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Wangler J, Jansky M. [Ensuring primary care in Germany-findings from a quantitative survey of general practitioners]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:998-1009. [PMID: 38862728 PMCID: PMC11349858 DOI: 10.1007/s00103-024-03896-4] [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: 02/08/2024] [Accepted: 05/13/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Given the risk of a shortage of general practitioners in private practice, the question arises as to which concepts can make an effective contribution. To date, there is a lack of studies that comprehensively shed light on how general practitioners, based on their professional experience, view different approaches to ensuring primary care in the long term. OBJECTIVES The aim of the study was to determine the positions, attitudes, and experiences of general practitioners with regard to ensuring primary care. METHODS Using an online survey, a total of 4176 general practitioners were surveyed between February and June 2023. In addition to the descriptive analysis, a t-test on independent samples was used to determine significant differences between two groups. RESULTS Of those surveyed, 42% reported a noticeable decline of general medical practices in their area. In addition, 53% saw a declining attractiveness of primary care for young doctors, which is attributed to three problem areas: 1) the position of primary care in the healthcare system, 2) requirements for training and further education, and 3) working conditions. In order to secure primary care, those surveyed were primarily in favor of the following approaches: establishing a primary care physician system (85%), increasing the promotion of interest and points of contact in training and further education (80%), strengthening multi-professional outpatient care centers (64%), restructuring curricula (56%) and admission criteria for medical studies (50%), and reforming general medical training (53%). CONCLUSIONS As the results show, general practitioners have their own suggestions and preferences that complement existing expert assessments. General practitioners should be more consistently involved in the planning, implementation, and evaluation of measures to stabilize primary care.
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Affiliation(s)
- Julian Wangler
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland.
| | - Michael Jansky
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Am Pulverturm 13, 55131, Mainz, Deutschland
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Breton M, Deville-Stoetzel N, Gaboury I, Duhoux A, Maillet L, Abou Malham S, Hudon C, Vedel I, Légaré F, Berbiche D, Touati N. Taxonomy of advanced access practice profiles among family physicians, nurse practitioners and nurses in university-affiliated team-based primary healthcare clinics in Quebec. BMJ Open 2023; 13:e074681. [PMID: 38086598 PMCID: PMC10729211 DOI: 10.1136/bmjopen-2023-074681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVES The advanced access model is highly recommended to improve timely access to primary healthcare (PHC). However, its adoption varies among PHC providers. We aim to identify the advanced access profiles of PHC providers. DESIGN A cross-sectional study was conducted between October 2019 and March 2020. Latent class analysis (LCA) measures were used to identify PHC provider profiles based on 14 variables, 2 organisational context characteristics (clinical size and geographical area) and 12 advanced access strategies. SETTING AND PARTICIPANTS All family physicians, nurse practitioners and nurses working in the 49 university-affiliated team-based PHC clinics in Quebec, Canada, were invited, of which 35 participated. PRIMARY OUTCOME MEASURE The LCA was based on 335 respondents. We determined the optimal number of profiles using statistical criteria (Akaike information criterion, Bayesian information criterion) and qualitatively named each of the six advanced access profiles. RESULTS (1) Low supply and demand planification (25%) was characterised by the smallest proportion of strategies used to balance supply and demand. (2) Reactive interprofessional collaboration (25%) was characterised by high collaboration and long opening periods for appointment scheduling. (3) Structured interprofessional collaboration (19%) was characterised by high use of interprofessional team meetings. (4) Small urban delegating practices (13%) was exclusively composed of family physicians and characterised by task delegation to other PHC providers on the team. (5) Comprehensive practices in urban settings (13%) was characterised by including as many services as possible on each visit. (6) Rural agility (4%) was characterised by the highest uptake of advanced access strategies based on flexibility, including adjusting the schedule to demand and having a large number of open-slot appointments available in the next 48 hours. CONCLUSION The different patterns of advanced access strategy adoption confirm the need for training to be tailored to individuals, categories of PHC providers and contexts.
