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Berger M, Mayer S, Simon J. A novel set of Austrian reference unit costs for comprehensive societal perspectives consistent with latest European costing methods for economic evaluations. Wien Klin Wochenschr 2024; 136:1-12. [PMID: 36564501 PMCID: PMC9786525 DOI: 10.1007/s00508-022-02128-6] [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: 06/10/2022] [Accepted: 11/15/2022] [Indexed: 12/25/2022]
Abstract
Decision making in public health often happens against the background of scarce resources. The systematic use of economic evaluations can be a main enabler in the alignment of public health goals with budgetary constraints. However, the lack of standardized methodology in terms of costing method and perspective are a critical barrier to the implementation of economic evaluations and the international comparability of results. We present a novel set of 22 reference unit costs (RUCs) optimized for cross-sectoral economic evaluations in Austria suitable for international comparability calculated using the standardized PECUNIA RUC Template. The common framework for costing and reporting, as well as the easy availability of the RUCs will reduce the burden on researchers and policy makers in future economic evaluations. The higher quality, accuracy, transparency and availability of economic evidence for policy design will help to improve the efficiency of public health-relevant healthcare decisions and make it easier for policy makers to bring funding arrangements and decision making across multiple sectors in line with Health-in-All-Policies goals.
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Affiliation(s)
- Michael Berger
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090, Vienna, Austria.
- Department of Psychiatry, University of Oxford, Warneford Hospital, OX3 7JX, Oxford, UK.
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Flinterman LE, González-González AI, Seils L, Bes J, Ballester M, Bañeres J, Dan S, Domagala A, Dubas-Jakóbczyk K, Likic R, Kroezen M, Batenburg R. Characteristics of Medical Deserts and Approaches to Mitigate Their Health Workforce Issues: A Scoping Review of Empirical Studies in Western Countries. Int J Health Policy Manag 2023; 12:7454. [PMID: 38618823 PMCID: PMC10590222 DOI: 10.34172/ijhpm.2023.7454] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 05/30/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Medical deserts are considered a problematic issue for many Western countries which try to employ multitude of policies and initiatives to achieve a better distribution of their health workforce (HWF). The aim of this study was to systematically map research and provide an overview of definitions, characteristics, contributing factors and approaches to mitigate medical deserts within the European Union (EU)-funded project "ROUTE-HWF" (a Roadmap OUT of mEdical deserts into supportive Health WorkForce initiatives and policies). METHODS We performed a scoping review to identify knowledge clusters/research gaps in the field of medical deserts focusing on HWF issues. Six databases were searched till June 2021. Studies reporting primary research from Western countries on definitions, characteristics, contributing factors, and approaches were included. Two independent reviewers assessed studies for eligibility, extracted data and clustered studies according to the four defined outcomes. RESULTS Two-hundred and forty studies were included (n=116, 48% Australia/New Zealand; n=105, 44% North America; n=20, 8% Europe). All used observational designs except for five quasi-experimental studies. Studies provided definitions (n=171, 71%), characteristics (n=95, 40%), contributing factors (n=112, 47%), and approaches to mitigate medical deserts (n=87, 36%). Most medical deserts were defined by the density of the population in an area. Contributing factors to HWF issues in medical deserts consisted in work-related (n=55, 23%) and lifestyle-related factors (n=33, 14%) of the HWF as well as sociodemographic characteristics (n=79, 33%). Approaches to mitigate them focused on training adapted to the scope of rural practice (n=67, 28%), HWF distribution (n=3, 1%), support/infrastructure (n=8, 3%) and innovative models of care (n=7, 3%). CONCLUSION Our study provides the first scoping review that presents and categorizes definitions, characteristics, contributing factors, and approaches to mitigate HWF issues in medical deserts. We identified gaps such as the scarcity of longitudinal studies to investigate the impact of factors contributing to medical deserts, and interventional studies to evaluate the effectiveness of approaches to mitigate HWF issues.
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Affiliation(s)
- Linda E. Flinterman
- Health Workforce and Organization Studies, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | - Laura Seils
- Avedis Donabedian Research Institute – UAB, Madrid, Spain
| | - Julia Bes
- Health Workforce and Organization Studies, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | | | | | - Sorin Dan
- Innovation and Entrepreneurship InnoLab, University of Vaasa, Vaasa, Finland
| | - Alicja Domagala
- Department of Health Policy and Management, Institute of Public Health, Jagiellonian University, Krakow, Poland
| | - Katarzyna Dubas-Jakóbczyk
- Department of Health Economics and Social Security, Institute of Public Health, Jagiellonian University, Krakow, Poland
| | - Robert Likic
- School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Marieke Kroezen
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Ronald Batenburg
- Health Workforce and Organization Studies, Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
- Department of Sociology, Radboud University, Nijmegen, The Netherlands
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Khattak FA, Saba M, Hakim M, Khan A, Aleem S, Afaq S, Ullah A, Rahim A, Haq ZU. Patient Satisfaction and Utilization of Ambulance Services in Prehospital Services at a Tertiary Care Hospital: A Cross-Sectional Study in Peshawar, Khyber Pakhtunkhwa, Pakistan. Air Med J 2023; 42:239-245. [PMID: 37356883 DOI: 10.1016/j.amj.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 03/06/2023] [Accepted: 03/07/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Patients reporting to emergency departments frequently use different ambulance services; therefore, the measurement of patient satisfaction is relevant to encouraging those services to meet patient expectations. The aim of this study was to determine the patients' satisfaction and utilization of different ambulance services at a tertiary health care hospital in Peshawar relating to prehospital services. METHODS This cross-sectional study was conducted at Lady Reading Hospital, Peshawar, Khyber Pakhtunkhwa, Pakistan, from July 2019 to January 2020 using a consecutive sampling technique with a total sample size of 378. The patients reporting to the emergency department using any ambulance service were included in this study. Different types of ambulance services were used as an outcome variable. Proportions were compared for the categoric variables using the chi-square test, whereas the 1-way analysis of variance test was used to determine the mean response time and age. Results were considered significant at a P value ≤ .050. All analyses were completed using SPSS version 20 (IBM Corp, Armonk, NY). RESULTS Of the total 378 study participants, approximately 166 (43.9%) used Rescue 1122 services, 99 (26.2%) used private ambulance services, and 44 (11.6%) used public ambulance services. Road traffic accidents were the most common complaint by 98 (25.9%, P < .003) participants. The mean response time for Rescue 1122 was 13.2 ± 18 minutes followed by the Chippa Foundation (private) at 17.8 ± 20 minutes (P < .005). Males (n = 254) were the predominant users of all services. Participants from the urban region (n = 112) used Rescue 1122, whereas the public ambulance service was used only by 31 patients (P < .005). Among all the ambulance services, 19 (61.3%) participants were not satisfied with the Chippa service regarding vehicle cleanliness, whereas participants were highly satisfied with Rescue 1122. CONCLUSION Overall, the patients were more satisfied with the services provided by the Rescue 1122 ambulances compared with all other ambulance services.
