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Divekar O, Kumar A, Divekar N, Kanegaonkar R. Cost Awareness of Anaesthetic Consumable Items Among the National Health Service (NHS) Staff and the Financial Impact on the NHS. Cureus 2024; 16:e63906. [PMID: 39099919 PMCID: PMC11298211 DOI: 10.7759/cureus.63906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
Background The financial burden of running the National Health Service (NHS) is high. Staff members should be aware of the cost of the equipment they use to enable efficient use of resources, reduce waste, and control spending. However, limited financial education at undergraduate and junior stages has contributed to relatively poor knowledge among healthcare workers at all levels. Anaesthetics is a speciality which uses a large amount of equipment; therefore, we aim to assess the cost awareness among staff for commonly used consumables. Furthermore, we aim to assess staff members' attitudes towards the financial and environmental impact of the equipment they use and whether this would change their practice. Methodology An electronic survey was sent to staff members from the anaesthetic department of the Medway NHS Foundation Trust during a one-month period. Respondents were asked to estimate the cost of 19 commonly used anaesthetic consumables, with an estimate categorised as correct if it was within 20% of the actual cost. At the end of the survey, there were five questions for respondents to answer regarding the financial and environmental impact of their current healthcare practice and possible alternatives. Results There were 69 respondents within the anaesthetic department from a variety of roles. Overall, only 9.37% of items were estimated correctly, with cheaper items commonly being overestimated and more expensive items being underestimated. Overall, 60% of respondents said the cost of an item would influence their use. The overwhelming majority claimed that the environmental impact was a concern, and most would favour recyclable/reusable alternatives. Conclusions Cost awareness among anaesthetic staff for commonly used equipment is poor. More education and training are necessary in this area as limited knowledge of service costs restricts the ability to make cost-efficient choices which are needed in the current NHS.
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Affiliation(s)
- Omkaar Divekar
- Trauma and Orthopaedics, St. George's University, London, GBR
| | - Abhinav Kumar
- Respiratory Medicine, Wrightington, Wigan and Leigh National Health Service (NHS) Foundation Trust, Manchester, GBR
| | | | - Rahul Kanegaonkar
- Ear, Nose & Throat, Canterbury Christ Church University, Canterbury, GBR
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King D, Gronholm PC, Knapp M, Hoffmann MS, Bonin EM, Brimblecombe N, Kadel R, Maughan B, O'Shea N, Richards M, Hoomans T, Evans-Lacko S. Effects of mental health status during adolescence on primary care costs in adulthood across three British cohorts. Soc Psychiatry Psychiatr Epidemiol 2024; 59:917-928. [PMID: 37358606 PMCID: PMC11116205 DOI: 10.1007/s00127-023-02507-y] [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: 03/29/2023] [Accepted: 05/25/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE This study examines the association between mental health problems in adolescence and general practice (GP) costs during adulthood up to age 50 in the UK. METHODS We conducted secondary analyses of three British birth cohorts (individuals born in single weeks in 1946, 1958 and 1970). Data for the three cohorts were analysed separately. All respondents who participated in the cohort studies were included. Adolescent mental health status was assessed in each cohort using the Rutter scale (or, for one cohort, a forerunner of that scale) completed in interviews with parents and teachers when cohort members were aged around 16. Presence and severity of conduct and emotional problems were modelled as independent variables in two-part regression models in which the dependent variable was costs of GP services from data collection sweeps up to mid-adulthood. All analyses were adjusted for covariates (cognitive ability, mother's education, housing tenure, father's social class and childhood physical disability). RESULTS Adolescent conduct and emotional problems, particularly when coexisting, were associated with relatively high GP costs in adulthood up to age 50. Associations were generally stronger in females than males. CONCLUSION Associations between adolescent mental health problems and annual GP cost were evident decades later, to age 50, suggesting that there could be significant future savings to healthcare budgets if rates of adolescent conduct and emotional problems could be reduced. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Derek King
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK.
| | - Petra C Gronholm
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Martin Knapp
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Mauricio S Hoffmann
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
- Department of Neuropsychiatry, Universidade Federal de Santa Maria, Avenida Roraima 1000, Building 26, Office 1446, Santa Maria, Brazil
- Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, Porto Alegre, Brazil
| | - Eva-Maria Bonin
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Nicola Brimblecombe
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Rajendra Kadel
- Public Health Wales, Policy and International Health Directorate, WHO CC on Investment for Health and Wellbeing, Cardiff, UK
| | - Barbara Maughan
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Nick O'Shea
- Chief Economist, Centre for Mental Health, London, UK
| | - Marcus Richards
- MRC Unit for Lifelong Health and Ageing at UCL, University College London, London, UK
| | - Ties Hoomans
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
| | - Sara Evans-Lacko
- Care Policy and Evaluation Centre, London School of Economics and Political Science, London, UK
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Luo D, Zhu X, Qiu X, Zhao J, Li X, Du Y. Healthcare preferences of chronic disease patients under China's hierarchical medical system: an empirical study of Tianjin's reform practice. Sci Rep 2024; 14:11631. [PMID: 38773132 PMCID: PMC11109171 DOI: 10.1038/s41598-024-62118-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/14/2024] [Indexed: 05/23/2024] Open
Abstract
To alleviate the contradiction in healthcare resources, the Chinese government formally established the framework of a hierarchical medical system in 2015, which contains the following brief generalities: " separate treatment of emergencies and slows, first-contact care at the primary, two-way referral, and upper and lower linkage, ". This study systematically summarizes and models the connotations of China's hierarchical medical system and a sample of 11,200 chronic disease patients in Tianjin, the largest port city in northern China, was selected for the empirical study to investigate the relationship between chronic disease patients' policy perceptions of the hierarchical medical system and their preference for healthcare. We found that under the strategy of separate treatment, improving the healthcare accessibility, drug supply, and lowering the cost of medical care would have a positive impact on increasing the preference of patients with chronic diseases to go to the primary hospitals. Under the two-way triage strategy, improving the level of physician services, referral convenience and treatment Standards have a positive impact on chronic disease patients' preference for primary care; The impact of the hierarchical medical system on the preference for healthcare differed between groups, focusing on differences in health literacy level, age and household type; The role of " upper and lower linkage " is crucial in the hierarchical medical system and it plays a part in mediating the influence of the " separate treatment of emergencies and slows" design and the "two-way referral " order on the treatment preferences of chronic disease patients. The results of the study provide a reference for the further development of a scientific and rational hierarchical medical system in the future.
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Affiliation(s)
- Da Luo
- Tianjin Key Laboratory of Cerebral Vascular and Neurodegenerative Diseases, Clinical College of Neurology, Neurosurgery and Neurorehabilitation, Tianjin Medical University, Tianjin Neurosurgical Institute, Tianjin Huanhu Hospital, Tianjin, 300350, China
- Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Xumin Zhu
- School of Economics and Management, Tiangong University, Tianjin, 300387, China
| | - Xinyu Qiu
- Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
| | - Jing Zhao
- Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China
- Tianjin Municipal Health Commission, Tianjin, 300070, China
| | - Xiangfei Li
- School of Economics and Management, Tiangong University, Tianjin, 300387, China.
| | - Yue Du
- Department of Social Medicine and Health Management, School of Public Health, Tianjin Medical University, Tianjin, 300070, China.
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Piscopo J, Groot W, Pavlova M. Determinants of public health expenditure in the EU. PLoS One 2024; 19:e0299359. [PMID: 38446804 PMCID: PMC10917289 DOI: 10.1371/journal.pone.0299359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Public health expenditure is one of the fastest-growing spending items in EU member states. As the population ages and wealth increases, governments allocate more resources to their health systems. In view of this, the aim of this study is to identify the key determinants of public health expenditure in the EU member states. METHODS This study is based on macro-level EU panel data covering the period from 2000 to 2018. The association between explanatory variables and public health expenditure is analyzed by applying both static and dynamic econometric modeling. RESULTS Although GDP and out-of-pocket health expenditure are identified as the key drivers of public health expenditure, there are other variables, such as health system characteristics, with a statistically significant association with expenditure. Other variables, such as election year and the level of public debt, result to exert only a modest influence on the level of public health expenditure. Results also indicate that the aging of the population, political ideologies of governments and citizens' expectations, appear to be statistically insignificant. CONCLUSION Since increases in public health expenditure in EU member states are mainly triggered by GDP increases, it is expected that differences in PHE per capita across member states will persist and, consequently, making it more difficult to attain the health equity sustainable development goal. Thus, measures to reduce EU economic inequalities, will ultimately result in reducing disparities in public health expenditures across member states.
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Affiliation(s)
- Joseph Piscopo
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Wim Groot
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
| | - Milena Pavlova
- Faculty of Health, Medicine and Life Sciences, Department of Health Services Research, CAPHRI, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands
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Kim AM, Lee JS. Factors Affecting the Preference for Hospitals Over Clinics in Primary Care in Korea. J Korean Med Sci 2024; 39:e10. [PMID: 38225783 PMCID: PMC10789526 DOI: 10.3346/jkms.2024.39.e10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 10/24/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND While the effect of gatekeeping was extensively studied, few efforts have been made to explain why the measures to strengthen gatekeeping do not work well in some countries. This study examined the patient factors related to the choice of level of health care facilities for outpatient care in Korea. METHODS We examined a population-based sample representative of the population of Korea aged 15 and over in the healthcare experience survey of 2021. A logistic regression model examined the factors associated with choosing hospitals or clinics for outpatient care. RESULTS Easy accessibility, kindness of medical staff, and recommendations from acquaintances were considered more important for those who chose clinics over hospitals. While those who chose clinics were more likely to feel that physicians and nurses more readily communicated with patients, those who chose hospitals were more likely to feel that the facility was comfortable. Whereas those who chose hospitals were more likely to trust the current health care system in Korea, those who chose clinics were more likely to think that the health care system needed to be reformed. The tendency was similar when analyzed only among those with good perceived health conditions and without chronic diseases. CONCLUSION This study demonstrates that the preference for hospitals over clinics is mainly based on desire rather than medical need and is not likely to be affected by measures intended to induce a voluntary change of behavior.
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Affiliation(s)
- Agnus M Kim
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
| | - Jin-Seok Lee
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul, Korea
- Institute of Health Policy and Management, Medical Research Center, Seoul National University, Seoul, Korea.
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Antonazzo IC, Rozza D, Conti S, Fornari C, Cortesi PA, Eteve‐Pitsaer C, Paris C, Gantzer L, Valentine D, Mantovani LG, Mazzaglia G. Treatment patterns in essential tremor: Real-world evidence from a United Kingdom and France primary care database. Eur J Neurol 2024; 31:e16064. [PMID: 37738526 PMCID: PMC11235796 DOI: 10.1111/ene.16064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/28/2023] [Accepted: 08/31/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND AND PURPOSE Essential tremor (ET) is one of the most common neurological disorders, but information on treatment pattern is still scant. The aim of this study was to describe the demographic and clinical characteristics, treatment patterns, and determinants of drug use in patients with newly diagnosed ET in France and the United Kingdom. METHODS Incident cases of ET diagnosed between January 1, 2015 and December 31, 2018 with 2 years of follow-up were identified by using The Health Improvement Network (THIN®) general practice database. During the follow-up, we assessed the daily prevalence of use and potential switches from first-line to second-line treatment or other lines of treatment. Logistic regression models were conducted to assess the effect of demographic and clinical characteristics on the likelihood of receiving ET treatment. RESULTS A total of 2957 and 3249 patients were selected in the United Kingdom and France, respectively. Among ET patients, drug use increased from 12 months to 1 month prior the date of index diagnosis (ID). After ID, nearly 40% of patients received at least one ET treatment, but during follow-up drug use decreased and at the end of the follow-up approximately 20% of patients were still on treatment. Among treated patients, ≤10% maintained the same treatment throughout the entire follow-up, nearly 20% switched, and 40%-75% interrupted any treatment. Results from the multivariate analysis revealed that, both in France and the United Kingdom, patients receiving multiple concomitant therapies and affected by psychiatric conditions were more likely to receive an ET medication. CONCLUSION This study shows that ET is an undertreated disease with a lower-than-expected number of patients receiving and maintaining pharmacological treatment. Misclassification of ET diagnosis should be acknowledged; thus, results require cautious interpretation.
