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Fleury MJ, Cao Z, Grenier G. Emergency Department Use among Patients with Mental Health Problems: Profiles, Correlates, and Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:864. [PMID: 39063441 PMCID: PMC11276606 DOI: 10.3390/ijerph21070864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 06/28/2024] [Accepted: 06/29/2024] [Indexed: 07/28/2024]
Abstract
Patients with mental health (MH) problems are known to use emergency departments (EDs) frequently. This study identified profiles of ED users and associated these profiles with patient characteristics and outpatient service use, and with subsequent adverse outcomes. A 5-year cohort of 11,682 ED users was investigated (2012-2017), using Quebec (Canada) administrative databases. ED user profiles were identified through latent class analysis, and multinomial logistic regression used to associate patients' characteristics and their outpatient service use. Cox regressions were conducted to assess adverse outcomes 12 months after the last ED use. Four ED user profiles were identified: "Patients mostly using EDs for accessing MH services" (Profile 1, incident MDs); "Repeat ED users" (Profile 2); "High ED users" (Profile 3); "Very high and recurrent high ED users" (Profile 4). Profile 4 and 3 patients exhibited the highest ED use along with severe conditions yet received the most outpatient care. The risk of hospitalization and death was higher in these profiles. Their frequent ED use and adverse outcomes might stem from unmet needs and suboptimal care. Assertive community treatments and intensive case management could be recommended for Profiles 4 and 3, and more extensive team-based GP care for Profiles 2 and 1.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, 1033, Pine Avenue West, Montreal, QC H3A 1A1, Canada
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC H4H 1R3, Canada; (Z.C.); (G.G.)
| | - Zhirong Cao
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC H4H 1R3, Canada; (Z.C.); (G.G.)
| | - Guy Grenier
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, 6875 LaSalle Blvd., Montreal, QC H4H 1R3, Canada; (Z.C.); (G.G.)
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Brousseau-Foley M, Blanchette V, Houle J, Trudeau F. Developing an interprofessional decision support tool for diabetic foot ulcers management in primary care within the family medicine group model: a Delphi study in Canada. BMC PRIMARY CARE 2024; 25:123. [PMID: 38643081 PMCID: PMC11031884 DOI: 10.1186/s12875-024-02387-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Primary care professionals encounter difficulties coordinating the continuum of care between primary care providers and second-line specialists and adhere to practice guidelines pertaining to diabetic foot ulcers management. Family medicine groups are providing primary care services aimed to improve access, interdisciplinary care, coordination and quality of health services, and reduce emergency department visits. Most professionals working in family medicine groups are primary care physicians and registered nurses. The aim of this study was to develop and validate an interprofessional decision support tool to guide the management of diabetic foot ulcers for primary care professionals working within the family medicine group model. METHODS A one-page decision tool developed by the research team was validated by an expert panel using a three-round Delphi protocol held between December 2019 and August 2021. The tool includes 43 individual actions and a care pathway from initial presentation to secondary prevention. Data collection was realized with both paper and electronic questionnaires, and answers were compiled in an electronic spreadsheet. Data was analyzed with use of descriptive statistics, and consensus for each item was defined as ≥ 80% agreement. RESULTS Experts from 12 pre-identified professions of the diabetic foot ulcer interdisciplinary care team were included, 39 participants out of the 59 invited to first round (66.1%), 34 out of 39 for second (87.2%) and 22 out of 34 for third (64.7%) rounds. All items included in the final version of the decision support tool reached consensus and were deemed clear, relevant and feasible. One or more professionals were identified to be responsible for every action to be taken. CONCLUSIONS This study provided a comprehensive decision support tool to guide primary care professionals in the management of diabetic foot ulcers. Implementation and evaluation in the clinical setting will need to be undertaken in the future.
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Affiliation(s)
- Magali Brousseau-Foley
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Boul. Des Forges, Trois-Rivières, Québec, 3351G8Z 4M3, Canada.