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Affiliation(s)
- Mylaine Breton
- Department of Community Health, University of Sherbrooke, Longueuil, Quebec, Canada
| | | | - Isabelle Gaboury
- Department of Family Medecine and Emergency Medicine, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Arnaud Duhoux
- Faculty of Nursing, University of Montreal, Montreal, Québec, Canada
| | - Lara Maillet
- National School of Public Administration, ENAP, Montreal, Québec, Canada
| | - Sabina Abou Malham
- School of Nursing Sciences, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medecine and Emergency Medicine, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Isabelle Vedel
- Department of Family Medicine, McGill University, Montreal, Québec, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Laval University, Québec, Québec, Canada
| | - Djamal Berbiche
- Department of Community Health, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Nassera Touati
- National School of Public Administration, ENAP, Montreal, Québec, Canada
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Contandriopoulos D, Bertoni K, Duhoux A, Randhawa GK. Pre-post analysis of the impact of British Columbia nurse practitioner primary care clinics on patient health and care experience. BMJ Open 2023; 13:e072812. [PMID: 37857545 PMCID: PMC10603457 DOI: 10.1136/bmjopen-2023-072812] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/01/2023] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE This study aims to evaluate the impact of a primary care nurse practitioner (NP)-led clinic model piloted in British Columbia (Canada) on patients' health and care experience. DESIGN The study relies on a quasi-experimental longitudinal design based on a pre-and-post survey of patients receiving care in NP-led clinics. The prerostering survey (T0) was focused on patients' health status and care experiences preceding being rostered to the NP clinic. One year later, patients were asked to complete a similar survey (T1) focused on the care experiences with the NP clinic. SETTING To solve recurring problems related to poor primary care accessibility, British Columbia opened four pilot NP-led clinics in 2020. Each clinic has the equivalent of approximately six full-time NPs, four other clinicians plus support staff. Clinics are located in four cities ranging from urban to suburban. PARTICIPANTS Recruitment was conducted by the clinic's clerical staff or by their care provider. A total of 437 usable T0 surveys and 254 matched and usable T1 surveys were collected. PRIMARY OUTCOME MEASURES The survey instrument was focused on five core dimensions of patients' primary care experience (accessibility, continuity, comprehensiveness, responsiveness and outcomes of care) as well as on the SF-12 Short-form Health Survey. RESULTS Scores for all dimensions of patients' primary care experience increased significantly: accessibility (T0=5.9, T1=7.9, p<0.001), continuity (T0=5.5, T1=8.8, p<0.001), comprehensiveness (T0=5.6, T1=8.4, p<0.001), responsiveness (T0=7.2, T1=9.5, p<0.001), outcomes of care (T0=5.0, T1=8.3, p<0.001). SF-12 Physical health T-scores also rose significantly (T0=44.8, T1=47.6, p<0.001) but no changes we found in the mental health T scores (T0=45.8, T1=46.3 p=0.709). CONCLUSIONS Our results suggest that the NP-led primary care model studied here likely constitutes an effective approach to improve primary care accessibility and quality.
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Affiliation(s)
| | - Katherine Bertoni
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
| | - Arnaud Duhoux
- Faculté des Sciences Infirmières, Université de Montréal, Montreal, Québec, Canada
| | - Gurprit K Randhawa
- School of Nursing, University of Victoria, Victoria, British Columbia, Canada
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Lavergne R, Peterson S, Rudoler D, Scott I, Mccracken R, Mitra G, Katz A. Productivity Decline or Administrative Avalanche? Examining Factors That Shape Changing Workloads in Primary Care. Healthc Policy 2023; 19:114-129. [PMID: 37695712 PMCID: PMC10519339 DOI: 10.12927/hcpol.2023.27152] [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: 09/13/2023] Open
Abstract
Background In Canada, family physicians (FPs) per capita have increased but so have access challenges. We explored changes in population characteristics, service delivery and FP practice that may help understand these trends. Methods We used linked administrative data in British Columbia to describe changes in patient ages and comorbidities, hospitalizations and receipt of services that may require FP coordination, review and/or follow-up: prescriptions dispensed, laboratory tests, diagnostic imaging (radiology and ultrasound), specialist visits and emergency department visits. We estimate the number of FPs delivering community-based comprehensive care and report changes in service volume per community-based FP visit. Results Between 1999/2000 and 2017/2018, people experienced fewer days in hospital, but the number of treated comorbidities, day surgeries and other services requiring FP coordination increased over and above the expected levels attributed to population aging. While the total number of FPs per capita have increased, numbers in community-based care have not and visits per physician have fallen. Increases in services that may involve FP coordination per community-based FP visit ranged from 32.2% for diagnostic radiology to 122.1% for lab tests. Conclusion Findings suggest substantially increased coordination workload per FP visit. Ongoing impacts of population aging and changing service delivery on primary care workload require further examination.
