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Sandholdt CT, Jønsson ABR, Reventlow S, Bach-Holm D, Line K, Kolko M, Jacobsen MH, Mathiesen OH, Waldorff FB. DETECT: DEveloping and testing a model to identify preventive vision loss among older paTients in gEneral praCTice - protocol for a complex intervention in Denmark. BMJ Open 2023; 13:e069974. [PMID: 37247966 PMCID: PMC10230986 DOI: 10.1136/bmjopen-2022-069974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/14/2023] [Indexed: 05/31/2023] Open
Abstract
INTRODUCTION The number of people living with visual impairment is increasing. Visual impairment causes loss in quality of life and reduce self-care abilities. The burden of disease is heavy for people experiencing visual impairment and their relatives. The severity and progression of age-related eye diseases are dependent on the time of detection and treatment options, making timely access to healthcare critical in reducing visual impairment. General practice plays a key role in public health by managing preventive healthcare, diagnostics and treatment of chronic conditions. General practitioners (GPs) coordinate services from other healthcare professionals. More involvement of the primary sector could potentially be valuable in detecting visual impairment. METHODS We apply the Medical Research Council framework for complex interventions to develop a primary care intervention with the GP as a key actor, aimed at identifying and coordinating care for patients with low vision. The development process will engage patients, relatives and relevant health professional stakeholders. We will pilot test the feasibility of the intervention in a real-world general practice setting. The intervention model will be developed through a participatory approach using qualitative and creative methods such as graphical facilitation. We aim to explore the potentials and limitations of general practice in relation to detection of preventable vision loss. ETHICS AND DISSEMINATION Ethics approval is obtained from local authority and the study meets the requirements from the Declaration of Helsinki. Dissemination is undertaken through research papers and to the broader public through podcasts and patient organisations.
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Affiliation(s)
- Catharina Thiel Sandholdt
- Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Alexandra Brandt Ryborg Jønsson
- Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
- Department of People and Technology, Roskilde University, Roskilde, Denmark
| | - Susanne Reventlow
- Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | - Daniella Bach-Holm
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Kessel Line
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Kobenhavn, Denmark
| | - Miriam Kolko
- Department of Ophthalmology, Rigshospitalet Glostrup, Glostrup, Denmark
- Department of Drug Design and Pharmacology, University of Copenhagen, Kobenhavn, Denmark
| | - Marie Honoré Jacobsen
- Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
| | | | - Frans Boch Waldorff
- Section of General Practice, Department of Public Health, University of Copenhagen, Kobenhavn, Denmark
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Fournaise A, Andersen-Ranberg K, Lauridsen JT, Espersen K, Gudex C, Bech M. Conceptual framework for acute community health care services - Illustrated by assessing the development of services in Denmark. Soc Sci Med 2023; 324:115857. [PMID: 37001279 DOI: 10.1016/j.socscimed.2023.115857] [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: 08/02/2022] [Revised: 02/13/2023] [Accepted: 03/17/2023] [Indexed: 04/22/2023]
Abstract
Acute community health care services can support continuity of care by acting as a bridge between the primary and secondary health care sectors in the early detection of acute disease and provision of treatment and care. Although acute community health care services are a political priority in many countries, the literature on their organization and effect is limited. We present a conceptual framework for describing acute community health care services that can be used to support the policies and guidelines for such services. For illustrative purposes, we apply the framework to the Danish acute community health care services using implementation data from 2020 and identify gaps and opportunities for learning. The framework identifies two key pairs of dimensions: (1) capacity & capability, and (2) coordination & collaboration. These dimensions, together with the governance structure and quality assurance initiatives, are of key importance to the effect of acute community health care services. While all Danish municipalities have implemented acute community health care services, application of the framework indicates considerable variation in their approaches. The conceptual framework provides a systematic approach supporting the development, implementation, evaluation, and monitoring of acute community health care services and can assist policymakers at both national and local levels in this work.
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Affiliation(s)
- Anders Fournaise
- Department of Cross-sectoral Collaboration, Region of Southern Denmark, Damhaven 12, 7100, Vejle, Denmark; Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark; Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark.
| | - Karen Andersen-Ranberg
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, 5000, Odense, Denmark; Geriatric Research Unit, Department of Geriatric Medicine, Odense University Hospital, J. B. Winsløws Vej 4, 5000, Odense, Denmark; Danish Aging Research Center, University of Southern Denmark, J. B. Winsløws Vej 9b, 5000, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense, Denmark.
| | - Jørgen T Lauridsen
- Department of Economics, University of Southern Denmark, Campusvej 55, 5000, Odense, Denmark.
| | - Kurt Espersen
- Department of Cross-sectoral Collaboration, Region of Southern Denmark, Damhaven 12, 7100, Vejle, Denmark.
| | - Claire Gudex
- Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 19, 5000, Odense, Denmark; Open Patient data Explorative Network (OPEN), Region of Southern Denmark, J. B. Winsløws Vej 9A, 5000, Odense, Denmark.
| | - Mickael Bech
- Department of Political Science and Public Management, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
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Braut H, Øygarden O, Storm M, Mikkelsen A. General practitioners' perceptions of distributed leadership in providing integrated care for elderly chronic multi-morbid patients: a qualitative study. BMC Health Serv Res 2022; 22:1085. [PMID: 36002824 PMCID: PMC9404619 DOI: 10.1186/s12913-022-08460-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 08/10/2022] [Indexed: 11/22/2022] Open
Abstract
Background Distributed Leadership (DL) has been suggested as being helpful when different health care professionals and patients need to work together across professional and organizational boundaries to provide integrated care (IC). This study explores whether General Practitioners (GPs) adopt leadership actions that transcend organizational boundaries to provide IC for patients and discusses whether the GPs’ leadership actions in collaboration with patients and health care professionals contribute to DL. Methods We interviewed GPs (n = 20) of elderly multimorbid patients in a municipality in Norway. A qualitative interpretive case design and Gioia methodology was applied to the collection and analysis of data from semi-structured interviews. Results GPs are involved in three processes when contributing to IC for elderly multimorbidity patients; the process of creating an integrated patient experience, the workflow process and the process of maneuvering organizational structures and medical culture. GPs take part in processes comparable to configurations of DL described in the literature. Patient micro-context and health care macro-context are related to observed configurations of DL. Conclusion Initiating or moving between different configurations of DL in IC requires awareness of patient context and the health care macro-context, of ways of working, capacity of digital tools and use of health care personnel. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08460-x.