- Centre Intégré Universitaire de Santé et de Services Sociaux de la Mauricie et du Centre-du-Québec (CIUSSS-MCQ) affiliated to Université de Montréal, Department of Family and Emergency Medicine, Faculty of Medicine, 731 Rue Ste-Julie, Trois-Rivières, Québec, G9A 1Y1, Canada.
| | - Virginie Blanchette
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Boul. Des Forges, Trois-Rivières, Québec, 3351G8Z 4M3, Canada
- VITAM - Research Centre on Sustainable Health, 2480 Chemin de la Canardière, Québec, QC, G1J 2G1, Canada
| | - Julie Houle
- Department of Nursing, Université du Québec à Trois-Rivières, 3351, Boul. Des Forges, Trois-Rivières, Québec, G8Z 4M3, Canada
| | - François Trudeau
- Department of Human Kinetics, Université du Québec à Trois-Rivières, Boul. Des Forges, Trois-Rivières, Québec, 3351G8Z 4M3, Canada
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Fleury MJ, Rochette L, Gentil L, Grenier G, Lesage A. Predictors of Physician Follow-Up Care Among Patients Affected by an Incident Mental Disorder Episode in Quebec (Canada). CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:100-115. [PMID: 37357714 PMCID: PMC10789227 DOI: 10.1177/07067437231182570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/27/2023]
Abstract
OBJECTIVES This study identified predictors of prompt (1+ outpatient physician consultations/within 30 days), adequate (3+/90 days) and continuous (5+/365 days) follow-up care from general practitioners (GPs) or psychiatrists among patients with an incident mental disorder (MD) episode. METHODS Study data were extracted from the Quebec Integrated Chronic Disease Surveillance System (QICDSS), which covers 98% of the population eligible for health-care services under the Quebec (Canada) Health Insurance Plan. This observational epidemiological study investigating the QICDSS from 1 April 1997 to 31 March 2020, is based on a 23-year patient cohort including 12+ years old patients with an incident MD episode (n = 2,670,133). Risk ratios were calculated using Robust Poisson regressions to measure patient sociodemographic and clinical characteristics, and prior service use, which predicted patients being more or less likely to receive prompt, adequate, or continuous follow-up care after their last incident MD episode, controlling for previous MD episodes, co-occurring disorders, and years of entry into the cohort. RESULTS A minority of patients, and fewer over time, received physician follow-up care after an incident MD episode. Women; patients aged 18-64; with depressive or bipolar disorders, co-occurring MDs-substance-related disorders (SRDs) or physical illnesses; those receiving previous GP follow-up care, especially in family medicine groups; patients with higher prior continuity of GP care; and previous high users of emergency departments were more likely to receive follow-up care. Patients living outside the Montreal metropolitan area; those without prior MDs; patients with anxiety, attention deficit hyperactivity, personality, schizophrenia and other psychotic disorders, or SRDs were less likely to receive follow-up care. CONCLUSION This study shows that vulnerable patients with complex clinical characteristics and those with better previous GP care were more likely to receive prompt, adequate or continuous follow-up care after an incident MD episode. Overall, physician follow-up care should be greatly improved.
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Affiliation(s)
- Marie-Josée Fleury
- Douglas Hospital Research Centre, Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Louis Rochette
- Institut National de Santé Publique du Québec, Quebec City, QC, Canada
| | - Lia Gentil
- Douglas Hospital Research Centre, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Hospital Research Centre, Montreal, QC, Canada
| | - Alain Lesage
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Département de Psychiatrie, Université de Montréal, Montréal, QC, Canada
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AGGARWAL MONICA, HUTCHISON BRIAN, ABDELHALIM REHAM, BAKER GROSS. Building High-Performing Primary Care Systems: After a Decade of Policy Change, Is Canada "Walking the Talk?". Milbank Q 2023; 101:1139-1190. [PMID: 37743824 PMCID: PMC10726918 DOI: 10.1111/1468-0009.12674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/29/2023] [Accepted: 08/15/2023] [Indexed: 09/26/2023] Open
Abstract
Policy Points Considerable investments have been made to build high-performing primary care systems in Canada. However, little is known about the extent to which change has occurred over the last decade with implementing programs and policies across all 13 provincial and territorial jurisdictions. There is significant variation in the degree of implementation of structural features of high-performing primary care systems across Canada. This study provides evidence on the state of primary care reform in Canada and offers insights into the opportunities based on changes that governments elsewhere have made to advance primary care transformation. CONTEXT Despite significant investments to transform primary care, Canada lags behind its peers in providing timely access to regular doctors or places of care, timely access to care, developing interprofessional teams, and communication across health care settings. This study examines changes over the last decade (2012 to 2021) in policies across 13 provincial and territorial jurisdictions that address the structural features of high-performing primary care systems. METHODS A multiple comparative case study approach was used to explore changes in primary care delivery across 13 Canadian jurisdictions. Each case consisted of (1) qualitative interviews with academics, provincial health care leaders, and health care professionals and (2) a literature review of policies and innovations. Data for each case were thematically analyzed within and across cases, using 12 structural features of high-performing primary care systems to describe each case and assess changes over time. FINDINGS The most significant changes include adopting electronic medical records, investments in quality improvement training and support, and developing interprofessional teams. Progress was more limited in implementing primary care governance mechanisms, system coordination, patient enrollment, and payment models. The rate of change was slowest for patient engagement, leadership development, performance measurement, research capacity, and systematic evaluation of innovation. CONCLUSIONS Progress toward building high-performing primary care systems in Canada has been slow and variable, with limited change in the organization and delivery of primary care. Canada's experience can inform innovation internationally by demonstrating how preexisting policy legacies constrain the possibilities for widespread primary care reform, with progress less pronounced in the attributes that impact physician autonomy. To accelerate primary care transformation in Canada and abroad, a national strategy and performance measurement framework is needed based on meaningful engagement of patients and other stakeholders. This must be accompanied by targeted funding investments and building strong data infrastructure for performance measurement to support rigorous research.
