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Kumpunen S, Matthews J, Amuthalingam T, Irving G, Bridgwood B, Pettigrew LM. Workplace-based knowledge exchange programmes between academics, policy-makers and providers of healthcare: a qualitative study. BMJ Lead 2024; 8:15-19. [PMID: 37442570 DOI: 10.1136/leader-2023-000756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/11/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Workplace-based knowledge exchange programmes (WKEPs), such as job shadowing or secondments, offer potential for health and care providers, academics, and policy-makers to foster partnerships, develop local solutions and overcome key differences in practices. Yet opportunities for exchange can be hard to find and are poorly reported in the literature. OBJECTIVES To understand the views of providers, academics and policy-makers regarding WKEPs, in particular, their motivations to participate in such exchanges and the perceived barriers and facilitators to participation. METHODS A qualitative study involving semistructured interviews with 20 healthcare providers, academics and policy-makers in England. Rapid data collection and analysis techniques were employed. Interviews formed part of a wider scoping study that mapped the characteristics and existing literature related to WKEPs. RESULTS Interviewees reported being motivated to develop, sponsor and/or participate in WKEPs with a clear purpose and defined outcomes that could demonstrate the value of the time out of work to their organisations. Perceived barriers included competitive application processes for national fellowships, a lack of knowing how to identify with whom to undertake an exchange (varying 'tribes'), and the burdens of time, costs and administration regarding arranging exchanges. WKEPs were reported to work best where there was a perceived sense of shared purpose, long-standing relationship and trust between organisations. Facilitators included existing confidentiality agreements and/or shared professional standards, as well as funding. CONCLUSION WKEPs were reported to be valuable experiences but required significant organisational buy-in and cooperation to arrange and sustain. To benefit emerging partnerships, such as the new integrated care systems in England, more outcomes evaluations of existing WKEPs are needed, and research focused on overcoming barriers to participation, such as time and costs.
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Affiliation(s)
- Stephanie Kumpunen
- Department of Applied Health Research, Institute of Epidemiology and Health Care, University College London, London, UK
- Nuffield Trust, London, UK
| | | | | | - Greg Irving
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Bernadeta Bridgwood
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Luisa M Pettigrew
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
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2
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Allen LN, Pettigrew LM, Exley J, Nugent R, Balabanova D, Villar-Uribe M, Baatiema L, Shubber Z, Mugambi J, Kidd M, Zewdie A, Padula I, Abimbola S. The role of Primary Health Care, primary care and hospitals in advancing Universal Health Coverage. BMJ Glob Health 2023; 8:e014442. [PMID: 38084496 PMCID: PMC10711840 DOI: 10.1136/bmjgh-2023-014442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/19/2023] [Indexed: 12/18/2023] Open
Affiliation(s)
- Luke N Allen
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Luisa M Pettigrew
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Josephine Exley
- Department of Disease Control, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Rachel Nugent
- Department of Global Health, University of Washington, Washington, DC, USA
| | | | - Manuela Villar-Uribe
- Health Nutrition and Population, World Bank Group, Washington, District of Columbia, USA
| | | | - Zara Shubber
- World Bank Group, Washington, District of Columbia, USA
| | - Joy Mugambi
- Kenya Association Family Physicians, Nakuru, Kenya
| | | | - Anteneh Zewdie
- International Institute for Primary Health Care, Addis, Ethiopia
| | - Inez Padula
- Department of Family and Community Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Seye Abimbola
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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3
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Mather M, Pettigrew LM, Navaratnam S. Barriers and facilitators to clinical behaviour change by primary care practitioners: a theory-informed systematic review of reviews using the Theoretical Domains Framework and Behaviour Change Wheel. Syst Rev 2022; 11:180. [PMID: 36042457 PMCID: PMC9429279 DOI: 10.1186/s13643-022-02030-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the barriers and facilitators to behaviour change by primary care practitioners (PCPs) is vital to inform the design and implementation of successful Behaviour Change Interventions (BCIs), embed evidence-based medicine into routine clinical practice, and improve quality of care and population health outcomes. METHODS A theory-led systematic review of reviews examining barriers and facilitators to clinical behaviour change by PCPs in high-income primary care contexts using