scholarly journals Do patients bypass primary care for common health problems under a free-access system? Experience of Taiwan

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Li-Lin Liang ◽  
Nicole Huang ◽  
Yi-Jung Shen ◽  
Annie Yu-An Chen ◽  
Yiing-Jenq Chou
Keyword(s):  
Primary Care ◽  
Cross Sectional Study ◽  
Free Access ◽  
Research Database ◽  
Cross Sectional ◽  
Factors Associated ◽  
Access System ◽  
Medical Centers ◽  
Academic Medical ◽  
Over Time

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.

scholarly journals Time Trends and Factors Associated with Antibiotic Prescribing in Swiss Primary Care (2008 to 2020)

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 837
Author(s):  
Nahara Anani Martínez-González ◽  
Stefania Di Gangi ◽  
Giuseppe Pichierri ◽  
Stefan Neuner-Jehle ◽  
Oliver Senn ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Trends ◽  
Antibiotic Consumption ◽  
Cross Sectional Study ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Employment Level ◽  
Cross Sectional ◽  
Factors Associated ◽  
Swiss Primary Care

Antibiotic resistance (ABR) is a major threat to public health, and the majority of antibiotics are prescribed in the outpatient setting, especially in primary care. Monitoring antibiotic consumption is one key measure in containing ABR, but Swiss national surveillance data are limited. We conducted a retrospective cross-sectional study to characterise the patterns of antibiotic prescriptions, assess the time trends, and identify the factors associated with antibiotic prescribing in Swiss primary care. Using electronic medical records data, we analysed 206,599 antibiotic prescriptions from 112,378 patients. Based on 27,829 patient records, respiratory (52.1%), urinary (27.9%), and skin (4.8%) infections were the commonest clinical indications for antibiotic prescribing. The most frequently prescribed antibiotics were broad-spectrum penicillins (BSP) (36.5%), fluoroquinolones (16.4%), and macrolides/lincosamides (13.8%). Based on the WHO AWaRe classification, antibiotics were 57.9% Core-Access and 41.7% Watch, 69% of which were fluoroquinolones and macrolides. Between 2008 and 2020, fluoroquinolones and macrolides/lincosamides prescriptions significantly declined by 53% and 51%; BSP prescriptions significantly increased by 54%. Increasing patients’ age, volume, and employment level were significantly associated with antibiotic prescribing. Our results may inform future antibiotic stewardship interventions to improve antibiotic prescribing.

scholarly journals Differences in the Epidemiological Characteristics and Clinical Outcomes of Pandemic (H1N1) 2009 Influenza, Compared with Seasonal Influenza

2010 ◽  
Vol 31 (7) ◽  
pp. 676-682 ◽  
Author(s):  
Kevin T. Shiley ◽  
Gregory Nadolski ◽  
Timothy Mickus ◽  
Neil O. Fishman ◽  
Ebbing Lautenbach
Keyword(s):  
Pandemic Influenza ◽  
Seasonal Influenza ◽  
Cross Sectional Study ◽  
Pandemic H1n1 ◽  
Cross Sectional ◽  
Medical Centers ◽  
Academic Medical ◽  
Clinical Presentations ◽  
Pandemic H1n1 2009 ◽  
Epidemiological Characteristics

Background.There are limited data comparing the clinical presentations, comorbidities, and outcomes of patients with infections due to seasonal influenza with patients with infections due to pandemic (H1N1) 2009 influenza.Objective.To compare the epidemiological characteristics and outcomes of pandemic (H1N1) 2009 influenza with those of seasonal influenza.Methods.A cross-sectional study was conducted among patients who received diagnoses during emergency department and inpatient encounters at 2 affiliated academic medical centers in Philadelphia, Pennsylvania. Cases of seasonal influenza during the period November 1, 2005, through June 1, 2008, and cases of pandemic influenza during the period from May 1, 2009, through August 7, 2009, were identified retrospectively.Results.Forty-nine cases of pandemic influenza and 503 cases of seasonal influenza were identified. Patients with pandemic H1N1 were younger (median age, 29 years) than patients with seasonal influenza (median age, 59 years) (P<.001). More patients with pandemic H1N1 (35 [71%] of 49) were African American, compared with patients with seasonal influenza (267 [53%] of 503;P= .02). Several symptoms were more common among patients with pandemic influenza infections than among patients with seasonal influenza infections: cough (98% vs 83%;P= .007), myalgias (71% vs 46%;P= .001), and pleuritic chest pain (45% vs 15%;P< .001). Pregnancy was the only comorbidity that occurred significantly more often in the pandemic influenza group than in the seasonal influenza group (16% vs 1%;P< .001). There were no significant differences in frequencies of deaths of hospitalized patients, intensive care unit admission, or length of hospitalization between groups.Conclusion.Other than pregnancy, there were few clinically important differences between infections due to seasonal influenza and those due to pandemic influenza. The greater rate of lower respiratory tract symptoms in pandemic cases might serve to differentiate pandemic influenza from seasonal influenza.