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Affiliation(s)
- Ruth Lavergne
- Associate Professor Tier II Canada Research Chair in Primary Care Department of Family Medicine Dalhousie University Halifax, NS
| | - Sandra Peterson
- Research Analyst Centre for Health Services and Policy Research University of British Columbia Vancouver, BC
| | - David Rudoler
- Associate Professor Faculty of Health Sciences Ontario Tech University Oshawa, ON Associate Professor Ontario Shores Centre for Mental Health Sciences, Whitby, ON
| | - Ian Scott
- Professor Department of Family Practice University of British Columbia Director Centre for Health Education Scholarship Vancouver, BC
| | - Rita Mccracken
- Assistant Professor Department of Family Practice University of British Columbia Vancouver, BC
| | - Goldis Mitra
- Clinical Assistant Professor Department of Family Practice University of British Columbia Vancouver, BC
| | - Alan Katz
- Professor Department of Family Medicine University of Manitoba Professor Department of Community Health Sciences University of Manitoba Winnipeg, MB
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Mathews M, Spencer S, Hedden L, Lukewich J, Poitras ME, Marshall EG, Brown JB, Sibbald S, Norful AA. The impact of funding models on the integration of registered nurses in primary health care teams: protocol for a multi-phase mixed-methods study in Canada. BMC PRIMARY CARE 2022; 23:290. [PMID: 36402965 PMCID: PMC9675973 DOI: 10.1186/s12875-022-01900-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/03/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Family practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care. METHODS This mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) an online survey with family practice nurses. The funding model analysis will employ policy scans to identify, describe, and compare the various funding models used in Canada to integrate family practice nurses in primary care. Case studies involving qualitative interviews with clinic teams (family practice nurses, physicians, and administrators) and family practice nurse activity logs will explore the variation of nursing professional practice, training, skill set, and team functioning in British Columbia, Nova Scotia, Ontario, and Quebec. Interview transcripts will be analysed thematically and comparisons will be made across funding models. Activity log responses will be analysed to represent nurses' time spent on independent, dependent, interdependent, or non-nursing work in each funding model. Finally, a cross-sectional online survey of family practice nurses in Canada will examine the relationships between funding models, nursing professional practice, training, skill set, team functioning, and patient care co-management in primary care. We will employ bivariate tests and multivariable regression to examine these relationships in the survey results. DISCUSSION This project aims to address a gap in the literature on funding models for family practice nurses. In particular, findings will support provincial and territorial governments in structuring funding models that optimise the roles of family practice nurses while establishing evidence about the benefits of interdisciplinary team-based care. Overall, the findings may contribute to the integration and optimisation of family practice nursing within primary health care, to the benefit of patients, primary healthcare providers, and health care systems nationally.