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Affiliation(s)
- Ippazio Cosimo Antonazzo
- Research Centre on Public Health (CESP)University of Milano‐BicoccaMonzaItaly
- Unit of Medical Statistics, Department of Clinical and Experimental MedicineUniversity of PisaPisaItaly
| | - Davide Rozza
- Research Centre on Public Health (CESP)University of Milano‐BicoccaMonzaItaly
| | - Sara Conti
- Research Centre on Public Health (CESP)University of Milano‐BicoccaMonzaItaly
| | - Carla Fornari
- Research Centre on Public Health (CESP)University of Milano‐BicoccaMonzaItaly
| | | | | | | | | | | | | | - Giampiero Mazzaglia
- Research Centre on Public Health (CESP)University of Milano‐BicoccaMonzaItaly
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Blinkenberg J, Hetlevik Ø, Sandvik H, Baste V, Hunskaar S. The impact of variation in out-of-hours doctors' referral practices: a Norwegian registry-based observational study. Fam Pract 2023; 40:728-736. [PMID: 36801994 PMCID: PMC10745277 DOI: 10.1093/fampra/cmad014] [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] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND In a gatekeeping system, the individual doctor's referral practice is an important factor for hospital activity and patient safety. OBJECTIVE The aim of the study was to investigate the variation in out-of-hours (OOH) doctors' referral practice, and to explore these variations' impact on admissions for selected diagnoses reflecting severity, and 30-day mortality. METHODS National data from the doctors' claims database were linked with hospital data in the Norwegian Patient Registry. Based on the doctor's individual referral rate adjusted for local organizational factors, the doctors were sorted into quartiles of low-, medium-low-, medium-high-, and high-referral practice. The relative risk (RR) for all referrals and for selected discharge diagnoses was calculated using generalized linear models. RESULTS The OOH doctors' mean referral rate was 110 referrals per 1,000 consultations. Patients seeing a doctor in the highest referring practice quartile had higher likelihood of being referred to hospital and diagnosed with the symptom of pain in throat and chest, abdominal pain, and dizziness compared with the medium-low quartile (RR 1.63, 1.49, and 1.95). For the critical conditions of acute myocardial infarction, acute appendicitis, pulmonary embolism, and stroke, we found a similar, but weaker, association (RR 1.38, 1.32, 1.24, and 1.19). The 30-day mortality among patients not referred did not differ between the quartiles. CONCLUSIONS Doctors with high-referral practice referred more patients who were later discharged with all types of diagnoses, including serious and critical conditions. With low-referral practice, severe conditions might have been overlooked, although the 30-day mortality was not affected.
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Affiliation(s)
- Jesper Blinkenberg
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Årstadveien 17, 5009 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009 Bergen, Norway
| | - Øystein Hetlevik
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009 Bergen, Norway
| | - Hogne Sandvik
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Årstadveien 17, 5009 Bergen, Norway
| | - Valborg Baste
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Årstadveien 17, 5009 Bergen, Norway
| | - Steinar Hunskaar
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Årstadveien 17, 5009 Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 17, 5009 Bergen, Norway
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Verhoeven C, Claessens Z, Lubeek SFK, Schers HJ. Needs and challenges among general practitioners in the management of actinic keratosis: a qualitative study. BMC PRIMARY CARE 2023; 24:260. [PMID: 38042808 PMCID: PMC10693056 DOI: 10.1186/s12875-023-02202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/07/2023] [Indexed: 12/04/2023]
Abstract
BACKGROUND Because of the increasing incidence of actinic keratosis (AK), optimal use of limited healthcare resources is essential. Although most patients can be managed in primary care, dermatology referrals are common. More profound knowledge of general practitioners' (GPs) considerations might assist in enhancing AK care. METHODS The aim of the current study was to gain insight into AK management in primary care by exploring the needs and challenges among GPs in the Netherlands. A qualitative study was conducted based on semi-structured in-depth interviews with 15 conveniently sampled Dutch GPs, focusing on the needs and challenges in AK management. A literature-informed, predefined topic list guided the interviews, which were recorded, transcribed ad verbatim, and thematically analysed using the Framework Method. RESULTS All GPs reported AK to be a clinical diagnosis and most GPs indicated that most AK patients could be managed in primary care. Cryotherapy was preferred and experience with 5-FU therapy was limited. Most GPs applied cryotherapy without discussing other treatment options with patients. Reasons for dermatology referrals included an incomplete treatment response, extensive lesions, difficult-to-treat areas, and serious doubts about the diagnosis. GPs reported a need for more education, especially on 5-FU therapy. Their main challenges were dealing with diagnostic uncertainty, treating extensive lesions, managing treatment-related skin reactions, and reconciling patient misconceptions. CONCLUSIONS This study shows various AK management approaches among Dutch GPs with suboptimal guideline compliance due to diverse underlying barriers. It suggests that more education might contribute to a more standardised and uniform AK management and supports further transition of AK care from hospital to primary care.
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Affiliation(s)
| | - Zilke Claessens
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Satish F K Lubeek
- Department of Dermatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Henk J Schers
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, 6500 HB, Nijmegen, PO Box 9101, The Netherlands.
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Lallier S, Hourantier C, Gilles de la Londe J, Billon G, Cadwallader JS, Piot MA. General practitioners' perceptions of dealing with patients with pressured speech: a qualitative study. Fam Pract 2023; 40:575-581. [PMID: 37656918 DOI: 10.1093/fampra/cmad088] [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] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Empathetic listening can be particularly challenging with patients presenting pressured speech, while time pressure and costs limit practitioners' availability. We aimed to explore general practitioners' (GPs') experiences when encountering a patient with pressured speech without pathological syndrome. METHODS Using a thematic analysis method, 19 semi-structured interviews were conducted with GPs purposively sampled in Ile-de-France region. RESULTS Three themes emerged. First, misgivings were aroused when meeting a patient with pressured speech, including frustration, displeasure, and a struggle to maintain focus. Second, huge efforts were needed to adhere to the appropriate clinical reasoning and care for these patients who need more time and energy. The very definition of this condition varies from one clinician to another, and for some, psychiatric conditions were systematically associated. Third, implementation of specific strategies was required to adjust to these patients: trying to create distance with the patient, to organize a framework in which the patient with pressured speech can express him or herself, and even strategies to increase GPs' availability. CONCLUSION The time and energy required to provide adequate care for patients presenting with pressured speech make it quite challenging, and this builds up pressure in the waiting room. But when medical demands take this form, there is a risk that clinicians will reject the patient or refer early to mental health services, leading to growing feelings of abandonment, the neglect of organic issues, and medical nomadism. Initial and continuing medical training focussing on advanced communication skills and multifocal approaches can foster long-term follow-up.
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Affiliation(s)
- Stéphanie Lallier
- Department of Medical Practice, Université de Paris-Cité, Epernon, Paris, France
| | - Christelle Hourantier
- Department of Child, Adolescent and Young Adult Psychiatry, Institut Mutualiste Montsouris, Paris, France
| | - Julie Gilles de la Londe
- Department of General Practice, University of Paris-Cité, Health Faculty, School of Medicine, Paris, France
| | - Grégoire Billon
- Maudsley Simulation, South London and Maudsley National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Jean-Sébastien Cadwallader
- Department of General Practice, Sorbonne University, Paris, France
- Institut Pierre Louis d'Épidémiologie Et de Santé Publique, INSERM, Sorbonne University, Paris, France
| | - Marie-Aude Piot
- Department of Child and Adolescent Psychiatry, Necker-Enfants Malades Hospital-APHP, Paris, France
- School of Medicine, Université de Paris-Cité- Health Faculty, Paris, France
- Université Paris-Saclay, UVSQ, INSERM, CESP, Team DevPsy, Paris, France
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Granja M, Alves L, Correia S. First contact with the health system: a survey study in northern Portugal. BMJ Open 2023; 13:e076849. [PMID: 37945304 PMCID: PMC10649470 DOI: 10.1136/bmjopen-2023-076849] [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: 06/18/2023] [Accepted: 10/19/2023] [Indexed: 11/12/2023] Open
Abstract
OBJECTIVE The objective of this study is to characterise the self-reported first contact with the health system and the reasons stated for each choice, testing associations with population characteristics. DESIGN Cross-sectional survey. SETTING Primary care department of a local health unit in northern Portugal. PARTICIPANTS Random sample of 4286 persons, retrieved from all registered adults. OUTCOMES Participants who stated they usually see the same doctor when a health problem arises were considered to adopt first-contact care and were asked to identify their regular doctor. Participants were asked why they adopt first-contact care or why they choose to do otherwise. Associations between personal characteristics and the adoption of first-contact care were tested using logistic regression. RESULTS There were 808 valid questionnaires received (19% response rate). The mean age of respondents was 53 years, 58% were women and 60% had a high school or higher degree. Most (71%) stated always seeing the same doctor when facing a health problem. This was a general practitioner (GP) in 84%. The main reasons were previous knowledge and trust in the doctor. When this doctor was not a GP, the main reason was the need to obtain an appointment quickly. Participants who chose first-contact care were less likely to have university degrees than those who did not (OR 0.31; 95% CI 0.13 to 0.76). Being registered with the same GP for over 1 year increased the odds of adopting first-contact care: twice as likely for those registered for 1-4 years with the same GP (2.07; 95% CI 1.04 to 4.11), and three times more likely for those registered for over 10 years (3.21; 95% CI 1.70 to 6.08). CONCLUSIONS The high adoption of first-contact care and the reasons given for this suggest a strong belief in primary care in this population. The longer patients experience continuity, the more they adopt first-contact care. The preferences of higher-educated patients regarding first-contact care deserve reflection.
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Affiliation(s)
- Mónica Granja
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Luís Alves
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Sofia Correia
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
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Stark S, Schaubroeck E, Kluge M, Burggraf L, Roos M, Borowski E, Van Poel E, Willems S, Kühlein T, Hueber S, Werner F. "The measures taken by the government overburdened the daily practice" - insights of the PRICOV-19 study on German general practitioners in times of COVID-19. BMC PRIMARY CARE 2023; 24:207. [PMID: 37821802 PMCID: PMC10568746 DOI: 10.1186/s12875-023-02115-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/18/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND The international study PRICOV-19 aims to assess the impact of the COVID-19 pandemic on the organisation of primary health care. The German part focuses on German general practitioners during the second wave of the COVID-19 pandemic. This paper addresses the following research questions: (1) How were changes in tasks on primary care and patient treatment perceived by GPs?, (2) What was the role of GPs during the pandemic, and how was their wellbeing?, (3) How did GPs perceive health policy measures?, and, (4) What influenced the attitudes of GPs on health policy measures? METHODS This study pursues a multi-country cross-sectional design. Data collection took place throughout Germany from 01.02. to 28.02.2021 with a quantitative online questionnaire consisting of 53 items. The questionnaire was analysed through descriptive and inferential analyses using correlation and multiple regression models. RESULTS The response rate was 20.4% (n = 349). The respondents were mainly GPs (59.6%) in single practices (62.5%) with a mean work experience of 15 to 20 years. GPs experienced a change in their work and practice organisation (80.3%). They felt a high responsibility (70.6%) and found their work has become more meaningful to them (76%). They also saw a lack of political support (75.2%) and that the measures taken by the government overburdened the daily practice (66.4%). Not many GPs were at risk of being distressed (53.4%) but rated the health policies rather negatively (60%). The multiple regression showed, the more GPs were exposed to risk of distress, the worse they assessed the government's measures. CONCLUSION GPs perceived their work as relevant and felt confident they could fulfil their tasks, but noticed that health policy initially hardly supported the outpatient sector. Health policies should increase their competence in relation to primary care, ensure its needs and consider an active inclusion of GPs in preparedness plans.
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Affiliation(s)
- Stefanie Stark
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - Emmily Schaubroeck
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Marie Kluge
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Larissa Burggraf
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
- Department for Sociology, University of Education, Schwäbisch Gmünd, Germany
| | - Marco Roos
- General Practice, Faculty of Medicine, University of Augsburg, Augsburg, Germany
| | - Eve Borowski
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Esther Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Thomas Kühlein
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Susann Hueber
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Felix Werner
- Institute of General Practice, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Erlangen, Germany
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Bi YN, Liu YA. GPs in UK: From Health Gatekeepers in Primary Care to Health Agents in Primary Health Care. Risk Manag Healthc Policy 2023; 16:1929-1939. [PMID: 37750073 PMCID: PMC10518152 DOI: 10.2147/rmhp.s416934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/01/2023] [Indexed: 09/27/2023] Open
Abstract
After 75 years of reformed practice, general practitioners (GPs) in the UK have transformed from health gatekeepers who simply provide medical decision-making such as diagnostic and treatment services and referral services, to health agents who proactively provide more relevant health services such as immunizations, health monitoring and health management, etc. In order to discuss this transformation of the role of the general practitioner and the conditions for the evolution of the role, this study chose the documentary analysis method to provide a comprehensive overview of the legal and normative documents related to the general practitioner. Furthermore, this study uses a comparative analysis method to conclude the definition and role characteristics of GPs as health agents. This study summarises the general pattern of evolution of GPs into health agents. The transformation into a health agent relies on the interpersonal trust and rigorous institutional of society on the general practitioner system. The expansion of GPs' clientele and range of services, together with the motivation to proactively provide services, have combined to push for a "qualitative change" in the GP's role as health agent. The transformation of the role of the general practitioner to a health agent is a historical necessity. It responds to the evolution of society's understanding of health and the need for higher levels of health. Therefore, recognizing the role of GPs as health agents is important for optimizing the use of health care resources and improving the health of society by taking advantage of this role.