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Affiliation(s)
- Harald Braut
- University of Stavanger Business School, Stavanger, Norway.
| | | | - Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
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Abstract
In Chile and the world, the supply of medical hours to provide care has been reduced due to the health crisis caused by COVID-19. As of December 2021, the outlook has been critical in Chile, both in medical and surgical care, where 1.7 million people wait for care, and the wait for surgery has risen from 348 to 525 days on average. This occurs mainly when the demand for care exceeds the supply available in the public system, which has caused serious problems in patients who will remain on hold and health teams have implemented management measures through prioritization measures so that patients are treated on time. In this paper, we propose a methodology to work in net for predicting the prioritization of patients on surgical waiting lists (SWL) embodied with a machine learning scheme for a high complexity hospital (HCH) in Chile. That is linked to the risk of each waiting patient. The work presents the following contributions; The first contribution is a network method that predicts the priority order of anonymous patients entering the SWL. The second contribution is a dynamic quantification of the risk of waiting patients. The third contribution is a patient selection protocol based on a dynamic update of the SWL based on the components of prioritization, risk, and clinical criteria. The optimization of the process was measured by a simulation of the total times of the system in HCH. The prioritization strategy proposed savings of medical hours allowing 20% additional surgeries to be performed, thus reducing SWL by 10%. The risk of waiting patients could drop by up to 8% annually. We hope to implement this methodology in real health care units.
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Willie MM, Childs B, Goolab G. The value proposition of efficiency discount options: The government employees medical scheme emerald value option case study. Afr J Prim Health Care Fam Med 2021; 13:e1-e8. [PMID: 33567847 PMCID: PMC7876986 DOI: 10.4102/phcfm.v13i1.2292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 07/23/2020] [Accepted: 07/29/2020] [Indexed: 11/22/2022] Open
Abstract
Background The Government Employees Medical Scheme (GEMS) introduced an EDO named the Emerald Value Option (EVO) in January 2017. The option was introduced to contain the cost of care whilst simultaneously improving the quality of care by championing care coordination. Aim This study aimed to assess the impact of introducing an EDO such as EVO as a cost-containment strategy using contracted provider networks and coordinated care. Setting The study was conducted using aggregated data from GEMS. Government Employees Medical Scheme is a restricted medical scheme available to government employees in South Africa. Methods This is a descriptive pairwise comparison study between the Emerald benefit option (the parent option), which does not have embedded care coordination, and its derivative, EVO. Results Membership and claims data for 2018 were analysed. Expenditure per life per month in 2018 on the EVO amounts to R1357.01. After adjusting for the risk profile of beneficiaries on the EVO, expenditure per life per month would be expected to be R1621.73 (based on the conventional Emerald option). This translates to a savings of 16.3%. Similarly, health outcomes for EVO were more favourable than expected, actual admission rates were lower at 23.2% versus 26.2% expected. Conclusions The EVO benefit design has succeeded in lowering the cost of care through network provider contracting and care coordination. The EVO has saved approximately R490 million in healthcare costs in 2018. If applied across the medical schemes industry, it is estimated that EVO contracting, and care coordination principles could save R20 billion per annum.
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Affiliation(s)
- Michael M Willie
- Policy Research and Monitoring, Council for Medical Schemes, Pretoria.
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Exploiting Inter-Organizational Relationships in Health Care: A Bibliometric Analysis and Literature Review. ADMINISTRATIVE SCIENCES 2020. [DOI: 10.3390/admsci10030057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Inter-organizational relationships are high on the health policy agenda. Scholars and practitioners have provided heterogeneous views about the triggers of collaborative practices and the success factors that underpin the sustainability of inter-organizational relationships in the health care domain. The article proposes a literature review aimed at systematizing current scientific research that contextualizes inter-organizational relationships to health care. A mixed approach was undertaken, which consisted of a bibliometric analysis followed by a narrative literature review. A tailored search strategy on Elsevier’s Scopus yielded 411 relevant records, which were carefully screened for inclusion in this study. After screening, 105 papers were found to be consistent with the study purposes and included in this literature review. The findings emphasize that the establishment and implementation of inter-organizational relationships in health care are affected by several ambiguities, which concern both the governance and the structuring of collaborative relationships. The viability and the success of inter-organizational relationships depend on the ability of both central and peripheral partners to acknowledge and address such ambiguities. Failure to do so involves an opportunistic participation to inter-organizational relationships. This endangers conflicting behaviors rather than collaboration among partners.