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Affiliation(s)
- Farhad Ali Khattak
- Research Cell, Khyber College of Dentistry, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Mehwish Saba
- Health Department, Nowshera, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Hakim
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Asad Khan
- College of Medical Technology, Bacha Khan Medical College, Mardan, Pakistan
| | - Saima Aleem
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Saima Afaq
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan; Department of Epidemiology and Biostatistics, School of Public Health Faculty of Medicine, Imperial College, London, United Kingdom.
| | - Abid Ullah
- Sarhad University of Science and Technology, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Abid Rahim
- Sardar Begum Dental College & Hospital, Gandhara University, Peshawar, Pakistan
| | - Zia Ul Haq
- Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Khyber Pakhtunkhwa, Pakistan
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Petrazzuoli F, Collins C, Van Poel E, Tatsioni A, Streit S, Bojaj G, Asenova R, Hoffmann K, Gabrani J, Klemenc-Ketis Z, Rochfort A, Adler L, Windak A, Nessler K, Willems S. Differences between Rural and Urban Practices in the Response to the COVID-19 Pandemic: Outcomes from the PRICOV-19 Study in 38 Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3674. [PMID: 36834369 PMCID: PMC9958860 DOI: 10.3390/ijerph20043674] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 06/18/2023]
Abstract
This paper explores the differences between rural and urban practices in the response to the COVID-19 pandemic, emphasizing aspects such as management of patient flow, infection prevention and control, information processing, communication and collaboration. Using a cross-sectional design, data were collected through the online PRICOV-19 questionnaire sent to general practices in 38 countries. Rural practices in our sample were smaller than urban-based practices. They reported an above-average number of old and multimorbid patients and a below-average number of patients with a migrant background or financial problems. Rural practices were less likely to provide leaflets and information, but were more likely to have ceased using the waiting room or to have made structural changes to their waiting room and to have changed their prescribing practices in terms of patients attending the practices. They were less likely to perform video consultations or use electronic prescription methods. Our findings show the existence of certain issues that could impact patient safety in rural areas more than in urban areas due to the underlying differences in population profile and supports. These could be used to plan the organization of care for similar future pandemic situations.
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Affiliation(s)
- Ferdinando Petrazzuoli
- Department of Clinical Sciences, Centre for Primary Health Care Research, Lund University, 21428 Malmö, Sweden
| | - Claire Collins
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
| | - Athina Tatsioni
- Research Unit for General Medicine and Primary Health Care, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Mittelstrasse 43, 3012 Bern, Switzerland
| | - Gazmend Bojaj
- Department of Management of Health Services and Institution, Heimerer College, 1000 Pristina, Kosovo
| | - Radost Asenova
- Department of Urology and General Practice, Faculty of Medicine, Medical University Plovdiv, 4003 Plovdiv, Bulgaria
| | - Kathryn Hoffmann
- Department of Social- and Preventive Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Jonila Gabrani
- Faculty of Medicine, University of Basel, 4001 Basel, Switzerland
| | - Zalika Klemenc-Ketis
- Department of Family Medicine, Medical Faculty, University of Maribor, Tabroska 8, 2000 Maribor, Slovenia
- Department of Family Medicine, Medical Faculty, University of Ljubljana, Poljanski Nasip 58, 1000 Ljubljana, Slovenia
- Ljubljana Community Health Centre, Metelkova 9, 1000 Ljubljana, Slovenia
| | - Andrée Rochfort
- Research Centre, Irish College of General Practitioners, D02 XR68 Dublin, Ireland
| | - Limor Adler
- Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6195001, Israel
| | - Adam Windak
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland
| | - Katarzyna Nessler
- Department of Family Medicine, Jagiellonian University Medical College, 31-061 Krakow, Poland
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, 9000 Ghent, Belgium
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Schrimpf A, Bleckwenn M, Braesigk A. COVID-19 Continues to Burden General Practitioners: Impact on Workload, Provision of Care, and Intention to Leave. Healthcare (Basel) 2023; 11:320. [PMID: 36766895 PMCID: PMC9914234 DOI: 10.3390/healthcare11030320] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 01/24/2023] Open
Abstract
General practitioners (GPs), already in a profession with a high workload, have been at the frontline of providing COVID-19-related healthcare in addition to routine care. Our study examined the impact of pandemic-related consultations and changes in practice organization on GPs' current workload and provision of healthcare in summer 2021 (May 2021-July 2021) and early 2022 (January 2022-February 2022). In total, 143 German GPs participated in an online survey in the summer of 2021. Of these, 51 GPs participated in the follow-up survey in 2022. Most GPs perceived an increase in consultation frequency, consultation times, and workload since the pandemic outbreak. Increased consultation times were related to the reduced provision of medical care to other patients with chronic diseases. More SARS-CoV-2 vaccination consultations were associated with reduced home visits, acute consultation times, and cancer screenings. A quarter of GPs considered leaving their job. Pandemic-related bureaucracy, restricted access to therapy and rehabilitation services specialized on COVID-19, unreliable vaccine deliveries, mandatory telematics-infrastructure implementation, and frequent changes in official regulations were the main reasons reported for dissatisfaction. Our results provide insights into how the pandemic continues to burden GPs' work routines and how better working conditions in times of high demand could be achieved in future pandemics.