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Affiliation(s)
- Ying-Nan Bi
- School of Political Science and Public Administration, Shandong University, Qingdao, People’s Republic of China
| | - Yu-An Liu
- School of Political Science and Public Administration, Shandong University, Qingdao, People’s Republic of China
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13
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Goh NM, Simonca C, Verroiotou M, Jenkins S. A Study Evaluating the Accuracy of Triage for Breast Referrals During the Covid-19 Pandemic in a Tertiary Hospital. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2023; 4:409-414. [PMID: 37638330 PMCID: PMC10457637 DOI: 10.1089/whr.2023.0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/29/2023]
Abstract
Objective To evaluate the accuracy of breast referral triage during Covid-19. Design Retrospective case study. Setting Primrose Breast Unit, Derriford Hospital, Plymouth. From March 17th to June 30th to encompass the height of the pandemic and the early enforced changes to practice. Participants All referrals received, triaged, and seen (n = 870) in the unit, identified by referral records. Main Outcome Measures The primary outcome measure of a positive disease state was of a histological diagnosis of cancer, with the absence of a cancer diagnosis representing a negative disease state. Accuracy has been determined by sensitivity and specificity calculations; thus defined by correctly triaging cancers to face-to-face clinics and benign cases to telephone or video clinics. Results Sixty-eight cancers (7.8% of referrals) were detected after initial triage and consultation, of which 51 (sensitivity = 75%) were triaged to one-stop-clinic; positive predictive value was 18.89%. Eight hundred two (specificity = 72.69%) of benign cases were triaged to phone or video clinic initially; negative predictive value was 97.15%. Comparing the study's incidence of cancer (7.8%) to the preceding year's (2019) of 6.8% with Yate's correction shows no significant difference (p < 0.05). Conclusion Triage accuracy is sufficiently robust to diagnose cancer promptly, which should reassure clinicians and decision makers within the cancer networks.
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Affiliation(s)
- Ngee-Ming Goh
- Primrose Breast Unit, University Hospitals Plymouth NHS Trust, Derriford, Plymouth, United Kingdom
| | - Claudiu Simonca
- The Breast Care Unit, Medway Maritime Hospital, Gillingham, United Kingdom
| | - Maria Verroiotou
- Primrose Breast Unit, University Hospitals Plymouth NHS Trust, Derriford, Plymouth, United Kingdom
| | - Stephane Jenkins
- Primrose Breast Unit, University Hospitals Plymouth NHS Trust, Derriford, Plymouth, United Kingdom
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Stavnes K, Ruud T, Benth JŠ, Hanssen-Bauer K, Solantaus T, Hilsen M, Skogøy BE, Kallander EK, Kufås E, Weimand BM. Norwegian health personnel's contacts and referrals for children of ill parents: an exploratory cross-sectional multi-centre study. BMC Health Serv Res 2023; 23:649. [PMID: 37330496 DOI: 10.1186/s12913-023-09607-0] [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: 10/04/2022] [Accepted: 05/26/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND In 2010, changes were made to the Norwegian Health Personnel Act. This led to all health personnel being obliged to support the patients' children and families. The aims of this study were to investigate whether health personnel contacted or referred the patients' children to family/friends or public services. We also investigated if there were factors in the family or the services that increased or decreased the degree of contacts and referrals. In addition the patients were asked whether the law had been a help or even a burden. This study was part of a larger multi-site study of children of ill parents conducted in five health trusts in Norway. METHOD We used cross-sectional data from 518 patients and 278 health personnel. The informants completed a questionnaire addressing the law. Data were analyzed by factor analysis and logistic regression. RESULTS The health personnel contacted/referred children to different services, but not to the degree desired by their parents. Only a few contacted family/friends, or the school and/or the public health nurse, those representing the helpers who live closest to the child, and thus well situated to participate in help and preventive efforts. The service most often referred to was the child welfare service. CONCLUSION The results indicate a change in contacts/referrals for children from their parents' health personnel but also reveal remaining needs for support/help for these children. Health personnel should strive to write more referrals and take more contacts than the current study suggests, to secure adequate support for children of ill parents in Norway, as intended in The Health Personnel Act.
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Affiliation(s)
- Kristin Stavnes
- The Regional Centre for Eating Disorders (RESSP), Nordland Hospital Trust, 8092, Bodø, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
- The Regional Centre for Eating Disorders (RESSP), Nordland Hospital Trust, Kløveråsveien 1, 8076, Bodø, Norway.
| | - Torleif Ruud
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Campus Ahus, Akershus, Norway
| | - Jūratė Šaltytė Benth
- Institute of Clinical Medicine, University of Oslo, Campus Ahus, Akershus, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Ketil Hanssen-Bauer
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Campus Ahus, Akershus, Norway
| | - Tytti Solantaus
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marit Hilsen
- Regional Centre for Child and Adolescent Mental Health, RBUP Øst Og Sør, Postboks 4623, 0405, Nydalen, Oslo, Norway
| | - Bjørg Eva Skogøy
- The Regional Centre for Eating Disorders (RESSP), Nordland Hospital Trust, 8092, Bodø, Norway
- Nordland Research Institute, Postboks 1490, 8049, Bodø, Norway
| | | | - Elin Kufås
- Vestre Viken Hospital Trust, Drammen, Norway
| | - Bente M Weimand
- Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway
- Department of Health, Social and Welfare Studies, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
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15
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Kelepouris E, St Peter W, Neumiller JJ, Wright EE. Optimizing Multidisciplinary Care of Patients with Chronic Kidney Disease and Type 2 Diabetes Mellitus. Diabetes Ther 2023:10.1007/s13300-023-01416-2. [PMID: 37209236 DOI: 10.1007/s13300-023-01416-2] [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] [Received: 03/27/2023] [Accepted: 04/19/2023] [Indexed: 05/22/2023] Open
Abstract
Diabetes is the leading cause of chronic kidney disease (CKD), a condition associated with significant morbidity and mortality. As these patients have a high risk of developing cardiovascular disease and end-stage kidney disease, there is a need for early detection and early initiation of appropriate therapeutic interventions that slow disease progression and prevent adverse outcomes. Due to the complex nature of diabetes and CKD management, a holistic, patient-centered, collaborative care approach delivered by a coordinated multidisciplinary team (ideally including a clinical pharmacist as part of a comprehensive medication management program) is needed. In this review, we discuss the barriers to effective care, the current multidisciplinary approach used for CKD prevention and treatment, and the potential ways that the multidisciplinary management of CKD associated with type 2 diabetes mellitus can be refined to improve patient outcomes.
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Affiliation(s)
- Ellie Kelepouris
- Division of Renal Electrolyte and Hypertension, University of Pennsylvania, Philadelphia, PA, USA.
| | - Wendy St Peter
- University of Minnesota, Minneapolis, MN, USA
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA
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16
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Bennett SR. Changes in Healthcare During the Past 30 Years: Can the National Health Service in the United Kingdom Survive? Cureus 2023; 15:e38120. [PMID: 37252534 PMCID: PMC10212742 DOI: 10.7759/cureus.38120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2023] [Indexed: 05/31/2023] Open
Abstract
At the turn of the century, the National Health Service (NHS) in the United Kingdom (UK) was considered one of the top public healthcare systems in the world. Not only was it comprehensive and inclusive, but it was also free at the point of delivery for the entire UK population. It was also largely available to visitors and the families of residents that lived outside the UK. During the past 30 years, the NHS has received more and more funding both in cash terms and as a percentage of the gross national product. Despite this, the general consensus is that the NHS is delivering a poor service. The current government is facing unprecedented strike action from all areas of the workforce including doctors and nurses. This editorial asks the following questions: Where has the money gone? What has caused the current crisis? Can the current NHS model survive in today's highly technological healthcare environment?
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Affiliation(s)
- Sean R Bennett
- Anesthesiology/Cardiac, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
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17
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Getting Your Foot in the Door: Access to Surgical Care for Thyroid Disease. J Surg Res 2023; 283:344-350. [PMID: 36427444 DOI: 10.1016/j.jss.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/19/2022] [Accepted: 11/02/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Access to specialty care can be challenging for patients, often involving multiple evaluations, laboratory tests, and referrals. To better understand the different pathways to specialty care, we examined the outcomes of patients evaluated for surgical thyroid disease at a single tertiary referral clinic. METHODS We reviewed 691 patients seen in the endocrine surgery clinic for thyroid disease (2018-2021). Patient demographics, referral source, referral reason, and reason for not receiving an operation were collected. The number of days from referral to initial clinic visit and from initial clinic visit to an operation were also collected. The Chi-square test, the independent t-test, the Kruskal-Wallis test, the Dunn-Bonferroni post hoc test, and multiple logistic regression tests were performed using SPSS. RESULTS The top reasons for referral were thyroid nodules (54.4%), hyperthyroidism (26.5%), and multinodular goiter (10.3%). Specialty clinic referrals came from endocrinologists (56.0%), self-referrals (15.5%), and primary care physicians (PCP; 14.4%). Self-referred patients had a shorter waiting time for an appointment than those referred by endocrinologists and PCPs. [median (IQR) (days) 12 (6-17) versus 16 (9-24) versus 16 (9-25), P < 0.001]. Overall, 450 (72.7%) patients underwent thyroid surgery. For those who underwent thyroidectomy, self-referred patients had a shorter time between initial clinic visit and the operation compared to those referred by endocrinologists and PCPs [median (IQR) (days) 2 (1-19) versus 19 (8-33) versus 16 (1-48), P < 0.001]. Patients referred for hyperthyroidism (odds ratio [OR] = 2.2, 95% confidence interval [CI] 1.3-10.5, P = 0.012 were more likely to undergo an operation than those referred for other reasons. CONCLUSIONS Access to specialty care for thyroid disease is facilitated and optimized when self-referrals are permitted. Reducing or eliminating the requirement for a provider referral may improve patients' access.
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Bojaj G, Tahirbegolli B, Beqiri P, Alloqi Tahirbegolli I, Van Poel E, Willems S, Rizanaj N, Hoxha I. Health Service Management and Patient Safety in Primary Care during the COVID-19 Pandemic in Kosovo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3768. [PMID: 36834461 PMCID: PMC9965489 DOI: 10.3390/ijerph20043768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/10/2023] [Accepted: 02/15/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Several changes must be made to the services to ensure patient safety and enable delivering services in environments where the danger of infection of healthcare personnel and patients in primary care (PC) institutions is elevated, i.e., during the COVID-19 pandemic. OBJECTIVE This study aimed to examine patient safety and healthcare service management in PHC practices in Kosovo during the COVID-19 pandemic. METHODS In this cross-sectional study, data were collected using a self-reported questionnaire among 77 PHC practices. RESULTS Our main finding reveals a safer organization of PC practices and services since the COVID-19 pandemic compared to the previous period before the pandemic. The study also shows a collaboration between PC practices in the close neighborhood and more proper human resource management due to COVID-19 suspicion or infection. Over 80% of the participating PC practices felt the need to introduce changes to the structure of their practice. Regarding infection protection measures (IPC), our study found that health professionals' practices of wearing a ring or bracelet and wearing nail polish improved during the COVID-19 pandemic compared to the pre-pandemic period. During the COVID-19 pandemic, PC practice health professionals had less time to routinely review guidelines or medical literature. Despite this, implementing triage protocols over the phone has yet to be applied at the intended level by PC practices in Kosovo. CONCLUSIONS Primary care practices in Kosovo responded to the COVID-19 pandemic crisis by modifying how they organize their work, implementing procedures for infection control, and enhancing patient safety.
