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Shahaed H, Glazier RH, Anderson M, Barbazza E, Bos VLLC, Saunes IS, Auvinen J, Daneshvarfard M, Kiran T. Soins primaires pour tous: Le Canada peut s’inspirer de pays semblables ayant un niveau élevé de continuité relationnelle entre patientèle et centres de soins primaires. CMAJ 2024; 196:E359-E368. [PMID: 38499306 PMCID: PMC10948188 DOI: 10.1503/cmaj.221824-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024] Open
Affiliation(s)
- Heba Shahaed
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Richard H Glazier
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Michael Anderson
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Erica Barbazza
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Véronique L L C Bos
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Ingrid S Saunes
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Juha Auvinen
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Maryam Daneshvarfard
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande
| | - Tara Kiran
- Faculté de médecine Temerty (Shahaed) et Département de médecine familiale et communautaire (Glazier, Kiran), Hôpital St. Michael, Université de Toronto; Centre MAP pour des solutions de santé urbaines (Glazier, Daneshvarfard, Kiran), Institut du savoir Li Ka Shing, Hôpital St. Michael; Institut de recherche en services de santé (ICES Centre) (Glazier, Kiran); Institut des politiques de la gestion et de l'évaluation de la santé (Glazier, Kiran), Université de Toronto, Toronto, Ont.; Département des politiques de la santé (Anderson), École londonienne d'économie et de sciences politiques, Londres, R.-U.; Département de santé publique et de médecine du travail (Barbazza, Bos), couverture sanitaire universelle (CSU) Amsterdam, Université d'Amsterdam, Amsterdam, Pays-Bas; Grappe de recherche sur les services de santé (Saunes), Division des services de santé, Institut norvégien de santé publique, Oslo, Norvège; Unité de recherche sur la santé des populations (Auvinen), Université d'Oulu; Centre de recherches médicales (Auvinen), Hôpital universitaire d'Oulu et Université d'Oulu, Oulu, Finlande.
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Shahaed H, Glazier RH, Anderson M, Barbazza E, Bos VLLC, Saunes IS, Auvinen J, Daneshvarfard M, Kiran T. Primary care for all: lessons for Canada from peer countries with high primary care attachment. CMAJ 2023; 195:E1628-E1636. [PMID: 38049161 DOI: 10.1503/cmaj.221824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Affiliation(s)
- Heba Shahaed
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Richard H Glazier
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Michael Anderson
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Erica Barbazza
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Véronique L L C Bos
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Ingrid S Saunes
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juha Auvinen
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Maryam Daneshvarfard
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Tara Kiran
- Temerty Faculty of Medicine (Shahaed), and Department of Family and Community Medicine (Glazier, Kiran), St. Michael's Hospital, University of Toronto; MAP Centre for Urban Health Solutions (Glazier, Daneshvarfard, Kiran), Li Ka Shing Knowledge Institute, St. Michael's Hospital; ICES Central (Glazier, Kiran); Institute of Health Policy, Management and Evaluation (Glazier, Kiran), University of Toronto, Toronto, Ont.; Department of Health Policy (Anderson), London School of Economics and Political Science, London, UK; Department of Public and Occupational Health (Barbazza, Bos), Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Cluster for Health Services Research (Saunes), Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway; Research Unit of Population Health (Auvinen), University of Oulu; Medical Research Center (Auvinen), Oulu University Hospital and University of Oulu, Oulu, Finland.