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Affiliation(s)
| | - BRIAN HUTCHISON
- Centre for Health Economics and Policy AnalysisMcMaster University
| | - REHAM ABDELHALIM
- Institute of Health PolicyManagement and EvaluationUniversity of Toronto
| | - G. ROSS BAKER
- Dalla Lana School of Public HealthUniversity of Toronto
- Institute of Health PolicyManagement and EvaluationUniversity of Toronto
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Ewusie J, Beyene J, Thabane L, Straus SE, Hamid JS. An improved method for analysis of interrupted time series (ITS) data: accounting for patient heterogeneity using weighted analysis. Int J Biostat 2022; 18:521-535. [PMID: 34473922 DOI: 10.1515/ijb-2020-0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 08/05/2021] [Indexed: 01/10/2023]
Abstract
Interrupted time series (ITS) design is commonly used to evaluate the impact of interventions in healthcare settings. Segmented regression (SR) is the most commonly used statistical method and has been shown to be useful in practical applications involving ITS designs. Nevertheless, SR is prone to aggregation bias, which leads to imprecision and loss of power to detect clinically meaningful differences. The objective of this article is to present a weighted SR method, where variability across patients within the healthcare facility and across time points is incorporated through weights. We present the methodological framework, provide optimal weights associated with data at each time point and discuss relevant statistical inference. We conduct extensive simulations to evaluate performance of our method and provide comparative analysis with the traditional SR using established performance criteria such as bias, mean square error and statistical power. Illustrations using real data is also provided. In most simulation scenarios considered, the weighted SR method produced estimators that are uniformly more precise and relatively less biased compared to the traditional SR. The weighted approach also associated with higher statistical power in the scenarios considered. The performance difference is much larger for data with high variability across patients within healthcare facilities. The weighted method proposed here allows us to account for the heterogeneity in the patient population, leading to increased accuracy and power across all scenarios. We recommend researchers to carefully design their studies and determine their sample size by incorporating heterogeneity in the patient population.
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Affiliation(s)
- Joycelyne Ewusie
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Joseph Beyene
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Biostatistics Unit, Father Sean O'Sullivan Research Centre, St Joseph's Healthcare, Hamilton, ON, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jemila S Hamid
- School of Epidemiology and Public Health, University of Ottawa Faculty of Medicine, Ottawa, ON, Canada
- Department of Mathematics and Statistics, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Facilitating Integration Through Team-Based Primary Healthcare: A Cross-Case Policy Analysis of Four Canadian Provinces. Int J Integr Care 2021; 21:12. [PMID: 34824561 PMCID: PMC8588891 DOI: 10.5334/ijic.5680] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 09/20/2021] [Indexed: 11/20/2022] Open
Abstract
Introduction: Team-based care can improve integrated health services by increasing comprehensiveness and continuity of care in primary healthcare (PHC) settings. Collaborative models involving providers from different professions can help to achieve coordinated, high-quality person-centred care. In Canada, there has been variation in both the timing/pace of adoption and approach to interprofessional PHC (IPHC) policy. Provinces are at different stages in the development, implementation, and evaluation of team-based PHC models. This paper describes how different policies, contexts, and innovations across four Canadian provinces (British Columbia, Alberta, Ontario, Quebec) facilitate or limit integrated health services through IPHC teams. Methods: Systematic searches identified 100 policy documents across the four provinces. Analysis was informed by Walt and Gilson’s Policy Triangle (2008) and Suter et al.’s (2009) health system integration principles. Provincial policy case studies were constructed and used to complete a cross-case comparison. Results: Each province implemented variations of an IPHC based model. Five key components were found that influenced IPHC and integrated health services: patient-centred care; team structures; information systems; financial management; and performance measurement. Conclusion: Heterogeneity of the implementation of PHC teams across Canadian provinces provides an opportunity to learn and improve interprofessional care and integrated health services across jurisdictions.
