scholarly journals The use of outcome and process indicators to incentivize integrated care for frail older people: a case study of primary care services in Sweden

2014 ◽  
Vol 14 (4) ◽  
Author(s):  
Anders Lars Anell ◽  
Anna Häger Glenngård
Keyword(s):  
Primary Care ◽  
Older People ◽  
Integrated Care ◽  
Frail Older People ◽  
Process Indicators ◽  
Care Services ◽  
Primary Care Services

scholarly journals Evaluation of primary care services in Hungary

2020 ◽  
Author(s):  
Imre Rurik ◽  
Zoltán Jancsó ◽  
László Kalabay ◽  
Levente Lánczi ◽  
Lajos Mester ◽  
...  
Keyword(s):  
Primary Care ◽  
Service Level ◽  
Comprehensive Overview ◽  
Process Indicators ◽  
Community Orientation ◽  
Care Services ◽  
Primary Care Services ◽  
Burn Out ◽  
Gate Keeping ◽  
Almost All

Abstract Background. It is a major challenge to show what configurations of primary care(PC) is associated with better outcomes, in terms of quality, equity and costs. The QUALICOPC Study tried to analyse and compare them within 35 countries, using validated questionnaires filled by family physicians/general practitioners (GPs). This paper aims to provide data of the Hungarian-arm of the QUALICOPC Study; to compare some findings to that of other participating countries; to give a comprehensive overview about the recent Hungarian PC system. Methods. Altogether 222 questionnaires were completed by Hungarian GPs, delivered by fieldworkers, in a geographically representative distribution. Results . Financing are based mostly on capitation, with smaller additional compensatory elements and minor quality incentives. The gate-keeping function is weak, although by referrals, the preference of patients is mostly considered. Communication between PC and specialists is often insufficient. Variety of available devices and equipment’s are appropriate. Single handed practices were 87%. Appointment instead of queuing is a new option and become more popular, mainly among better educated and urban patients. GPs are involved in the management of almost all chronic condition of all generations. Half of them estimate their job as still interesting, burn-out symptoms were rarely found. Among the evaluated process indicators, access, continuity, comprehensiveness and coordination were rated as satisfactory, together with equity among health outcome indicators. Financing is not sufficient, therefore many GPs are involved in other earning activities. The increasing shortage of manpower is a major challenge. Conclusions. In the past 2 decades, there was visible improvement at service level and in economic circumstances. Cooperation and communication between different levels of health care provision should be improved, focusing better to community orientation and to preventive services. There is a need for specific primary care oriented guidelines to define the expected tasks of GPs.

scholarly journals Exploring the implementation and delivery of primary care services for transgender individuals in Ontario: case study protocol

2020 ◽  
Vol 21 ◽  
Author(s):  
Erin Ziegler ◽  
Ruta Valaitis ◽  
Nancy Carter ◽  
Cathy Risdon ◽  
Jennifer Yost
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Access To Health Care ◽  
Care Providers ◽  
Case Study Methodology ◽  
Care Services ◽  
Services Delivery ◽  
Primary Care Services ◽  
Care Models

Abstract Background: Historically transgender adults have experienced barriers in accessing primary care services. In Ontario, Canada, health care for transgender adults is accessed through primary care; however, a limited number of practitioners provide care, and patients are often waiting and/or traveling great distances to receive care. The purpose of this protocol is to understand how primary care is implemented and delivered for transgender adults. The paper presents how the case study method can be applied to explore implementation of health services delivery for the transgender population in primary care. Methods: Case study methodology will be used to explore this phenomenon in different primary care contexts. Normalization Process Theory is used as a guide. Three cases known to provide transgender primary care and represent different Ontario primary care models have been identified. Comparing transgender care implementation and delivery across different models is vital to understanding how care provision to this population can be supported. Qualitative interviews will be conducted. Participants will also complete the NoMAD (NOrmalization MeAsure Development) survey, a tool measuring implementation processes. The tool will be modified to explore the implementation of primary care services for transgender individuals. Documentary evidence will be collected. Cross-case synthesis will be completed to compare the cases. Discussion: Findings will provide an Ontario perspective on the implementation and delivery of primary care for transgender adults in different primary care models. Results may be applicable to other primary care settings in Canada and other nations with similar systems. Barriers and facilitators in delivery and implementation will be identified. Providing an understanding and increasing awareness of the implementation and delivery of primary care may help to reduce the invisibility and disparities transgender individuals experience when accessing primary care services. Understanding delivery of care could allow care providers to implement primary care services for transgender individuals, improving access to health care for this vulnerable population.

scholarly journals How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018422 ◽  
Author(s):  
Valerie Moran ◽  
Pauline Allen ◽  
Imelda McDermott ◽  
Kath Checkland ◽  
Lynsey Warwick-Giles ◽  
...  
Keyword(s):  
Primary Care ◽  
Conflicts Of Interest ◽  
New Governance ◽  
Telephone Surveys ◽  
Face To Face ◽  
Study Approach ◽  
Telephone Interviews ◽  
Care Services ◽  
Primary Care Services