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Sax Å, Nord M, Cedersund E, Olaison A, Sverker A, Kastbom L. Trustful conversations: a qualitative interview study on older patients' experiences of the intervention Proactive healthcare in a Swedish primary care setting. Prim Health Care Res Dev 2023; 24:e53. [PMID: 37614171 PMCID: PMC10466206 DOI: 10.1017/s1463423623000427] [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: 01/20/2022] [Revised: 05/27/2022] [Accepted: 06/11/2023] [Indexed: 08/25/2023] Open
Abstract
AIM To explore older patients' experiences of the intervention Proactive healthcare for frail elderly persons. BACKGROUND Previous research has indicated that continuity and good access to primary care can improve satisfaction in older people seeking care. However, little is known about the older patients' experiences in taking part of interventions aiming to enhance the care. METHODS Individual interviews were conducted with 24 older patients who participated in the intervention Proactive healthcare for frail elderly persons, selected from nine Swedish primary care centres. Interviews were analysed using qualitative content analysis. FINDINGS Older patients' experiences of the intervention involved five manifest categories: Ways of naming the elder care team, covering the older patients' lack of understanding regarding their connection to the team, and the need for clarity on this and on how the specialised care provided differed from conventional care; Availability, indicating how older patients associated easy access and a direct telephone number with a team nurse available at certain times with a sense of security; The importance of relations, covering how patients appreciated continuity in their personal and professional conversations with staff; A feeling of safety and trust, stressing the value of older persons attach to being given enough time, to be listened to and being recognised as people; and Finiteness of life, which refers to the difficulty of having end-of-life conversations and the need for experienced staff with personal knowledge of the patients. The latent theme Trustful conversations was created to give a deeper meaning to the content of the categories.Trustful conversations, created through good personal knowledge of patients and continuity of contact, engender a feeling of safety in older patients. Using elder care teams could result in a better quality of care, with increased satisfaction and feelings of security among patients, and a reduction in healthcare needs.
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Affiliation(s)
- Åsa Sax
- Primary Health Care Centre in Ljungsbro, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Magnus Nord
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre in Valla, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elisabet Cedersund
- Department of Culture and Society, Linköping University, Linköping, Sweden
| | - Anna Olaison
- Department of Culture and Society, Linköping University, Linköping, Sweden
| | - Annette Sverker
- Pain and Rehabilitation Center, and Department of Activity and Health, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Lisa Kastbom
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Centre in Ekholmen, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Pahlavanyali S, Hetlevik Ø, Blinkenberg J, Hunskaar S. Continuity of care for patients with chronic disease: a registry-based observational study from Norway. Fam Pract 2022; 39:570-578. [PMID: 34536072 PMCID: PMC9295609 DOI: 10.1093/fampra/cmab107] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Continuity of care (CoC) is accepted as a core value of primary care and is especially appreciated by patients with chronic conditions. Nevertheless, there are few studies investigating CoC for these patients across levels of healthcare. OBJECTIVE This study aims to investigate CoC for patients with somatic chronic diseases, both with regular general practitioners (RGPs) and across care levels. METHODS We conducted a registry-based observational study by using nationwide consultation data from Norwegian general practices, out-of-hours services, hospital outpatient care, and private specialists with public contracts. Patients with diabetes mellitus (type I or II), asthma, chronic obstructive pulmonary disease, or heart failure in 2012, who had ≥2 consultations with these diagnoses during 2014 were included. CoC was measured during 2014 by using the usual provider of care (UPC) index and Bice-Boxerman continuity of care score (COCI). Both indices have a value between 0 and 1. RESULTS Patients with diabetes mellitus comprised the largest study population (N = 79,165) and heart failure the smallest (N = 4,122). The highest mean UPC and COCI were measured for patients with heart failure, 0.75 and 0.77, respectively. UPC increased gradually with age for all diagnoses, while COCI showed this trend only for asthma. Both indices had higher values in urban areas. CONCLUSIONS Our findings suggest that CoC in Norwegian healthcare system is achieved for a majority of patients with chronic diseases. Patients with heart failure had the highest continuity with their RGP. Higher CoC was associated with older age and living in urban areas.