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Affiliation(s)
- Anne Schrimpf
- Department of General Practice, Faculty of Medicine, Leipzig University, 04109 Leipzig, Germany
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Morgan T, Tapley A, Davey A, Holliday E, Fielding A, van Driel M, Ball J, Spike N, FitzGerald K, Morgan S, Magin P. Influence of rurality on general practitioner registrars' participation in their practice's after-hours roster: A cross-sectional study. Aust J Rural Health 2022; 30:343-351. [PMID: 35196416 PMCID: PMC9305465 DOI: 10.1111/ajr.12850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate whether practice rurality and rural training pathway are associated with general practitioner registrars' participation in their practice's after-hours care roster. DESIGN A cross-sectional analysis of data (2017-2019) from the Registrar Clinical Encounters in Training study, an ongoing inception cohort study of Australian general practitioner registrars. The principal analyses used logistic regression. SETTING Three national general practitioner regional training organisations across 3 Australian states. PARTICIPANTS General practitioner registrars in training within regional training organisations. MAIN OUTCOME MEASURE Involvement in practice after-hours care was indicated by a dichotomous response on a 6-monthly Registrar Clinical Encounters in Training study questionnaire item. RESULTS 1576 registrars provided 3158 observations (response rate 90.3%). Of these, 1574 (48.6% [95% confidence interval: 46.8-50.3]) involved registrars contributing to their practice's after-hours roster. In major cities, 40% of registrar terms involved contribution to their practice's after-hours roster; in regional and remote practices, 62% contributed to the after-hours roster. On multivariable analysis, both level of rurality of practice (odds ratio(OR) 1.75, P = .007; and OR 1.74, P = .026 for inner regional and outer regional/remote locations, respectively, versus major city) and rural training pathway of registrar (OR 1.65, P = .008) were significantly associated with more after-hours roster contribution. Other associations were registrars' later training stage, larger practices and practices not routinely bulk billing. Significant regional variability in after-hours care was identified (after adjusting for rurality). CONCLUSION These findings suggest that registrars working rurally and those training on the rural pathway are more often participating in practice after-hours rosters. This has workforce implications, and implications for the educational richness of registrars' training environment.
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Affiliation(s)
- Tobias Morgan
- School of Population HealthFaculty of Medicine and HealthUNSW SydneySydneyNew South WalesAustralia
| | - Amanda Tapley
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNew South WalesAustralia
- NSW & ACT Research and Evaluation UnitGP SynergyRegional Training OrganisationMayfield WestNew South WalesAustralia
| | - Andrew Davey
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNew South WalesAustralia
- NSW & ACT Research and Evaluation UnitGP SynergyRegional Training OrganisationMayfield WestNew South WalesAustralia
| | - Elizabeth Holliday
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNew South WalesAustralia
| | - Alison Fielding
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNew South WalesAustralia
- NSW & ACT Research and Evaluation UnitGP SynergyRegional Training OrganisationMayfield WestNew South WalesAustralia
| | - Mieke van Driel
- Primary Care Clinical UnitFaculty of MedicineUniversity of QueenslandRoyal Brisbane & Women's HospitalBrisbaneQueenslandAustralia
| | - Jean Ball
- Clinical Research Design and Statistical Support Unit (CReDITSS)Hunter Medical Research InstituteNew Lambton HeightsNew South WalesAustralia
| | - Neil Spike
- Department of General Practice and Primary Health CareUniversity of MelbourneCarltonVictoriaAustralia
- Eastern Victoria General Practice TrainingRegional Training OrganisationHawthornVictoriaAustralia
| | - Kristen FitzGerald
- Tasmanian School of MedicineUniversity of TasmaniaHobartTasmaniaAustralia
- General Practice Training TasmaniaRegional Training OrganisationHobartTasmaniaAustralia
| | - Simon Morgan
- NSW & ACT Research and Evaluation UnitGP SynergyRegional Training OrganisationMayfield WestNew South WalesAustralia
- Elermore Vale General PracticeElermore ValeNew South WalesAustralia
| | - Parker Magin
- School of Medicine and Public HealthUniversity of NewcastleCallaghanNew South WalesAustralia
- NSW & ACT Research and Evaluation UnitGP SynergyRegional Training OrganisationMayfield WestNew South WalesAustralia
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Rurik I, Nánási A, Jancsó Z, Kalabay L, Lánczi LI, Móczár C, Semanova C, Schmidt P, Torzsa P, Ungvári T, Kolozsvári LR. Evaluation of primary care services in Hungary: a comprehensive description of provision, professional competences, cooperation, financing, and infrastructure, based on the findings of the Hungarian-arm of the QUALICOPC study. Prim Health Care Res Dev 2021; 22:e36. [PMID: 34193332 PMCID: PMC8278788 DOI: 10.1017/s1463423621000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/03/2020] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary health care provision in terms of quality, equity, and costs are different by countries. The Quality and Costs of Primary Care (QUALICOPC) study evaluated these domains and parameters in 35 countries, using uniformized method with validated questionnaires filled out by family physicians/general practitioners (GPs).This paper aims to provide data of the Hungarian-arm of the QUALICOPC study and to give an overview about the recent Hungarian primary care (PC) system. METHODS The questionnaires were completed in 222 Hungarian GP practices, delivered by fieldworkers, in a geographically representative distribution. Descriptive analysis was performed on the data. FINDINGS Financing is based mostly on capitation, with additional compensatory elements and minor financial incentives. The gate-keeping function is weak. The communication between GPs and specialists is often insufficient. The number of available devices and equipment are appropriate. Single-handed practices are predominant. Appointment instead of queuing is a new option and is becoming more popular, mainly among better-educated and urban patients. GPs are involved in the management of almost all chronic condition of all generations. Despite the burden of administrative tasks, half of the GPs estimate their job as still interesting, burn-out symptoms were rarely found. Among the evaluated process indicators, access, continuity, comprehensiveness, and coordination were rated as satisfactory, together with equity among health outcome indicators. Financing is insufficient; therefore, many GPs are involved in additional income-generating activities. The old age of the GPs and the lack of the younger GPs generation contributes to a shortage in manpower. Cooperation and communication between different levels of health care provision should be improved, focusing better on community orientation and on preventive services. Financing needs continuous improvement and appropriate incentives should be implemented. There is a need for specific PC-oriented guidelines to define properly the tasks and competences of GPs.