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Affiliation(s)
- Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1.
| | - Sarah Spencer
- Faculty of Health Sciences, Simon Fraser University, BC, Burnaby, Canada
| | - Lindsay Hedden
- Faculty of Health Sciences, Simon Fraser University, BC, Burnaby, Canada
| | - Julia Lukewich
- Faculty of Nursing, Memorial University, St John's, NL, Canada
| | - Marie-Eve Poitras
- Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Judith Belle Brown
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1
| | - Shannon Sibbald
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond Street, Second Floor, Rm 2140, London, ON, Canada, N6G 2M1
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Blanco-Fraile C, Madrazo-Pérez M, Fradejas-Sastre V, Rayón-Valpuesta E. The evolution of the role of nursing in primary health care using Bourdieu’s concept of habitus. A grounded theory study. PLoS One 2022; 17:e0265378. [PMID: 35580088 PMCID: PMC9113590 DOI: 10.1371/journal.pone.0265378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/01/2022] [Indexed: 11/18/2022] Open
Abstract
Aims
To analyse the global process by which Spanish nurses have acquired a differentiated role in primary health care and to develop a theory that explains the evolution of this role.
Design
Grounded Theory was selected, as proposed by Glaser and Strauss, following the theoretical framework of Bourdieu’s habitus.
Methods
Thirteen in-depth interviews were conducted between 2012 and 2015, using theoretical sampling and seeking maximum variability. The analysis of the data included progressive coding and categorization, constant comparative analysis and memo writing.
Results
A core category emerged, “Autonomy”, composed of three categories: "Between illusion and ignorance. Genesis of a habitus", "The recognisable and recognised habitus" and "Habitus called into question", showing the genesis of the nursing role in primary health care and the elements that influence the autonomy of the role: the ability to decide their training, assume their own leadership, configure teams and acquire independent skills. “Seeking autonomy” was the substantive theory that emerged from the data.
Conclusion
The results reveal the elements that strengthen the autonomous professional role and that this role is legitimated when two elements are identified: the acquisition of a habitus, based on practices carried out regularly and the recognition of this habitus by the population and others professionals.
Impact
The results of this study identify the elements that guide and strengthen the professional role and redefine the concept of autonomy. These are operational findings and could potentially be used to define new strategies for advancing the role of nursing in primary health care.
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Affiliation(s)
| | | | - Victor Fradejas-Sastre
- Faculty of Nursing, University of Cantabria, Santander, Cantabria, Spain
- Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
- * E-mail:
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Lafrance S, Demont A, Thavorn K, Fernandes J, Santaguida C, Desmeules F. Economic evaluation of advanced practice physiotherapy models of care: a systematic review with meta-analyses. BMC Health Serv Res 2021; 21:1214. [PMID: 34753487 PMCID: PMC8579553 DOI: 10.1186/s12913-021-07221-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background The objective of this systematic review is to appraise evidence on the economic evaluations of advanced practice physiotherapy (APP) care compared to usual medical care. Methods Systematic searches were conducted up to September 2021 in selected electronic bibliographical databases. Economic evaluation studies on an APP model of care were included. Economic data such as health care costs, patient costs, productivity losses were extracted. Methodological quality of included studies was assessed with the Effective Public Health Practice Project tool and the Critical Appraisal Skills Programme checklist. Meta-analyses were performed and mean differences (MD) in costs per patient were calculated using random-effect inverse variance models. Certainty of the evidence was assessed with the GRADE Approach. Results Twelve studies (n = 14,649 participants) including four randomized controlled trials, seven analytical cohort studies and one economic modeling study were included. The clinical settings of APP models of care included primary, emergency and specialized secondary care such as orthopaedics, paediatrics and gynaecology. The majority of the included participants were adults with musculoskeletal disorders (n = 12,915). Based on low quality evidence, health system costs including salaries, diagnostic tests, medications, and follow-up visits were significantly lower with APP care than with usual medical care, at 2 to 12-month follow-up (MD: -139.08 €/patient; 95%CI: -265.93 to -12.23; n = 7648). Based on low quality evidence, patient costs including travel and paid medication prescriptions, or treatments were significantly higher with APP care compared to usual medical care, at 2 to 6-month follow-up (MD: 29.24 €/patient; 95%CI: 0.53 to 57.95 n = 1485). Based on very low quality evidence, no significant differences in productivity losses per patient were reported between both types of care (MD: 590 €/patient; 95%CI: -100 to 1280; n = 819). Conclusions This is the first systematic review and meta-analysis on the economic evaluation of APP models of care. Low quality evidence suggests that APP care might result in lower health care costs, but higher patient costs compared to usual medical care. Costs differences may vary depending on various factors such as the cost methodology used and on the clinical setting. More evidence is needed to evaluate cost benefits of APP models of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07221-6.
