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McCartney G, Johnstone C, Dover L. The changing shape of general practice in Scotland: the rise of the 'megapractice'. Public Health 2024; 233:185-189. [PMID: 38908308 DOI: 10.1016/j.puhe.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/16/2024] [Accepted: 05/21/2024] [Indexed: 06/24/2024]
Abstract
OBJECTIVES To describe the trends in the nature of general practices in Scotland between 2014/15 and 2023. STUDY DESIGN Descriptive ecological study. METHODS We obtained data from Public Health Scotland and used general practitioner (GP) practice codes, practice names, and the General Medical Council (GMC) numbers of their listed GPs to describe trends in practice characteristics and to identify individual practices that were likely to be operating as a single entity. RESULTS Defining practice entities is difficult because different GP practice codes are often retained when GPs are performing across multiple practices. If GP practice codes alone are used, the median practice list size increased from 5094 to 5881, and the mean from 5588 to 6289, between 2013/14 and 2020/21. There was one outlier practice that grew to have over 45,000 patients registered by 2020/21. However, this underestimates the extent of this new mega-practice phenomenon. Using the GMC numbers of GPs listed as performers to identify where the same GPs are working across multiple GP practice codes, we identified a series of mega-practices that span across health board areas and which have experienced a dramatic increase in their list size (with the two largest having list sizes of over 101,000 and 77,000 patients, respectively). CONCLUSIONS Further research is needed to better understand: how mega-practices provide services and whether this differs from other practices; where financial rewards accumulate within mega-practices; differences in staffing between mega-practices and other models; and the impacts mega-practices have on the quality and continuity of care and on health and inequality outcomes.
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Affiliation(s)
- Gerry McCartney
- School of Social and Political Sciences, University of Glasgow, Adam Smith Building, 28 Bute Gardens, Glasgow G12 8RS, UK.
| | - Chris Johnstone
- Renfrewshire Health and Social Care Partnership, Paisley, UK
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O Shea M, Kiely B, O'Donnell P, Smith SM. An evaluation of the social deprivation practice grant in Irish general practice. BJGP Open 2024; 8:BJGPO.2023.0195. [PMID: 38395435 DOI: 10.3399/bjgpo.2023.0195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND The inverse care law states that availability of good medical care varies inversely with the need for it in the population served. In 2019, the main medical union and the Department of Health in the Republic of Ireland (RoI), agreed on funding a social deprivation practice grant for general practices in urban deprived areas. AIM To examine the implementation and impact of the social deprivation practice grant in participating general practices. DESIGN & SETTING A mixed-methods study with sequential design based in Irish general practice. METHOD Data were collected using a questionnaire and online semi-structured interviews with GPs and practice staff. Data were analysed separately, and the findings compared to examine the extent to which they converged or diverged. RESULTS There were 25 survey responses and nine interviews. All practices reported the grant was beneficial and most practices utilised the grant to fund additional doctor hours (17/25). Both surveys and interviews indicated that a small amount of additional funding allowed additional clinical need in areas of deprivation to be addressed, but there were some barriers identified in accessing the grant and implementing planned expenditure. CONCLUSION Delivery of health care in areas of socioeconomic deprivation presents significant challenges. While there were some problems with implementation, the introduction of a small, targeted grant for general practices in areas of social deprivation allowed those practices to enhance their services, with tailored initiatives seeking to meet the needs of their patient populations.