scholarly journals Geographical distribution of family physicians in Japan: A nationwide cross-sectional study

2019 ◽  
Author(s):  
Shuhei Yoshida ◽  
Masatoshi Matsumoto ◽  
Saori Kashima ◽  
Soichi Soichi Koike ◽  
Susumu Tazuma ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Rural Areas ◽  
Census Data ◽  
Family Physicians ◽  
Cross Sectional Study ◽  
Government Support ◽  
Free Access ◽  
Cross Sectional ◽  
Physician Distribution

Abstract Background Geographical maldistribution of physicians, and their subsequent shortage in rural areas, has been a serious problem in Japan and in other countries. Family Medicine, a new board-certified specialty started 10 years ago in Japan by Japan Primary Care Association (JPCA), may be a solution to this problem. Methods We obtained the workplace information of 527 (78.4%) of the 672 JPCA-certified family physicians from an online database. From the national census data, we also obtained the workplace information of board-certified general internists, surgeons, obstetricians/gynaecologists and paediatricians and of all physicians as the same-generation comparison group (ages 30 to 49). Chi-squared test and residual analysis were conducted to compare the distribution between family physicians and other specialists. Results 519 JPCA-certified family physicians and 137,587 same-generation physicians were analysed. The distribution of family physicians was skewed to municipalities with a lower population density, which shows a sharp contrast to the urban-biased distribution of other specialists. The proportion of family physicians in non-metropolitan municipalities was significantly higher than that expected based on the distribution of all same-generation physicians (p<0.001). Conclusions Family physicians distributed in favour of rural areas much more than any other specialists in Japan. The better balance of family physician distribution reported from countries with a strong primary care orientation seems to hold even in a country where primary care orientation is weak, physician distribution is not regulated, and patients have free access to healthcare. Family physicians comprise only 0.2% of all Japanese physicians. However, if their population grows, they can potentially rectify the imbalance of physician distribution. Government support is mandatory to promote family medicine in Japan.

scholarly journals Computerization of primary health care: the manager as a change agent

2021 ◽  
Vol 74 (2) ◽  
Author(s):  
Tarcísio Laerte Gontijo ◽  
Paola Karol Martins Lima ◽  
Eliete Albano de Azevedo Guimarães ◽  
Valéria Conceição de Oliveira ◽  
Humberto Ferreira de Oliveira Quites ◽  
...  
Keyword(s):  
Primary Care ◽  
Implementation Process ◽  
Cross Sectional Study ◽  
Minas Gerais ◽  
Software Systems ◽  
Cross Sectional ◽  
Technological Infrastructure ◽  
Factors Associated ◽  
Care Systems ◽  
Primary Care Professionals

ABSTRACT Objective: To analyze factors associated with the implementation of software systems of the e-SUS Primary Care strategy in municipalities of Minas Gerais. Methods: This is a cross-sectional study conducted with municipal managers of the e-SUS Primary Care strategy. A sample of cities stratified according to population size was selected. Descriptive, bivariate, and multivariate analyzes were performed to identify factors associated with the implementation of the systems. Results: In 49.1% (95%CI: 39.5-58.8) of the municipalities investigated, some of the e-SUS Primary Care systems were implemented. Time working as a strategy manager (OR: 3.03) and training for Primary Care professionals in the municipality (OR: 2.28) were associated with the implementation of the systems. Conclusion: The presence of a trained manager leading the implementation process impacted the implementation of the e-SUS AB strategy software systems in the municipalities of Minas Gerais. It is also essential to highlight the need to improve the technological infrastructure for the computerization of Primary Care.

scholarly journals Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Cesar I. Fernandez-Lazaro ◽  
Juan M. García-González ◽  
David P. Adams ◽  
Diego Fernandez-Lazaro ◽  
Juan Mielgo-Ayuso ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Cross Sectional Study ◽  
World Health ◽  
Healthcare Team ◽  
Sectional Study ◽  
Adherence To Treatment ◽  
Related Factors ◽  
Cross Sectional ◽  
Factors Associated

