTICA trial reported a high willingness to have medications deprescribed. Trial registration Clinicaltrials.gov (NCT03724539), KOFAM (Swiss national portal) (SNCTP000003060), Universal Trial Number (U1111-1226-8013) Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01488-8.
Collapse
Affiliation(s)
- Katharina Tabea Jungo
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Rahel Meier
- Institute of Primary Care, University and University Hospital of Zurich, Zurich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University and University Hospital of Zurich, Zurich, Switzerland
| | - Nathalie Schwab
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudio Schneider
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Emily Reeve
- Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia.,Geriatric Medicine Research, Faculty of Medicine and College of Pharmacy, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - Marco Spruit
- Department of Information and Computing Sciences, Utrecht University, Utrecht, The Netherlands.,Public Health & Primary Care, Leiden University Medical Centre, Leiden University, Leiden, The Netherlands
| | - Matthias Schwenkglenks
- Institute of Pharmaceutical Medicine (ECPM), University of Basel, Basel, Switzerland.,Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.,Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
| |
Collapse
|
12
|
Elston DM. Participation bias, self-selection bias, and response bias. J Am Acad Dermatol 2021:S0190-9622(21)01129-4. [PMID: 34153389 DOI: 10.1016/j.jaad.2021.06.025] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/09/2021] [Indexed: 11/23/2022]
Affiliation(s)
- Dirk M Elston
- Department of Dermatology, Medical University of South Carolina, Charleston, South Carolina.
| |
Collapse
|
13
|
Kriston L, Hahlweg P, Härter M, Scholl I. A skills network approach to physicians' competence in shared decision making. Health Expect 2020; 23:1466-1476. [PMID: 32869476 PMCID: PMC7752189 DOI: 10.1111/hex.13130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 06/30/2020] [Accepted: 08/04/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Measurement of physicians' competence in shared decision making (SDM) remains challenging with frequent disagreement between assessment methods. OBJECTIVE To conceptualize and measure physicians' SDM competence as an organized network of behavioural skills and to determine whether processing patient-reported data according to this model can be used to predict observer-rated competence. DESIGN Secondary analysis of an observational study. SETTING AND PARTICIPANTS Primary and specialty outpatient care physicians and consecutively recruited adult patients with a chronic condition who faced a treatment decision with multiple acceptable choices. MEASURES Network parameters constructed from patients' assessment of physicians' SDM skills as measured by the 9-item Shared Decision Making Questionnaire (SDM-Q-9) and observer-rated SDM competence of physicians measured by three widely used observer-rated instruments. RESULTS 29 physicians (12 female, 17 male; mean age 50.3 years) recruited 310 patients (59.4% female, 40.6% male; mean age 54.0 years) facing a decision mainly regarding type 2 diabetes (36.4%), chronic back pain (32.8%) or depressive disorder (26.8%). Although most investigated skills were interrelated, elicitation of the patient's treatment preferences showed the strongest associations with the other skills. Network parameters of this skill were also decisive in predicting observer-rated competence. Correlation between predicted competence scores and observer-rated measurements ranged from 0.710 to 0.785. CONCLUSIONS Conceptualizing physicians' SDM competence as a network of interacting skills enables the measurement of observer-rated competence using patient-reported data. In addition to theoretical implications for defining and training medical competences, the findings open a new way to measure physicians' SDM competence under routine conditions.
Collapse
Affiliation(s)
- Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Pola Hahlweg
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Isabelle Scholl
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
14
|
Meier R, Valeri F, Senn O, Rosemann T, Chmiel C. Quality performance and associated factors in Swiss diabetes care - A cross-sectional study. PLoS One 2020; 15:e0232686. [PMID: 32369830 PMCID: PMC7200167 DOI: 10.1371/journal.pone.0232686] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/17/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION Quality indicators and pay-for-performance schemes aim to improve processes and outcomes in clinical practice. However, general practitioner and patient characteristics influence quality indicator performance. In Switzerland, no data on the pay-for-performance approach exists and the use of quality indicators has been marginal. The aim of this study was to describe quality indicator performance in diabetes care in Swiss primary care and to analyze associations of practice, general practitioner and patient covariates with quality indicator performance. METHODS For this cross-sectional study, we used medical routine data from an electronic medical record database. Data from 71 general practitioners and all their patients with diabetes were included. Starting in July 2018, we retrieved 12-month retrospective data about practice, general practitioner and patient characteristics, laboratory values, comorbidities and co-medication. Based on this data, we assessed quality indicator performance of process and intermediate outcomes for glycated hemoglobin, blood pressure, cholesterol and associations of practice, general practitioner and patient characteristics with individual and cumulative quality indicator performance. We calculated odds ratios (OR) and 95% confidence intervals (CI) using regression methods. RESULTS We assessed 3,383 patients with diabetes (57% male, mean age 68.3 years). On average, patients fulfilled 3.56 (standard deviation: 1.89) quality indicators, whereas 17.2% of the patients fulfilled all six quality indicators. On practice and general practitioner level, we found no associations with cumulative quality indicator performance. On patient level, gender (ref = male) (OR: 0.83, CI: 0.78-0.88), number of treating general practitioners (OR: 0.94, CI: 0.91-0.97), number of comorbidities (OR: 1.43, CI: 1.38-1.47) and number of consultations (OR: 1.02, CI: 1.02-1.02) were associated with cumulative quality indicator performance. CONCLUSION The influence of practice, general practitioner and patient characteristics on quality indicator performance was surprisingly small and room for improvement in quality indicator performance of Swiss general practitioners seems to exist in diabetes care.
Collapse
Affiliation(s)
- Rahel Meier
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zürich, Switzerland
- * E-mail:
| | - Fabio Valeri
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zürich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zürich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zürich, Switzerland
| | - Corinne Chmiel
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zürich, Switzerland
| |
Collapse
|