1
|
Aggarwal M, Hutchison B, Kokorelias KM, Mehta K, Greenberg L, Moran K, Barber D, Samson K. Impact of remuneration, extrinsic and intrinsic incentives on interprofessional primary care teams: protocol for a rapid scoping review. BMJ Open 2023; 13:e072076. [PMID: 37336539 DOI: 10.1136/bmjopen-2023-072076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
INTRODUCTION Interprofessional teams and funding and payment provider arrangements are key attributes of high-performing primary care. Several Canadian jurisdictions have introduced team-based models with different payment models. Despite these investments, the evidence of impact is mixed. This has raised questions about whether team-based primary care models are being implemented to facilitate team collaboration and effectiveness. Thus, we present a protocol for a rapid scoping review to systematically map, synthesise and summarise the existing literature on the impact of provider remuneration mechanisms and extrinsic and intrinsic incentives in team-based primary care. This review will answer three research questions: (1) What is the impact of provider remuneration models on team, patient, provider and system outcomes in primary care?; (2) What extrinsic and intrinsic incentives have been used in interprofessional primary care teams?; and (3) What is the impact of extrinsic and intrinsic team-based incentives on team, patient, provider and system outcomes? METHODS AND ANALYSIS We will conduct a rapid scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews guidelines. We will search electronic databases (Medline, Embase, CINAHL, PsycINFO, EconLit) and grey literature sources (Google Scholar, Google). This review will consider all empirical studies and full-text English-language articles published between 2000 and 2022. Reviewers will independently perform the literature search, data extraction and synthesis of included studies. The Mixed Methods Appraisal Tool will be used to appraise the quality of evidence. The literature will be synthesised, summarised and mapped to themes that answer the research question of this review. ETHICS AND DISSEMINATION Ethics approval is not required. Findings from this study will be written for publication in an open-access peer-review journal and presented at national and international conferences. Knowledge users are part of the research team and will assist with disseminating findings to the public, clinicians, funders and professional associations.
Collapse
Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Brian Hutchison
- Department of Family Medicine, Health Research Methods, Evidence, and Impact, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Kristina Marie Kokorelias
- Department of Geriatric Medicine, Sinai Health and University Health Network, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute and Department of Occupational Therapy and Occupational Sciences, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Kavita Mehta
- Association of Family Health Teams of Ontario, Toronto, Ontario, Canada
| | | | - Kimberly Moran
- Ontario College of Family Physicians, Toronto, Ontario, Canada
| | - David Barber
- Department of Family Medicine, Queen's University, Kingston, Ontario, Canada
| | - Kevin Samson
- East Wellington Family Health Team, Erin/Rockwood, Ontario, Canada
| |
Collapse
|
2
|
Breton M, Gaboury I, Beaulieu C, Sasseville M, Hudon C, Malham SA, Maillet L, Duhoux A, Rodrigues I, Haggerty J. Revising the advanced access model pillars: a multimethod study. CMAJ Open 2022; 10:E799-E806. [PMID: 36199244 PMCID: PMC9477472 DOI: 10.9778/cmajo.20210314] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The advanced access model was developed 20 years ago and has been implemented in several countries. We aimed to revise and operationalize the pillars and subpillars of the advanced access model based on its contemporary practice by professionals in primary health care. METHODS This multimethod sequential study was informed by a literature review and an expert panel of provincial and local decision-makers, primary health care clinic members (family physicians, nurses and administrative staff), patients and researchers from the province of Quebec. Throughout the consultation process, participants were asked to develop a common vision of the pillars and subpillars that make up the advanced access model and to react to suggested definitions or content. RESULTS The revised advanced access model is defined by 5 pillars, of which 2 were updated from the original model ("Appointment system" and "Interprofessional practice"), 1 was merged with a revised pillar ("Develop contingency plans" with "Planning of needs and supply") and 1 underwent major transformations ("Backlog reduction" to "Continuous adjustment"). A new pillar concerning communication emerged from the consultation process. Subsequent steps for operationalizing definitions of subpillars confirmed the nature of the revised advanced access pillars and stabilized their content. INTERPRETATION The overall consultation process resulted in a revised contemporary advanced access model, with strong consensus among participating experts. The revised model will be used to develop a reflective tool for primary health care professionals to evaluate their advanced access practice.