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Affiliation(s)
- Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anna Nánási
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Zoltán Jancsó
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Kalabay
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Csaba Móczár
- Irinyi Primary Care Health Center, Kecskemét, Hungary
| | - Csilla Semanova
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Péter Schmidt
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Tímea Ungvári
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - László Róbert Kolozsvári
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Mayer S, Fischer C, Zechmeister-Koss I, Ostermann H, Simon J. Are Unit Costs the Same? A Case Study Comparing Different Valuation Methods for Unit Cost Calculation of General Practitioner Consultations. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:1142-1148. [PMID: 32940231 DOI: 10.1016/j.jval.2020.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 06/09/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To inform allocation decisions in any healthcare system, robust cost data are indispensable. Nevertheless, recommendations on the most appropriate valuation approaches vary or are nonexistent, and no internationally accepted gold standard exists. This costing analysis exercise aims to assess the impact and implications of different calculation methods and sources based on the unit cost of general practitioner (GP) consultations in Austria. METHODS Six costing methods for unit cost calculation were explored, following 3 Austrian methodological approaches (AT-1, AT-2, AT-3) and 3 approaches applied in 3 other European countries (Germany, The Netherlands, United Kingdom). Drawing on Austrian data, mean unit costs per GP consultation were calculated in euros for 2015. RESULTS Mean unit costs ranged from €15.6 to €42.6 based on the German top-down costing approach (DE) and the Austrian Physicians' Chamber's price recommendations (AT-3), respectively. The mean unit cost was estimated at €18.9 based on Austrian economic evaluations (AT-1) and €17.9 based on health insurance payment tariffs (AT-2). The Dutch top-down (NL) and the UK bottom-up approaches (UK) yielded higher estimates (NL: €25.3, UK: €29.8). Overall variation reached 173%. CONCLUSIONS Our study is the first to systematically investigate the impact of differing calculation methods on unit cost estimates. It shows large variations with potential impact on the conclusions in an economic evaluation. Although different methodological choices may be justified by the adopted study perspective, different costing approaches introduce variation in cross-study/cross-country cost estimates, leading to decreased confidence in data quality in economic evaluations.
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Affiliation(s)
- Susanne Mayer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Claudia Fischer
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | | | | | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, Vienna, Austria.
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Hodgetts G, Brown G, Batić-Mujanović O, Gavran L, Jatić Z, Račić M, Tešanović G, Zahilić A, Martin M, Birtwhistle R. Twenty-five years on: revisiting Bosnia and Herzegovina after implementation of a family medicine development program. BMC FAMILY PRACTICE 2020; 21:7. [PMID: 31931726 PMCID: PMC6958717 DOI: 10.1186/s12875-020-1079-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 01/03/2020] [Indexed: 11/10/2022]
Abstract
Background The wars that ravaged the former Socialist Federal Republic of Yugoslavia in the 1990’s resulted in the near destruction of the healthcare system, including education of medical students and the training of specialist physicians. In the latter stages of the war, inspired by Family Medicine programs in countries such as Canada, plans to rebuild a new system founded on a strong primary care model emerged. Over the next fifteen years, the Queen’s University Family Medicine Development Program in Bosnia and Herzegovina played an instrumental role in rebuilding the primary care system through educational initiatives at the undergraduate, residency, Masters, PhD, and continuing professional development levels. Changes were supported by new laws and regulations to insure sustainability. This study revisited Bosnia and Herzegovina (B-H) 8-years after the end of the program to explore the impact of initiatives through understanding the perspectives and experiences of individuals at all levels of the primary care system from students, deans of medical schools, Family Medicine residents, practicing physicians, Health Center Directors and Association Leaders. Methods Qualitative exploratory design using purposeful sampling. Semi-structured interviews and focus groups with key informants were conducted in English or with an interpreter as needed and audiotaped. Transcripts and field notes were analyzed using an interpretative phenomenological approach to identify major themes and subthemes. Results Overall, 118 participants were interviewed. Three major themes and 9 subthemes were identified including (1) The Development of Family Medicine Education, (subthemes: establishment of departments of family medicine, undergraduate medical curriculum change), (2) Family Medicine as a Discipline (Family Medicine specialization, academic development, and Family Medicine Associations), and (3) Health Care System Issues (continuity of care, comprehensiveness of care, practice organization and health human resources). Conclusions Despite the impact of years of war and the challenges of a complex and unstable postwar environment, initiatives introduced by the Queen’s Program succeeded in establishing sustainable changes, allowing Family Medicine in B-H to continue to adapt without abandoning its strong foundations. Despite the success of the program, the undervaluing of Primary Care from a human resource and health finance perspective presents ongoing threats to the system.