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Næss G, Wyller TB, Kirkevold M. Structured follow-up of frail home-dwelling older people in primary health care: is there a special need, and could a checklist be of any benefit? A qualitative study of experiences from registered nurses and their leaders. J Multidiscip Healthc 2019; 12:675-690. [PMID: 31686832 PMCID: PMC6709575 DOI: 10.2147/jmdh.s212283] [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] [Received: 04/15/2019] [Accepted: 07/02/2019] [Indexed: 11/23/2022] Open
Abstract
Aim To identify experiences and opinions about the need for a structured follow-up and to identify potential benefits and barriers to the use of a checklist (Sub Acute Functional decline in the Older people [SAFE]) when caring for frail home-dwelling older people. Background The complexity of older peoples’ health situation requires more coordinated health care across health care levels and a better structured follow-up than is currently being offered, especially in the transitional phase between hospital discharge and primary care, but also in more stable phases at home. Design This was a qualitative study using focus group interviews. Methods Data were collected during six focus group interviews in three districts in a municipality. Nineteen registered nurses (RNs) and seventeen leaders responsible for the follow-up of frail home-dwelling older people participated. Participants were representatives of the RNs in homecare and their leaders. Results Our results highlight that although most RNs and their leaders saw a number of significant benefits to conducting a structured assessment and follow-up of frail older people home care recipients, a number of barriers made this difficult to realize on a daily basis. Conclusion There is no common perception that a structured follow-up of frail home-dwelling older people in primary health care is an important and contributing factor to better quality of health care. Despite this, most RNs and leaders found that the use of a structured checklist such as SAFE was a benefit to achieving a structured follow-up of the frail older people. We identified several factors of importance to whether a structured follow-up with a checklist is conducted in home care.
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Affiliation(s)
- Gro Næss
- Charm Research Centre for Habilitation and Rehabilitation Models & Services, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Nursing and Health Sciences, Faculty of Health and Sciences, University of South- Eastern Norway, Kongsberg, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Torgeir Bruun Wyller
- Charm Research Centre for Habilitation and Rehabilitation Models & Services, Institute of Health and Society, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Marit Kirkevold
- Charm Research Centre for Habilitation and Rehabilitation Models & Services, Institute of Health and Society, University of Oslo, Oslo, Norway.,Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway
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Kneck Å, Flink M, Frykholm O, Kirsebom M, Ekstedt M. The Information Flow in a Healthcare Organisation with Integrated Units. Int J Integr Care 2019; 19:20. [PMID: 31592046 PMCID: PMC6764182 DOI: 10.5334/ijic.4192] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 09/17/2019] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Integrated care is believed to provide support to patients with multiple long-term and complex conditions. Transparency in information delivery is key for shared decision-making, and co-production of care. This study aimed to explore information pathways within an integrated healthcare and social care organisation and describe how information continuity was delivered for an older patient with complex care needs. METHODS An explorative single-case study conducted in a Swedish healthcare organization where municipality and the county council have integrated their services. One focus group discussion and six individual interviews were conducted. RESULTS Information flow to partners in care was obstructed, with compensatory double documentation, complementary information channels, and information loss. A heavy burden was on the patient and relatives to keep track of and communicate information between different caregivers. Patients were expected to be active partners in their own care, but were largely excluded from the information flow. DISCUSSION Even integration of care organisations does not imply that integrated care is delivered at the sharp end of practice. An integrated electronic health record is needed to improve accessibility of care information from within all the organisations, facilitating handovers between professionals and levels of care, and involving patients in the information flow.
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Affiliation(s)
- Åsa Kneck
- Ersta Sköndal Bräcke University College, Department of Health Care Sciences, Stockholm, SE
| | - Maria Flink
- Division of Family medicine and Primary care, NVS, Karolinska Institutet, SE
| | - Oscar Frykholm
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, SE
| | - Marie Kirsebom
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Växjö, SE
| | - Mirjam Ekstedt
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, SE
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Växjö, SE
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Simonÿ C, Riber C, Bodtger U, Birkelund R. Striving for Confidence and Satisfaction in Everyday Life with Chronic Obstructive Pulmonary Disease: Rationale and Content of the Tele-Rehabilitation Programme >C☺PD-Life>>. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183320. [PMID: 31505861 PMCID: PMC6766220 DOI: 10.3390/ijerph16183320] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 08/29/2019] [Accepted: 09/03/2019] [Indexed: 12/31/2022]
Abstract
Background: More feasible rehabilitation programmes for patients with chronic obstructive pulmonary disease (COPD) are warranted. Even so, still in its infancy, telerehabilitation to COPD patients reveals promising results, wherefore it is anticipated to contribute significant value to the current challenges of rehabilitation to these patients. To expand useful knowledge in the field, more sophisticated telerehabilitation interventions must be developed and appraised, but first and foremost, thoroughly described. Aims and methods: The aim of this article is to give a detailed description of the rationale and content of the >C☺PD-Life>> programme, within the bounds of the checklist of Template for Intervention Description and Replication (TIDieR). Approach:>C☺PD-Life>> is a telerehabilitation programme for COPD patients delivered as a study intervention by an interprofessional team of clinicians collaborating from both the hospital and the municipal healthcare system. Making use of two-way audio and visual communication software, 15 patients participated in the intervention via a tablet computer from their private setting. The programme was a six-month-long empowerment-based rehabilitation that aimed to support COPD patients in leading a satisfactory and confident life with appropriate physical activity and high disease management. Conclusions: A long-term interprofessional cross-sectoral telerehabilitation programme has been justified and described. The intervention was tested in 2017–2018 and the qualitative appraisal, along with an analysis of case-based measurements of development in physical capacity, COPD Assesment Test, and health management, is currently under production.
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Affiliation(s)
- Charlotte Simonÿ
- Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Faelledvej 7, 4200 Slagelse, Denmark.
- Institute of the Regional Health Services Research, University of Southern Denmark, 5230 Odense, Denmark.
| | - Claus Riber
- Department of Physiotherapy and Occupational Therapy, Slagelse Hospital, Faelledvej 7, 4200 Slagelse, Denmark.
| | - Uffe Bodtger
- Institute of the Regional Health Services Research, University of Southern Denmark, 5230 Odense, Denmark.
- Department of Respiratory Medicine, Naestved Hospital, Ringstedgade 61, 4700 Naestved, Denmark.
- Department of Respiratory Medicine, Zealand University Hospital, Sygehusvej 10, 4000 Roskilde, Denmark.
| | - Regner Birkelund
- Institute of the Regional Health Services Research, University of Southern Denmark, 5230 Odense, Denmark.