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Jimenez G, Matchar D, Koh CHG, van der Kleij R, Chavannes NH, Car J. The Role of Health Technologies in Multicomponent Primary Care Interventions: Systematic Review. J Med Internet Res 2021; 23:e20195. [PMID: 33427676 PMCID: PMC7834942 DOI: 10.2196/20195] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/23/2020] [Accepted: 11/11/2020] [Indexed: 01/15/2023] Open
Abstract
Background Several countries around the world have implemented multicomponent interventions to enhance primary care, as a way of strengthening their health systems to cope with an aging chronically ill population and rising costs. Some of these efforts have included technology-based enhancements as one of the features to support the overall intervention, but their details and impacts have not been explored. Objective This study aimed to identify the role of digital/health technologies within wider multifeature interventions that are aimed at enhancing primary care, and to describe their aims and stakeholders, types of technologies used, and potential impacts. Methods A systematic review was performed following Cochrane guidelines. An electronic search, conducted on May 30, 2019, was supplemented with manual and grey literature searches in December 2019, to identify multicomponent interventions that included at least one technology-based enhancement. After title/abstract and full text screening, selected articles were assessed for quality based on their study design. A descriptive narrative synthesis was used for analysis and presentation of the results. Results Of 37 articles, 14 (38%) described the inclusion of a technology-based innovation as part of their multicomponent interventions to enhance primary care. The most commonly identified technologies were the use of electronic health records, data monitoring technologies, and online portals with messaging platforms. The most common aim of these technologies was to improve continuity of care and comprehensiveness, which resulted in increased patient satisfaction, increased primary care visits compared to specialist visits, and the provision of more health prevention education and improved prescribing practices. Technologies seem also to increase costs and utilization for some parameters, such as increased consultation costs and increased number of drugs prescribed. Conclusions Technologies and digital health have not played a major role within comprehensive innovation efforts aimed at enhancing primary care, reflecting that these technologies have not yet reached maturity or wider acceptance as a means for improving primary care. Stronger policy and financial support, and advocacy of key stakeholders are needed to encourage the introduction of efficient technological innovations, which are backed by evidence-based research, so that digital technologies can fulfill the promise of supporting strong sustainable primary care.
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Affiliation(s)
- Geronimo Jimenez
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - David Matchar
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
| | - Choon Huat Gerald Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Josip Car
- Centre for Population Health Sciences (CePHaS), Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
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Multicomponent interventions for enhancing primary care: a systematic review. Br J Gen Pract 2020; 71:e10-e21. [PMID: 33257458 PMCID: PMC7716873 DOI: 10.3399/bjgp20x714199] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/17/2020] [Indexed: 01/13/2023] Open
Abstract
Background Many countries have implemented interventions to enhance primary care to strengthen their health systems. These programmes vary widely in features included and their impact on outcomes. Aim To identify multiple-feature interventions aimed at enhancing primary care and their effects on measures of system success — that is, population health, healthcare costs and utilisation, patient satisfaction, and provider satisfaction (quadruple-aim outcomes). Design and setting Systematic review and narrative synthesis. Method Electronic, manual, and grey-literature searches were performed for articles describing multicomponent primary care interventions, providing details of their innovation features, relationship to the ‘4Cs’ (first contact, comprehensiveness, coordination, and continuity), and impact on quadruple-aim outcomes. After abstract and full-text screening, articles were selected and their quality appraised. Results were synthesised in a narrative form. Results From 37 included articles, most interventions aimed to improve access, enhance incentives for providers, provide team-based care, and introduce technologies. The most consistent improvements related to increased primary care visits and screening/preventive services, and improved patient and provider satisfaction; mixed results were found for hospital admissions, emergency department visits, and expenditures. The available data were not sufficient to link interventions, achievement of the 4Cs, and outcomes. Conclusion Most analysed interventions improved some aspects of primary care while, simultaneously, producing non-statistically significant impacts, depending on the features of the interventions, the measured outcome(s), and the populations being studied. A critical research gap was revealed, namely, in terms of which intervention features to enhance primary care (alone or in combination) produce the most consistent benefits.