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Affiliation(s)
- Geoffrey Hodgetts
- Department of Family Medicine, Faculty of Health Sciences, Queen's University, Haynes Hall, 115 Clarence Street, Kingston, Ontario, K7L 3N6, Canada.
| | - Glenn Brown
- Department of Family Medicine, Faculty of Health Sciences, Queen's University, Haynes Hall, 115 Clarence Street, Kingston, Ontario, K7L 3N6, Canada
| | - Olivera Batić-Mujanović
- Department of Family Medicine, Faculty of Medicine, University of Tuzla, Tuzla, Bosnia and Herzegovina
| | - Larisa Gavran
- Department of Family Medicine, Faculty of Medicine, University of Zenica, Zenica, Bosnia and Herzegovina
| | - Zaim Jatić
- Department of Family Medicine, Faculty of Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Maja Račić
- Department of Family Medicine, Faculty of Medicine, University of East Sarajevo, Foča, Bosnia and Herzegovina
| | - Gordana Tešanović
- Department of Family Medicine, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Amra Zahilić
- Department of Family Medicine, Faculty of Medicine, University of Mostar, Mostar, Bosnia and Herzegovina
| | - Mary Martin
- Department of Family Medicine, Center for Studies in Primary Care, Queen's University, Kingston, Canada
| | - Richard Birtwhistle
- Department of Family Medicine, Faculty of Health Sciences, Queen's University, Haynes Hall, 115 Clarence Street, Kingston, Ontario, K7L 3N6, Canada
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Sommersguter-Reichmann M, Reichmann G. Distribution of Health Care Resources in Austria - Inequality Assessment of Different Health Care Resources at Different Points in Time. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2019; 50:418-430. [PMID: 31821771 DOI: 10.1177/0020731419893058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A major objective of health policy in many countries is to avoid inequality in the distribution of health care resources. Our goal is to provide initial insight into the inequality in the regional distribution of different health care resources per capita and the variation of the inequality over time in Austria to provide starting points for policy recommendations and international comparisons. We also aim to examine whether the type of inequality measure and need-adjustment has an impact on the results. The findings reveal that inequality in the distribution of GPs with contracts with social health insurance is comparably small, but we observe an increase in inequality from 2002 to 2014. In general, there is a clear trend toward private physicians, of whom private specialists preferably open their practices in densely populated areas. Despite considerable reductions in public hospital beds between 2002 and 2014, the distribution across regions remains almost constant. The use of different inequality measures and need-adjustment provides additional insights so that custom-made policies to reduce inequalities can be developed.
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Affiliation(s)
| | - Gerhard Reichmann
- Department of Information Science and Information Systems, Karl-Franzens-University Graz, Graz, Austria
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Ab Rahman N, Husin M, Dahian K, Mohamad Noh K, Atun R, Sivasampu S. Job satisfaction of public and private primary care physicians in Malaysia: analysis of findings from QUALICO-PC. HUMAN RESOURCES FOR HEALTH 2019; 17:82. [PMID: 31684972 PMCID: PMC6829856 DOI: 10.1186/s12960-019-0410-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 09/05/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Job satisfaction of doctors is an important factor determining quality and performance of a health system. The aim of this study was to assess job satisfaction among doctors of the public and private primary care clinics in Malaysia and evaluate factors that could influence the job satisfaction rating. METHODS This study was part of the Quality and Costs of Primary Care (QUALICOPC) Malaysia, a cross-sectional survey conducted between August 2015 and June 2016 in Malaysia. Data was collected from doctors recruited from public and private primary care clinics using a standardised questionnaire. Comparisons were made between doctors working in public and private clinics, and logistic regression analysis was used to determine factors influencing the likelihood of job satisfaction outcomes. RESULTS A total of 221 doctors from the public and 239 doctors from the private sector completed the questionnaire. Compared to private doctors, a higher proportion of public doctors felt they were being overloaded with the administrative task (59.7% vs 36.0%) and part of the work does not make sense (33.9% vs 18.4%). Only 62.9% of public doctors felt that there was a good balance between effort and reward while a significantly higher proportion (85.8%) of private doctors reported the same. Over 80% of doctors in both sectors indicated continued interest in their job and agreed that being a doctor is a well-respected job. Logistic regression analysis showed public-private sector and practice location (urban-rural) to be significantly associated with work satisfaction outcomes. CONCLUSION A higher proportion of public doctors experienced pressure from administrative tasks and felt that part of their work does not make sense than their colleague in the private sector. At the same time, the majority of private doctors reported positive outcome on effort-and-reward balance compared to only one third of public doctors. The finding suggests that decreasing administrative workload and enhancing work-based supports might be the most effective ways to improve job satisfaction of primary care doctors because these are some of the main aspects of the job that doctors, especially in public clinics, are most unhappy with.