- Department of Health Research, Lillebaelt Hospital, University Hospital of Southern Denmark, Beriderbakken 4, 7100 Vejle, Denmark.
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Riordan F, McGrath N, Dinneen SF, Kearney PM, McHugh SM. 'Sink or Swim': A Qualitative Study to Understand How and Why Nurses Adapt to Support the Implementation of Integrated Diabetes Care. Int J Integr Care 2019; 19:2. [PMID: 30971868 PMCID: PMC6450245 DOI: 10.5334/ijic.4215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/12/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Integrated care, organising care delivery within and between services, is an approach to improve the quality of care. Existing specialist roles have evolved to work across settings and services to integrate care. However, there is limited insight into how these expanded roles are implemented, including how they may be shaped by context. This paper examines how new diabetes nurse specialists working across care boundaries, together with hospital-based diabetes nurse specialists, adapt to support the implementation of integrated care. METHODS We conducted semi-structured focus groups and interviews with diabetes nurse specialists purposively sampled by work setting and health service region (n = 30). Analysis was data-driven, coding actions or processes to stay closer to the data and using In Vivo codes to preserve meaning. FINDINGS Community nurse specialists described facing a choice of "sink or swim" when appointed with limited guidance on their role. To 'swim' and implement their role, required them to use their initiative and adapt to the local context. When first appointed, both community and hospital nurse specialists actively managed misconceptions of their role by other staff. To establish clinics in general practices, community nurse specialists capitalised on professional contacts to access GPs who might utilise their role. They built GP trust by adopting practice norms and responding to individual needs. They adapted to the lack of a multidisciplinary team "safety net" in the community, by "practicing at a higher level", working more autonomously. Developing professional links and pursuing on-going education was a way to create an alternative 'safety net' so as to feel confident in their clinical decision-making when working in the community. Workarounds facilitated information flow (i.e. patient blood results, treatment, and appointments) between settings in the absence of an electronic record shared between general practices and hospital settings. CONCLUSIONS Flexibility and innovation facilitates a new way of working across boundaries. Successful implementation of nurse specialist-led integrated care requires strategies to address elements in the inner (differences in practice organisation, role acceptance) and outer (information systems) context.
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Affiliation(s)
- Fiona Riordan
- School of Public Health, Western Gateway Building, University College Cork, IE
| | - Niamh McGrath
- School of Public Health, Western Gateway Building, University College Cork, IE
| | - Sean F. Dinneen
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, School of Medicine, National University of Ireland, Galway, IE
| | - Patricia M. Kearney
- School of Public Health, Western Gateway Building, University College Cork, IE
| | - Sheena M. McHugh
- School of Public Health, Western Gateway Building, University College Cork, IE
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Bodenhagen L, Suvei SD, Juel WK, Brander E, Krüger N. Robot technology for future welfare: meeting upcoming societal challenges – an outlook with offset in the development in Scandinavia. HEALTH AND TECHNOLOGY 2019. [DOI: 10.1007/s12553-019-00302-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dinesen B, Spindler H. The Use of Telerehabilitation Technologies for Cardiac Patients to Improve Rehabilitation Activities and Unify Organizations: Qualitative Study. JMIR Rehabil Assist Technol 2018; 5:e10758. [PMID: 30455168 PMCID: PMC6277831 DOI: 10.2196/10758] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 08/05/2018] [Accepted: 10/07/2018] [Indexed: 01/29/2023] Open
Abstract
Background Cardiovascular disease is a leading cause of death globally causing 31% of all deaths worldwide. The Danish health care system is characterized by fragmented delivery of services and rehabilitation activities. The Teledialog Telerehabilitation Program for cardiac patients was developed and tested to rectify fragmentation and improve the quality of care. The Teledialog program was based on the assumption that a common communication platform shared by health care professionals, patients, and relatives could reduce or eliminate the fragmentation in the rehabilitation process and improve cooperation between the health professionals. Objective This study aimed to assess the interorganizational cooperation between health care professionals across sectors (hospitals, municipal health care centers) in a cardiac telerehabilitation program. Methods Theories of networks between organizations, the sociology of professions, and the “community of practice” approach were used in a case study of a cardiac telerehabilitation program. A triangulation of data collection techniques were used including documents, participant observation (n=76 hours), and qualitative interviews with healthcare professionals (n=37). Data were analyzed using NVivo 11.0. Results The case study of cooperation in an interorganizational context of cardiac telerehabilitation program is characterized by the following key themes and patterns: (1) integrated workflows via a shared digital rehabilitation plan that help integrate workflow between health care professions and organizations, (2) joint clinical practice showed as a community of practice in telerehabilitation developed across professions and organizations, and (3) unifying the organizations as cooperation has advanced via a joint telerehabilitation program across municipalities and hospitals. Conclusions The Teledialog Telerehabilitation Program was a new innovative cardiac program tested on a large scale across hospitals, health care centers, and municipalities. Assessments showed that the Teledialog program and its associated technologies helped improve interorganizational cooperation and reduce fragmentation. The program helped integrate the organizations and led to the creation of a community of practice. Further research is needed to explore long-term effects of implementation of telerehabilitation technologies and programs. Trial Registration ClinicalTrials.gov NCT01752192; http://clinicaltrials.gov/ct2/show/NCT01752192 (Archived by WebCite at http://www.webcitation.org/6yR3tdEpb)
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Affiliation(s)
- Birthe Dinesen
- Laboratory for Welfare Technology - Telehealth & Telerehabilitation, Sensory-Motor Interaction, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg East, Denmark
| | - Helle Spindler
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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Høyem A, Gammon D, Berntsen GR, Steinsbekk A. Policies Make Coherent Care Pathways a Personal Responsibility for Clinicians: A Discourse Analysis of Policy Documents about Coordinators in Hospitals. Int J Integr Care 2018; 18:5. [PMID: 30093843 PMCID: PMC6078125 DOI: 10.5334/ijic.3617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 06/19/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION In response to increase of patients with complex conditions, policies prescribe measures for improving continuity of care. This study investigates policies introducing coordinator roles in Norwegian hospitals that have proven challenging to implement. METHODS This qualitative study of policy documents employed a discourse analysis inspired by Carol Bacchi's 'What's the problem represented to be?'. We analysed six legal documents (2011-2016) and selected parts of four whitepapers presenting the statutory patient care coordinator and contact physician roles in hospitals. RESULTS The 'problem' represented in the policies is lack of coherent pathways and lack of stable responsible professionals. Extended personal responsibility for clinical personnel as coordinators is the prescribed solution. Their duties are described in terms of ideals for coherent pathways across conditions and contexts. System measures to support and orchestrate the individual patient's pathway (e.g. resources, infrastructure) are scarcely addressed. CONCLUSIONS AND DISCUSSION We suggest that the policies' construction of the 'problem' as a responsibility issue, result in that neither diversity of patients' coordination needs, nor heterogeneity of hospital contexts regarding necessary system support for coordinators, is set on the agenda. Adoption of rhetoric from diagnosis-specific standardized pathways obscures unique challenges in creating coherent pathways for patients with complex needs.