PRISMA. Embase, MEDLINE, PsychInfo, HMIC and Cochrane Library were searched. Content and framework analysis was used to map reported barriers and facilitators to the Theoretical Domains Framework (TDF) and describe emergent themes. Intervention functions and policy categories to change behaviour associated with these domains were identified using the COM-B Model and Behaviour Change Wheel (BCW). RESULTS Four thousand three hundred eighty-eight reviews were identified. Nineteen were included. The average quality score was 7.5/11. Reviews infrequently used theory to structure their methods or interpret their findings. Barriers and facilitators most frequently identified as important were principally related to 'Knowledge', 'Environmental context and resources' and 'Social influences' TDF domains. These fall under the 'Capability' and 'Opportunity' domains of COM-B, and are linked with interventions related to education, training, restriction, environmental restructuring and enablement. From this, three key areas for policy change include guidelines, regulation and legislation. Factors least frequently identified as important were related to 'Motivation' and other psychological aspects of 'Capability' of COM-B. Based on this, BCW intervention functions of persuasion, incentivisation, coercion and modelling may be perceived as less relevant by PCPs to change behaviour. CONCLUSIONS PCPs commonly perceive barriers and facilitators to behaviour change related to the 'Capability' and 'Opportunity' domains of COM-B. PCPs may lack insight into the role that 'Motivation' and aspects of psychological 'Capability' have in behaviour change and/or that research methods have been inadequate to capture their function. Future research should apply theory-based frameworks and appropriate design methods to explore these factors. With no 'one size fits all' intervention, these findings provide general, transferable insights into how to approach changing clinical behaviour by PCPs, based on their own views on the barriers and facilitators to behaviour change. SYSTEMATIC REVIEW REGISTRATION A protocol was submitted to the London School of Hygiene and Tropical Medicine via the Ethics and CARE form submission on 16.4.2020, ref number 21478 (available on request). The project was not registered on PROSPERO.
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Affiliation(s)
- Melissa Mather
- Maidstone and Tunbridge Wells NHS Trust, Tunbridge Wells Hospital, Tonbridge Road, Pembury, Tunbridge Wells, Kent, TN2 4QJ, UK.
| | - Luisa M Pettigrew
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Pl, London, WC1H 9SH, UK.,UCL Department of Primary Care and Population Health, UCL Medical School, Upper Third Floor, Rowland Hill Street, London, NW3 2PF, UK
| | - Stefan Navaratnam
- Northern Devon Healthcare NHS Trust, North Devon District Hospital, Raleigh Heights, Barnstaple, EX31 4JB, UK
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4
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Affiliation(s)
- Luisa M Pettigrew
- London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, London, UK
| | | | - Nicholas Mays
- London School of Hygiene and Tropical Medicine, Department of Health Services Research and Policy, London, UK
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Pettigrew LM, Kumpunen S, Rosen R, Posaner R, Mays N. Lessons for 'large-scale' general practice provider organisations in England from other inter-organisational healthcare collaborations. Health Policy 2018; 123:51-61. [PMID: 30509873 DOI: 10.1016/j.healthpol.2018.10.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 09/26/2018] [Accepted: 10/29/2018] [Indexed: 11/30/2022]
Abstract
Policymakers in England are increasingly encouraging the formation of 'large-scale' general practice provider collaborations with the expectation that this will help deliver better quality services and generate economies of scale. However, solid evidence that these expectations will be met is limited. This paper reviews evidence from other inter-organisational healthcare collaborations with similarities in their development or anticipated impact to identify lessons. Medline. SSCI, Embase and HMIC database searches identified a range of initiatives which could provide transferable evidence. Iterative searching was undertaken to identify further relevant evidence. Thematic analysis was used to identify areas to consider in the development of large-scale general practice providers. Framework analysis was used to identify challenges which may affect the ability of such providers to achieve their anticipated impact. A narrative approach was used to synthesise the evidence. Trade-offs exist in 'scaling-up' between mandated and voluntary collaboration; networks versus single organisations; small versus large collaborations; and different types of governance structures in terms of sustainability and performance. While positive impact seems plausible, evidence suggests that it is not a given that clinical outcomes or patient experience will improve, nor that cost savings will be achieved as a result of increasing organisational size. Since the impact and potential unintended consequences are not yet clear, it would be advisable for policymakers to move with caution, and be informed by ongoing evaluation.