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Affiliation(s)
- Simon Lafrance
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada. .,Maisonneuve-Rosemont Hospital Research Center, Université de Montréal Affiliated Research Center, Montreal, Quebec, Canada.
| | - Anthony Demont
- INSERM 1123 ECEVE, Faculty of Medicine, Paris-Diderot University, Paris, France.,Physiotherapy School, University of Orleans, Orleans, France
| | - Kednapa Thavorn
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Julio Fernandes
- Hôpital du Sacré-Coeur de Montréal Research Center, Université de Montréal Affiliated Research Center, Montreal, Quebec, Canada.,Department of Surgery, Faculty of Medecine, Université de Montréal, Montreal, Quebec, Canada
| | - Carlo Santaguida
- Department of Neurology and Neurosurgery, Faculty of Medecine, McGill University Health Center, Montreal, Quebec, Canada
| | - François Desmeules
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.,Maisonneuve-Rosemont Hospital Research Center, Université de Montréal Affiliated Research Center, Montreal, Quebec, Canada
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Ries NM. Conceptualizing interprofessional working - when a lawyer joins the healthcare mix. J Interprof Care 2021; 35:953-962. [PMID: 33445987 DOI: 10.1080/13561820.2020.1856799] [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] [Indexed: 10/22/2022]
Abstract
Research, policy and practice in the field of interprofessional collaboration have focused on how medical, nursing, allied health and social care practitioners work together to positively impact patient care. This paper extends conceptual thinking about interprofessional practice by focusing on lawyers as part of the interprofessional mix. This attention is prompted by medical-legal partnerships (MLPs), a service model by which lawyers join health care settings to assist patients with unmet, and often health-harming, legal needs. MLPs are present in around 450 hospitals and other health care sites across the United States and the model has spread to other countries, including Australia, the United Kingdom and Canada. However, enthusiasm for the MLP model is not yet matched by good evidence on how, when and for whom the model works. Interprofessional scholars contend that imprecise terminology and poor conceptualization of interprofessional arrangements hinder high-quality research and evaluation. In response to their critiques, this paper formulates a stepwise conceptual framework to guide the design, implementation and study of interprofessional arrangements that connect health, social care and legal practitioners. This framework draws on findings from national surveys of MLP initiatives in several countries and adapts several key conceptual frameworks that have been developed from systematic reviews of interprofessional working in primary health care. These conceptual frameworks are valuable because they promote clarity about different modes of interprofessional working and characterize the factors at macro (policy, funding), meso (organizational) and micro (practitioner, patient) levels that help or hinder professionals from different disciplines in working together. The paper considers factors at these three levels that require particular attention when lawyers join health care settings and proposes questions for future research in this emerging area.
