Sustaining Chronic Disease Management in Primary Care: Lessons from a Demonstration Project

2007 ◽  
Vol 13 (2) ◽  
pp. 121 ◽  
Author(s):  
Anna Williams ◽  
Mark Harris ◽  
Kathy Daffurn ◽  
Gawaine Powell Davies ◽  
Shane Pascoe ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Chronic Disease ◽  
Health Service ◽  
Service Providers ◽  
Care Delivery ◽  
Demonstration Project ◽  
Service Utilisation ◽  
Primary Health

Chronic disease self-management (CDSM) programs have been found effective in improving clinical, behavioural, and self-efficacy outcomes associated with a range of chronic illnesses, and evidence suggests that CDSM is effective in reducing health care costs and health service utilisation. As the setting where most chronic disease is managed, primary health care is an ideal setting for supporting CDSM. This study aimed to explore the uptake and sustainability of CDSM within routine activities of primary health care clinicians involved in the implementation of a demonstration project within an Area Health Service in Sydney NSW. Interviews and focus groups were conducted with managers and clinicians involved in the project. Findings included (1) widespread support from participants for CDSM (2) participating clinicians thought that CDSM was valuable to themselves, their clients and the health system (3) the program required clients to be able to speak and understand English and so presented many barriers for implementation in CALD communities, and (4) the program was not effective in engaging some key members of the primary care team; in particular, general practitioners. The study highlights system design issues including communication and continuity of care between service providers, workforce supply and demands of acute care delivery in the community that will need to be addressed for sustainable and effective CDSM to be achieved.

scholarly journals Rural health care in New Zealand: the case of Coast to Coast Health Centre, Wellsford, an early Integrated Family Health Centre

2015 ◽  
Vol 7 (4) ◽  
pp. 309 ◽  
Author(s):  
Antony Raymont ◽  
Mary-Anne Boyd ◽  
Timothy Malloy ◽  
Nancy Malloy
Keyword(s):  
Health Care ◽  
Primary Health Care ◽  
New Zealand ◽  
Health Service ◽  
Rural Health ◽  
Service Providers ◽  
Health Centre ◽  
Service Utilisation ◽  
Primary Health ◽  
Wide Range

INTRODUCTION: Primary health care is critical, particularly in rural areas distant from secondary care services. AIM: To describe the development of Coast to Coast Health Centre (CTCHC) at Wellsford, north of Auckland, New Zealand and reflect on its achievements and ongoing challenges. METHODS: Interviews were conducted with staff and management of CTCHC and with other health service providers. Surveys of staff and a sample of enrolled patients were undertaken. Numerical data on service utilisation were obtained from the practice and from national datasets. RESULTS: The CTCHC provides a wide range of services, including after-hours care, maternity and radiology, across a network of electronically connected sites, as well as interdisciplinary training for a range of health students. General practitioner (GP) recruitment is problematic and nursing roles have been expanded. Staff report positively on the work environment. Consultation rates are higher than in comparable practices, especially consultations with nurses. Rates of hospital admission are relatively low. The development of the CTCHC was assisted by formation of a local primary health organisation (PHO) and by recognition by the local district health board (DHB). Issues with poor coordination of local services, and less service provision than is characteristic in urban areas, remain. Contracting processes with the DHB were complex and time-consuming. The merging of the local PHO into a larger PHO within the Waitemata DHB catchment inhibited progression towards more complete locality planning. DISCUSSION: A dedicated and locally controlled provider was able to generate a more than usually complete community health service for Wellsford and area. KEYWORDS: Interdisciplinary; New Zealand; primary health care; rural health services

scholarly journals The Future of Health Care: Protocol for Measuring the Potential of Task Automation Grounded in the National Health Service Primary Care System (Preprint)

2018 ◽  
Author(s):  
Matthew Willis ◽  
Paul Duckworth ◽  
Angela Coulter ◽  
Eric T Meyer ◽  
Michael Osborne
Keyword(s):  
Machine Learning ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Care Staff ◽  
Primary Health ◽  
The Future