Collapse
Affiliation(s)
- Mylaine Breton
- Faculty of Medicine and Health Sciences (Breton, Gaboury, Beaulieu, Hudon, Malham), Université de Sherbrooke, Longueuil, Que.; Faculty of Nursing (Sasseville), Université Laval, Québec, Que.; Centre de recherche du CHUS (Hudon), Sherbrooke, Que.; Faculty of Medicine (Rodrigues), Université de Montréal; École nationale d'administration publique (Maillet), Montréal, Que.; Faculty of Nursing (Duhoux), Université de Montréal; Faculty of Medicine and Health Sciences (Haggerty), McGill University, Montréal, Que.
| | - Isabelle Gaboury
- Faculty of Medicine and Health Sciences (Breton, Gaboury, Beaulieu, Hudon, Malham), Université de Sherbrooke, Longueuil, Que.; Faculty of Nursing (Sasseville), Université Laval, Québec, Que.; Centre de recherche du CHUS (Hudon), Sherbrooke, Que.; Faculty of Medicine (Rodrigues), Université de Montréal; École nationale d'administration publique (Maillet), Montréal, Que.; Faculty of Nursing (Duhoux), Université de Montréal; Faculty of Medicine and Health Sciences (Haggerty), McGill University, Montréal, Que
| | - Christine Beaulieu
- Faculty of Medicine and Health Sciences (Breton, Gaboury, Beaulieu, Hudon, Malham), Université de Sherbrooke, Longueuil, Que.; Faculty of Nursing (Sasseville), Université Laval, Québec, Que.; Centre de recherche du CHUS (Hudon), Sherbrooke, Que.; Faculty of Medicine (Rodrigues), Université de Montréal; École nationale d'administration publique (Maillet), Montréal, Que.; Faculty of Nursing (Duhoux), Université de Montréal; Faculty of Medicine and Health Sciences (Haggerty), McGill University, Montréal, Que
| | - Maxime Sasseville
- Faculty of Medicine and Health Sciences (Breton, Gaboury, Beaulieu, Hudon, Malham), Université de Sherbrooke, Longueuil, Que.; Faculty of Nursing (Sasseville), Université Laval, Québec, Que.; Centre de recherche du CHUS (Hudon), Sherbrooke, Que.; Faculty of Medicine (Rodrigues), Université de Montréal; École nationale d'administration publique (Maillet), Montréal, Que.; Faculty of Nursing (Duhoux), Université de Montréal; Faculty of Medicine and Health Sciences (Haggerty), McGill University, Montréal, Que
| | - Catherine Hudon
- Faculty of Medicine and Health Sciences (Breton, Gaboury, Beaulieu, Hudon, Malham), Université de Sherbrooke, Longueuil, Que.; Faculty of Nursing (Sasseville), Université Laval, Québec, Que.; Centre de recherche du CHUS (Hudon), Sherbrooke, Que.; Faculty of Medicine (Rodrigues), Université de Montréal; École nationale d'administration publique (Maillet), Montréal, Que.; Faculty of Nursing (Duhoux), Université de Montréal; Faculty of Medicine and Health Sciences (Haggerty), McGill University, Montréal, Que
| | - Sabina Abou Malham
- Faculty of Medicine and Health Sciences (Breton, Gaboury, Beaulieu, Hudon, Malham), Université de Sherbrooke, Longueuil, Que.; Faculty of Nursing (Sasseville), Université Laval, Québec, Que.; Centre de recherche du CHUS (Hudon), Sherbrooke, Que.; Faculty of Medicine (Rodrigues), Université de Montréal; École nationale d'administration publique (Maillet), Montréal, Que.; Faculty of Nursing (Duhoux), Université de Montréal; Faculty of Medicine and Health Sciences (Haggerty), McGill University, Montréal, Que
| | - Lara Maillet
- Faculty of Medicine and Health Sciences (Breton, Gaboury, Beaulieu, Hudon, Malham), Université de Sherbrooke, Longueuil, Que.; Faculty of Nursing (Sasseville), Université Laval, Québec, Que.; Centre de recherche du CHUS (Hudon), Sherbrooke, Que.; Faculty of Medicine (Rodrigues), Université de Montréal; École nationale d'administration publique (Maillet), Montréal, Que.; Faculty of Nursing (Duhoux), Université de Montréal; Faculty of Medicine and Health Sciences (Haggerty), McGill University, Montréal, Que
| | - Arnaud Duhoux
- Faculty of Medicine and Health Sciences (Breton, Gaboury, Beaulieu, Hudon, Malham), Université de Sherbrooke, Longueuil, Que.; Faculty of Nursing (Sasseville), Université Laval, Québec, Que.; Centre de recherche du CHUS (Hudon), Sherbrooke, Que.; Faculty of Medicine (Rodrigues), Université de Montréal; École nationale d'administration publique (Maillet), Montréal, Que.; Faculty of Nursing (Duhoux), Université de Montréal; Faculty of Medicine and Health Sciences (Haggerty), McGill University, Montréal, Que
| | - Isabel Rodrigues
- Faculty of Medicine and Health Sciences (Breton, Gaboury, Beaulieu, Hudon, Malham), Université de Sherbrooke, Longueuil, Que.; Faculty of Nursing (Sasseville), Université Laval, Québec, Que.; Centre de recherche du CHUS (Hudon), Sherbrooke, Que.; Faculty of Medicine (Rodrigues), Université de Montréal; École nationale d'administration publique (Maillet), Montréal, Que.; Faculty of Nursing (Duhoux), Université de Montréal; Faculty of Medicine and Health Sciences (Haggerty), McGill University, Montréal, Que
| | - Jeannie Haggerty
- Faculty of Medicine and Health Sciences (Breton, Gaboury, Beaulieu, Hudon, Malham), Université de Sherbrooke, Longueuil, Que.; Faculty of Nursing (Sasseville), Université Laval, Québec, Que.; Centre de recherche du CHUS (Hudon), Sherbrooke, Que.; Faculty of Medicine (Rodrigues), Université de Montréal; École nationale d'administration publique (Maillet), Montréal, Que.; Faculty of Nursing (Duhoux), Université de Montréal; Faculty of Medicine and Health Sciences (Haggerty), McGill University, Montréal, Que