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Affiliation(s)
- Gazmend Bojaj
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
- Principal Family Medicine Center, 32000 Kline, Kosovo
| | - Bernard Tahirbegolli
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
- National Sports Medicine Centre, 10000 Prishtina, Kosovo
| | - Petrit Beqiri
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
| | - Iliriana Alloqi Tahirbegolli
- Laboratory Technician Department, Heimerer College, 10000 Prishtina, Kosovo
- Hematology Clinic, University Clinical Center of Kosovo, 10000 Prishtina, Kosovo
| | - Esther Van Poel
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, 9000 Ghent, Belgium
| | - Nderim Rizanaj
- Nursing Department, Heimerer College, 10000 Prishtina, Kosovo
| | - Ilir Hoxha
- Department of Health Institutions and Services Management, Heimerer College, 10000 Prishtina, Kosovo
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH 03766, USA
- Evidence Synthesis Group, 10000 Prishtina, Kosovo
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19
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Hou X, Liu L, Cain J. Can higher spending on primary healthcare mitigate the impact of ageing and non-communicable diseases on health expenditure? BMJ Glob Health 2022; 7:e010513. [PMID: 36564087 PMCID: PMC9791382 DOI: 10.1136/bmjgh-2022-010513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/13/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Financing healthcare for ageing populations has become an increasingly urgent policy concern. Primary healthcare (PHC) has been viewed as the cornerstone of health systems. While most research has examined the effects of PHC on population health, there is still a relative paucity of analysis on the effects of PHC on health expenditures, particularly, in low-income and middle-income countries. Knowledge on PHC's potential role in mitigating the impact of ageing and non-communicable diseases (NCDs) on health expenditure remains limited. METHODS Using publicly accessible secondary data at country level, this paper examines the impact of ageing and the NCD burden on health expenditures. Regression with the interaction terms is used to explore whether greater expenditures on PHC can mitigate the growing fiscal pressure from ageing and the NCD burden. RESULTS The empirical evidence shows that a higher share of PHC spending is correlated with lower per capita non-PHC spending, after controlling for population aged 60 and over and NCD burden, and gross domestic product per capita. However, the mitigating effects of PHC spending to reduce non-PHC expenditure caused by ageing and NCDs are not significant. CONCLUSIONS The findings suggest that more PHC spending can potentially lower total health expenditure. However, higher primary health spending cannot fulfil that potential without scrupulous attention to the way it is delivered. More spending on PHC, together with changes in PHC service delivery, highlighting its coordination and referring roles, will put nations on a pathway to achieving universal health coverage more sustainably.
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Affiliation(s)
- Xiaohui Hou
- Health, Nutrition and Population Global Practice, World Bank Group, Washington, District of Columbia, USA
| | - Lingrui Liu
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, CT, USA
| | - Jewelwayne Cain
- Health Nutrition and Population Global Practice, World Bank Group, Washington, District of Columbia, USA
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Johannessen TR, Halvorsen S, Atar D, Munkhaugen J, Nore AK, Wisløff T, Vallersnes OM. Cost-effectiveness of a rule-out algorithm of acute myocardial infarction in low-risk patients: emergency primary care versus hospital setting. BMC Health Serv Res 2022; 22:1274. [PMID: 36271364 PMCID: PMC9587629 DOI: 10.1186/s12913-022-08697-6] [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: 01/04/2022] [Accepted: 10/18/2022] [Indexed: 11/24/2022] Open
Abstract
Aims Hospital admissions of patients with chest pain considered as low risk for acute coronary syndrome contribute to increased costs and crowding in the emergency departments. This study aims to estimate the cost-effectiveness of assessing these patients in a primary care emergency setting, using the European Society of Cardiology (ESC) 0/1-h algorithm for high-sensitivity cardiac troponin T, compared to routine hospital management. Methods A cost-effectiveness analysis was conducted. For the primary care estimates, costs and health care expenditure from the observational OUT-ACS (One-hoUr Troponin in a low-prevalence population of Acute Coronary Syndrome) study were compared with anonymous extracted administrative data on low-risk patients at a large general hospital in Norway. Patients discharged home after the hs-cTnT assessment were defined as low risk in the primary care cohort. In the hospital setting, the low-risk group comprised patients discharged with a non-specific chest pain diagnosis (ICD-10 codes R07.4 and Z03.5). Loss of health related to a potential increase in acute myocardial infarctions the following 30-days was estimated. The primary outcome measure was the costs per quality-adjusted life year (QALY) of applying the ESC 0/1-h algorithm in primary care. The secondary outcomes were health care costs and length of stay in the two settings. Results Differences in costs comprise personnel and laboratory costs of applying the algorithm at primary care level (€192) and expenses related to ambulance transports and complete hospital costs for low-risk patients admitted to hospital (€1986). Additional diagnostic procedures were performed in 31.9% (181/567) of the low-risk hospital cohort. The estimated reduction in health care cost when using the 0/1-h algorithm outside of hospital was €1794 per low-risk patient, with a mean decrease in length of stay of 18.9 h. These numbers result in an average per-person QALY gain of 0.0005. Increased QALY and decreased costs indicate that the primary care approach is clearly cost-effective. Conclusion Using the ESC 0/1-h algorithm in low-risk patients in emergency primary care appears to be cost-effective compared to standard hospital management, with an extensive reduction in costs and length of stay per patient.
Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08697-6.
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Affiliation(s)
- Tonje R Johannessen
- Department of General Practice, Institute of Health and Society, University of Oslo, 1130 Blindern, 0318, Oslo, NO, Norway. .,Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway.
| | - Sigrun Halvorsen
- Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Dan Atar
- Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - John Munkhaugen
- Department of Medicine, Drammen Hospital, Vestre Viken Hospital Trust, Drammen, Norway.,Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Kathrine Nore
- Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Odd Martin Vallersnes
- Department of General Practice, Institute of Health and Society, University of Oslo, 1130 Blindern, 0318, Oslo, NO, Norway.,Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency, Oslo, Norway
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Antonazzo IC, Conti S, Rozza D, Fornari C, Eteve-Pitsaer C, Paris C, Gantzer L, Valentine D, Mantovani LG, Mazzaglia G. Time trends in the incidence of essential tremor: Evidences from UK and France primary care data. Front Neurol 2022; 13:987618. [PMID: 36203992 PMCID: PMC9531026 DOI: 10.3389/fneur.2022.987618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 08/16/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Although essential tremor (ET) is considered a common adult movement disorder, evidence on its incidence is still scant. This study aims at estimating ET incidence in two European countries, namely, the UK and France. Methods Incident cases of ET were identified within the Health Improvement Network (THIN®) database between 1st January 2014 and 31 December 2019. Yearly crude and standardized incidence rates (IR) were estimated across the study period for both countries. Poisson regression models were built to assess temporal trends in IRs and differences between sexes and age classes. Results In total, 4,970 and 4,905 incident cases of ET were identified in the UK and France, respectively. The yearly average crude IR (per 100,000 person-years) was 18.20 (95%CI: 15.09-21.32) in UK and 21.42 (17.83-25.00) in France, whereas standardized ones were 19.51 (18.97-20.01) and 19.50 (18.97-20.05). Regression analyses showed slightly increasing trends in both countries, higher incidence among males, and a significant increase with age. Yearly average IR increased from 3.96 (0.95-6.97) and 5.28 (1.12-9.44) in subjects aged <20 years to 49.27 (26.29-72.24) and 51.52 (30.19-72.86) in those aged >80 year in UK and France. Conclusions Standardized ET incidence was comparable in the UK and France, showing a slight increase in both countries, reporting a higher value among people aged 60 years and older. This study outlines the need to conduct future studies to estimate the burden of ET in terms of disease control and healthcare resource utilization.
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Affiliation(s)
| | - Sara Conti
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy,*Correspondence: Sara Conti
| | - Davide Rozza
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | - Carla Fornari
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
| | | | | | | | | | | | - Giampiero Mazzaglia
- Research Centre on Public Health (CESP), University of Milano-Bicocca, Monza, Italy
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Dougherty S, Lorenzoni L, Marino A, Murtin F. The impact of decentralisation on the performance of health care systems: a non-linear relationship. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:705-715. [PMID: 34657202 PMCID: PMC8520686 DOI: 10.1007/s10198-021-01390-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 09/30/2021] [Indexed: 05/10/2023]
Abstract
This paper examines the role of institutions-notably the degree of administrative decentralisation across levels of government-in health care decision-making and health spending as well as life expectancy. The empirical analysis builds on a new methodology to analyse health sector performance. In particular, the present analysis examines the impact of centralisation versus decentralisation of responsibilities across levels of government, making use of newly collected data on governance and expenditure assignment, as well as non-linear empirical specifications. An interlocking U-shaped relationship is found with respect to expenditure and life expectancy. Under moderate decentralisation, public spending in health care is lower, while life expectancy is higher, compared with more centralised systems; however, in highly decentralised systems, public spending is higher and life expectancy is lower. This finding of a "fish-shaped" relationship for decentralisation and outcomes also helps to understand recent reforms of OECD health systems, which have often reverted towards more moderate degrees of administrative decentralisation.
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Affiliation(s)
- Sean Dougherty
- Organisation for Economic Co-Operation and Development, Paris, France
| | - Luca Lorenzoni
- Organisation for Economic Co-Operation and Development, Paris, France
| | - Alberto Marino
- Department of Health Policy, London School of Economics, London, UK
| | - Fabrice Murtin
- Organisation for Economic Co-Operation and Development, Paris, France
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Coughlan B, Woolgar M, Mann A, Duschinsky R. Clinical perspectives on the identification of neurodevelopmental conditions in children and changes in referral pathways: qualitative interviews. BMJ Open 2022; 12:e049821. [PMID: 35418420 PMCID: PMC9014038 DOI: 10.1136/bmjopen-2021-049821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Previous work has raised questions about the role of general practitioners (GPs) in the identification of neurodevelopmental conditions such as autism spectrum disorders (autism) and attention deficit hyperactivity disorders (ADHD). This study aimed to explore how GPs identify these conditions in practice and their perspectives on recent changes to local referral pathways that mean referrals to the neurodevelopmental team come through educational professionals and health visitors, rather than GPs. This study also aimed to explore Child and Adolescent Mental Health Services (CAMHS) specialist's perspectives on the role of GPs. SETTING GP practices, local neurodevelopmental services and specialist CAMHS services in the UK. PARTICIPANTS semistructured interviews were conducted with GPs (n=8), specialists in local CAMHS (n=7), and professionals at national CAMHS services around the country (n=10). Interviews were conducted between January and May 2019. A framework approach informed by thematic analysis was used to analyse the data. RESULTS GPs drew on various forms of tacit and explicit information including behavioural markers, parental report, prior knowledge of the family, expert and lay resources. Opinions varied between GPs regarding changes to the referral pathway, with some accepting the changes and others describing it as a 'disaster'. CAMHS specialists tended to feel that GPs required more neurodevelopmental training and time to conduct consultations. CONCLUSION This study adds to the literature showing that GPs use an array of information sources when making referral decisions for autism and ADHD. Further work is urgently required to evaluate the impact of reconfiguring neurodevelopmental referral pathways such that GPs have a diminished role in identification.
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Affiliation(s)
- Barry Coughlan
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Matt Woolgar
- Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Alissa Mann
- Department of Psychology, University of Bath, Bath, UK
| | - Robbie Duschinsky
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Wiltshire A, Jackman JM, Moreta L, Ghidei L. Changing the Narrative, Starting With Us. Reprod Sci 2022; 29:2067-2070. [DOI: 10.1007/s43032-022-00915-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 03/11/2022] [Indexed: 10/18/2022]
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Luo L, Zhang Y, Zhang Y, Feng C, Zhang X. Large hospitals' outpatient diversion system in China: Following individual intention and referral. Int J Health Plann Manage 2022; 37:1973-1989. [PMID: 35212026 DOI: 10.1002/hpm.3436] [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: 04/03/2020] [Revised: 10/29/2021] [Accepted: 01/21/2022] [Indexed: 02/05/2023] Open
Abstract
In this study, we explored the strategies and suggestions for the outpatient diversion system of large hospitals in Chinese underdeveloped areas of primary medical care, under the consideration of balancing patients' intention and compliance with the referral system. An empirical study was conducted on the relationship among medical need, visiting intention and health-seeking behaviour to verify the effect of intention-system mixed outpatient diversion mode in China's large hospitals. Examination of the demographic characteristics, insurance, and residence information revealed that outpatients could be divided into three categories before the application of the referral system. Then, due to the implementation of the referral system, the willingness of some patients to seek medical treatment has changed. Consequently, the service path for outpatients could be consolidated into two categories with differentiated behavioural characteristics, which were respectively driven by personal intention and service system. According to the utility value intervention of the referral system for outpatient seeking behaviour, some measures and strategies can be explored to build a new system that combines personal connotation and system utility to realise the effective distribution and management of outpatients in large hospitals in Chinese underdeveloped areas.
