Service quality and the optimum number of members in intermunicipal cooperation: The case of emergency primary care services in Norway

Abstract Neurocognitive Disorders (NCD) is an increasingly common condition in the community. The General Practitioner (GP) in Primary Care Services (PCS), have a crucial role in early detection of NCD and is usually the first professional to detect the signs of MCI. The objective of this study was to test the feasibility and utility of the cognitive screening instrument QMCI in Primary Care. A community sample of 436 people 65+ living in the community was randomly selected from a larger group of old people with mental health concerns (N=2734), referred by their GPs. The mean age of the sample was 75.2 years (sd 7.2), with 41.3% men and 58.7% women; 60.4% married followed by 28.7% widows. The education level was low with 21% illiterate and 69,8% people with 4 years education. The QMCI mean was 37.1/100 (sd 16.2). The amount of people screening positive for cognitive impairment QMCI (<62/100) was 94.2%. In the distribution of people with cognitive impairment by Global Deterioration Scale (GDS) three recoded categories, of the 286 people 76,1% where classified as having very mild or mild impairment, 19,4% moderate or moderately serious and 4,5% severe or very severe impairment. These results confirm the perception of GPs about their clients having mental health concerns and the ability of QMCI accurately discriminate MCI. The QMCI is very brief (3-5mins) fitting the short time of GPs to assess cognitive status and timely refer clients to nonpharmacological interventions that could postpone NCD symptoms.

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Supplier-induced demand for urgent after-hours primary care services

Health Economics ◽

10.1002/hec.3779 ◽

2018 ◽

Vol 27 (10) ◽

pp. 1594-1608 ◽

Cited By ~ 1

Author(s):

Thomas Longden ◽

Jane Hall ◽

Kees van Gool

Keyword(s):

Primary Care ◽

Induced Demand ◽

Care Services ◽

Primary Care Services ◽

After Hours

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Assessment of the participation of primary care services in national tuberculosis control program in Gharbia Governorate

Egyptian Journal of Chest Diseases and Tuberculosis ◽

10.1016/j.ejcdt.2017.03.005 ◽

2017 ◽

Vol 66 (2) ◽

pp. 321-325 ◽

Cited By ~ 1

Author(s):

Sherif A. Essa ◽

Mohammad H. Kamel ◽

Osama I. Mohammad ◽

Nashwa M. Shawky Ahmad

Keyword(s):

Primary Care ◽

Control Program ◽

Tuberculosis Control ◽

Care Services ◽

Primary Care Services ◽

National Tuberculosis Control Program ◽

Tuberculosis Control Program ◽

National Tuberculosis ◽

National Tuberculosis Control

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Effect of a Reduced Postpartum Length of Stay Program on Primary Care Services Use by Mothers and Infants

PEDIATRICS ◽

10.1542/peds.106.s3.937 ◽

2000 ◽

Vol 106 (Supplement_3) ◽

pp. 937-941

Author(s):

Kenneth D. Mandl ◽

Charles J. Homer ◽

Oren Harary ◽

Jonathan A. Finkelstein

Keyword(s):