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Affiliation(s)
- Audhild Høyem
- Centre for Quality Improvement and Development, University Hospital of North Norway, Box 20, N-9038, Tromsø, NO
| | - Deede Gammon
- Norwegian Centre for E-health Research, University Hospital of North Norway, Box 35, N-9038 Tromsø, NO
- Center for Shared Decision-Making and Collaborative Care Research, Oslo University Hospital HF Division of Medicine, Box 4950 Nydalen, N-0424 Oslo, NO
| | - Gro Rosvold Berntsen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Box 35, N-9038 Tromsø, NO
- Department of primary care, Institute of Community medicine, UiT The Arctic University of Norway, Tromsø, NO
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Box 8905, N-7491 Trondheim, NO
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Auschra C. Barriers to the Integration of Care in Inter-Organisational Settings: A Literature Review. Int J Integr Care 2018; 18:5. [PMID: 29632455 PMCID: PMC5887071 DOI: 10.5334/ijic.3068] [Citation(s) in RCA: 117] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 10/31/2017] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION In recent years, inter-organisational collaboration between healthcare organisations has become of increasingly vital importance in order to improve the integration of health service delivery. However, different barriers reported in academic literature seem to hinder the formation and development of such collaboration. THEORY AND METHODS This systematic literature review of forty studies summarises and categorises the barriers to integrated care in inter-organisational settings as reported in previous studies. It analyses how these barriers operate. RESULTS Within these studies, twenty types of barriers have been identified and then categorised in six groups (barriers related to administration and regulation, barriers related to funding, barriers related to the inter-organisational domain, barriers related to the organisational domain, barriers related to service delivery, and barriers related to clinical practices). Not all of these barriers emerge passively, some are set up intentionally. They are not only context-specific, but are also often related and influence each other. DISCUSSION AND CONCLUSION The compilation of these results allows for a better understanding of the characteristics and reasons for the occurrence of barriers that impede collaboration aiming for the integration of care, not only for researchers but also for practitioners. It can help to explain and counteract the slow progress and limited efficiency and effectiveness of some of the inter-organisational collaboration in healthcare settings.
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Affiliation(s)
- Carolin Auschra
- Freie Universität Berlin, Department of Management, Boltzmannstr. 20, 14195 Berlin, DE
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15
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The Emergence and Unfolding of Telemonitoring Practices in Different Healthcare Organizations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15010061. [PMID: 29301384 PMCID: PMC5800160 DOI: 10.3390/ijerph15010061] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Revised: 12/19/2017] [Accepted: 12/22/2017] [Indexed: 01/18/2023]
Abstract
Telemonitoring, a sub-category of telemedicine, is promoted as a solution to meet the challenges in Western healthcare systems in terms of an increasing population of people with chronic conditions and fragmentation issues. Recent findings from large-scale telemonitoring programs reveal that these promises are difficult to meet in complex real-life settings which may be explained by concentrating on the practices that emerge when telemonitoring is used to treat patients with chronic conditions. This paper explores the emergence and unfolding of telemonitoring practices in relation to a large-scale, inter-organizational home telemonitoring program which involved 5 local health centers, 10 district nurse units, four hospitals, and 225 general practice clinics in Denmark. Twenty-eight interviews and 28 h of observations of health professionals and administrative staff were conducted over a 12-month period from 2014 to 2015. This study's findings reveal how telemonitoring practices emerged and unfolded differently among various healthcare organizations. This study suggests that the emergence and unfolding of novel practices is the result of complex interplay between existing work practices, alterations of core tasks, inscriptions in the technology, and the power to either adopt or ignore such novel practices. The study enhances our understanding of how novel technology like telemonitoring impacts various types of healthcare organizations when implemented in a complex inter-organizational context.