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Affiliation(s)
- Le Luo
- Business School, Sichuan University, Chengdu, Sichuan, China
| | - Yuxuan Zhang
- Wu Yuzhang Honors College, Sichuan University, Chengdu, Sichuan, China
| | - Yumeng Zhang
- HEOA Group, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China.,Institute for Healthy Cities and West China Research Center for Rural Health Development, Sichuan University, Chengdu, Sichuan, China
| | - Chenchen Feng
- West China School of Nursing / Outpatient Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xinli Zhang
- Business School, Sichuan University, Chengdu, Sichuan, China
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Noels E, Lugtenberg M, Wakkee M, Ramdas KHR, Bindels PJE, Nijsten T, van den Bos RR. Process evaluation of a multicentre randomised clinical trial of substituting surgical excisions of low-risk basal cell carcinomas from secondary to primary care. BMJ Open 2022; 12:e047745. [PMID: 35197331 PMCID: PMC8867327 DOI: 10.1136/bmjopen-2020-047745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES In 2016, the SKINCATCH Trial, a clustered multi-centre randomised trial, was initiated to assess whether low-risk basal cell carcinomas (BCCs) can be treated by general practitioners (GPs) without loss of quality of care. The trial intervention consisted of a tailored 2-day educational course on skin cancer management. The aim of this process evaluation was to investigate GPs' exposure to the intervention, implementation of the intervention and experiences with the intervention and trial. RESEARCH DESIGN AND METHODS Data on exposure to the intervention, implementation and experiences were obtained at several points during the trial. Complementary quantitative components (ie, surveys, database analysis, medical record analysis) and qualitative components (ie, interviews and focus groups) were used. Quantitative data were analysed using descriptive statistics; qualitative data were summarised (barrier interviews) or audiorecorded, transcribed verbatim and thematically analysed using Atlas.Ti (focus groups). RESULTS Following a 100% intervention exposure, results concerning the implementation of the trial showed that aside from the low inclusion rate of patients with low-risk BCCs (n=54), even less excisions of low-risk BCCs were performed (n=40). Although the intervention was experienced as highly positive, several barriers were mentioned regarding the trial including administrative challenges, lack of time and high workload of GPs, low volume of BCC patients and patients declining to participate or requesting a referral to a dermatologist. CONCLUSIONS Although GPs' participation in the highly valued training was optimal, several barriers may have contributed to the low inclusion and excision rate of low-risk BCCs. While some of the issues were trial-related, other barriers such as low patient-volume and patients requesting referrals are applicable outside the trial setting as well. This may question the feasibility of substitution of surgical excisions of low-risks BCCs from secondary to primary care in the current Dutch setting. TRIAL REGISTRATION NUMBER Trial NL5631 (NTR5746).
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Affiliation(s)
- Eline Noels
- Dermatology, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | | | - Marlies Wakkee
- Dermatology, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | | | | | - Tamar Nijsten
- Dermatology, Erasmus MC Rotterdam, Rotterdam, The Netherlands
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Van Poel E, Vanden Bussche P, Klemenc-Ketis Z, Willems S. How did general practices organize care during the COVID-19 pandemic: the protocol of the cross-sectional PRICOV-19 study in 38 countries. BMC PRIMARY CARE 2022; 23:11. [PMID: 35172744 PMCID: PMC8760114 DOI: 10.1186/s12875-021-01587-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/15/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND General practitioners (GPs) play a crucial role in the fight against the COVID-19 pandemic as the first point of contact for possibly infected patients and are responsible for short and long-term follow-up care of the majority of COVID-19 patients. Nonetheless, they experience many barriers to fulfilling this role. The PRICOV-19 study investigates how GP practices in 38 countries are organized during the COVID-19 pandemic to guarantee safe, effective, patient-centered, and equitable care. Also, the shift in roles and tasks and the wellbeing of staff members is researched. Finally, PRICOV-19 aims to study the association with practice- and health care system characteristics. It is expected that both characteristics of the GP practice and health care system features are associated with how GP practices can cope with these challenges. This paper describes the protocol of the study. METHODS Using a cross-sectional design, data are collected through an online questionnaire sent to GP practices in 37 European countries and Israel. The questionnaire is developed in multiple phases, including a pilot study in Belgium. The final version includes 53 items divided into six sections: patient flow (including appointments, triage, and management for routine care); infection prevention; information processing; communication; collaboration and self-care; and practice and participant characteristics. In the countries where data collection is already finished, between 13 and 636 GP practices per country participated in the study. Questionnaire data are linked with OECD and HSMR data regarding national policy responses to the pandemic and analyzed using multilevel models considering the system- and practice-level. DISCUSSION To the best of our knowledge, the PRICOV-19 study is the largest and most comprehensive study that examines how GP practices function during the COVID-19 pandemic. Its results can significantly contribute to better preparedness of primary health care systems across Europe for future major outbreaks of infectious diseases.
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Affiliation(s)
- E Van Poel
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - P Vanden Bussche
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Z Klemenc-Ketis
- Department of Family Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Family Medicine, University of Maribor, Maribor, Slovenia
- Ljubljana Community Health Centre, Metelkova 9, 1000, Ljubljana, Slovenia
| | - S Willems
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
- Quality and Safety Ghent, Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
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Schmalstieg-Bahr K, Popert UW, Scherer M. The Role of General Practice in Complex Health Care Systems. Front Med (Lausanne) 2021; 8:680695. [PMID: 34901044 PMCID: PMC8655229 DOI: 10.3389/fmed.2021.680695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
According to the WHO, in a complex system, "there are so many interacting parts that it is difficult (…), to predict the behavior of the system based on knowledge of its component parts. "In countries without general practitioner (GP)-gatekeeping, the number of possible interactions and therefore the complexity increases. Patients may consult any doctor without contacting their GP. Family medicine core values, e.g., comprehensive care, and core tasks, e.g., care coordination, might be harder to implement and maintain. How are GPs perceived and how do they perceive themselves if no GP-gatekeeping exists? Does the absence of any GP-gatekeeping influence family medicine core values? A PubMed and Cochrane search was performed. The results are summarized in form of a narrative review. Four perspectives regarding the GP's role were identified. The GPs' self-perception regarding family medicine core values and tasks is independent of their function as gatekeepers, but they appreciate this role. Patient satisfaction is also independent of the health care system. Depending on the acquisition of income, specialists have different opinions of GP-gatekeeping. Policymakers want GPs to play a central role within the health care system, but do not commit to full gatekeeping. The GPs and policymakers emphasize the importance of family medicine specialty training. Further international studies are needed to determine if family medicine core values and tasks can be better accomplished by GP-gatekeeping. Specialty training should be mandatory in all countries to enable GPs to fulfill these values and tasks and to act as coordinators and/or gatekeepers.
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Affiliation(s)
| | - Uwe Wolfgang Popert
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Eppendorf, Hamburg, Germany
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Abstract
Background: A physician or health care provider (HCP) referral is usually needed for children to access multidisciplinary health services for obesity management; however, offering families the option to self-refer can enhance equity and access to care. Methods: We completed a retrospective medical record review to explore patient characteristics and program engagement of children with obesity who were self- (n = 18) or HCP-referred (n = 120) for obesity management. Results: Our descriptive data suggested that children who were self-referred presented with a healthier clinical profile and missed fewer appointments than their peers referred by HCPs. Conclusions: Prospective research is needed to examine whether health services and treatment outcomes differ between self- and HCP-referred children in obesity management.
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Affiliation(s)
- Laura McGeown
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
| | - Geoff D C Ball
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Aislin R Mushquash
- Department of Psychology, Lakehead University, Thunder Bay, Ontario, Canada
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Tummers J, Tobi H, Schalk B, Tekinerdogan B, Leusink G. State of the practice of health information systems: a survey study amongst health care professionals in intellectual disability care. BMC Health Serv Res 2021; 21:1247. [PMID: 34794424 PMCID: PMC8603513 DOI: 10.1186/s12913-021-07256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Care for people with an Intellectual Disability (ID) is complex: multiple health care professionals are involved and use different Health Information Systems (HISs) to store medical and daily care information on the same individuals. The objective of this study is to identify the HISs needs of professionals in ID care by addressing the obstacles and challenges they meet in their current HISs. METHODS We distributed an online questionnaire amongst Dutch ID care professionals via different professional associations and care providers. 328 respondents answered questions on their HISs. An inventory was made of HIS usage purposes, problems, satisfaction and desired features, with and without stratification on type of HIS and care professional. RESULTS Typical in ID care, two types of HISs are being used that differ with respect to their features and users: Electronic Client Dossiers (ECDs) and Electronic Patient Dossiers (EPDs). In total, the respondents mentioned 52 unique HISs. Groups of care professionals differed in their satisfaction with ECDs only. Both HIS types present users with difficulties related to the specifics of care for people with an ID. Particularly the much needed communication between the many unique HISs was reported a major issue which implies major issues with inter-operability. Other problems seem design-related as well. CONCLUSION This study can be used to improve current HISs and design new HISs that take ID care professionals requirements into account.
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Affiliation(s)
- Joep Tummers
- Information Technology, Wageningen University & Research, Hollandseweg 1, 6701KN, Wageningen, The Netherlands
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Hilde Tobi
- Biometris, Wageningen University & Research, Droevendaalsesteeg 1, 6706OB, Wageningen, The Netherlands
| | - Bianca Schalk
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
| | - Bedir Tekinerdogan
- Information Technology, Wageningen University & Research, Hollandseweg 1, 6701KN, Wageningen, The Netherlands.
| | - Geraline Leusink
- Department of Primary and Community Care, Radboud University Medical Center, P.O. Box 9101, 6500, HB, Nijmegen, The Netherlands
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Curnow E, Tyagi V, Salisbury L, Stuart K, Melville-Jóhannesson B, Nicol K, McCormack B, Dewing J, Magowan R, Sagan O, Bulley C. Person-Centered Healthcare Practice in a Pandemic Context: An Exploration of People's Experience of Seeking Healthcare Support. FRONTIERS IN REHABILITATION SCIENCES 2021; 2:726210. [PMID: 36188789 PMCID: PMC9397956 DOI: 10.3389/fresc.2021.726210] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 08/09/2021] [Indexed: 01/19/2023]
Abstract
Background: The recent COVID-19 pandemic increased pressure upon healthcare resources resulting in compromised health services. Enforced national lockdown led to people being unable to access essential services in addition to limiting contact with social support networks. The novel coronavirus, and subsequent condition known as long covid were not well-understood and clinicians were not supported by existing guidelines or pathways. Our study explored people's experiences of healthcare during this period with a person-centered "lens." Methods: Ninety-seven people participated in our online survey about their experiences of the pandemic, particularly while socially isolated and their experiences of healthcare. Following completion of the survey, 11 of these participants agreed to further semi-structured interviews to explore this further in their own words. Interview conversations were transcribed, checked; together with the responses to open questions in the survey. The data were then analyzed thematically by members of the research team. We conducted framework analysis from a post-positivist perspective, using the Person-centered Practice Framework to explore participants' experiences. Results: There were few examples of people describing person-centered care. People experienced barriers to accessing support, and negative experiences of care that represented complexities enacting person-centered care at each level of the framework (processes, practice environment, prerequisites, and macro context). These barriers were influenced greatly by the pandemic, for example, with health professionals being harder to access. Some experiences related to the ways in which health professionals responded to the context, for example, positive examples included active listening, recognition of people's experiences, seeking to find out more, and engaging in collaborative problem-solving. Discussion: People want to feel heard, supported to navigate healthcare systems, source trustworthy information, find appropriate services, and collaborate in learning and problem-solving with healthcare professionals. There have been enormous challenges to the provision of healthcare throughout the pandemic. Moving forward is crucial with emphasis on overcoming barriers to person-centered healthcare. This should focus on steps now and also in planning for the possibility of further rapid changes in the demand for and provision of healthcare.
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Affiliation(s)
- Eleanor Curnow
- Division of Dietetics, Nutrition and Biological Sciences, Physiotherapy, Podiatry and Radiography, School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom,*Correspondence: Eleanor Curnow
| | - Vaibhav Tyagi
- Division of Nursing and Paramedic Science, School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Lisa Salisbury
- Division of Dietetics, Nutrition and Biological Sciences, Physiotherapy, Podiatry and Radiography, School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Kim Stuart
- Research and Knowledge Exchange Development Unit, Queen Margaret University, Edinburgh, United Kingdom
| | | | - Kath Nicol
- Division of Dietetics, Nutrition and Biological Sciences, Physiotherapy, Podiatry and Radiography, School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Brendan McCormack
- Division of Nursing and Paramedic Science, School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Jan Dewing
- Division of Nursing and Paramedic Science, School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Ruth Magowan
- Division of Nursing and Paramedic Science, School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Olivia Sagan
- Division of Psychology, Sociology and Education, School of Arts, Social Sciences and Management, Queen Margaret University, Edinburgh, United Kingdom
| | - Cathy Bulley
- Division of Dietetics, Nutrition and Biological Sciences, Physiotherapy, Podiatry and Radiography, School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
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Detecting Undifferentiation of Tertiary and County Hospitals in China in Adoption of DRG Instrument. Healthcare (Basel) 2021; 9:healthcare9080922. [PMID: 34442059 PMCID: PMC8393376 DOI: 10.3390/healthcare9080922] [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: 04/13/2021] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Undifferentiated function for medical institutes in different levels had been a barrier to China’s healthcare reform. Thus, this study aimed to detect medical services that were capable offered both in tertiary and county hospitals in China and discuss the process of detection. (2) Method: Data of 2 tertiary hospitals that were city level and 12 county-level hospitals from one city in China were collected and grouped into diagnosis-related groups (DRGs). A strategy with four steps was devised by considering the aspects of service volume, in-hospital mortality rate, in-hospital adverse events rate, and inpatient cost. Additionally, a comparison of each indicator was made between city- versus county-level hospitals. (3) Results: There were no differences in service quality between the two levels of hospitals while county hospitals had lower average inpatient costs in 129 DRGs that covered 39.5% of all cases. About CNY 0.26 billion would be saved if certain cases were paid at county-level prices. (4) Conclusion: The study proposed a strategy with four steps that could help in locating the range of diseases in which patients’ admission suffered from the problem of undifferentiation between hospitals’ functions to reduce the irrational growth of healthcare expenditure.