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Affiliation(s)
- N. Ab Rahman
- Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Block B4, No. 1, Jalan Setia Murni U13/52, 40170 Shah Alam, Selangor Malaysia
| | - M. Husin
- Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Block B4, No. 1, Jalan Setia Murni U13/52, 40170 Shah Alam, Selangor Malaysia
| | - K. Dahian
- Clinical Research Centre, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak Malaysia
| | - K. Mohamad Noh
- Faculty of Medicine, Cyberjaya University College of Medical Sciences, Cyberjaya, Selangor Malaysia
| | - R. Atun
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA United States of America
| | - S. Sivasampu
- Institute for Clinical Research, National Institutes of Health (NIH), Ministry of Health Malaysia, Block B4, No. 1, Jalan Setia Murni U13/52, 40170 Shah Alam, Selangor Malaysia
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12
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Hoffmann K, George A, Van Loenen T, De Maeseneer J, Maier M. The influence of general practitioners on access points to health care in a system without gatekeeping: a cross-sectional study in the context of the QUALICOPC project in Austria. Croat Med J 2019; 60:316-324. [PMID: 31483117 PMCID: PMC6734571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 06/10/2019] [Indexed: 10/14/2023] Open
Abstract
AIM To assess the rates of specialist visits and visits to hospital emergency departments (ED) among patients in Austria with and without concurrent general practitioner (GP) consultation and among patients with and without chronic disease. METHODS The cross-sectional questionnaire study was conducted in the context of the QUALICOPC project in 2012. Fieldworkers recruited 1596 consecutive patients in 184 GP offices across Austria. The 41-question survey addressed patients' experiences with regard to access to, coordination, and continuity of primary care, as well demographics and health status. Descriptive statistics as well as univariate and multivariate regression models were applied. RESULTS More than 90% of patients identified a GP as a primary source of care. Among all patients, 85.5% reported having visited a specialist and 26.4% the ED at least once in the previous year. Having a usual GP did not change the rate of specialist visits. Additionally, patients with chronic disease had a higher likelihood of presenting to the ED despite having a GP as a usual source of care. CONCLUSION Visiting specialists in Austria is quite common, and the simple presence of a GP as a usual source of care is insufficient to regulate pathways within the health care system. This can be particularly difficult for chronic care patients who often require care at different levels of the system and show higher frequency of ED presentations.
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Jirovsky E, Hoffmann K, Mayrhuber EAS, Mechili EA, Angelaki A, Sifaki-Pistolla D, Petelos E, van den Muijsenbergh M, van Loenen T, Dückers M, Kolozsvári LR, Rurik I, Rotar Pavlič D, Sandoval DC, Borgioli G, Pinilla MJC, Ajduković D, De Graaf P, van Ginneken N, Dowrick C, Lionis C. Development and evaluation of a web-based capacity building course in the EUR-HUMAN project to support primary health care professionals in the provision of high-quality care for refugees and migrants. Glob Health Action 2019; 11:1547080. [PMID: 30499386 PMCID: PMC6282415 DOI: 10.1080/16549716.2018.1547080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The ongoing refugee crisis has revealed the need for enhancing primary health care (PHC) professionals' skills and training. OBJECTIVES The aim was to strengthen PHC professionals in European countries in the provision of high-quality care for refugees and migrants by offering a concise modular training that was based on the needs of the refugees and PHC professionals as shown by prior research in the EUR-HUMAN project. METHODS We developed, piloted, and evaluated an online capacity building course of 8 stand-alone modules containing information about acute health issues of refugees, legal issues, provider-patient communication and cultural aspects of health and illness, mental health, sexual and reproductive health, child health, chronic diseases, health promotion, and prevention. The English course template was translated into seven languages and adapted to the local contexts of six countries. Pre- and post-completion knowledge tests were administered to effectively assess the progress and knowledge increase of participants so as to issue CME certificates. An online evaluation survey post completion was used to assess the acceptability and practicability of the course from the participant perspective. These data were analyzed descriptively. RESULTS A total of 390 participants registered for the online course in 6 countries with 175 completing all modules of the course, 47.7 % of them medical doctors. The mean time for completion was 10.77 hours. In total, 123 participants completed the online evaluation survey; the modules on acute health needs, legal issues (both 44.1%), and provider-patient communication/cultural issues (52.9%) were found particularly important for the daily practice. A majority expressed a will to promote the online course among their peers. CONCLUSION This course is a promising learning tool for PHC professionals and when relevant supportive conditions are met. The course has the potential to empower PHC professionals in their work with refugees and other migrants.
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Affiliation(s)
- Elena Jirovsky
- a Department of General Practice and Family Medicine , Medical University of Vienna , Vienna , Austria
| | - Kathryn Hoffmann
- a Department of General Practice and Family Medicine , Medical University of Vienna , Vienna , Austria
| | | | - Enkeleint Aggelos Mechili
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
| | - Agapi Angelaki
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
| | - Dimitra Sifaki-Pistolla
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
| | - Elena Petelos
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
| | - Maria van den Muijsenbergh
- c Department of Primary and Community Care , Radboud University Medical Centre , Nijemegen , The Netherlands
| | - Tessa van Loenen
- c Department of Primary and Community Care , Radboud University Medical Centre , Nijemegen , The Netherlands
| | | | - László Róbert Kolozsvári
- e Department of Family and Occupational Medicine, Faculty of Public Health , University of Debrecen , Debrecen , Hungary
| | - Imre Rurik
- e Department of Family and Occupational Medicine, Faculty of Public Health , University of Debrecen , Debrecen , Hungary
| | - Danica Rotar Pavlič
- f Department of Family Medicine , University of Ljubljana , Lubljana , Slovenia
| | | | - Giulia Borgioli
- h Azienda USL Toscana Centro - Global Health Center , Region of Tuscany , Florence , Italy
| | | | - Dean Ajduković
- j Department of Psychology, Faculty of Humanities and Social Sciences , University of Zagreb , Zagreb , Croatia
| | - Pim De Graaf
- g European Forum for Primary Care , Utrecht , The Netherlands
| | - Nadja van Ginneken
- k Primary Medical Care , University of Liverpool , Liverpool , United Kingdom
| | - Christopher Dowrick
- k Primary Medical Care , University of Liverpool , Liverpool , United Kingdom
| | - Christos Lionis
- b Clinic of Social and Family Medicine, School of Medicine , University of Crete , Heraklion , Greece
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Jaklič TK, Kovač J, Maletič M, Bunc KT. Analysis of Patient Satisfaction with Emergency Medical Services. Open Med (Wars) 2018; 13:493-502. [PMID: 30426087 PMCID: PMC6227734 DOI: 10.1515/med-2018-0073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 09/15/2018] [Indexed: 12/05/2022] Open
Abstract
Background This study analyses the degree of patient satisfaction regarding the Emergency Medical Services (EMS) by taking into account the waiting time which is considered to be associated with the success of the EMS organizational model. Methodology Between 1 Jan 2016 and 31 March 2016 a cross-sectional research study among visitors of the EMS clinics in the EMS of the Primary Health Services of Gorenjska was performed. The EUROPEP survey was used for rating the degree of patient satisfaction. Statistical methods were utilized to determine the differences among the studied variables, namely the t test, one way ANOVA, as well as post-hoc multiple comparisons, were used. Results Nearly all questions associated with the patient survey scored higher than 4.0, indicating patients were generally very satisfied with EMS treatment. Patients were least satisfied with the length of time spent waiting for an examination. The results showed that the waiting time is a statistically significant factor concerning all four dimensions of patient satisfaction: medical staff, clinical facilities, clinical equipment and organization of services (p < 0.05). Conclusions Research results have confirmed that the effectiveness of the EMS organizational model impacts on the degree of patient satisfaction. The research also revealed a deficiency in the current EMS organizational services at the prehospital level, given that triage frequently failed to be carried out upon a patient’s arrival at the EMS clinics.