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Affiliation(s)
- Luisa M Pettigrew
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK; Nuffield Trust, 59 New Cavendish Street, London, W1G 7LP, UK.
| | | | - Rebecca Rosen
- Nuffield Trust, 59 New Cavendish Street, London, W1G 7LP, UK
| | - Rachel Posaner
- Library & Information Service, Health Services Management Centre, University of Birmingham, Park House, 40 Edgbaston Park Road, Birmingham, B15 2RT, UK
| | - Nicholas Mays
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK; Nuffield Trust, 59 New Cavendish Street, London, W1G 7LP, UK
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Moosa S, Peersman W, Derese A, Kidd M, Pettigrew LM, Howe A, Martinez-Bianchi V, De Maeseneer J. Emerging role of family medicine in South Africa. BMJ Glob Health 2018; 3:e000736. [PMID: 30233837 PMCID: PMC6135463 DOI: 10.1136/bmjgh-2018-000736] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/28/2018] [Accepted: 04/30/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Shabir Moosa
- Department of Family Medicine, University of Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Wim Peersman
- Social and Community Work Research Group, Odisee University College, Brussels, Belgium
| | - Anselme Derese
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | - Michael Kidd
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Luisa M Pettigrew
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Amanda Howe
- Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Jan De Maeseneer
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
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7
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Glonti K, Struckmann V, Alconada A, Pettigrew LM, Hernandez-Santiago V, Minue S, Risso-Gill I, McKee M, Legido-Quigley H. Exploring the training and scope of practice of GPs in England, Germany and Spain. Gac Sanit 2018; 33:148-155. [PMID: 29576244 DOI: 10.1016/j.gaceta.2017.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/13/2017] [Accepted: 10/16/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore general practitioner (GP) training, continuing professional development, scope of practice, ethical issues and challenges in the working environment in three European countries. METHOD Qualitative study of 35 GPs from England, Germany and Spain working in urban primary care practices. Participants were recruited using convenience and snowball sampling techniques. Semi-structured interviews were recorded, transcribed and analysed by four independent researchers adopting a thematic approach. RESULTS Entrance to and length of GP training differ between the three countries, while continuing professional development is required in all three, although with different characteristics. Key variations in the scope of practice include whether there is a gatekeeping role, whether GPs work in multidisciplinary teams or singlehandedly, the existence of appraisal processes, and the balance between administrative and clinical tasks. However, similar challenges, including the need to adapt to an ageing population, end-of-life care, ethical dilemmas, the impact of austerity measures, limited time for patients and gaps in coordination between primary and secondary care are experienced by GPs in all three countries. CONCLUSION Primary health care variations have strong historical roots, derived from the different national experiences and the range of clinical services delivered by GPs. There is a need for an accessible source of information for GPs themselves and those responsible for safety and quality standards of the healthcare workforce. This paper maps out the current situation before Brexit is being implemented in the UK which could see many of the current EU arrangements and legislation to assure professional mobility between the UK and the rest of Europe dismantled.
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Affiliation(s)
- Ketevan Glonti
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Verena Struckmann
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | - Alvaro Alconada
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Luisa M Pettigrew
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Virginia Hernandez-Santiago
- Division of Population Health Sciences, Medical Research Institute, University of Dundee, Dundee, United Kingdom
| | - Sergio Minue
- Andalusian School of Public Health, Granada, Spain
| | | | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, Singapore.