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Affiliation(s)
- Muireann O Shea
- Discipline of Public Health and Primary Care, Trinity College, Dublin, Ireland
| | - Bridget Kiely
- Department of General Practice, Royal College of Surgeons in Ireland University of Medicine and Health Science, Dublin, Ireland
| | | | - Susan M Smith
- Discipline of Public Health and Primary Care, Trinity College, Dublin, Ireland
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Vettini A, Brennan GK, Mercer SW, Jackson CA. Severe mental illness and cardioprotective medication prescribing: a qualitative study in general practice. BJGP Open 2024; 8:BJGPO.2023.0176. [PMID: 38355146 DOI: 10.3399/bjgpo.2023.0176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/28/2023] [Accepted: 12/14/2023] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Patients with severe mental illness (SMI) die 10-20 years earlier than the general population. They have a higher risk of cardiovascular disease (CVD) yet may experience lower cardioprotective medication prescribing. AIM To understand the challenges experienced by GPs in prescribing cardioprotective medication to patients with SMI. DESIGN & SETTING A qualitative study with 15 GPs from 11 practices in two Scottish health boards, including practices servicing highly deprived areas (Deep End). METHOD Semi-structured one-to-one interviews with fully qualified GPs with clinical experience of patients with SMI. Interviews were transcribed verbatim and analysed thematically. RESULTS Participants aimed to routinely prescribe cardioprotective medication to relevant patients with SMI but were hampered by various challenges. These structural and contextual barriers included the following: lack of funding for chronic disease management; insufficient consultation time; workforce shortages; IT infrastructure; and navigating boundaries with mental health services. Patient-related barriers included patients' complex health and social needs, their understandable prioritisation of mental health needs or existing physical conditions, and presentation during crises. Professional barriers comprised GPs' desire to practise holistic medicine rather than treating via cardioprotective prescribing in isolation, and concerns about patients' medication concordance if patients were not prioritising this aspect of their health care at that particular time. In terms of enablers for cardioprotective prescribing, participants emphasised continuity of care as fundamental in engaging this patient group in effective cardiovascular health management. A cross-cutting theme was the current GP workforce crisis leading to 'firefighting' and diminishing capacity for primary prevention. This was particularly acute in Deep End practices, which have a high proportion of patients with complex needs and greater resource challenges. CONCLUSION Although participants aspire to prescribe cardioprotective medication to patients with SMI, professional-, system- and patient-level barriers often make this challenging, particularly in deprived areas owing to patient complexity and the inverse care law.
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Affiliation(s)
- Amanda Vettini
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Gearóid K Brennan
- Faculty of Health Sciences & Sport, University of Stirling, Stirling, UK
| | - Stewart W Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Caroline A Jackson
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
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Xia Q, Huang Q, Li J, Xu Y, Ge S, Zhang X, Li M, Yu D, Tang X, Xia Y. Evaluating the quality of home care in community health service centres: A machine learning approach. J Adv Nurs 2024. [PMID: 38808517 DOI: 10.1111/jan.16234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/11/2024] [Accepted: 04/29/2024] [Indexed: 05/30/2024]
Abstract
AIMS The aim of the study is to develop a model using a machine learning approach that can effectively identify the quality of home care in communities. DESIGN A cross-sectional design. METHODS In this study, we evaluated the quality of home care in 170 community health service centres between October 2022 and February 2023. The Home Care Service Quality Questionnaire was used to collect information on home care structure, process and outcome quality. Then, an intelligent and comprehensive evaluation model was developed using a convolutional neural network, and its performance was compared with random forest and logistic regression models through various performance indicators. RESULTS The convolutional neural network model was built upon seven variables, which encompassed the qualification of home nursing staff, developing and practicing emergency plan to cope with different emergency rescues in home environment, being equipped with medication and supplies for first aid according to specific situations, assessing nutrition condition of home patients, allocation of the number of home nursing staff, cases of new pressure ulcers and patient satisfaction rate. Remarkably, the convolutional neural network model demonstrated superior performance, outperforming both the random forest and regression models. CONCLUSION The successful development and application of the convolutional neural network model highlight its ability to leverage data from community health service centres for rapid and accurate grading of home care quality. This research points the way to home care quality improvement. IMPACT The model proposed in this study, coupled with the aforementioned factors, is expected to enhance the accuracy and efficiency of a comprehensive evaluation of home care quality. It will also help managers to take purposeful measures to improve the quality of home care. REPORTING METHOD The reporting of this study (Observational, cross-sectional study) conforms to the STROBE statement. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The application of this model has the potential to contribute to the advancement of high-quality home care, particularly in lower-middle-income communities.