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Affiliation(s)
- Tatjana Kitić Jaklič
- Primary Health Care Gorenjska, Health Centre Kranj, Gosposvetska ulica 10, 4000 Kranj, Slovenia
| | - Jure Kovač
- University of Maribor, Faculty of Organizational Sciences, Kidričeva cesta 55a, 4000 Kranj, Slovenia
| | - Matjaž Maletič
- University of Maribor, Faculty of Organizational Sciences, Kidričeva cesta 55a, 4000 Kranj, Slovenia
| | - Ksenija Tušek Bunc
- University of Maribor, Faculty of Medicine, Taborska ulica 8, 2000 Maribor, Slovenia
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15
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Reform der Primärversorgung in Österreich. Wien Med Wochenschr 2018; 168:406-414. [DOI: 10.1007/s10354-017-0613-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/16/2017] [Indexed: 11/25/2022]
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Hassel D, Verheij R, Batenburg R. Assessing the variation in workload among general practitioners in urban and rural areas: An analysis based on SMS time sampling data. Int J Health Plann Manage 2018; 34:e474-e486. [DOI: 10.1002/hpm.2663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 11/08/2022] Open
Affiliation(s)
- Daniël Hassel
- NIVELNetherlands Institute for Health Services Research Utrecht The Netherlands
- Centre for Labour Relations in the Public SectorCAOP The Hague The Netherlands
| | - Robert Verheij
- NIVELNetherlands Institute for Health Services Research Utrecht The Netherlands
| | - Ronald Batenburg
- NIVELNetherlands Institute for Health Services Research Utrecht The Netherlands
- Department of SociologyRadboud University Nijmegen The Netherlands
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Nørøxe KB, Pedersen AF, Bro F, Vedsted P. Mental well-being and job satisfaction among general practitioners: a nationwide cross-sectional survey in Denmark. BMC FAMILY PRACTICE 2018; 19:130. [PMID: 30055571 PMCID: PMC6064618 DOI: 10.1186/s12875-018-0809-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/27/2018] [Indexed: 01/12/2023]
Abstract
Background Poor mental well-being and low job satisfaction among physicians can have significant negative implications for the physicians and their patients and may also reduce the cost efficiency in health care. Mental distress is increasingly common in physicians, including general practitioners (GPs). This study aimed to examine mental well-being and job satisfaction among Danish GPs and potential associations with age, gender and practice organisation. Methods Data was collected in a nationwide questionnaire survey among Danish GPs in 2016. Register data on GPs and their patient populations was used to explore differences between respondents and non-respondents. Associations were estimated using multivariate logistic regression analysis. Results Of 3350 eligible GPs, 1697 (50.7%) responded. Lower response rate was associated with increasing numbers of comorbid, aging or deprived patients. About half of participating GPs presented with at least one burnout symptom; 30.6% had high emotional exhaustion, 21.0% high depersonalisation and 36.6% low personal accomplishment. About a quarter (26.2%) experienced more than one of these symptoms, and 10.4% experienced all of them. Poor work-life balance was reported by 16.2%, low job satisfaction by 22.1%, high perceived stress by 20.6% and poor general well-being by 18.6%. Constructs were overlapping; 8.4% had poor overall mental health, which was characterized by poor general well-being, high stress and ≥ 2 burnout symptoms. In contrast, 24.6% had no burnout symptoms and reported high levels of general well-being and job satisfaction. Male GPs more often than female GPs reported low job satisfaction, depersonalisation, complete burnout and poor overall mental health. Middle-aged (46–59 years) GPs had higher risk of low job satisfaction, burnout and suboptimal self-rated health than GPs in other age groups. GPs in solo practices more often assessed the work-life balance as poor than GPs in group practices. Conclusion The prevalence of poor mental well-being and low job satisfaction was generally high, particularly among mid-career GPs and male GPs. Approximately 8% was substantially distressed, and approximately 25% reported positive mental well-being and job satisfaction, which shows huge variation in the mental well-being among Danish GPs. The results call for targeted interventions to improve mental well-being and job satisfaction among GPs. Electronic supplementary material The online version of this article (10.1186/s12875-018-0809-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karen Busk Nørøxe
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Anette Fischer Pedersen
- Research Unit for General Practice & Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Flemming Bro
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
| | - Peter Vedsted
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark
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Pohontsch NJ, Hansen H, Schäfer I, Scherer M. General practitioners' perception of being a doctor in urban vs. rural regions in Germany - A focus group study. Fam Pract 2018; 35:209-215. [PMID: 29029048 PMCID: PMC5892171 DOI: 10.1093/fampra/cmx083] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Inadequate recruitment numbers for GPs in rural regions give cause for concern. Working in rural regions is less attractive among medical students because of strong associations concerning a higher workload, restriction of privacy and demands exceeding their competences. We aimed to explore perceptions of GPs working in urban versus rural regions to contrast these prejudices. METHODS We conducted nine focus groups with GPs [female = 21, male = 44] from urban and rural regions, using a semi-structured guideline. Transcripts were content analyzed using deductive and inductive categories. RESULTS Urban GPs perceived themselves as a provider of medical services and rural GPs as being a medical companion. Compared to urban GPs, GPs from non-urban regions portray themselves more strongly as a family physician that accompanies patients 'from the cradle to the grave' and is responsible for the treatment of any medical issue. They emphasized their close relationship with their patients. Rural GPs establish a close relationship with their patients and considered this as beneficial for the treatment relationship. This aspect seems to play a subordinate role for urban GPs. CONCLUSIONS GPs enjoy their work and the role they play in their patients' lives. Being a rural GP was described very positively. Greater emphasis should be made on positive aspects of being a GP in rural regions, e.g. by university lectures given by rural GPs, campaigns emphasizing the positive aspects of working as a GP [in rural regions], promotion of work placements or incentives for working in rural general practices.