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Andersen AB, Frederiksen K, Kolbaek R, Beedholm K. Governing citizens and health professionals at a distance: A critical discourse analysis of policies of intersectorial collaboration in Danish health-care. Nurs Inq 2017; 24. [DOI: 10.1111/nin.12196] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Anne Bendix Andersen
- Department of Science in Nursing; Aarhus University Health; Aarhus Denmark
- Medical Department and Department of Cardiology; Regional Hospital Viborg; Viborg Denmark
- Center for Clinical Research in Nursing; Regional Hospital Viborg; Viborg Denmark
| | | | - Raymond Kolbaek
- Center for Clinical Research in Nursing; Regional Hospital Viborg; Viborg Denmark
| | - Kirsten Beedholm
- Department of Science in Nursing; Aarhus University Health; Aarhus Denmark
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Elf M, Flink M, Nilsson M, Tistad M, von Koch L, Ytterberg C. The case of value-based healthcare for people living with complex long-term conditions. BMC Health Serv Res 2017; 17:24. [PMID: 28077130 PMCID: PMC5225615 DOI: 10.1186/s12913-016-1957-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 12/15/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the patient's experience of her or his entire cycle of care, including the use of well-defined outcome measurements. Challenges arise when the approach is applied to health services for people living with long-term complex conditions that require support from various healthcare services. The aim of this work is to critically discuss the value-based approach and its implications for patients with long-term complex conditions. Two cases from clinical practice and research form the foundation for our reasoning, illustrating several challenges regarding value-based health services for people living with long-term complex conditions. DISCUSSION Achieving value-based health services that provide the health outcomes that matter to patients and providing greater patient-centredness will place increased demands on the healthcare system. Patients and their informal caregivers must be included in the development and establishment of outcome measures. The outcome measures must be standardized to allow evaluation of specific conditions at an aggregated level, but they must also be sensitive enough to capture each patient's individual needs and goals. Healthcare systems that strive to establish value-based services must collaborate beyond the organizational boundaries to create clear patient trajectories in order to avoid fragmentation. The shift towards value-based health services has the potential to align healthcare-service delivery with patient-centred care if serious efforts to take the patient's perspective into account are made. This is especially challenging in fragmented healthcare systems and for patients with long-term- and multi-setting-care needs.
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Affiliation(s)
- Marie Elf
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden.
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
- Department of Social Work, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Marie Nilsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
- Department of Social Work, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Malin Tistad
- School of Education, Health and Social Studies, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
| | - Lena von Koch
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
- Department of Neurobiology, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Charlotte Ytterberg
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden
- Functional Area Occupational Therapy & Physiotherapy, Karolinska University Hospital Huddinge, Stockholm, Sweden
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18
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Hvidberg L, Lagerlund M, Pedersen AF, Hajdarevic S, Tishelman C, Vedsted P. Awareness of cancer symptoms and anticipated patient interval for healthcare seeking. A comparative study of Denmark and Sweden. Acta Oncol 2016; 55:917-24. [PMID: 26882008 DOI: 10.3109/0284186x.2015.1134808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background Recent epidemiologic data show that Denmark has considerably poorer survival from common cancers than Sweden. This may be related to a lower awareness of cancer symptoms and longer patient intervals in Denmark than in Sweden. The aims of this study were to: 1) compare population awareness of three possible symptoms of cancer (unexplained lump or swelling, unexplained bleeding and persistent cough or hoarseness); 2) compare anticipated patient interval when noticing any breast changes, rectal bleeding and persistent cough; and 3) examine whether potential differences were noticeable in particular age groups or at particular levels of education in a Danish and Swedish population sample. Method Data were derived from Module 2 of the International Cancer Benchmarking Partnership. Telephone interviews using the Awareness and Beliefs about Cancer measure were conducted in 2011 among 3000 adults in Denmark and 3070 adults in Sweden. Results Danish respondents reported a higher awareness of two of three symptoms (i.e. unexplained lump or swelling and persistent cough or hoarseness) and a shorter anticipated patient interval for two of three symptoms studied (i.e. any breast changes and rectal bleeding) than Swedish respondents. Differences in symptom awareness and anticipated patient interval between these countries were most pronounced in highly educated respondents. Conclusion Somewhat paradoxically, the highest awareness of symptoms of cancer and the shortest anticipated patient intervals were found in Denmark, where cancer survival is lower than in Sweden. Thus, it appears that these differences in symptom awareness and anticipated patient interval do not help explain the cancer survival disparity between Denmark and Sweden.
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Affiliation(s)
- Line Hvidberg
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark
- Section for General Medical Practice, Department of Public Health, Aarhus University, Denmark
| | - Magdalena Lagerlund
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, Sweden
| | - Anette F. Pedersen
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark
| | | | - Carol Tishelman
- Department of Learning, Informatics, Management and Ethics (LIME), Medical Management Center, Karolinska Institutet, Sweden
- Innovation Centre, Karolinska University Hospital, Sweden
| | - Peter Vedsted
- Research Centre for Cancer Diagnosis in Primary Care (CaP), Research Unit for General Practice, Department of Public Health, Aarhus University, Denmark
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Interorganisational Integration: Healthcare Professionals' Perspectives on Barriers and Facilitators within the Danish Healthcare System. Int J Integr Care 2016; 16:4. [PMID: 27616948 PMCID: PMC5015550 DOI: 10.5334/ijic.2449] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction: Despite many initiatives to improve coordination of
patient pathways and intersectoral cooperation, Danish health care is still
fragmented, lacking intra- and interorganisational integration. This study
explores barriers to and facilitators of interorganisational integration as
perceived by healthcare professionals caring for patients with chronic
obstructive pulmonary disease within the Danish healthcare system. Methods: Seven focus groups were conducted in January through July
2014 with 21 informants from general practice, local healthcare centres and a
pulmonary department at a university hospital in the Capital Region of
Denmark. Results and discussion: Our results can be grouped into five
influencing areas for interorganisational integration: communication/information
transfer, committed leadership, patient engagement, the role and competencies of
the general practitioner and organisational culture. Proposed solutions to
barriers in each area hold the potential to improve care integration as
experienced by individuals responsible for supporting and facilitating it.
Barriers and facilitators to integrating care relate to clinical, professional,
functional and normative integration. Especially, clinical, functional and
normative integration seems fundamental to developing integrated care in
practice from the perspective of healthcare professionals.