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Affiliation(s)
- Qiujie Xia
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Qiyuan Huang
- School of Nursing, Fujian Medical University, Fuzhou, Fujian, China
| | - Jingjie Li
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Yue Xu
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
- Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Song Ge
- Department of Natural Sciences, University of Houston-Downtown, Houston, Texas, USA
| | - Xiao Zhang
- School of Information & Engineering, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Mei Li
- The People's Hospital of Pizhou, Xuzhou, Jiangsu, China
| | - Dehong Yu
- The People's Hospital of Pizhou, Xuzhou, Jiangsu, China
| | - Xianping Tang
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Youbing Xia
- School of Nursing, Xuzhou Medical University, Xuzhou, Jiangsu, China
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Donaghy E, Sweeney K, Henderson D, Angus C, Cullen M, Hemphill M, Wang HH, Guthrie B, Mercer SW. Primary care transformation in Scotland: a qualitative evaluation of the views of patients. Br J Gen Pract 2024:BJGP.2023.0437. [PMID: 38228359 PMCID: PMC11104515 DOI: 10.3399/bjgp.2023.0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 11/20/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND The new Scottish GP contract introduced in April 2018 aims to improve quality of care through expansion of the multidisciplinary team (MDT) to enable GPs to spend more time as expert medical generalists with patients with complex needs. AIM To explore patients' views on the changes in general practice in Scotland since the inception of the new contract. DESIGN AND SETTING Qualitative study with 30 patients (10 living in urban deprived areas, 10 living in urban affluent/mixed urban areas, and 10 living in remote and rural areas). METHOD In-depth semi-structured interviews with thematic analysis. RESULTS Patients were generally unaware of the new GP contract, attributing recent changes in general practice to the COVID-19 pandemic. Ongoing concerns included access to GP consultations (especially face-to-face ones), short consultation length with GPs, and damage to continuity of care and the GP-patient relationship. Most patients spoke positively about consultations with MDT staff but still wanted to see a known GP for health concerns that they considered potentially serious. These issues were especially concerning for patients with multiple complex problems, particularly those from deprived areas. CONCLUSION Following the introduction of the new Scottish GP contract, patients in this study's sample were accepting of first contact care from the MDT but still wanted continuity of care and longer face-to-face consultations with GPs. These findings suggest that the expert generalist role of the GP is not being adequately supported by the new contract, especially in deprived areas, though further quantitative research is required to confirm this.
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Affiliation(s)
- Eddie Donaghy
- Centre for Population Health Studies, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Kieran Sweeney
- Centre for Population Health Studies, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - David Henderson
- Centre for Population Health Studies, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Colin Angus
- Centre for Population Health Studies, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Morag Cullen
- Centre for Population Health Studies, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Mary Hemphill
- Centre for Population Health Studies, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Harry Hx Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Bruce Guthrie
- Centre for Population Health Studies, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Stewart W Mercer
- Centre for Population Health Studies, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Eyanoer PC, Zaluchu F. Obstacles in Basic Health Service When Dealing with COVID-19: A Reflection for Improvement. J Multidiscip Healthc 2024; 17:1671-1679. [PMID: 38646017 PMCID: PMC11032679 DOI: 10.2147/jmdh.s446298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/25/2024] [Indexed: 04/23/2024] Open
Abstract
Background & Aims COVID-19 has been in control since mass vaccination and other coordinated efforts have been conducted. The WHO has even made an announcement to stop the public health emergency of international concern (PHEIC) toward COVID-19. Because of the very massive impacts of COVID-19, it is necessary to have a reflection toward what we have gone through to obtain information from inside the health service by interviewing the health officers who were the frontliners in fighting the disease during the pandemic. This research attempts to reveal the practical experiences of the officers when the COVID-19 pandemic took place. Methods This research conducted in-depth interviews with the Heads of Puskesmas (a Public Health Center) and the staff of Puskesmas in Medan. The total sample number of informants is 30 people. The data were managed by preparing the suitable themes with the inductive approach. Results There are three main themes obtained from the analysis results. Those three themes are 1) the condition of Puskesmas, 2) the impacts of the health service, and 3) the COVID-19 control. Those three themes show the fundamental problems affecting the efforts to overcome COVID-19. It is revealed that funding, personnel quantity, and bureaucracy cause the effort to overcome COVID-19 to have been impeded. Meanwhile, based on external factors, the officers had to deal with negative issues on COVID-19. Therefore, whether we like it or not to admit the fact, the health service has not been conducted maximally. Conclusion It is necessary to have comprehensive revision and change to evaluate the condition of health service, particularly in Puskesmas. A wider and deeper reflection is required so that the pandemic preparation in the future can be improved further.