BACKGROUND Recent advances in technology have reopened an old debate on which sectors will be most affected by automation. This debate is ill served by the current lack of detailed data on the exact capabilities of new machines and how they are influencing work. Although recent debates about the future of jobs have focused on whether they are at risk of automation, our research focuses on a more fine-grained and transparent method to model task automation and specifically focus on the domain of primary health care. OBJECTIVE This protocol describes a new wave of intelligent automation, focusing on the specific pressures faced by primary care within the National Health Service (NHS) in England. These pressures include staff shortages, increased service demand, and reduced budgets. A critical part of the problem we propose to address is a formal framework for measuring automation, which is lacking in the literature. The health care domain offers a further challenge in measuring automation because of a general lack of detailed, health care–specific occupation and task observational data to provide good insights on this misunderstood topic. METHODS This project utilizes a multimethod research design comprising two phases: a qualitative observational phase and a quantitative data analysis phase; each phase addresses one of the two project aims. Our first aim is to address the lack of task data by collecting high-quality, detailed task-specific data from UK primary health care practices. This phase employs ethnography, observation, interviews, document collection, and focus groups. The second aim is to propose a formal machine learning approach for probabilistic inference of task- and occupation-level automation to gain valuable insights. Sensitivity analysis is then used to present the occupational attributes that increase/decrease automatability most, which is vital for establishing effective training and staffing policy. RESULTS Our detailed fieldwork includes observing and documenting 16 unique occupations and performing over 130 tasks across six primary care centers. Preliminary results on the current state of automation and the potential for further automation in primary care are discussed. Our initial findings are that tasks are often shared amongst staff and can include convoluted workflows that often vary between practices. The single most used technology in primary health care is the desktop computer. In addition, we have conducted a large-scale survey of over 156 machine learning and robotics experts to assess what tasks are susceptible to automation, given the state-of-the-art technology available today. Further results and detailed analysis will be published toward the end of the project in early 2019. CONCLUSIONS We believe our analysis will identify many tasks currently performed manually within primary care that can be automated using currently available technology. Given the proper implementation of such automating technologies, we expect considerable staff resources to be saved, alleviating some pressures on the NHS primary care staff. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11232

scholarly journals Chronic substance use and self-harm in a primary health care setting

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Elsie Breet ◽  
Jason Bantjes ◽  
Ian Lewis
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Substance Use ◽  
Primary Health Care ◽  
Emergency Departments ◽  
Service Utilisation ◽  
Health Care Settings ◽  
Primary Health ◽  
Self Harm ◽  
Primary Health Care Settings

Background: Chronic substance use (CSU) is associated with health problems, including selfharm, placing a significant burden on health care resources and emergency departments (EDs). This is problematic in low- and middle-income countries like South Africa (SA), where primary care facilitates and emergency departments (EDs) are often poorly resourced.Aim: To investigate the epidemiology of CSU and self-harm and to consider the implications for primary health care service delivery and suicide prevention in SA.Methods: Data were collected from 238 consecutive self-harm patients treated at the emergency department (ED) of an urban hospital in SA. The data were analysed using bivariate and multivariate analyses.Results: Approximately 37% of self-harm patients reported CSU. The patients in the CSU subgroup, compared to other self-harm patients, were more likely to be men (odds ratio[OR] = 8.33, 95% confidence interval [CI] = 3.19–20.9, p < 0.001), to have self-harmed by inflicting damage to their body tissue OR = 4.45, 95% CI = 1.77–11.2, p < 0.01) and to have a history of self-harm (OR = 3.71, 95% CI = 1.44–9.54, p = 0.007). A significantly smaller proportion of CSU patients, compared to other self-harm patients, were referred for psychiatric assessment (OR = 8.05, 95% CI = 4.16–15.7, p < 0.001).Conclusion: The findings of this study confirm that CSU is associated with greater service utilisation and repetition of self-harm among patients in primary health care settings. Treating self-harm as the presenting problem within primary care settings does not necessarily ensure that patients receive the care that they need. It might be helpful to include psychiatric assessments and screening for CSU as an integral component of care for self-harm patientswho present in primary health care settings.

Multidisciplinary collaboration in primary care: through the eyes of patients

2013 ◽  
Vol 19 (3) ◽  
pp. 190 ◽  
Author(s):  
Lynn H. Cheong ◽  
Carol L. Armour ◽  
Sinthia Z. Bosnic-Anticevich
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Chronic Illness ◽  
Health Care Professionals ◽  
Care Delivery ◽  
Primary Health Care System ◽  
Structured Interviews ◽  
Multidisciplinary Collaboration ◽  
Primary Health

Managing chronic illness is highly complex and the pathways to access health care for the patient are unpredictable and often unknown. While multidisciplinary care (MDC) arrangements are promoted in the Australian primary health care system, there is a paucity of research on multidisciplinary collaboration from patients’ perspectives. This exploratory study is the first to gain an understanding of the experiences, perceptions, attitudes and potential role of people with chronic illness (asthma) on the delivery of MDC in the Australian primary health care setting. In-depth semi-structured interviews were conducted with asthma patients from Sydney, Australia. Qualitative analysis of data indicates that patients are significant players in MDC and their perceptions of their chronic condition, perceived roles of health care professionals, and expectations of health care delivery, influence their participation and attitudes towards multidisciplinary services. Our research shows the challenges presented by patients in the delivery and establishment of multidisciplinary health care teams, and highlights the need to consider patients’ perspectives in the development of MDC models in primary care.