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dos Santos AM, Giovanella L. [Managing comprehensive care: a case study in a health district in Bahia State, Brazil]. CAD SAUDE PUBLICA 2016; 32:e00172214. [PMID: 27027458 DOI: 10.1590/0102-311x00172214] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 07/23/2015] [Indexed: 11/21/2022] Open
Abstract
This study analyzed management of comprehensive care in a health district in Bahia State, Brazil, at the political, institutional, organizational, and healthcare practice levels and the challenges for establishing coordinated care between municipalities. The information sources were semi-structured interviews with administrators, focal groups with healthcare professionals and users, institutional documents, and observations. A comprehensive and critical analysis was produced with dialectical hermeneutics as the reference. The results show that the Inter-Administrators Regional Commission was the main regional governance strategy. There is a fragmentation between various points and lack of communications linkage in the network. Private interests and partisan political interference overlook the formally agreed-upon flows and create parallel circuits, turning the right to health into currency for trading favors. Such issues hinder coordination of comprehensive care in the inter-municipal network.
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Affiliation(s)
- Adriano Maia dos Santos
- Instituto Multidisciplinar em Saúde, Universidade Federal da Bahia, Vitória da Conquista, Brazil
| | - Ligia Giovanella
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Pavlič DR, Sever M, Klemenc-Ketiš Z, Švab I. Process quality indicators in family medicine: results of an international comparison. BMC FAMILY PRACTICE 2015; 16:172. [PMID: 26631138 PMCID: PMC4667500 DOI: 10.1186/s12875-015-0386-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 11/20/2015] [Indexed: 11/29/2022]
Abstract
Background The aim of our study was to describe variability in process quality in family medicine among 31 European countries plus Australia, New Zealand, and Canada. The quality of family medicine was measured in terms of continuity, coordination, community orientation, and comprehensiveness of care. Methods The QUALICOPC study (Quality and Costs of Primary Care in Europe) was carried out among family physicians in 31 European countries (the EU 27 except for France, plus Macedonia, Iceland, Norway, Switzerland, and Turkey) and three non-European countries (Australia, Canada, and New Zealand). We used random sampling when national registers of practitioners were available. Regional registers or lists of facilities were used for some countries. A standardized questionnaire was distributed to the physicians, resulting in a sample of 6734 participants. Data collection took place between October 2011 and December 2013. Based on completed questionnaires, a three-dimensional framework was established to measure continuity, coordination, community orientation, and comprehensiveness of care. Multilevel linear regression analysis was performed to evaluate the variation of quality attributable to the family physician level and the country level. Results None of the 34 countries in this study consistently scored the best or worst in all categories. Continuity of care was perceived by family physicians as the most important dimension of quality. Some components of comprehensiveness of care, including medical technical procedures, preventive care and health care promotion, varied substantially between countries. Coordination of care was identified as the weakest part of quality. We found that physician-level characteristics contributed to the majority of variation. Conclusions A comparison of process quality indicators in family medicine revealed similarities and differences within and between countries. The researchers found that the major proportion of variation can be explained by physicians’ characteristics. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0386-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danica Rotar Pavlič
- Department of Family Medicine, University of Ljubljana, Medical Faculty, Poljanski nasip 58, 1000, Ljubljana, Slovenia.
| | - Maja Sever
- Statistical Office of the Republic of Slovenia, Litostrojska 54, 1000, Ljubljana, Slovenia.
| | - Zalika Klemenc-Ketiš
- Department of Family Medicine, University of Ljubljana, Medical Faculty, Poljanski nasip 58, 1000, Ljubljana, Slovenia. .,Department of Family Medicine, Medical Faculty, University of Maribor, Taborska 8, 2000, Maribor, Slovenia.
| | - Igor Švab
- Department of Family Medicine, University of Ljubljana, Medical Faculty, Poljanski nasip 58, 1000, Ljubljana, Slovenia.
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Guassora AD, Jarlbaek L, Thorsen T. Preparing general practitioners to receive cancer patients following treatment in secondary care: a qualitative study. BMC Health Serv Res 2015; 15:202. [PMID: 25982302 PMCID: PMC4451744 DOI: 10.1186/s12913-015-0856-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 05/05/2015] [Indexed: 11/11/2022] Open
Abstract
Background Many patients consider the interface between secondary and primary care difficult, and in particular, the transition of care between these different parts of the healthcare system presents problems. This interface has long been recognized as a critical point for quality of care. The purpose of our study is to formulate solutions to problems identified by cancer patients and healthcare professionals during the transition from hospital back to general practice on completion of primary treatment for cancer. Methods A qualitative study based on focus groups at a seminar for professionals in both primary and secondary healthcare. Participants discussed solutions to problems which had previously been identified in patient interviews and in focus groups with general practitioners (GPs), hospital doctors, and nursing staff. The data were analyzed using framework analysis. Results Solutions, endorsed by all groups at the seminar to improve transition back to general practice after primary treatment for cancer, were: 1) To add nurses’ discharge letters addressing psychosocial matters to medical discharge letters; 2) To send medical discharge letters earlier from some hospital departments to GPs; 3) To provide plans and future affiliations for patients when they leave a department, and 4) To arrange a return visit to general practice dedicated to discussion of the patients’ cancer disease and the treatment experience. Conclusions The transition of care of cancer patients appears too complex to be coordinated by administrative standards alone. We recommend that healthcare professionals are more engaged and present in the coordination of care across organizational boundaries.
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Affiliation(s)
- Ann Dorrit Guassora
- The Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, 5, Øster Farimagsgade, Postbox 2099, , 1014, Copenhagen K, Denmark.
| | - Lene Jarlbaek
- PAVI, Knowledge Center for Rehabilitation and Palliative Care, National Institute of Public Health, University of Southern Denmark, 5A, Øster Farimagsgade 5A, 2nd floor, 1353, Copenhagen, Denmark.
| | - Thorkil Thorsen
- The Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen, 5, Øster Farimagsgade, Postbox 2099, , 1014, Copenhagen K, Denmark.