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Affiliation(s)
- Putri Chairani Eyanoer
- Department of Community and Preventive Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatera, Indonesia
| | - Fotarisman Zaluchu
- Social Anthropology Department, Universitas Sumatera Utara, Medan, North Sumatera, Indonesia
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Sweeney KD, Donaghy E, Henderson D, Huang H, Wang HH, Thompson A, Guthrie B, Mercer SW. Patients' experiences of GP consultations following the introduction of the new GP contract in Scotland: a cross-sectional survey. Br J Gen Pract 2024; 74:e63-e70. [PMID: 38253549 PMCID: PMC10824335 DOI: 10.3399/bjgp.2023.0239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 09/13/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The new Scottish GP contract commenced in April 2018 with a stated aim of mitigating health inequalities. AIM To determine the health characteristics and experiences of patients consulting GPs in deprived urban (DU), affluent urban (AU), and remote and rural (RR) areas of Scotland. DESIGN AND SETTING In 2022, a postal survey of a random sample of adult patients from 12 practices who had consulted a GP within the previous 30 days was undertaken. METHOD Patient characteristics and consultation experiences in the three areas (DU, AU, RR) were evaluated using validated measures including the Consultation and Relational Empathy (CARE) Measure and Patient Enablement Instrument (PEI). RESULTS In total, 1053 responses were received. In DU areas, multimorbidity was more common (78% versus 58% AU versus 68% RR, P<0.01), complex presentations (where the consultation addressed both psychosocial and physical problems) were more likely (16% versus 10% AU versus 11% RR, P<0.05), and more consultations were conducted by telephone (42% versus 31% AU versus 31% RR, P<0.01). Patients in DU areas reported lower satisfaction (82% DU completely, very, or fairly satisfied versus 90% AU versus 86% RR, P<0.01), lower perceived GP empathy (mean CARE score 38.9 versus 42.1 AU versus 40.1 RR, P<0.05), lower enablement (mean PEI score 2.6 versus 3.2 AU versus 2.8 RR, P<0.01), and less symptom improvement (P<0.01) than those in AU or RR areas. Face-to-face consultations were associated with significantly higher satisfaction, enablement, and perceived GP empathy than telephone consultations in RR areas (all P<0.05). CONCLUSION Four years after the start of the new GP contract in Scotland, patients' experiences of GP consultations suggest that the inverse care law persists.
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Affiliation(s)
- Kieran D Sweeney
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Eddie Donaghy
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - David Henderson
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Huayi Huang
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Harry Hx Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Andrew Thompson
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | - Bruce Guthrie
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Stewart W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Donaghy E, Huang H, Henderson D, Wang HH, Guthrie B, Mercer SW. Primary care transformation in Scotland: a qualitative study of GPs' and multidisciplinary team members' views. Br J Gen Pract 2024; 74:e1-e8. [PMID: 38154939 PMCID: PMC10756001 DOI: 10.3399/bjgp.2023.0086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/05/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND The Scottish Government's vision to transform primary care includes expansion of the primary care multidisciplinary team (MDT), formalised in the new GP contract in April 2018. AIM To explore practitioners' views on the expansion of MDT working in Scotland. DESIGN AND SETTING Qualitative study with GPs and a range of MDT staff working in three different population settings in Scotland. METHOD In-depth semi-structured interviews were carried out by telephone with 8 GPs and 19 MDT staff between May and June 2022. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was conducted to identify commonalities and divergences in the interviews. RESULTS Internal challenges facing MDT staff included adapting to the fast pace of primary care, building new relationships, training and professional development needs, line management issues, and monitoring and evaluation of performance. External challenges included the ongoing effects of the COVID-19 pandemic, lack of time, difficulties with hybrid working, and low staff morale. Most GPs reported that expansion of their roles as expert medical specialists had not yet happened because their workload had not decreased (and in many cases had increased). In deprived areas, insufficient resources to deal with the high numbers of patients with complex multimorbidity remained a key issue. Interviewees in remote and rural settings felt the new contract did not take into account the unique challenges of providing primary care services in such areas, and recruitment and accommodation were cited as particular problems. CONCLUSION Although there has been substantial expansion of the primary care MDT, which most GPs welcome, many challenges to effective implementation remain that must be addressed if transformation of primary care in Scotland is to become a reality.