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Wranik WD, Price S, Haydt SM, Edwards J, Hatfield K, Weir J, Doria N. Implications of interprofessional primary care team characteristics for health services and patient health outcomes: A systematic review with narrative synthesis. Health Policy 2019; 123:550-563. [PMID: 30955711 DOI: 10.1016/j.healthpol.2019.03.015] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/11/2019] [Accepted: 03/23/2019] [Indexed: 01/19/2023]
Abstract
Interprofessional primary care (IPPC) teams are promoted as an alternative to single profession physician practices in primary care with focus on preventive care and chronic disease management. Characteristics of teams can have an impact on their performance. We synthesized quantitative, qualitative or mixed-methods evidence addressing the design of IPPC teams. We searched Ovid MEDLINE, Embase, CINAHL, and PAIS using search terms focused on IPPC teams. Studies were included if they discussed the influence of team structure, organization, financial arrangements, or policies and procedures, or either health care processes or outputs, health outcomes, or costs, and were conducted in Australia, Canada, the United Kingdom or New Zealand between 2003 and 2016. We screened 11,707 titles, 5366 abstracts, and selected 77 full text articles (38 qualitative, 31 quantitative and 8 mixed-methods). Literature focused on the implications of team characteristics on team processes, such as teamwork, collaboration, or satisfaction of patients or providers. Despite heterogeneity of contexts, some trends are observable: shared space, common vision and goals, clear definitions of roles, and leadership as important to good teamwork. The impacts of these on health care outputs or patient health are not clear. To move the state of knowledge beyond perception of what works well for IPPC teams, researchers should focus on quantitative causal inference about the linkages between team characteristics and patient health.
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Affiliation(s)
- Wiesława Dominika Wranik
- School of Public Administration, Faculty of Management, Dalhousie University, Canada; Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University, Canada.
| | - Sheri Price
- School of Nursing, Faculty of Health Professions, Dalhousie University, Canada
| | - Susan M Haydt
- School of Public Administration, Faculty of Management, Dalhousie University, Canada
| | | | - Krista Hatfield
- School of Journalism and Communication, Carleton University, Canada
| | - Julie Weir
- Halifax Partnership, Dalhousie University, Canada
| | - Nicole Doria
- Maritime SPOR Support Unit, Dalhousie University, Canada
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Fernández Castillo RJ. Knowledge and beliefs about chronic non cancer pain management for family medicine group nurses. ENFERMERIA CLINICA 2018; 28:S1130-8621(17)30195-X. [PMID: 29358065 DOI: 10.1016/j.enfcli.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/23/2017] [Indexed: 10/18/2022]
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Lee C, Sung NJ, Lim HS, Lee JH. Emergency Department Visits Can Be Reduced by Having a Regular Doctor for Adults with Diabetes Mellitus: Secondary Analysis of 2013 Korea Health Panel Data. J Korean Med Sci 2017; 32:1921-1930. [PMID: 29115072 PMCID: PMC5680489 DOI: 10.3346/jkms.2017.32.12.1921] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 09/04/2017] [Indexed: 01/09/2023] Open
Abstract
Chronic diseases pose a major challenge to population health worldwide. Diabetes is a major chronic disease that is managed overwhelmingly in primary care. There is an increasing recognition of the role that primary care physicians play to achieve high-quality care for patients with diabetes. By analyzing 2013 Korean Health Panel data, the authors aimed to determine the current status of having a regular doctor (RD) for adults (aged 18 years or older) with diabetes. In addition, the association of having a RD with the experience of emergency department (ED) visits was determined in this study. Among adults with diabetes, those with RD accounted for 41.0%. The older the age group and the higher the Charlson comorbidity index score, the higher the percentage of adults with diabetes had RD. Even for those with RD, coordination of care was very poor (positive answer: 27.1%). After adjustment for confounding variables, those having (vs. not having) a RD (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.35-0.94), especially those whose RDs delivered good comprehensiveness of care (OR, 0.47; 95% CI, 0.26-0.84) or worked at a primary care clinic (OR, 0.43; 95% CI, 0.22-0.81), and those whose longitudinal relationship with a RD was 5 years or less (OR, 0.45; 95% CI, 0.22-0.91) were less likely to have ED visits within the last year. In conclusion, health care policies that promote having a RD who delivers high-quality primary care could decrease unnecessary ED visits by diabetic adults. This can partly reduce ED overcrowding in Korea.
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Affiliation(s)
- Clara Lee
- Department of Family Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Nak Jin Sung
- Department of Family Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea
| | - Hyeong Seok Lim
- Department of Family Medicine, Jeongeup Asan Hospital, Jeongeup, Korea
| | - Jae Ho Lee
- Department of Family Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea.
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