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de Vries FMC, Driessen RJB, Welbie M, Tjin EPM, van de Kerkhof PCM. Structure, quality and accessibility of the Dutch acne healthcare; a care providers' perspective. J DERMATOL TREAT 2021; 32:269-276. [PMID: 33754925 DOI: 10.1080/09546634.2021.1906521] [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] [Indexed: 10/21/2022]
Abstract
Background: Despite the wide range of available treatment modalities a delay between the first outbreak of acne vulgaris and an effective treatment outcome is experienced by many patients. Considering the growing incentives to improve patient satisfaction and quality of care while reducing healthcare costs, insights into the structure, quality and accessibility of acne healthcare services beyond guidelines are therefore needed.Objective: To provide insights into the structure, quality and accessibility of acne healthcare services.Methods: A qualitative study was conducted according to the principles of 'situational analysis'. The Dutch acne healthcare system was taken as an illustrative example. Twenty-four semi-structured interviews were conducted among representatives of the 4 main Dutch professions providing acne care. All interviews were audiotaped, transcribed verbatim and analyzed.Results: Multiple facilitators and barriers emerged from the interviews. Identified facilitators were care providers delivering personalized patient care and having a positive attitude toward formalized multidisciplinary care delivery. A lack of streamlined referral pathways and standardization in acne severity-assessment, financial aspects and unfamiliarity with the content and added value of other acne care professionals were identified as barriers. Further research is recommended to investigate how de-medicalisation, the gatekeepers role, and the impact of location and work setting influence the quality of and accessibility to care.Conclusions: Identified facilitators and barriers and an overall positive attitude of care providers toward multidisciplinary care provision provides opportunities for the utilization of future guidelines involving streamlined referral pathways and good working arrangements between all acne care providing professions.
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Affiliation(s)
- F M C de Vries
- Research Group Innovation in Healthcare Processes in Pharmacology, HU University of Applied Sciences Utrecht, The Netherlands.,Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R J B Driessen
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Welbie
- Research Group Innovation in Healthcare Processes in Pharmacology, HU University of Applied Sciences Utrecht, The Netherlands
| | - E P M Tjin
- Research Group Innovation in Healthcare Processes in Pharmacology, HU University of Applied Sciences Utrecht, The Netherlands
| | - P C M van de Kerkhof
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Nystrøm V, Lurås H, Midlöv P, Leonardsen ACL. What if something happens tonight? A qualitative study of primary care physicians' perspectives on an alternative to hospital admittance. BMC Health Serv Res 2021; 21:447. [PMID: 33975573 PMCID: PMC8112060 DOI: 10.1186/s12913-021-06444-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/26/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Due to demographic changes, hospital emergency departments in many countries are overcrowded. Internationally, several primary healthcare models have been introduced as alternatives to hospitalisation. In Norway, municipal acute wards (MAWs) have been implemented as primary care wards that provide observation and medical treatment for 24 h. The intention is to replace hospitalisation for patients who require acute admission but not specialist healthcare services. The aim of this study was to explore primary care physicians' (PCPs') perspectives on admission to a MAW as an alternative to hospitalisation. METHODS The study had a qualitative design, including interviews with 21 PCPs in a county in southeastern Norway. Data were analysed with a thematic approach. RESULTS The PCPs described uncertainty when referring patients to the MAW because of the fewer diagnostic opportunities there than in the hospital. Admission of patients to the MAW was assumed to be unsafe for both PCPs, MAW nurses and physicians. The PCPs assumed that medical competence was lower at the MAW than in the hospital, which led to scepticism about whether their tentative diagnoses would be reconsidered if needed and whether a deterioration of the patients' condition would be detected. When referring patients to a MAW, the PCPs experienced disagreements with MAW personnel about the suitability of the patient. The PCPs emphasised the importance of patients' and relatives' participation in decisions about the level of treatment. Nevertheless, such participation was not always possible, especially when patients' wishes conflicted with what PCPs considered professionally sound. CONCLUSIONS The PCPs reported concerns regarding the use of MAWs as an alternative to hospitalisation. These concerns were related to fewer diagnostic opportunities, lower medical expertise throughout the day, uncertainty about the selection of patients and challenges with user participation. Consequently, these concerns had an impact on how the PCPs utilised MAW services.
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Affiliation(s)
- Vivian Nystrøm
- Department of Health and Welfare, Østfold University College, (PB) 700, 1757 Halden, Norway
| | - Hilde Lurås
- Health Services Research Unit, Akershus University Hospital, (PB) 1000, 1478 Lørenskog, Norway
- Institute of Clinical Medicine, Campus Ahus, University of Oslo, Lørenskog, Norway
| | - Patrik Midlöv
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, (PB) 50332, 202 13 Malmö, Sweden
| | - Ann-Chatrin Linqvist Leonardsen
- Department of Health and Welfare, Østfold University College, (PB) 700, 1757 Halden, Norway
- Østfold Hospital Trust, Halden, Norway
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Calanzani N, Chang A, Van Melle M, Pannebakker MM, Funston G, Walter FM. Recognising Colorectal Cancer in Primary Care. Adv Ther 2021; 38:2732-2746. [PMID: 33864597 PMCID: PMC8052540 DOI: 10.1007/s12325-021-01726-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/24/2021] [Indexed: 12/15/2022]
Abstract
Colorectal cancer (CRC) is the third most common cancer worldwide. Primary care professionals can play an important role in both prevention and early detection of CRC. Most CRCs are attributed to modifiable lifestyle factors, which can be addressed within primary care, and promotion of population-based screening programmes can aid early cancer detection in asymptomatic patients. Primary care professionals have a vital role in clinically assessing patients presenting with symptoms that may indicate cancer, as most patients with CRC first present with symptoms. These assessments are often challenging—many of the symptoms of CRC are non-specific and commonly occur in patients presenting with non-malignant disease. The range of options for investigating symptomatic patients in primary care is rapidly growing. Simple tests, such as faecal immunochemical testing (FIT), are now being used to guide decisions around referral for more invasive tests, such as colonoscopy, while direct access to specialist investigations is also becoming more common. Clinical decision support tools (CDSTs) which calculate cancer risk based on symptomatology, patient characteristics and test results can provide an additional resource to guide decisions on further investigation. This article explores the challenges of CRC prevention and detection from the primary care perspective, discusses current evidence-based approaches for CRC detection used in primary care (with examples from UK guidelines), and highlights emerging research which may likely alter practice in the future.
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Affiliation(s)
- Natalia Calanzani
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Aina Chang
- School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Marije Van Melle
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Merel M Pannebakker
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Garth Funston
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK
| | - Fiona M Walter
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB1 8RN, UK.
- Centre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, Australia.
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van Gool K, Mu C, Hall J. Does more investment in primary care improve health system performance? Health Policy 2021; 125:717-724. [PMID: 33906796 DOI: 10.1016/j.healthpol.2021.03.004] [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: 08/01/2020] [Revised: 02/04/2021] [Accepted: 03/06/2021] [Indexed: 10/21/2022]
Abstract
This study examines the association between primary care investment and performance, in 34 OECD countries for 2005-15. Specifically, we explore whether an increasing investment in primary care is associated with improved performance, and whether particular characteristics of organisation and delivery are associated with a better return on primary care investment. We take advantage of new data sources that provide rich information on health and health systems as well as economic and distributional characteristics. Multilevel modelling was utilised to analyse cross-country variation. The results show that greater investment in primary care does not improve health system performance for complex targets (i.e., no reduction in preventable hospital admissions) though there is modest improvement in breast and cervical cancer screening rates. We also found that those countries in which GPs are more aware of health promotion/preventive activities achieve higher screening rates with the same amount of investment. The findings imply that primary care investment strategies need to look beyond high-level expenditure and characteristics of primary care strength, to institutional and funding arrangements and how these link to policy goals. Despite broad enthusiasm for strengthening primary care in general, we conclude that primary care policy needs to be appropriately targeted to improve health system performance.
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Affiliation(s)
- Kees van Gool
- Center for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Australia
| | - Chunzhou Mu
- Center for Quantitative Economics, Jilin University, No. 2699 Qianjin Avenue, Gaoxin District, Changchun 130012, China.
| | - Jane Hall
- Center for Health Economics Research and Evaluation (CHERE), University of Technology Sydney, Australia
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Kokkonen J, Varonen S. Reliability of Primary Health Care Audiograms by Non-qualified Examiners-An Analysis of 1,224 Cases. Otol Neurotol 2021; 42:e261-e266. [PMID: 33351556 DOI: 10.1097/mao.0000000000002982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the accuracy of primary health care audiograms conducted by non-qualified examiners in a non-standard acoustic environment. STUDY DESIGN Retrospective chart review. SETTING Referring primary health care institutions and hospital hearing center. PATIENTS One thousand two hundred twenty four adult patients evaluated for hearing aid fitting at North Karelia Central hospital in years 2017 and 2018. MAIN OUTCOME MEASURES Intraclass correlation coefficient (ICC), mean threshold differences, and mean absolute errors were used to assess agreement between primary health care and hospital audiograms. Primary health care audiometry sensitivity, specificity and positive (PPV) and negative (NPV) predictive values were calculated for hearing aid candidacy in general and open ear mold candidacy in particular. RESULTS ICC for both better ear hearing level (BEHL0.5,1,2,4 kHz) and pure-tone average (PTA0.5,1,2,4 kHz) in frequencies 0.5, 1, 2, and 4 kHz was 0.82, and in individual full octave frequencies from 0.125 to 8 kHz ranged from 0.70 to 0.83. Mean threshold differences in BEHL0.5,1,2,4 kHz and PTA0.5,1,2,4 kHz were 1.8 and 1.6 dB and mean absolute errors 4.9 and 5.3 dB, respectively. Sensitivity for hearing aid candidacy was 0.97, specificity 0.58, PPV 0.92, and NPV 0.79. CONCLUSIONS Primary health care audiometry is reasonably accurate, allowing preselection of patients to adequate hearing care pathways.
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Affiliation(s)
- Jukka Kokkonen
- Department of Otorhinolaryngology, North Karelia Central Hospital, Joensuu, Finland
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Residents' Willingness to Maintain Contracts with Family Doctors: a Cross-sectional Study in China. J Gen Intern Med 2021; 36:622-631. [PMID: 33140279 PMCID: PMC7947157 DOI: 10.1007/s11606-020-06306-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Most previous studies of the family doctor contract services (FDCS) evaluated its quality by using residents' signing rates, awareness, and satisfaction. We hypothesize that renewal willingness could be another important indicator to examine the quality of FDCS. OBJECTIVE To measure residents' willingness to maintain contracts with family doctors and examine the influencing factors. DESIGN Cross-sectional study. PARTICIPANTS 11,250 residents in 31 provincial administrative regions across China. MAIN METHODS A multistage stratified random sampling method was used to recruit participants. Univariate analysis, mixed-effect regression model analysis, and stepwise multivariate logistic regression analysis were performed to determine the influencing factors of residents' willingness to maintain contracts with family doctors. KEY RESULTS About 71.3% participants who contracted with and received healthcare services from family doctors were willing to maintain contracts with family doctors in China. Residents registering as local households (OR = 1.192, 95% CI = 1.039-1.368), enrolled in medical insurance (OR = 1.299, 95% CI = 1.011-1.668), reporting better health (OR = 1.246, 95% CI = 1.100-1.413), with shorter walking time to the nearest healthcare center (compared with > 30 min walking time, < 15 min: OR = 1.209, 95% CI = 1.003-1.458; 15-30 min: OR = 1.288, 95% CI = 1.124-1.475), and trusting in (OR = 4.403, 95% CI = 3.849-5.036) and satisfied with (OR = 18.514, 95% CI = 16.195-21.165) their family doctors had significantly higher willingness to maintain contracts with family doctors. CONCLUSIONS Residents' willingness to maintain contracts with family doctors could be another evaluation indicator of the quality of FDCS in China. Improving the accessibility and quality of healthcare services from family doctors may increase residents' willingness to keep contracts with family doctors and promote the implementation of FDCS.