Primary Care ◽

Length Of Stay ◽

Early Discharge ◽

Urgent Care ◽

Care Utilization ◽

Care Services ◽

Primary Care Services ◽

Ambulatory Services ◽

The Impact ◽

Services Use

Objective. To determine the impact of reduced postpartum length of stay (LOS) on primary care services use. Methods. Design: Retrospective quasiexperimental study, comparing 3 periods before and 1 period after introducing an intervention and adjusting for time trends.Setting: A managed care plan.Intervention: A reduced obstetrical LOS program (ROLOS), offering enhanced education and services.Participants: mother-infant dyads, delivered during 4 time periods: February through May 1992, 1993, and 1994, before ROLOS, and 1995, while ROLOS was in effect.Independent Measures: Pre-ROLOS or the post-ROLOS year.Outcome Measures: Telephone calls, visits, and urgent care events during the first 3 weeks postpartum summed as total utilization events. Results. Before ROLOS, LOS decreased gradually (from 51.6 to 44.3 hours) and after, sharply to 36.5 hours. Although primary care use did not increase before ROLOS, utilization for dyads increased during ROLOS. Before ROLOS, there were between 2.37 and 2.72 utilization events per dyad; after, there were 4.60. Well-child visits increased slightly to .98 visits per dyad, but urgent visits did not. Conclusion. This program resulted in shortened stays and more primary care use. There was no increase in infant urgent primary care utilization. Early discharge programs that incorporate and reimburse for enhanced ambulatory services may be safe for infants; these findings should not be extrapolated to mandatory reduced LOS initiatives without enhancement of care.

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Virtual Primary Care Implementation during COVID-19 in High-Income Countries: A Scoping Review (Preprint)

10.2196/preprints.31222 ◽

2021 ◽

Author(s):

Kristina De Vera ◽

Priyanka Challa ◽

Rebecca H Liu ◽

Kaitlin Fuller ◽

Anam Shahil Feroz ◽

...

Keyword(s):

Primary Care ◽

Scoping Review ◽

Primary Care Physicians ◽

Underserved Populations ◽

High Income ◽

Lessons Learned ◽

Regulatory Policies ◽

Care Services ◽

Virtual Care ◽

Primary Care Services

BACKGROUND Primary care physicians across the world are grappling with adopting virtual services to provide appropriate patient care during the COVID-19 pandemic. As the crisis continues, it is imperative to recognize the wide-scale barriers and seek strategies to mitigate the challenges of rapid adoption to virtual care felt by patients and physicians alike. OBJECTIVE The purpose of this scoping review was to map the challenges, strategies, and lessons learned from high-income countries that can be mobilized to inform decision-makers on how to best implement virtual primary care services during and after the COVID-19 pandemic. Moreover, the findings of our scoping review identified the barriers and strategies within the Quadruple Aim components, which may prove to be an effective implementation strategy for virtual care adoption in primary care settings. METHODS The two concepts of virtual care and COVID-19 were searched in MEDLINE, EMBASE, and CINAHL on Aug 10, 2020, and Scopus was searched on Aug 15, 2020. The database searches returned 10,549 citations and an additional 766 citations were retrieved from searching the citations from the reference lists of articles that met all inclusion criteria. After deduplication, 6,580 unique citations remained. Following title and abstract screening, 1,260 full-text articles were reviewed, of which 49 articles were included for data extraction, and 38 articles met the eligibility criteria for inclusion in the review. RESULTS Seven factors were identified as major barriers to the implementation of virtual primary care. Of the 38 articles included in this scoping review, 20 (53%) articles focused on challenges to equitable access to care, specifically regarding the lack of access to internet, smartphones, and Internet bandwidth for rural, seniors, and underserved populations. The second most common factor discussed in the articles was the lack of funding for virtual care (n= 14; 37%), such as inadequate reimbursement policies for virtual care. Other factors included negative patient and clinician perceptions of virtual care (n=11; 29%), lack of appropriate regulatory policies (n= 10, 26%), inappropriate clinical workflows (n= 9, 24%), lack of virtual care infrastructure (n= 8; 21%), and lastly, a need for appropriate virtual care training and education for clinicians (n=5;13%). CONCLUSIONS This review identified several barriers and strategies to mitigate those barriers that address the challenges of virtual primary care implementation related to equity, regulatory policies, technology and infrastructure, education, clinician and patient experience, clinical workflows, and funding for virtual care. These strategies included providing equitable alternatives to access care for patients with limited technical literacy and English proficiency and altering clinical workflows to integrate virtual care services. As many countries enter potential subsequent waves of the COVID-19 pandemic, applying early lessons learned to mitigate implementation barriers can help with the transition to equitable and appropriate virtual primary care services.

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