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Affiliation(s)
- Nola M Ries
- Law
- Health
- Justice Research Centre, Faculty of Law, University of Technology Sydney, Broadway Australia
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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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van den Bussche H. Die Zukunftsprobleme der hausärztlichen Versorgung in Deutschland: Aktuelle Trends und notwendige Maßnahmen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:1129-1137. [DOI: 10.1007/s00103-019-02997-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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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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12
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Lavergne MR, Scott I, Mitra G, Snadden D, Blackie D, Goldsmith LJ, Rudoler D, Hedden L, Grudniewicz A, Ahuja MA, Marshall EG. Regional differences in where and how family medicine residents intend to practise: a cross-sectional survey analysis. CMAJ Open 2019; 7:E124-E130. [PMID: 30819692 PMCID: PMC6397032 DOI: 10.9778/cmajo.20180152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Family medicine residents choose among a range of practice options as they enter the physician workforce. We describe the demographic and personal characteristics of Canadian family medicine residents and examine differences in the intentions of residents from Ontario, Quebec, Western Canada and Atlantic Canada at the completion of their training, in terms of practice comprehensiveness, organizational model, clinical domains, practice settings and populations served. METHODS We analyzed national survey data collected by the College of Family Physicians of Canada and 16 university-based family medicine residency programs. We tabulated bivariable descriptive results and used logistic regression to estimate odds of practice intentions across regions, adjusting for family medicine resident characteristics. RESULTS Of 1680 respondents (61.5% of 2731 family medicine residents invited to participate), 66.3% (n = 1095) reported it was somewhat or highly likely they would commit to providing comprehensive care to the same group of patients within their first 3 years of practice. This percentage varied from 40.3% in Atlantic Canada to 85.1% in Ontario. In addition, 31.5% (n = 522) reported it was somewhat or highly likely they would focus only on specific clinical areas. Most respondents reported it was somewhat or highly likely that they would practise in a group physician practice (93.8%) or interprofessional team-based practice (88.1%), and only 7.7% expected to have a solo practice. INTERPRETATION Intentions for comprehensive and focused practice varied, but over 80% of family medicine residents indicated they intended to practise in a team-based model in all regions. Policy-makers and workforce planners should consider the impact of family medicine residents' intentions on policy objectives.
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Affiliation(s)
- M Ruth Lavergne
- Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Ian Scott
- Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Goldis Mitra
- Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - David Snadden
- Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Doug Blackie
- Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Laurie J Goldsmith
- Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - David Rudoler
- Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Lindsay Hedden
- Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Agnes Grudniewicz
- Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Megan A Ahuja
- Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
| | - Emily Gard Marshall
- Faculty of Health Sciences (Lavergne, Goldsmith, Hedden), Simon Fraser University, Burnaby, BC; Department of Family Practice (Scott, Mitra), Faculty of Medicine, University of British Columbia, Vancouver, BC; Department of Family Practice (Snadden), Faculty of Medicine, University of British Columbia Northern Medical Program, Prince George, BC; School of Leadership Studies (Blackie), Royal Roads University, Victoria, BC; University of Ontario Institute of Technology (Rudoler), Oshawa, Ont.; Telfer School of Management (Grudniewicz), University of Ottawa, Ottawa, Ont.; Centre for Health Services and Policy Research (Ahuja), School of Population and Public Health, University of British Columbia, Vancouver, BC; Department of Family Medicine (Marshall), Faculty of Medicine, Dalhousie University, Halifax, NS
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Contandriopoulos D, Perroux M, Duhoux A. Formalisation and subordination: a contingency theory approach to optimising primary care teams. BMJ Open 2018; 8:e025007. [PMID: 30478127 PMCID: PMC6254417 DOI: 10.1136/bmjopen-2018-025007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Revised: 10/19/2018] [Accepted: 10/25/2018] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE While there is consensus on the need to strengthen primary care capacities to improve healthcare systems' performance and sustainability, there is only limited evidence on the best way to organise primary care teams. In this article, we use a conceptual framework derived from contingency theory to analyse the structures and process optimisation of multiprofessional primary care teams. DESIGN We focus specifically on inter-relationships between three dimensions: team size, formalisation of care processes and nurse autonomy. Interview-based qualitative data for each of these three dimensions were converted into ordinal scores. Data came from eight pilot sites in Quebec (Canada). RESULTS We found a positive association between team size and formalisation (correlation score 0.55) and a negative covariation (correlation score -0.64) between care process formalisation and nurses' autonomy/subordination. Despite the study being exploratory in nature, such relationships validate the idea that these dimensions should be analysed conjointly and are coherent with our suggestion that using a framework derived from a contingency approach makes sense. CONCLUSIONS The results provide insights about the structural design of nurse-intensive primary care teams. Non-physicians' professional autonomy is likely to be higher in smaller teams. Likewise, a primary care team that aims to increase nurses' and other non-physicians' professional autonomy should be careful about the extent to which it formalises its processes.
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Affiliation(s)
| | - Mélanie Perroux
- Regroupement des Aidants Naturels du Québec, Montreal, Canada
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