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Patient-centered handovers between hospital and primary health care: An assessment of medical records. Int J Med Inform 2015; 84:355-62. [DOI: 10.1016/j.ijmedinf.2015.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 11/21/2022]
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Health care agreements as a tool for coordinating health and social services. Int J Integr Care 2014; 14:e036. [PMID: 25550691 PMCID: PMC4276032 DOI: 10.5334/ijic.1452] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 10/29/2014] [Accepted: 11/06/2014] [Indexed: 11/26/2022] Open
Abstract
Introduction In 2007, a substantial reform changed the administrative boundaries of the Danish health care system and introduced health care agreements to be signed between municipal and regional authorities. To assess the health care agreements as a tool for coordinating health and social services, a survey was conducted before (2005–2006) and after the reform (2011). Theory and methods The study was designed on the basis of a modified version of Alter and Hage's framework for conceptualising coordination. Both surveys addressed all municipal level units (n = 271/98) and a random sample of general practitioners (n = 700/853). Results The health care agreements were considered more useful for coordinating care than the previous health plans. The power relationship between the regional and municipal authorities in drawing up the agreements was described as more equal. Familiarity with the agreements among general practitioners was higher, as was the perceived influence of the health care agreements on their work. Discussion Health care agreements with specific content and with regular follow-up and systematic mechanisms for organising feedback between collaborative partners exemplify a useful tool for the coordination of health and social services. Conclusion There are substantial improvements with the new health agreements in terms of formalising a better coordination of the health care system.
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Lid TG, Oppedal K, Pedersen B, Malterud K. Alcohol-related hospital admissions: missed opportunities for follow up? A focus group study about general practitioners' experiences. Scand J Public Health 2012; 40:531-6. [PMID: 22899559 DOI: 10.1177/1403494812456636] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS To explore general practitioners' (GPs') follow-up experiences with patients discharged from hospital after admittance for alcohol-related somatic conditions. DESIGN AND PARTICIPANTS Two focus groups with GPs (four women and 10 men), calling for stories about whether the intervention given in the hospital had been recognised by the GP and how this knowledge affected their follow up of the patient's alcohol problem. Systematic text condensation was applied for analysis. FINDINGS A majority of the GPs had experienced patients with already recognised alcohol problems being rediscovered by the hospital staff. Still, they presented examples of how seeing the patient in a different context might present new opportunities. Few participants had received adequate information from the hospital about their patient's alcohol status, and they emphasised that a report about what had happened and what was planned was needed for follow up. Care pathways for patients with alcohol problems were seen as fragmented. Yet they described how alcohol-related hospital admissions might function as an eye-opener for the patient and a window of opportunity for lifestyle change. CONCLUSIONS Hospital admittances provide important opportunities for change, but hospital care is seen as fragmented and poorly communicated to the GPs. For shared responsibility and follow up, all participating agents, including the patient, must be sufficiently informed about what has happened and what will follow. For the patient, hospital admittance is usually brief, while the relationship with their GP is long term, even lifelong. GPs are therefore key partners for programme development.
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Affiliation(s)
- Torgeir Gilje Lid
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
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Romøren TI, Torjesen DO, Landmark B. Promoting coordination in Norwegian health care. Int J Integr Care 2011; 11:e127. [PMID: 22128282 PMCID: PMC3226017 DOI: 10.5334/ijic.581] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2010] [Revised: 06/26/2011] [Accepted: 07/19/2011] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION The Norwegian health care system is well organized within its two main sectors-primary health and long-term care on the one hand, and hospitals and specialist services on the other. However, the relation between them lacks mediating structures. POLICY PRACTICE Enhancing coordination between primary and secondary health care has been central in Norwegian health care policy in the last decade. In 2003 a committee was appointed to identify coordination problems and proposed a lot of practical and organisational recommendations. It relied on an approach challenging primary and secondary health care in shared geographical regions to take action. However, these proposals were not implemented. In 2008 a new Minister of Health and Care worked out plans under the key term "Coordination Reform". These reform plans superseded and expanded the previous policy initiatives concerning cooperation, but represented also a shift in focus to a regulative and centralised strategy, including new health legislation, structural reforms and use of economic incentives that are now about to be implemented. DISCUSSION The article analyses the perspectives and proposals of the previous and the recent reform initiatives in Norway and discusses them in relation to integrated care measures implemented in Denmark and Sweden.
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Affiliation(s)
- Tor Inge Romøren
- Centre for Care Research, Gjøvik University College, Teknologiveien 22, 2802 Gjøvik, Norway
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Integration of healthcare rehabilitation in chronic conditions. Int J Integr Care 2010; 10:e033. [PMID: 20216953 PMCID: PMC2834924 DOI: 10.5334/ijic.507] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2009] [Revised: 11/27/2009] [Accepted: 12/09/2009] [Indexed: 11/20/2022] Open
Abstract
Introduction Quality of care provided to people with chronic conditions does not often fulfil standards of care in Denmark and in other countries. Inadequate organisation of healthcare systems has been identified as one of the most important causes for observed performance inadequacies, and providing integrated healthcare has been identified as an important organisational challenge for healthcare systems. Three entities—Bispebjerg University Hospital, the City of Copenhagen, and the GPs in Copenhagen—collaborated on a quality improvement project focusing on integration and implementation of rehabilitation programmes in four conditions. Description of care practice Four multidisciplinary rehabilitation intervention programmes, one for each chronic condition: chronic obstructive pulmonary disease, type 2 diabetes, chronic heart failure, and falls in elderly people were developed and implemented during the project period. The chronic care model was used as a framework for support of implementing and integration of the four rehabilitation programmes. Conclusion and discussion The chronic care model provided support for implementing rehabilitation programmes for four chronic conditions in Bispebjerg University Hospital, the City of Copenhagen, and GPs' offices. New management practices were developed, known practices were improved to support integration, and known practices were used for implementation purposes. Several barriers to integrated care were identified.
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