| |
Collapse
|
3
|
Toloo GS, Lim D, Chu K, Kinnear FB, Morel DG, Wraith D, FitzGerald G. Acceptability of emergency department triage nurse's advice for patients to attend general practice: A cross-sectional survey. Emerg Med Australas 2021; 34:376-384. [PMID: 34788904 DOI: 10.1111/1742-6723.13903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/26/2021] [Accepted: 10/26/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Demand for ED care is increasing at a rate higher than population growth. Strategies to attenuate ED demands include diverting low-acuity general practice-type ED attendees to alternate primary healthcare settings. The present study assessed the ED attendees' receptiveness to accept triage nurse's face-to-face advice to explore alternate options for medical care and what factors influence the level of acceptance. METHODS The ED attendees of four major public hospital EDs in Brisbane were surveyed between August and October 2018, using a questionnaire informed by Health Belief Model's cues to action. RESULTS Of the 514 valid responses, 81% of respondents were very likely/likely to accept the triage nurse's advice to see a general practitioner. Self-perceived urgency of presenting condition/s (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.78-0.97), not having confidence in general practitioner (OR 0.37, 95% CI 0.21-0.66) and having a medical record at the hospital (OR 0.60, 95% CI 0.36-0.99) were negatively associated with the likelihood of accepting the advice. For every point increase in perceived seriousness, the odds of accepting the advice decreased by 16% (95% CI 6-25%). CONCLUSION Most of the participants believed that EDs were for emergent care and they attended the ED because they perceived their presenting condition/s to be serious and/or urgent. The acceptability of face-to-face advice by triage nurse to seek help in general practice was influenced by perceived threats of the illness, and the underlying beliefs about availability, accessibility, suitability and affordability of the service.
Collapse
Affiliation(s)
- Ghasem Sam Toloo
- School of Public Health and Social Work, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Lim
- School of Health Sciences, Western Sydney University, Sydney, New South Wales, Australia.,College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Kevin Chu
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Frances B Kinnear
- Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Emergency Medicine and Children's Service, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Douglas G Morel
- Emergency Department, Redcliffe Hospital, Brisbane, Queensland, Australia
| | - Darren Wraith
- School of Public Health and Social Work, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Gerry FitzGerald
- School of Public Health and Social Work, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Queensland, Australia
| |
Collapse
|
4
|
Lehto M, Mustonen K, Raina M, Kauppila T. Differences between recorded diagnoses of patients of an emergency department and office-hours primary care doctors: a register-based study in a Finnish town. Int J Circumpolar Health 2021; 80:1935593. [PMID: 34077332 PMCID: PMC8174484 DOI: 10.1080/22423982.2021.1935593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
To determine the extent to which it is possible to provide continuity of primary care for those who visit Emergency Departments (EDs) we studied how recorded diagnoses in primary care differ, depending on whether the patient is met in an ED or a primary care office-hours practice. In the present, 12-year follow-up study a report generator of the Electronic Health Record-system provided monthly figures for the number of different recorded diagnoses using the International Classification of Diagnoses (10thedition, ICD-10) and the total number of ED doctors and office-hour visits to General Practitioners (GPs). The 20 most common diagnoses covered 48.1% of the visits with recorded diagnoses to the office hour GPs and 45.9% of the visits to the doctors of the ED. Of these 20 diagnoses, 10 were common in both systems. These 10 diagnoses constituted about 30% of the diagnoses given by ED doctors. Furthermore, five out of the six most common diagnoses were the same in the ED and office-hours practices. The doctors in EDs and office-hour GPs treat quite similar patient material. This may provide organisational ways to reorganise the work of primary care and to guarantee continuity of care for those who may benefit from it.
Collapse
Affiliation(s)
- Mika Lehto
- City of Vantaa, Vantaa, Finland.,Department of General Practice, University of Helsinki, Helsinki, Finland
| | - Katri Mustonen
- Department of General Practice, University of Helsinki, Helsinki, Finland
| | | | - Timo Kauppila
- Department of General Practice, University of Helsinki, Helsinki, Finland.,Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki, Helsinki, Finland.,Department of General Practice, University of Tampere, Tampere, Finland
| |
Collapse
|