scholarly journals Regional Variation of Avoidable Hospitalisations: An Observational Study

2021 ◽  
Author(s):  
Niklaus Gygli ◽  
Franziska Zúñiga ◽  
Michael Simon
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Health Care ◽  
Congestive Heart Failure ◽  
Primary Health Care ◽  
Observational Study ◽  
Regional Variation ◽  
Care Delivery ◽  
Regional Patterns ◽  
Primary Health

Abstract Background Primary health care is subject to regional variation, which may be due to unequal and inefficient distribution of services. One key measure of such variation are avoidable hospitalisations, i.e., hospitalisations for conditions that could have been dealt with in situ by sufficient primary health care provision. Particularly, avoidable hospitalisations for ambulatory care-sensitive conditions (ACSCs) are a substantial and growing burden for health care systems that require targeting in health care policy. Aims Using data from the Swiss Federal Statistical Office (SFSO) from 2017, we applied small area analysis to visualize regional variation to comprehensively map avoidable hospitalisations for five ACSCs from Swiss nursing homes, home care organisations and the general population. Methods This retrospective observational study used data on all Swiss hospitalisations in 2017 to assess regional variations of avoidable hospitalisations for angina pectoris, congestive heart failure, chronic obstructive pulmonary disease , diabetes complications and hypertension. We used small areas (MedStat), utilisation-based hospital service areas (HSAs), and administrative districts (Cantons) as geographic zones. The outcomes of interest were age and sex standardised rates of avoidable hospitalisations for ACSCs in adults (>15years). Our inferential analyses used linear mixed models with Gaussian distribution. Results We identified 46,479 hospitalisations for ACSC, or 4.3% of all hospitalisations. Most of these occurred in the elderly population for congestive heart failure and COPD. The median rate of avoidable hospitalisation for ACSC was 1,080 (IQR 893 – 1,274) per 100.000 inhabitants. We found substantial regional variation for HSAs and administrative districts as well as disease-specific regional patterns. Conclusions Differences in continuity of care might be key drivers for regional variation of avoidable hospitalisations for ACSCs. These results provide a new perspective on the functioning of primary care structures in Switzerland and call for novel approaches in effective primary care delivery.

Trust in Relationships Between Primary Health Care Organisations

2001 ◽  
Vol 7 (1) ◽  
pp. 56 ◽  
Author(s):  
Jenny Adam ◽  
Rae Walker
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Service Providers ◽  
Care Service ◽  
Local Population ◽  
Partnership Development ◽  
Health And Wellbeing ◽  
Primary Health ◽  
Primary Care Sector

In Victoria the primary health care sector is in a period of change intended to strengthen the integration of a complex service system through a process of partnership development based on collaboration. The partnerships are voluntary alliances of the primary care service providers, usually within a locality of two to three local government areas. Their purpose is to improve the health and wellbeing of the local population by strengthening inter-agency coordination in the areas of needs identification, planning and service delivery. Trust is a key issue in this process. This paper is a report of the first stage of a study to explore trust in the context of relationships between organisations in the primary care sector.

scholarly journals Community oriented primary care in Tshwane District, South Africa: Assessing the first phase of implementation

2013 ◽  
Vol 5 (1) ◽  
Author(s):  
Hans-Friedemann Kinkel ◽  
Tessa Marcus ◽  
Shehla Memon ◽  
Nomonde Bam ◽  
Jannie Hugo
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Providers ◽  
Service Providers ◽  
Health Sector ◽  
Political Commitment ◽  
Care Providers ◽  
Primary Health

Background: Re-engineering primary health care is a cornerstone of the health sector reforminitiated nationally in South Africa in 2009. Using the concept of ward based NGO-run healthposts, Tshwane District, Gauteng, began implementing community oriented primary care (COPC) through ward based outreach teams (WBOT) in seven wards during 2011.Objectives: This study sought to gain insight into how primary health care providers understood and perceived the first phase of implementing COPC in the Tshwane district.Method: Qualitative research was performed through focus group interviews with staff of the seven health posts during September 2011 and October 2011. It explored primary health careproviders’ understanding, perception and experience of COPC.Results: Participants raised organisational, workplace and community relationship issues in the discussions. Organisationally, these related to the process of initiating and setting up COPC and the relationship between governmental and nongovernmental organisations. Issues that arose around the workplace related to the job situation and employment status and remuneration of health post staff. Community related issues centred on the role and relationship between service providers and their communities.Conclusion: COPC touched a responsive nerve in the health care system, both nationallyand locally. It was seen as an effective way to respond to South Africa’s crisis of health care. Initiating the reform was inevitably a complex process. In this initial phase of implementing COPC the political commitment of governmental and nongovernmental organisations was evident. What still had to be worked through was how the collaboration would materialise in practice on the ground.

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