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Affiliation(s)
- Sahar Pahlavanyali
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Øystein Hetlevik
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Jesper Blinkenberg
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre, Bergen, Norway
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Mikkola I, Morgan S, Winell K, Jokelainen J, Frittitta L, Heikkala E, Hagnäs M. Association of personalised care plans with monitoring and control of clinical outcomes, prescription of medication and utilisation of primary care services in patients with type 2 diabetes: an observational real-world study. Scand J Prim Health Care 2022; 40:39-47. [PMID: 35148662 PMCID: PMC9090399 DOI: 10.1080/02813432.2022.2036458] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To study the association of personalised care plans with monitoring and controlling clinical outcomes, prescription of cardiovascular and antihyperglycaemic medication and utilisation of primary care services in patients with type 2 diabetes (T2D). PATIENTS Primary care T2D outpatients from the Rovaniemi Health Centre. SETTING The municipal health centre, Rovaniemi, Finland. DESIGN A cross-sectional, observational, retrospective register-based study. The patients were divided into three groups: 'no care plan entries' (usual care); '1-2 care plan entries'; and '3 or more care plan entries'. MAIN OUTCOME MEASURES Monitoring of clinical and biochemical measures, achievement of treatment targets, prescription of cardiovascular and antihyperglycemic medication, and use of primary care services. RESULTS A total of 5104 patients with T2D (mean age 65.5 years (SD 12.4)), of which 67% had at least one care plan entry. Compared to usual care, the establishment of a care plan (either care plan group) was associated with better monitoring of glycosylated haemoglobin A1c, low-density-lipoprotein cholesterol, systolic blood pressure (sBP), and renal function, and there was more frequent prescription of all cardiovascular and antihyperglycemic medication. Patients in either care plan group were more likely to achieve sBP target (p < 0.05). Patients without a care plan had more unplanned primary care physician contacts compared to patients in care plan groups (p < 0.001). CONCLUSION Establishment of a care plan is associated with more intensive and focussed care of patients with T2D. The appropriate use of primary care resources is essential and personalised care plans may contribute to the treatment of patients with T2D.Key PointsCare planning aims to empower patients with type 2 diabetes. This study demonstrates that personalised care planning is associated withmore frequent monitoring for clinical outcomes,more frequent prescription of cardiovascular and antihyperglycemic medication andmore frequent utilisation of planned diabetes consultations when compared to usual care.
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Affiliation(s)
- Ilona Mikkola
- Rovaniemi Health Centre, Rovaniemi, Finland
- CONTACT Ilona Mikkola , P.O. Box 8216, RovaniemiFI-96101, Finland
| | - Simon Morgan
- Elermore Vael General Practice, Elermore Vale, Australia
| | | | - Jari Jokelainen
- Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
- Unit of General Practice, Oulu University Hospital, Oulu, Finland
| | - Lucia Frittitta
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Diabetes, Obesity and Dietetic Center, Garibaldi-Nesima Medical Center, Catania, Italy
| | | | - Maria Hagnäs
- Rovaniemi Health Centre, Rovaniemi, Finland
- Endocrinology, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- Diabetes, Obesity and Dietetic Center, Garibaldi-Nesima Medical Center, Catania, Italy
- Center for Life Course Health Research, University of Oulu, Oulu, Finland
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Lian OS, Hansen AH. Factors facilitating patient satisfaction among women with medically unexplained long-term fatigue: A relational perspective. Health (London) 2015; 20:308-26. [DOI: 10.1177/1363459315583158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Bodily conditions that are difficult to identify, explain and treat with the aid of medical knowledge and technology appear to be particularly challenging to medical encounters. Patients are often dissatisfied with the help they receive, and they often experience that their medical needs are not met. To explore factors facilitating patient satisfaction among patients with a medically unexplained condition, we ask: what is the importance of individual versus relational factors in facilitating patient satisfaction in clinical encounters between general practitioners (GPs) and women with medically unexplained long-term fatigue? We approach this question through a statistical analysis of survey data collected from a net sample of 431 women recruited through a patient organisation for people suffering from myalgic encephalomyelitis in 2013. Participants were asked about their experiences with general practitioners in the Norwegian national health system in two different phases: shortly after illness onset, and current regular general practitioner last 12 months. The questions evolved around themes concerning shared understanding and decision making, being taken seriously, being paid due respect and being treated as an equal partner. Through descriptive statistics and multivariable logistic regression analyses, we explored how their experiences were related to individual and relational factors, respectively. Free-text comments from the questionnaires were used while interpreting the results. The analysis illuminates that relational aspects in medical encounters between GPs and ME patients, especially continuity, congruence in doctor–patient views and being seen by a specialist, are important catalysts of patient satisfaction. The probability of being satisfied with the initial investigation was more than six times higher in women who were referred to specialists, compared to those who were not. We conclude that continuity of care and experiences of being in a partnership that operates on a common ground – a shared understanding of the patient’s illness – foster patient satisfaction among women with medically unexplained long-term fatigue.
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Affiliation(s)
- Olaug S Lian
- University of Tromsø – The Arctic University of Norway, Norway
| | - Anne Helen Hansen
- University of Tromsø – The Arctic University of Norway, Norway; University Hospital of North Norway, Norway
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