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Pettigrew LM, Kumpunen S, Mays N, Rosen R, Posaner R. The impact of new forms of large-scale general practice provider collaborations on England's NHS: a systematic review. Br J Gen Pract 2018; 68:e168-e177. [PMID: 29440013 PMCID: PMC5819982 DOI: 10.3399/bjgp18x694997] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 08/31/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Over the past decade, collaboration between general practices in England to form new provider networks and large-scale organisations has been driven largely by grassroots action among GPs. However, it is now being increasingly advocated for by national policymakers. Expectations of what scaling up general practice in England will achieve are significant. AIM To review the evidence of the impact of new forms of large-scale general practice provider collaborations in England. DESIGN AND SETTING Systematic review. METHOD Embase, MEDLINE, Health Management Information Consortium, and Social Sciences Citation Index were searched for studies reporting the impact on clinical processes and outcomes, patient experience, workforce satisfaction, or costs of new forms of provider collaborations between general practices in England. RESULTS A total of 1782 publications were screened. Five studies met the inclusion criteria and four examined the same general practice networks, limiting generalisability. Substantial financial investment was required to establish the networks and the associated interventions that were targeted at four clinical areas. Quality improvements were achieved through standardised processes, incentives at network level, information technology-enabled performance dashboards, and local network management. The fifth study of a large-scale multisite general practice organisation showed that it may be better placed to implement safety and quality processes than conventional practices. However, unintended consequences may arise, such as perceptions of disenfranchisement among staff and reductions in continuity of care. CONCLUSION Good-quality evidence of the impacts of scaling up general practice provider organisations in England is scarce. As more general practice collaborations emerge, evaluation of their impacts will be important to understand which work, in which settings, how, and why.
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Affiliation(s)
- Luisa M Pettigrew
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London
| | | | - Nicholas Mays
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London
| | | | - Rachel Posaner
- Library and Information Service, Health Services Management Centre, University of Birmingham, Birmingham
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Walsh A, Pettigrew LM. A global perspective on education for primary care: a WONCA special edition. Educ Prim Care 2016; 27:341-342. [PMID: 27691908 DOI: 10.1080/14739879.2016.1224984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
Affiliation(s)
- Allyn Walsh
- a Department of Family Medicine , McMaster University , Hamilton , Canada
| | - Luisa M Pettigrew
- b Department of Health Services Research and Policy , London School of Hygiene and Tropical Medicine , London , United Kingdom
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Walpole SC, Shortall C, van Schalkwyk MC, Merriel A, Ellis J, Obolensky L, Casanova Dias M, Watson J, Brown CS, Hall J, Pettigrew LM, Allen S. Time to go global: a consultation on global health competencies for postgraduate doctors. Int Health 2016; 8:317-23. [PMID: 27241136 PMCID: PMC5039817 DOI: 10.1093/inthealth/ihw019] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/03/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Globalisation is having profound impacts on health and healthcare. We solicited the views of a wide range of stakeholders in order to develop core global health competencies for postgraduate doctors. METHODS Published literature and existing curricula informed writing of seven global health competencies for consultation. A modified policy Delphi involved an online survey and face-to-face and telephone interviews over three rounds. RESULTS Over 250 stakeholders participated, including doctors, other health professionals, policymakers and members of the public from all continents of the world. Participants indicated that global health competence is essential for postgraduate doctors and other health professionals. Concerns were expressed about overburdening curricula and identifying what is 'essential' for whom. Conflicting perspectives emerged about the importance and relevance of different global health topics. Five core competencies were developed: (1) diversity, human rights and ethics; (2) environmental, social and economic determinants of health; (3) global epidemiology; (4) global health governance; and (5) health systems and health professionals. CONCLUSIONS Global health can bring important perspectives to postgraduate curricula, enhancing the ability of doctors to provide quality care. These global health competencies require tailoring to meet different trainees' needs and facilitate their incorporation into curricula. Healthcare and global health are ever-changing; therefore, the competencies will need to be regularly reviewed and updated.
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Affiliation(s)
- Sarah C Walpole
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Hull York Medical School, York, UK
| | - Clare Shortall
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Doctors of the World, London, UK
| | - May Ci van Schalkwyk
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Royal Free Hospital, London, UK
| | - Abi Merriel
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Jayne Ellis
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Malawi Liverpool Wellcome Trust, Malawi
| | - Lucy Obolensky
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Global and Remote Healthcare, Plymouth University, Plymouth, UK
| | - Marisa Casanova Dias
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Camden & Islington NHS Foundation Trust, London, UK
| | - Jessica Watson
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Colin S Brown
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Hospital for Tropical Diseases, University College London Hospitals, London, UK
| | - Jennifer Hall
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Institute for Global Health, University College London, London, UK
| | - Luisa M Pettigrew
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Steve Allen
- Global Health Curriculum group, Academy of Medical Royal Colleges,10 Dallington Street, London, EC1 V 0DB, UK Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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Affiliation(s)
- Florian L Stigler
- Institute of General Practice and Evidence-Based Health Services Research, Medical University of Graz, Graz 8010, Austria; Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK.