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Skarshaug LJ, Kaspersen SL, Bjørngaard JH, Pape K. How does general practitioner discontinuity affect healthcare utilisation? An observational cohort study of 2.4 million Norwegians 2007-2017. BMJ Open 2021; 11:e042391. [PMID: 33593777 PMCID: PMC7888374 DOI: 10.1136/bmjopen-2020-042391] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Patients may benefit from continuity of care by a personal physician general practitioner (GP), but there are few studies on consequences of a break in continuity of GP. Investigate how a sudden discontinuity of GP care affects their list patients' regular GP consultations, out-of-hours consultations and acute hospital admissions, including admissions for ambulatory care sensitive conditions (ACSC). DESIGN Cohort study linking person-level national register data on use of health services and GP affiliation with data on GP activity and GP characteristics. SETTING Primary care. PARTICIPANTS 2 409 409 Norwegians assigned to the patient lists of 2560 regular GPs who, after 12 months of stable practice, had a sudden discontinuity of practice lasting two or more months between 2007 and 2017. PRIMARY AND SECONDARY OUTCOME MEASURES Monthly GP consultations, out-of-hours consultations, acute hospital admissions and ACSC admissions in periods during and 12 months after the discontinuity, compared with the 12-month period before the discontinuity using logistic regression models. RESULTS All patient age groups had a 3%-5% decreased odds of monthly regular GP consultations during the discontinuity. Odds of monthly out-of-hours consultations increased 2%-6% during the discontinuity for all adult age groups. A 7%-9% increase in odds of ACSC admissions during the period 1-6 months after discontinuity was indicated in patients over the age of 65, but in general little or no change in acute hospital admissions was observed during or after the period of discontinuity. CONCLUSIONS Modest changes in health service use were observed during and after a sudden discontinuity in practice among patients with a previously stable regular GP. Older patients seem sensitive to increased acute hospital admissions in the absence of their personal GP.
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Affiliation(s)
- Lena Janita Skarshaug
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Silje Lill Kaspersen
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Digital, SINTEF, Trondheim, Norway
| | - Johan Håkon Bjørngaard
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Faculty of Nursing and Health Sciences, Nord Universitet - Levanger Campus, Levanger, Norway
| | - Kristine Pape
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Mulyanto J, Wibowo Y, Kringos DS. Exploring general practitioners' perceptions about the primary care gatekeeper role in Indonesia. BMC FAMILY PRACTICE 2021; 22:5. [PMID: 33397307 PMCID: PMC7780672 DOI: 10.1186/s12875-020-01365-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/27/2020] [Indexed: 11/16/2022]
Abstract
Background In the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population. To be effective, gatekeeping relies on the performance of general practitioners (GPs). However, the perceptions held by Indonesian GPs about their gatekeeper role are not yet well documented. This study describes the self-perceived knowledge, attitudes and performance of Indonesian GPs with respect to the gatekeeper role and explores associated factors. Methods We conducted a cross-sectional study of all primary care facilities (N = 75) contracted by the regional NHI office in the Banyumas district. The 73 participating GPs completed a written questionnaire that assessed their knowledge, attitudes and performance in relation to the gatekeeper role. Personal and facility characteristics were analysed in a generalised linear model as possible associating factors, as well as for the association between GPs’ knowledge and attitude with performance as gatekeepers. Results GPs scored relatively high in the domains of knowledge and performance but scored lower in their attitudes towards the gatekeeper role of primary care. In the full-adjusted model, no factors were significantly associated with the knowledge score. Work experience as GPs, private or civil service employment status and rural or urban location of the primary care facility were linked to attitude scores. Full- or part-time employment and type of facility were factors associated with the performance score. Attitude scores were positively associated with performance score. Conclusion GPs in Indonesia are knowledgeable and report that they adequately perform their function as gatekeepers in primary care. However, their attitudes towards the gatekeeper function are less positive. Attitudes and performance with respect to the primary care gatekeeper role are likely influenced more by contextual factors such as location and type of facility than by personal factors. Efforts to address contextual issues could include improvements in practice standards for privately practising physicians and public information campaigns about gatekeeping regulations. Such efforts will be crucial to improving the gatekeeper role of primary care in Indonesia and assuring efficient access to high-quality care for all. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01365-w.
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Affiliation(s)
- Joko Mulyanto
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia. .,Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam; and Amsterdam Public Health Research Institute, Amsterdam, Netherlands.
| | - Yudhi Wibowo
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
| | - Dionne S Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam; and Amsterdam Public Health Research Institute, Amsterdam, Netherlands
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Ramzi S, Cant PJ. Comparison of the urgent referral for suspected breast cancer process with patient age and a predictive multivariable model. BJS Open 2020; 5:6044706. [PMID: 33688948 PMCID: PMC7944494 DOI: 10.1093/bjsopen/zraa023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 09/14/2020] [Indexed: 11/30/2022] Open
Abstract
Background The urgent 2-week wait referral for suspected breast cancer system (U2WW) in the UK prioritizes primary care referrals to one-stop breast clinics as ‘urgent’ or ‘choose and book’ (C&B). The aim of this study was to evaluate the accuracy of U2WW in discriminating cancer versus no cancer, and to consider alternative criteria. Methods Clinical features elicited in primary care and demographics of consecutive female patients in a specialist breast clinic were collated at the time of consultation from May 2008 to July 2017. U2WW was compared with patient age alone and a multivariable model in terms of accuracy and net cost for eight underlying cost–benefit assumptions. Results There were 7915 eligible referrals: 4877 urgent (61.6 per cent) and 3038 C&B (38.4 per cent) referrals. Breast cancer was diagnosed in 546 patients (6.9 per cent): 491 (10.1 per cent) in urgent and 55 (1.8 per cent) in C&B referrals (P < 0.001). The multivariable model summated the significant variables: age (odds ratio (OR) 1.07, 95 per cent c.i. 1.07 to 1.08), tumour (OR 4.85, 3.62 to 6.52), observed change (OR 1.73, 1.34 to 2.23), pain (OR 0.46, 0.35 to 0.61) and gravidity (OR 0.72, 0.54 to 0.95). The area under the curve was 0.651 for U2WW, 0.784 for age alone, and 0.824 for the multivariable model (P <0.001 for all comparisons). Considering the cost assumptions, age alone and the multivariable model were either more accurate than U2WW, or as accurate but less costly. Conclusion The U2WW is surpassed by patient age as a single referral criterion. A multivariable model based on demographics and simple clinical features outperformed both. The continued use of the U2WW needs to be reconsidered.
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Affiliation(s)
- S Ramzi
- Primrose Breast Care Centre, Derriford Hospital, University Hospitals Plymouth NHS Trust, UK
| | - P J Cant
- Primrose Breast Care Centre, Derriford Hospital, University Hospitals Plymouth NHS Trust, UK
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Engels A, König HH, Magaard JL, Härter M, Hawighorst-Knapstein S, Chaudhuri A, Brettschneider C. Depression treatment in Germany - using claims data to compare a collaborative mental health care program to the general practitioner program and usual care in terms of guideline adherence and need-oriented access to psychotherapy. BMC Psychiatry 2020; 20:591. [PMID: 33317480 PMCID: PMC7737360 DOI: 10.1186/s12888-020-02995-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 12/03/2020] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Societies strive for fast-delivered, evidence-based and need-oriented depression treatment within budget constraints. To explore potential improvements, selective contracts can be implemented. Here, we evaluate if the German collaborative psychiatry-neurology-psychotherapy contract (PNP), which extends the gatekeeping-based general practitioner (GP) program, improved guideline adherence or need-oriented and timely access to psychotherapy compared to usual care (UC). METHODS We conducted a retrospective observational cohort study based on health insurance claims data. After we identified patients with depression who were on sick leave due to a mental disorder in 2015, we applied entropy balancing to adjust for selection effects and employed chi-squared tests to compare guideline adherence of the received treatment between PNP, the GP program and UC. Subsequently, we applied an extended cox regression to assess need-orientation by comparing the relationship between accumulated sick leave days and waiting times for psychotherapy across health plans. RESULTS N = 23,245 patients were included. Regarding guideline adherence, we found no significant differences for most severity subgroups; except that patients with a first moderate depressive episode received antidepressants or psychotherapy more often in UC. Regarding need-orientation, we observed that the effect of each additional month of sick leave on the likelihood of starting psychotherapy was increased by 6% in PNP compared to UC. Irrespective of the health plan, we found that within the first 12 months only between 24.3 and 39.7% (depending on depression severity) received at least 10 psychotherapy sessions or adequate pharmacotherapy. CONCLUSIONS The PNP contract strengthens the relationship between sick leave days and the delay until the beginning of psychotherapy, which suggests improvements in terms of need-oriented access to care. However, we found no indication for increased guideline adherence and - independent of the health plan - a gap in sufficient utilization of adequate treatment options.
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Affiliation(s)
- Alexander Engels
- Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- grid.13648.380000 0001 2180 3484Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246 Hamburg, Germany
| | - Julia Luise Magaard
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- grid.13648.380000 0001 2180 3484Department of Medical Psychology, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Ariane Chaudhuri
- grid.491710.a0000 0001 0339 5982AOK Baden-Württemberg, Stuttgart, Germany
| | - Christian Brettschneider
- grid.13648.380000 0001 2180 3484Department of Health Economics and Health Services Research, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistr. 52, Building W37, 20246 Hamburg, Germany
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Kirkdale CL, Archer Z, Thornley T, Wright D, Valeur M, Gourlay N, Ayerst K. Accessing Mole-Scanning through Community Pharmacy: A Pilot Service in Collaboration with Dermatology Specialists. PHARMACY 2020; 8:pharmacy8040231. [PMID: 33287210 PMCID: PMC7768496 DOI: 10.3390/pharmacy8040231] [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] [Received: 10/28/2020] [Revised: 11/20/2020] [Accepted: 11/27/2020] [Indexed: 11/16/2022] Open
Abstract
Early identification and treatment of malignant melanoma is crucial to prevent mortality. The aim of this work was to describe the uptake, profile of users and service outcomes of a mole scanning service in the community pharmacy setting in the UK. In addition, health care costs saved from the perspective of general practice were estimated. The service allowed patients to have concerning skin lesions scanned with a dermatoscopy device which were analyzed remotely by clinical dermatology specialists in order to provide recommendations for the patient. Patients were followed up to ascertain the clinical outcome. Data were analyzed for 6355 patients and 9881 scans across 50 community pharmacies. The majority of the scans required no further follow-up (n = 8763, 88.7%). Diagnosis was confirmed for 70.4% (n = 757/1118) of scans where patients were recommended to seek further medical attention. Of these, 44.3% were ultimately defined as normal (n = 335) and 6.2% as malignant melanoma (n = 47/757). An estimated 0.7% of scans taken as part of the service led to a confirmed diagnosis of malignant melanoma. This service evaluation has shown that a mole scanning service available within community pharmacies is effective at triaging patients and ultimately playing a part in identifying diagnoses of malignant melanoma.
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Affiliation(s)
| | - Zoe Archer
- ScreenCancer UK Ltd., Innovation Centre, Maidstone Road, Chatham, Kent ME5 9FD, UK; (Z.A.); (M.V.); (K.A.)
| | - Tracey Thornley
- Boots UK, Thane Road, Nottingham NG90 1BS, UK; (T.T.); (N.G.)
- School of Pharmacy, University of Nottingham, University Park, Nottingham NG7 2RD, UK
| | - David Wright
- School of Pharmacy, University of East Anglia, Norwich Research Park, Norwich NR4 7TJ, UK;
| | - Mette Valeur
- ScreenCancer UK Ltd., Innovation Centre, Maidstone Road, Chatham, Kent ME5 9FD, UK; (Z.A.); (M.V.); (K.A.)
| | - Nicola Gourlay
- Boots UK, Thane Road, Nottingham NG90 1BS, UK; (T.T.); (N.G.)
| | - Kurt Ayerst
- ScreenCancer UK Ltd., Innovation Centre, Maidstone Road, Chatham, Kent ME5 9FD, UK; (Z.A.); (M.V.); (K.A.)
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Greenfield G, Blair M, Aylin PP, Saxena S, Majeed A, Bottle A. Characteristics of frequent paediatric users of emergency departments in England: an observational study using routine national data. Emerg Med J 2020; 38:146-150. [PMID: 33199272 DOI: 10.1136/emermed-2019-209122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 09/03/2020] [Accepted: 10/04/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Frequent attendances of the same users in emergency departments (ED) can intensify workload pressures and are common among children, yet little is known about the characteristics of paediatric frequent users in EDs. AIM To describe the volume of frequent paediatric attendance in England and the demographics of frequent paediatric ED users in English hospitals. METHOD We analysed the Hospital Episode Statistics dataset for April 2014-March 2017. The study included 2 308 816 children under 16 years old who attended an ED at least once. Children who attended four times or more in 2015/2016 were classified as frequent users. The preceding and subsequent years were used to capture attendances bordering with the current year. We used a mixed effects logistic regression with a random intercept to predict the odds of being a frequent user in children from different sociodemographic groups. RESULTS One in 11 children (9.1%) who attended an ED attended four times or more in a year. Infants had a greater likelihood of being a frequent attender (OR 3.24, 95% CI 3.19 to 3.30 vs 5 to 9 years old). Children from more deprived areas had a greater likelihood of being a frequent attender (OR 1.57, 95% CI 1.54 to 1.59 vs least deprived). Boys had a slightly greater likelihood than girls (OR 1.05, 95% CI 1.04 to 1.06). Children of Asian and mixed ethnic groups were more likely to be frequent users than those from white ethnic groups, while children from black and 'other' had a lower likelihood (OR 1.03, 95% CI 1.01 to 1.05; OR 1.04, 95% CI 1.01 to 1.06; OR 0.88, 95% CI 0.86 to 0.90; OR 0.90, 95% CI 0.87 to 0.92, respectively). CONCLUSION One in 11 children was a frequent attender. Interventions for reducing paediatric frequent attendance need to target infants and families living in deprived areas.