Abstract Background Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The aim of this study is to assess adherence to treatment and related-factors among patients with chronic conditions in primary care settings. Methods A cross-sectional study was conducted among 299 adult patients with ≥1 chronic condition(s) and prescribed medication in primary healthcare centers of Spain. The Morisky-Green-Levine questionnaire was used to assess medication adherence via face-to-face interviews. Crude and adjusted multivariable logistic regression models were used to analyze factors associated with adherence using the Multidimensional Model proposed by the World Health Organization — social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors. Results The proportion of adherent patients to treatment was 55.5%. Older age (adjusted odds ratio 1.31 per 10-year increment, 95% CI 1.01–1.70), lower number of pharmacies used for medication refills (0.65, 95% CI 0.47–0.90), having received complete treatment information (3.89, 95% CI 2.09–7.21), having adequate knowledge about medication regimen (4.17, 95% CI 2.23–7.80), and self-perception of a good quality of life (2.17, 95% CI 1.18–4.02) were independent factors associated with adherence. Conclusions Adherence to treatment for chronic conditions remained low in primary care. Optimal achievement of appropriate levels of adherence through tailored multifaceted interventions will require attention to the multidimensional factors found in this study, particularly those related to patients’ education and their information needs.

scholarly journals Primary care and population factors associated with NHS Health Check coverage: a national cross-sectional study

2013 ◽  
Vol 35 (3) ◽  
pp. 431-439 ◽  
Author(s):  
M. Artac ◽  
A. R. H. Dalton ◽  
H. Babu ◽  
S. Bates ◽  
C. Millett ◽  
...  
Keyword(s):  
Primary Care ◽  
Cross Sectional Study ◽  
Health Check ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Nhs Health Check

Factors associated with inappropriate attitude towards antibiotic usage among outpatients of a large public primary care center in Malaysia: A cross sectional study.

2020 ◽  
Author(s):  
Zati Sabrina Ahmad Zubaidi ◽  
Khasnur Abdul Malek ◽  
Zaliha Ismail
Keyword(s):  
Primary Care ◽  
Cross Sectional Study ◽  
Antibiotic Usage ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated ◽  
Care Specialist ◽  
Low Education ◽  
Knowledge And Attitude ◽  
The Relationship

Abstract Background: Antibiotic resistance is one of the biggest global threat in modern medicine. The situation is even more consequential in lower-and middle-income countries (LMIC) as financial limitations and political instability may become barriers to an impactful health policy. Therefore, The World Health organization has urge all nations to increase public awareness on antibiotic through effective educational interventions. In order for interventions to be successful, it is important to acknowledge that each country is unique in its problems as the demographic in LMIC are diverse. This study aims to identify the community’s attitude appropriateness towards antibiotic usage and their knowledge gaps, the relationship between antibiotic knowledge and their attitude as well as factors associated with inappropriate attitude towards antibiotic among outpatients attending an established primary care specialist center in Malaysia.Methodology : This cross-sectional study was conducted among 256 respondents attending a public primary care specialist clinic center. Those who fulfilled the inclusion and exclusion criteria from June to August 2017 were given a self-administered, validated and translated questionnaire. Pearson correlation was used to deduce the relationship between knowledge and attitude. Chi square test, independent t-test and multiple logistic regression were used to determine factors associated with inappropriate attitude towards antibiotic.Results: It was found that the respondents’ mean attitude and knowledge score were 29.5 ± 4.19 and 5.94 ± 2.4 respectively. The highest inappropriate attitude response was expecting antibiotic from the doctor for common colds and the most frequent incorrect knowledge response was on the domain of role of antibiotics. There is a weak positive relationship between antibiotic knowledge and attitude (r=0.315, n=256, p=0.0001). Respondents with low education level and poor antibiotic knowledge were at least 2.5 times more likely to have inappropriate attitude when handling antibiotics.Conclusion: Our study demonstrated the common inappropriate attitude towards antibiotic and areas of knowledge gap among the population. Antibiotic education should be incorporated in non-pharmacological measures of viral illnesses that is targeted among those with low education and poor antibiotic knowledge. The weak relationship between antibiotic knowledge and attitude suggest that health campaign should focus on behavioral change rather than a theoretical approach.

scholarly journals Factors associated with shared decision making among primary care physicians: Findings from a multicentre cross-sectional study

2017 ◽  
Vol 21 (1) ◽  
pp. 212-221 ◽  
Author(s):  
Matthew Menear ◽  
Mirjam Marjolein Garvelink ◽  
Rhéda Adekpedjou ◽  
Maria Margarita Becerra Perez ◽  
Hubert Robitaille ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Shared Decision Making ◽  
Primary Care Physicians ◽  
Cross Sectional Study ◽  
Shared Decision ◽  
Sectional Study ◽  
Cross Sectional ◽  
Factors Associated
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