ObjectivesFrom April 2015, NHS England (NHSE) started to devolve responsibility for commissioning primary care services to clinical commissioning groups (CCGs). The aim of this paper is to explore how CCGs are managing potential conflicts of interest associated with groups of GPs commissioning themselves or their practices to provide services.DesignWe carried out two telephone surveys using a sample of CCGs. We also used a qualitative case study approach and collected data using interviews and meeting observations in four sites (CCGs).Setting/participantsWe conducted 57 telephone interviews and 42 face-to-face interviews with general practitioners (GPs) and CCG staff involved in primary care co-commissioning and observed 74 meetings of CCG committees responsible for primary care co-commissioning.ResultsConflicts of interest were seen as an inevitable consequence of CCGs commissioning primary care. Particular problems arose with obtaining unbiased clinical input for new incentive schemes and providing support to GP provider federations. Participants in meetings concerning primary care co-commissioning declared conflicts of interest at the outset of meetings. Different approaches were pursued regarding GPs involvement in subsequent discussions and decisions with inconsistency in the exclusion of GPs from meetings. CCG senior management felt confident that the new governance structures and policies dealt adequately with conflicts of interest, but we found these arrangements face limitations. While the revised NHSE statutory guidance on managing conflicts of interest (2016) was seen as an improvement on the original (2014), there still remained some confusion over various terms and concepts contained therein.ConclusionsDevolving responsibility for primary care co-commissioning to CCGs created a structural conflict of interest. The NHSE statutory guidance should be refined and clarified so that CCGs can properly manage conflicts of interest. Non-clinician members of committees involved in commissioning primary care require training in order to make decisions requiring clinical input in the absence of GPs.

scholarly journals Age-Friendly Primary Health Care: An Assessment of Current Service Provision for Older Adults in Hong Kong

2013 ◽  
Vol 6 ◽  
pp. HSI.S12434 ◽  
Author(s):  
Jean Woo ◽  
Benise Mak ◽  
Fannie Yeung
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Hong Kong ◽  
Older People ◽  
Service Providers ◽  
Care Needs ◽  
Care Services ◽  
Primary Care Services ◽  
Aging Populations ◽  
Training Community

There has been no study evaluating whether primary care services are sufficiently oriented towards the older population in Hong Kong, particularly those with increasing frailty. Since primary care is a key first interface in promotion and maintenance of health in older people, an assessment of the age-friendliness of service provisions is of critical importance in optimizing the health of aging populations. The age-friendliness of primary care services for older people was assessed using focus groups of elderly people and also of service providers who care for them. Discussion content was based on the WHO guidelines for age-friendly primary care in the following areas: Information, education and training, community-based health care management systems, and the physical environment. Desirable improvements were identified in all domains. The findings underscore the need for wider dissemination of health care needs of older people in the primary care setting.

scholarly journals Evaluation of primary care services in Hungary: a comprehensive description of provision, professional competences, cooperation, financing, and infrastructure, based on the findings of the Hungarian-arm of the QUALICOPC study

2021 ◽  
Vol 22 ◽  
Author(s):  
Imre Rurik ◽  
Anna Nánási ◽  
Zoltán Jancsó ◽  
László Kalabay ◽  
Levente István Lánczi ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Financial Incentives ◽  
Descriptive Analysis ◽  
Health Care Provision ◽  
Care Provision ◽  
Process Indicators ◽  
Care Services ◽  
Primary Care Services ◽  
Almost All

Abstract Background: Primary health care provision in terms of quality, equity, and costs are different by countries. The Quality and Costs of Primary Care (QUALICOPC) study evaluated these domains and parameters in 35 countries, using uniformized method with validated questionnaires filled out by family physicians/general practitioners (GPs). This paper aims to provide data of the Hungarian-arm of the QUALICOPC study and to give an overview about the recent Hungarian primary care (PC) system. Methods: The questionnaires were completed in 222 Hungarian GP practices, delivered by fieldworkers, in a geographically representative distribution. Descriptive analysis was performed on the data. Findings: Financing is based mostly on capitation, with additional compensatory elements and minor financial incentives. The gate-keeping function is weak. The communication between GPs and specialists is often insufficient. The number of available devices and equipment are appropriate. Single-handed practices are predominant. Appointment instead of queuing is a new option and is becoming more popular, mainly among better-educated and urban patients. GPs are involved in the management of almost all chronic condition of all generations. Despite the burden of administrative tasks, half of the GPs estimate their job as still interesting, burn-out symptoms were rarely found. Among the evaluated process indicators, access, continuity, comprehensiveness, and coordination were rated as satisfactory, together with equity among health outcome indicators. Financing is insufficient; therefore, many GPs are involved in additional income-generating activities. The old age of the GPs and the lack of the younger GPs generation contributes to a shortage in manpower. Cooperation and communication between different levels of health care provision should be improved, focusing better on community orientation and on preventive services. Financing needs continuous improvement and appropriate incentives should be implemented. There is a need for specific PC-oriented guidelines to define properly the tasks and competences of GPs.

scholarly journals Performance evaluation of primary care services for the treatment of tuberculosis

2014 ◽  
Vol 48 (6) ◽  
pp. 1044-1053 ◽  
Author(s):  
Daiane Medeiros da Silva ◽  
Jordana de Almeida Nogueira ◽  
Lenilde Duarte de Sá ◽  
Anneliese Domingues Wysocki ◽  
Lucia Marina Scatena ◽  
...  
Keyword(s):  
Primary Care ◽  
Professional Training ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Professional Qualification ◽  
Process Indicators ◽  
Care Services ◽  
Primary Care Services ◽  
Directly Observed Treatment ◽  
Structural Indicators

Objective Evaluating the performance of primary care services for the treatment of tuberculosis according to the assessment referential of health services (structure/process) in Cabedelo, a port city in the state of Paraíba. Method An evaluation quantitative, cross-sectional study, in which were carried out 117 interviews with health professionals using a structured instrument. The analysis was based on the construction of indicators using a standardized value for the reduced variable (z=1). Results The structural indicators showed regular performance for the following variables: professional training, access to record instruments and coordination with other services. The process indicators related to external actions and information about the disease had unsatisfactory performance. The directly observed treatment and the flows of reference/counter-reference had regular performance. Conclusion The focused professional qualification, the fragmentation of practices and the unsystematic home care constitute obstacles for carrying out actions aimed at providing expanded, continuous and resolute care.



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