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Affiliation(s)
- Geva Greenfield
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Mitch Blair
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Paul P Aylin
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Sonia Saxena
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Alex Bottle
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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Liang LL, Huang N, Shen YJ, Chen AYA, Chou YJ. Do patients bypass primary care for common health problems under a free-access system? Experience of Taiwan. BMC Health Serv Res 2020; 20:1050. [PMID: 33208148 PMCID: PMC7677770 DOI: 10.1186/s12913-020-05908-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 11/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background A common challenge for free-access systems is that people may bypass primary care and seek secondary care through self-referral. Taiwan’s government has undertaken various initiatives to mitigate bypass; however, little is known about whether the bypass trend has decreased over time. This study examined the extent to which patients bypass primary care for treatment of common diseases and factors associated with bypass under Taiwan’s free-access system. Methods This repeated cross-sectional study analyzed data from Taiwan’s National Health Insurance Research Database. A random sample of 1 million enrollees was drawn repeatedly from the insured population during 2000–2017. To capture visits beyond the community level, the bypass rate was defined as the proportion of self-referred visits to the top two levels of providers, namely academic medical centers and regional hospitals, among all visits to all providers. Subgroup analyses were conducted for visits with a single diagnosis. Logistic regressions were used to investigate factors associated with bypass. Results The standardized bypass rate for all diseases analyzed exhibited a decreasing trend. In 2017, it was low for common cold (0.7–1.3%), moderate for hypertension (14.0–29.5%), but still high for diabetes (32.0–47.0%). Moreover, the likelihood of bypass was higher for male, patients with higher salaries or comorbidities, and in areas with more physicians practicing in large hospitals or less physicians working in primary care facilities. Conclusions Although the bypass trend has decreased over time, continuing efforts may be required to reduce bypass associated with chronic diseases. Both patient sociodemographic and market characteristics were associated with the likelihood of bypass. These results may help policymakers to develop strategies to mitigate bypass. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05908-w.
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Affiliation(s)
- Li-Lin Liang
- Department of Business Management, National Sun Yat-sen University, No. 70, Lienhai Rd, Kaohsiung, 804, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, No.155, Section 2, Li-Nong Street, Taipei, 112, Taiwan
| | - Yi-Jung Shen
- Institute of Hospital and Health Care Administration, National Yang-Ming University, No.155, Section 2, Li-Nong Street, Taipei, 112, Taiwan
| | - Annie Yu-An Chen
- RAND Corporation, 1766 Main Street, Santa Monica, CA, USA.,Pardee RAND Graduate School, 1766 Main Street, Santa Monica, CA, USA
| | - Yiing-Jenq Chou
- Institute of Public Health, National Yang-Ming University, No.155, Sec. 2, Li-Nong St., Beitou Dist, Taipei, 112, Taiwan.
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Szarkowski A, Toe D. Pragmatics in Deaf and Hard of Hearing Children: An Introduction. Pediatrics 2020; 146:S231-S236. [PMID: 33139436 DOI: 10.1542/peds.2020-0242b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 11/24/2022] Open
Abstract
We introduce this supplement and highlight the importance of the development of pragmatic skills in children who are DHH.
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Affiliation(s)
- Amy Szarkowski
- Children's Center for Communication/Beverly School for the Deaf, Beverly, Massachusetts; .,Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts; and
| | - Dianne Toe
- School of Education, Faculty of Arts and Education, Deakin University, Geelong, Victoria, Australia
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47
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Coughlan B, Duschinsky R, O'Connor ME, Woolgar M. Identifying and managing care for children with autism spectrum disorders in general practice: A systematic review and narrative synthesis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1928-1941. [PMID: 32667097 DOI: 10.1111/hsc.13098] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Abstract
Many healthcare systems are organised such that General Practitioners (GPs) often have a key role in identifying autism spectrum disorders (hereafter collectively referred to as autism) in children. In this review, we explored what GPs know about autism and the factors that influence their ability to identify and manage care for their patients with autism in practice. We conducted a systematic narrative review using eight electronic databases. These included Embase and MEDLINE via Ovid, Web of Knowledge, PsycINFO via Ebscohost, PubMed, Scopus, ProQuest Dissertations and Thesis, and Applied Social Sciences Index and Abstracts (ASSIA) via ProQuest. Our search yielded 2,743 citations. Primary research studies were included, and we did not impose any geographical, language or date restrictions. We identified 17 studies that met our inclusion criteria. Studies included in the review were conducted between 2003 and 2019. We thematically synthesised the material and identified the following themes: the prototypical image of a child with autism; experience, sources of information, and managing care; barriers to identification; strategies to aid in identification; and characteristics that facilitate expertise. Together, the findings from this review present a mixed picture of GP knowledge and experiences in identifying autism and managing care for children with the condition. At one end of the continuum, there were GPs who had not heard of autism or endorsed outmoded aetiological theories. Others, however, demonstrated a sound knowledge of the conditions but had limited confidence in their ability to identify the condition. Many GPs and researchers alike called for more training and this might be effective. However, framing the problem as one of a lack of training risks silences the array of organisational factors that impact on a GP's ability to provide care for these patients.
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Affiliation(s)
- Barry Coughlan
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Robbie Duschinsky
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Matt Woolgar
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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48
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Mackenzie L, Beavis AM, Tan ACW, Clemson L. Systematic Review and Meta-Analysis of Intervention Studies with General Practitioner Involvement Focused on Falls Prevention for Community-Dwelling Older People. J Aging Health 2020; 32:1562-1578. [PMID: 32912102 DOI: 10.1177/0898264320945168] [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] [Indexed: 01/18/2023]
Abstract
Objectives: Falls are a significant health problem for the ageing population. This review aimed to identify effective falls prevention interventions with involvement of general practitioners (GPs). Methods: Systematic review of randomised controlled trials conducted from 1999-2019, with meta-analysis. Searches located 2736 articles. A quality assessment was conducted of all included studies. Results: 21 randomised controlled trials met the inclusion criteria and 19 studies could be included in a meta-analysis. Overall, studies were not effective for reducing multiple falls (Relative Risk (RR) 1.16, 95% CI .97-1.39 and p = .10) or reducing one or more falls (RR .91, 95% CI: .82-1.01 and p = .08), but were effective for reducing injurious falls (RR .76, 95% CI: .66-.87 and p = .001). Discussion: Studies involving the GP in an active role and aligned with the primary care context were effective. The fidelity of interventions was limited by independent GP decisions and older participants being required to initiate the intervention.
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Affiliation(s)
- Lynette Mackenzie
- Discipline of Occupational Therapy, School of Health Sciences, 4334The University of Sydney, Australia
| | - Ann-Marie Beavis
- Discipline of Occupational Therapy, School of Health Sciences, 4334The University of Sydney, Australia
| | - Amy C W Tan
- Ageing Work and Health Research Unit, School of Health Sciences, 4334The University of Sydney, Australia
| | - Lindy Clemson
- Ageing Work and Health Research Unit, School of Health Sciences, 4334The University of Sydney, Australia
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49
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Alva Staufert MF, Ferreira GE, Sharma S, Gutiérrez Camacho C, Maher CG. A look into the challenges and complexities of managing low back pain in Mexico. Glob Public Health 2020; 16:936-946. [PMID: 32816643 DOI: 10.1080/17441692.2020.1808038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Low back pain is a global health problem. In Mexico it is one of the most common musculoskeletal conditions as well as the leading cause of disability. This review provides an overview of the challenges and complexities of managing low back pain in Mexico. It begins with an explanation of the Mexican healthcare system and an overview of the burden of low back pain. Usual care for low back pain in Mexico is then contrasted with recommended best practice care to highlight common evidence-practice gaps and drivers of poor care. Finally, solutions are proposed based on positive experiences from other countries. Delving into the Mexican health framework and the burden of low back pain will provide a better understanding of why it is important to pay attention to this musculoskeletal disorder. Potential steps required to reduce the burden are also outlined to benefit not only the people suffering from low back pain but also the Mexican economy and society.
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Affiliation(s)
| | - Giovanni E Ferreira
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | - Sweekriti Sharma
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
| | | | - Chris G Maher
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Institute for Musculoskeletal Health, The University of Sydney and Sydney Local Health District, Sydney, Australia
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50
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Kassai R, van Weel C, Flegg K, Tong SF, Han TM, Noknoy S, Dashtseren M, Le An P, Ng CJ, Khoo EM, Noh KM, Lee MC, Howe A, Goodyear-Smith F. Priorities for primary health care policy implementation: recommendations from the combined experience of six countries in the Asia-Pacific. Aust J Prim Health 2020; 26:351-357. [PMID: 32746962 DOI: 10.1071/py19194] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/31/2020] [Indexed: 11/23/2022]
Abstract
Primary health care is essential for equitable, cost-effective and sustainable health care. It is the cornerstone to achieving universal health coverage against a backdrop of rising health expenditure and aging populations. Implementing strong primary health care requires grassroots understanding of health system performance. Comparing successes and barriers between countries may help identify mutual challenges and possible solutions. This paper compares and analyses primary health care policy in Australia, Malaysia, Mongolia, Myanmar, Thailand and Vietnam. Data were collected at the World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Asia-Pacific regional conference in November 2017 using a predetermined framework. The six countries varied in maturity of their primary health care systems, including the extent to which family doctors contribute to care delivery. Challenges included an insufficient trained and competent workforce, particularly in rural and remote communities, and deficits in coordination within primary health care, as well as between primary and secondary care. Asia-Pacific regional policy needs to: (1) focus on better collaboration between public and private sectors; (2) take a structured approach to information sharing by bridging gaps in technology, health literacy and interprofessional working; (3) build systems that can evaluate and improve quality of care; and (4) promote community-based, high-quality training programs.
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Affiliation(s)
- Ryuki Kassai
- Department of Community and Family Medicine, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295. Japan; and Corresponding author.
| | - Chris van Weel
- Department of Primary and Community Care, Radboud University Medical Center, 117-ELG, PO Box 9101, 6500HB Nijmegen, The Netherlands; and Department of Health Services Research and Policy, Australian National University, 63A Eggleston Road, Acton, ACT 2601, Australia
| | - Karen Flegg
- World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA), 12A-05 Chartered Square Building, 152 North Sathon Road, Silom, Bangrak, Bangkok 10500, Thailand
| | - Seng Fah Tong
- Department of Family Medicine, Faculty of Medicine, National University of Malaysia, Jalan Yaakob Latif, Bandar Tun Razak, 56000 Kuala Lumpur, Malaysia
| | - Tin Myo Han
- Myanmar General Practitioners Society, No. 246, Theinbu Road, Mingalar Taung Nyunt Township, Yangon 11221, Myanmar
| | - Sairat Noknoy
- The Royal College of Family Physicians of Thailand, 11th Floor, The Royal Golden Jubilee Building, New Petchaburi 47 Road, Bangkapi, Bangkok 10310, Thailand
| | - Myagmartseren Dashtseren
- Department of Family Medicine, Mongolian National University of Medical Sciences, Zorig Street, POB 48/111, Ulaanbaatar 14210, Mongolia
| | - Pham Le An
- Family Medicine Training Center, University of Medicine and Pharmacy, 217 Hong Bang Street, District 5, Ho Chi Minh City 700000, Vietnam; and Vietnamese Association Family Physician, 217 Hong Bang Street, District 5, Ho Chi Minh City 700000, Vietnam
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Jalan Lembah Pantai, 50603 Kuala Lumpur, Malaysia
| | - Kamaliah Mohd Noh
- Cyberjaya University College of Medical Sciences, Persiaran Bestari, Cyber 11, 63000 Cyberjaya, Selangor Darul Ehsan, Malaysia
| | - Meng-Chih Lee
- Institute of Medicine, Chung Shan Medical University, 110 Section 1, Chien Kuo North Road, Taichung 40201, Taiwan; and Institute of Population Health Sciences, National Health Research Institutes, Miaoli, 35 Keyan Road, Zhunan, Miaoli County 35053, Taiwan
| | - Amanda Howe
- Health Services and Primary Care, Norwich Medical School, University of East Anglia, Norwich Research Park, Earlham Road, Norwich, Norfolk NR4 7TJ, UK
| | - Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, University of Auckland, PB 92 019, Auckland 1142, New Zealand
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