| | - James Macinko
- Departments of Health Policy and Management and Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Luisa M Pettigrew
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Raman Kumar
- Academy of Family Physicians of India, New Delhi, India
| | - Chris van Weel
- Radboud University Medical Center, Nijmegen, Netherlands; Australian Primary Health Care Research Institute, Australian National University, Canberra, ACT, Australia
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Pettigrew LM, Mathauer I. Voluntary Health Insurance expenditure in low- and middle-income countries: Exploring trends during 1995-2012 and policy implications for progress towards universal health coverage. Int J Equity Health 2016; 15:67. [PMID: 27089877 PMCID: PMC4836104 DOI: 10.1186/s12939-016-0353-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/04/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Most low- and middle-income countries (LMIC) rely significantly on private health expenditure in the form of out-of-pocket payments (OOP) and voluntary health insurance (VHI). This paper assesses VHI expenditure trends in LMIC and explores possible explanations. This illuminates challenges deriving from changes in VHI expenditure as countries aim to progress equitably towards universal health coverage (UHC). METHODS Health expenditure data was retrieved from the WHO Global Health Expenditure Database to calculate VHI, OOP and general government health (GGHE) expenditure as a share of total health expenditure (THE) for the period of 1995-2012. A literature analysis offered potential reasons for trends in countries and regions. RESULTS In 2012, VHI as a percentage of THE (abbreviated as VHI%) was below 1 % in 49 out of 138 LMIC. Twenty-seven countries had no or more than five years of data missing. VHI% ranged from 1 to 5 % in 39 LMIC and was above 5 % in 23 LMIC. There is an upwards average trend in VHI% across all regions. However, increases in VHI% cannot be consistently linked with OOP falling or being redirected into private prepayment. There are various countries which exhibit rising VHI alongside a rise in OOP and fall in GGHE, which is a less desirable path in order to equitably progress towards UHC. DISCUSSION AND CONCLUSION Reasons for the VHI expenditure trends across LMIC include: external influences; government policies on the role of VHI and its regulation; and willingness and ability of the population to enrol in VHI schemes. Many countries have paid insufficient attention to the potentially risky role of VHI for equitable progress towards UHC. Expanding VHI markets bear the risk of increasing fragmentation and inequities. To avoid this, health financing strategies need to be clear regarding the role given to VHI on the path towards UHC.
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Affiliation(s)
- Luisa M. Pettigrew
- />Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
| | - Inke Mathauer
- />Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- />Department of Health Systems Governance and Financing, World Health Organization, Avenue Appia, Geneva, Switzerland
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Affiliation(s)
- Luisa M Pettigrew
- Department of Health Services Research and Policy, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1 9SH, UK.
| | - Jan De Maeseneer
- Department of Family Medicine and Primary Health Care, Ghent University, Ghent, Belgium
| | | | - Akye Essuman
- Family Medicine Unit, Department of Community Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Michael R Kidd
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Andy Haines
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London WC1 9SH, UK
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14
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Glonti K, Struckmann V, Alconada A, Pettigrew LM, Hernandez-Santiago V, Minue S, Risso-Gill I, McKee M, Legido-Quigley H. Training and scope of practice of GPs in Europe- A qualitative study in three European countries. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Pettigrew LM, MacVicar R. Overcoming challenges in primary care education: stories from Rwanda. Education for Primary Care 2015; 26:342. [DOI: 10.1080/14739879.2015.1079968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Affiliation(s)
- Michael R Kidd
- Faculty of Medicine, Nursing and Health Sciences, Flinders University, Australia
| | | | | | - Pratap N Prasad
- Department of General Practice and Emergency Medicine, Institute of Medicine, Tribhuvan University Teaching Hospital, Kathmandu, Nepal
| | - Luisa M Pettigrew
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK; World Organization of Family Doctors, Silom, Bangrak, Bangkok 10500, Thailand.