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Affiliation(s)
- Eddie Donaghy
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Huayi Huang
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - David Henderson
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Harry Hx Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Bruce Guthrie
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Stewart W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
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Allen LN, Azab H, Jonga R, Gordon I, Karanja S, Thaker N, Evans J, Ramke J, Bastawrous A. Rapid methods for identifying barriers and solutions to improve access to community health services: a scoping review. BJGP Open 2023; 7:BJGPO.2023.0047. [PMID: 37474255 PMCID: PMC11176707 DOI: 10.3399/bjgpo.2023.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/15/2023] [Accepted: 07/16/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The advancement of universal health coverage (UHC) is largely based on identifying and addressing barriers to accessing community health services. Traditional qualitative research approaches provide excellent insights but have unfeasibly high resource requirements for most care providers. AIM To identify, categorise, and evaluate methods that have been used to identify barriers to and/or solutions for improving access to community-based health services, grounded in engagement with affected communities, excluding approaches that take >14 days. DESIGN & SETTING This was a scoping review. METHOD Following Joanna Briggs Institute (JBI) guidelines, a search was undertaken using the Cochrane Library, Ovid MEDLINE, Ovid Embase, Ovid Global Health, and Google Scholar. An information specialist designed the search, and dual independent review and data charting were used. RESULTS In total, 44 studies were included from 30 countries, reporting on 18 different clinical services. Thirty studies used self-described 'rapid' approaches; however, the majority of these did not justify what they meant by this term. Nearly half of the studies used mixed- or multi-methods and triangulation to verify early findings. All of the qualitative studies used interviews and/or focus groups, which were often supplemented with observations, document review, and mapping activities. The use of in situ snowball and convenience sampling; community members as data collectors and cultural guides; collaborative summarisation (review of findings with community members and end-users); and deductive framework analysis expedited the research processes. There were no data on costs. CONCLUSION There are a wide range of methods that can be used to deliver timely information about barriers to access. The methods employed in the articles reviewed tended to use traditional data collection approaches in innovative ways.
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Affiliation(s)
- Luke N Allen
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Hagar Azab
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Ronald Jonga
- Department of Audit and Clinical Effectiveness, Northampton Foundation trust, Northampton, UK
| | - Iris Gordon
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Karanja
- Centre for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Nam Thaker
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Jennifer Evans
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Jacqueline Ramke
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Andrew Bastawrous
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
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10
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Mercer SW, Blane D, Donaghy E, Henderson D, Lunan C, Sweeney K. Health inequalities, multimorbidity and primary care in Scotland. Future Healthc J 2023; 10:219-225. [PMID: 38162206 PMCID: PMC10753226 DOI: 10.7861/fhj.2023-0069] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Scotland has an ageing population and the widest health inequalities in Western Europe. Multiple health conditions develop ∼10-15 years earlier in deprived areas than in affluent areas. General practice is central to the effective and safe management of such complex multiple health conditions, but the inverse care law has permeated deprived communities ('Deep End' general practices) for the past 50 years. A new, radical, Scottish GP contract was introduced in April 2018, which has a vision to improve quality of care through cluster working and expansion of the multidisciplinary team (MDT), enabling GPs to deliver 'expert generalism' to patients with complex needs. It states a specific intention to address health inequalities and also to support the integration of health and social care. Here, we discuss recent evidence for whether the ambition of the new GP contract, to reduce health inequalities, is being achieved.
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Affiliation(s)
- Stewart W Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David Blane
- General Practice & Primary Care, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Eddie Donaghy
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David Henderson
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Carey Lunan
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Kieran Sweeney
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
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Mercer SW, Lunan C, Henderson D, Blane DN. Is Scotland's new GP contract addressing the inverse care law? Future Healthc J 2023; 10:287-290. [PMID: 38162197 PMCID: PMC10753203 DOI: 10.7861/fhj.2023-0068] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Scotland, like many countries around the world, has wide health inequalities resulting, in part, from the longstanding 'inverse care law', in which a mismatch between patient needs and provision of care in general practice in deprived areas results in poorer care and worse patient outcomes compared with affluent areas. In early 2018, Scotland embarked on a new GP contract, a stated aim of which was to reduce healthcare inequalities. National data on avoidable mortality showed a 4.8 (2019) and 4.9 (2021)-fold higher rate in the most deprived compared with the most affluent decile of the population. However, the distribution of whole-time equivalent (WTE) general practice clinicians per 10,000 patients, including GPs, and practice-employed practice nurses and other allied healthcare professionals, showed the opposite trend in both 2019 and 2022, with fewer WTE clinicians of all types in GP practices in deprived areas compared with affluent areas. These findings suggest that radical change is needed to reverse the inverse care law in Scotland.
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Affiliation(s)
- Stewart W Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Carey Lunan
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David Henderson
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - David N Blane
- General Practice & Primary Care, School of Health & Wellbeing, University of Glasgow, Glasgow, UK
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