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Affiliation(s)
- Nadine J Pohontsch
- Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Heike Hansen
- Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Ingmar Schäfer
- Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Chang WT, Leu HI, Chen HP, Lin MH, Chen TJ, Hwang SJ, Chou LF, Wang PH. Temporal availability of obstetrics and gynecology clinics in Taiwan: A nationwide survey. Taiwan J Obstet Gynecol 2017; 56:636-641. [DOI: 10.1016/j.tjog.2017.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2016] [Indexed: 10/18/2022] Open
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20
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Hoffmann K, Wojczewski S, Aarendonk D, Maier M, Dorner TE, de Maeseneer J. No common understanding of profession terms utilized in health services research : An add-on qualitative study in the context of the QUALICOPC project in Austria. Wien Klin Wochenschr 2017; 129:52-58. [PMID: 27995317 PMCID: PMC5247533 DOI: 10.1007/s00508-016-1146-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 11/21/2016] [Indexed: 10/28/2022]
Abstract
BACKGROUND Health services research, especially in primary care, is challenging because the systems differ widely between countries. This study aimed to explore the different understanding of the terminology used, particularly, regarding the professions nursing and medical secretaries. METHODS The study was an add-on study to the Quality and Costs in Primary Care (QUALICOPC) project in Austria and designed as qualitative research. The qualitative phase was conducted by using semi-structured telephone interviews with general practitioners (GP). and17 GPs participated in the study. RESULTS No uniform meaning of the terms commonly utilized for the abovementioned health professions could be found among Austrian GPs. For example, under the profession term practice assistants, nurses as well as literal medical secretaries with and without special education and related work competencies and responsibilities were subsumed. CONCLUSIONS Our study results show that no uniform meaning of the terms commonly utilized for above described health profession could be found even within one country by GPs. These findings are highly relevant, especially, when trying to compare results with similar data from other countries or negotiating about workforce issues. Our findings implicate several action points for health services research and health policy. We propose the development of a harmonized terminology in Europe for the health profession based on standards of undergraduate and postgraduate education, competencies and continuous education commitments. This would not only benefit comparative health system research but also patient safety across Europe.
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Affiliation(s)
- Kathryn Hoffmann
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090, Vienna, Austria.
| | - Silvia Wojczewski
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090, Vienna, Austria
| | | | - Manfred Maier
- Department of General Practice and Family Medicine, Center for Public Health, Medical University of Vienna, Kinderspitalgasse 15/I, 1090, Vienna, Austria
| | - Thomas Ernst Dorner
- Institute for Social Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Jan de Maeseneer
- Department of General Practice and Primary Health Care, Ghent University, Ghent, Belgium
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Kriegel J, Rebhandl E, Hockl W, Stöbich AM. [Primary Health Care in Austria - Tu Felix Austria nube - Concept for networking in the primary care of Upper Austria]. Wien Med Wochenschr 2016; 167:293-305. [PMID: 27878397 DOI: 10.1007/s10354-016-0531-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/31/2016] [Indexed: 11/30/2022]
Abstract
The primary health care in rural areas in Austria is currently determined by challenges such as ageing of the population, the shift towards chronic and age-related illnesses, the specialist medical and hospital-related education and training of physicians' as well growing widespread difficulty of staffing doctor's office. The objective is to realize a general practitioner centered and team-oriented primary health care (PHC) approach by establishing networked primary health care in rural areas of Austria. Using literature research, online survey, expert interviews and expert workshops, we identified different challenges in terms of primary health care in rural areas. Further, current resources and capacities of primary health care in rural areas were identified using the example of the district of Rohrbach. Twelve design dimensions and 51 relevant measurement indicators of a PHC network were delineated and described. Based on this, 12 design approaches of PHC concept for the GP-centered and team-oriented primary health care in rural areas have been developed.
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Affiliation(s)
- Johannes Kriegel
- Fakultät Gesundheit und Soziales, FH Oberösterreich, Garnisonstraße 21, 4020, Linz/Donau, Österreich.
| | - Erwin Rebhandl
- Arzt für Allgemeinmedizin, Marktplatz 43, 4170, Haslach an der Mühl, Österreich
| | - Wolfgang Hockl
- Arzt für Allgemeinmedizin, Sportplatzstraße, 4470, Enns, Österreich
| | - Anna-Maria Stöbich
- Fakultät Gesundheit und Soziales, FH Oberösterreich, Garnisonstraße 21, 4020, Linz/Donau, Österreich
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