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Pettigrew LM, MacVicar R. Overcoming challenges in primary care education. Education for Primary Care 2015; 26:120-1. [DOI: 10.1080/14739879.2015.11494325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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MacVicar R, Pettigrew LM. Overcoming challenges in primary care education. Education for Primary Care 2015; 26:2. [DOI: 10.1080/14739879.2015.11494298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- Luisa M Pettigrew
- International Department, RCGP, 30 Euston Square, London NW1 2FB, UK.
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Pettigrew LM, Perera D, Wass V. Qualitative study of motivators and outcomes of Sri Lankan doctors achieving MRCGPInternational. Education for Primary Care 2013; 24:251-7. [DOI: 10.1080/14739879.2013.11494184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Affiliation(s)
- Ha-Neul Seo
- Harvard University Health Services, Cambridge, MA, USA.
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Abstract
OBJECTIVES To conduct an exploratory study to learn about the experiences of GPs who have undertaken international work. DESIGN Cross-sectional survey SETTING Online survey of UK-based GPs. Members of all UK RCGP faculties were invited to participate by email and the survey was publicised on the RCGP website PARTICIPANTS All UK-based GPs MAIN OUTCOME MEASURES Types of UK and international work undertaken, barriers, competencies gained, influence on career and future plans. RESULTS The study identified 439 respondents, in a variety of GP roles at all career stages, who had undertaken international work in their role as a doctor. GPs are undertaking international work in both high and low/middle-income countries, engaging in a wide range of clinical and non-clinical activities. Respondents reported gaining a range of competencies from international work, which could be transferred back to the UK setting to a variable degree. Commonly cited barriers to international work were having to leave friends and family, and concerns regarding future employment and pension. Most reported that engaging in international work had influenced the direction of their career, with the largest proportion stating that they wish to work predominantly in the UK, with some international work in the future. CONCLUSION The study highlights the variety of ways in which UK GPs are combining UK general practice and international work, competencies gained with such work, and ability to transfer these back to the UK setting. Historical barriers to international work still exist and future research could further examine the value of such work.
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Affiliation(s)
- Chris Smith
- NIHR In-Practice Fellow, Imperial College, NIHR In-Practice Fellow , Department of Primary Care and Public Health, Reynolds, Building, Charing Cross Campus St Dunstan's Road, London W6 8RP , UK
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O’Hare AE, Bremner L, Nash M, Happé F, Pettigrew LM. A Clinical Assessment Tool for Advanced Theory of Mind Performance in 5 to 12 Year Olds. J Autism Dev Disord 2009; 39:916-28. [DOI: 10.1007/s10803-009-0699-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Accepted: 01/20/2009] [Indexed: 10/21/2022]
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Carlson RV, van Ginneken NH, Pettigrew LM, Davies A, Boyd KM, Webb DJ. The three official language versions of the Declaration of Helsinki: what's lost in translation? J Med Ethics 2007; 33:545-8. [PMID: 17761826 PMCID: PMC2598189 DOI: 10.1136/jme.2006.018168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND The Declaration of Helsinki, the World Medical Association's (WMA's) statement of ethical guidelines regarding medical research, is published in the three official languages of the WMA: English, French and Spanish. METHODS A detailed comparison of the three official language versions was carried out to determine ways in which they differed and ways in which the wording of the three versions might illuminate the interpretation of the document. RESULTS There were many minor linguistic differences between the three versions. However, in paragraphs 1, 6, 29, 30 and in the note of clarification to paragraph 29, there were differences that could be considered potentially significant in their ethical relevance. INTERPRETATION Given the global status of the Declaration of Helsinki and the fact that it is translated from its official versions into many other languages for application to the ethical conduct of research, the differences identified are of concern. It would be best if such differences could be eliminated but, at the very least, a commentary to explain any differences that are unavoidable on the basis of language or culture should accompany the Declaration of Helsinki. This evidence further strengthens the case for international surveillance of medical research ethics as has been proposed by the WMA.
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Affiliation(s)
- Robert V Carlson
- Archie Duncan Fellow in Medical Ethics, Medical Teaching Organisation, University of Edinburgh, Chancellor's Building, Edinburgh EH16 4SB, UK.
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