The Future of Health Care in the Kurdistan Region — Iraq: Toward an Effective, High-Quality System with an Emphasis on Primary Care

2014 ◽  
Author(s):  
Melinda Moore ◽  
C. Anthony ◽  
Yee-Wei Lim ◽  
Spencer Jones ◽  
Adrian Overton ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality System ◽  
Kurdistan Region ◽  
High Quality ◽  
The Future

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

Evidence-based training in treatment treatments: The case of pediatric psychopharmacology

2011 ◽  
Vol 26 (S2) ◽  
pp. 2048-2048
Author(s):  
P.S. Jensen
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Controlled Trial ◽  
Evidence Based ◽  
Care Providers ◽  
Clinical Practices ◽  
High Quality ◽  
Health Care Practitioners ◽  
Evidence Based Treatments

IntroductionDespite major research advances in pediatric psychopharmacology and psychotherapy over the last 20 years, the lack of well-trained specialists has posed almost insurmountable barriers to many children and families from receiving high-quality, evidence-based assessment and treatments. The REACH Institute, an international non-profit organization dedicated to disseminating evidence-based treatments, has developed portable, effective methods to train primary care and specialty health providers in pediatric psychopharmacology and psychotherapies.ObjectivesTo develop effective, scientifically-proven methods for teaching and disseminating evidence-based treatments.AimsTo develop, disseminate, and evaluate high quality approaches for teaching primary care and specialty mental health practitioners in pediatric psychopharmacology.MethodsUsing novel approaches grounded in scientific behavioral change technologies, over 700 health care providers have been trained in evidence-based pediatric psychopharmacology in sites across multiple countries, including the US, Canada, and Norway. All trainings are rigorously evaluated for changes in health care practitioners' behaviors and clinical practices, including within an NIH-funded randomized controlled trial (RCT).ResultsTrainings have been very well-received across multiple countries, requiring only minor adaptations. These trainings have been effective in yielding changes in health care practitioners abilities and actual clinical practices, enabling more children to access appropriate pediatric psychopharmacology.ConclusionsEffective and disseminable methods for changing health care practitioners behaviors in applying pediatric psychopharmacology treatments are possible, and can be adapted to different countries, languages, and cultural contexts.

scholarly journals Increasing equity of access to high-quality mental health services in primary care: a mixed-methods study

2013 ◽  
Vol 1 (2) ◽  
pp. XXXX-XXXX ◽  
Author(s):  
C Dowrick ◽  
C Chew-Graham ◽  
K Lovell ◽  
J Lamb ◽  
S Aseem ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Mental Health Problems ◽  
Research Programme ◽  
Psychosocial Interventions ◽  
Well Being ◽  
High Quality ◽  
Underserved Groups

BackgroundEvidence-based interventions exist for common mental health problems. However, many people are unable to access effective care because it is not available to them or because interactions with caregivers do not address their needs. Current policy initiatives focus on supply-side factors, with less consideration of demand.Aim and objectivesOur aim was to increase equity of access to high-quality primary mental health care for underserved groups. Our objectives were to clarify the mental health needs of people from underserved groups; identify relevant evidence-based services and barriers to, and facilitators of, access to such services; develop and evaluate interventions that are acceptable to underserved groups; establish effective dissemination strategies; and begin to integrate effective and acceptable interventions into primary care.Methods and resultsExamination of evidence from seven sources brought forward a better understanding of dimensions of access, including how people from underserved groups formulate (mental) health problems and the factors limiting access to existing psychosocial interventions. This informed a multifaceted model with three elements to improve access: community engagement, primary care quality and tailored psychosocial interventions. Using a quasi-experimental design with a no-intervention comparator for each element, we tested the model in four disadvantaged localities, focusing on older people and minority ethnic populations. Community engagement involved information gathering, community champions and focus groups, and a community working group. There was strong engagement with third-sector organisations and variable engagement with health practitioners and commissioners. Outputs included innovative ways to improve health literacy. With regard to primary care, we offered an interactive training package to 8 of 16 practices, including knowledge transfer, systems review and active linking, and seven agreed to participate. Ethnographic observation identified complexity in the role of receptionists in negotiating access. Engagement was facilitated by prior knowledge, the presence of a practice champion and a sense of coproduction of the training. We developed a culturally sensitive well-being intervention with individual, group and signposting elements and tested its feasibility and acceptability for ethnic minority and older people in an exploratory randomised trial. We recruited 57 patients (57% of target) with high levels of unmet need, mainly through general practitioners (GPs). Although recruitment was problematic, qualitative data suggested that patients found the content and delivery of the intervention acceptable. Quantitative analysis suggested that patients in groups receiving the well-being intervention improved compared with the group receiving usual care. The combined effects of the model included enhanced awareness of the psychosocial intervention among community organisations and increased referral by GPs. Primary care practitioners valued community information gathering and access to the Improving Access to Mental Health in Primary Care (AMP) psychosocial intervention. We consequently initiated educational, policy and service developments, including a dedicated website.ConclusionsFurther research is needed to test the generalisability of our model. Mental health expertise exists in communities but needs to be nurtured. Primary care is one point of access to high-quality mental health care. Psychosocial interventions can be adapted to meet the needs of underserved groups. A multilevel intervention to increase access to high-quality mental health care in primary care can be greater than the sum of its parts.Study registrationCurrent Controlled Trials ISRCTN68572159.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

Report on the Future Role of the Pediatrician in the Delivery of Health Care

PEDIATRICS ◽  
1991 ◽  
Vol 87 (3) ◽  
pp. 401-409
Author(s):  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Tertiary Care ◽  
Health Needs ◽  
Group Practice ◽  
Quality Health Care ◽  
The Future ◽  
Quality Health ◽  
Level I

The pediatrician now and in the future should be recognized as the specialist specifically trained to provide comprehensive, coordinated health care to infants, children, adolescents, and young adults throughout growth and development. This care, which can be described as primary care, encompasses problems of Level I, II, and III complexity. Although the majority of the pediatrician's practice time will be devoted to Level I and Level II services, the actual mix of a pediatrician's practice will be influenced by practice location, individual training, competency, interest, and the financial structure of the pediatric practice. The pediatrician will work with multiprofessional teams to coordinate and supervise comprehensive family-centered care for the child with multiple handicaps. The pediatrician should provide consultation to other physicians and various community child care programs. The trend toward group practice will continue. The increasing number of women in pediatrics and the desire of almost all physicians for a more balanced lifestyle will enhance group practice (part-time and shared). Pediatrics lends itself especially well to this type of care. Shared overhead and expenses will decrease costs and may allow for specialized care by individuals within the group—a development that will enhance the competency of the group as a whole and individual practice satisfaction. To ensure access of sophisticated medical knowledge and technology to all children, the number of pediatric subspecialists will continue to increase. Because of continued emphasis on education and research, most subspecialists will be located in tertiary care teaching centers, although multisystem subspecialists may also work in primary care settings. Pediatric subspecialists should diagnose and treat patients with complex illnesses and, after developing an ongoing therapeutic plan, return them to their pediatricians for ongoing care. A significant portion of the subspecialist's time should be spent in research. Enhanced networks of patient referral and regionalization of tertiary care should be encouraged to provide cost-effective care to the relatively small number of pediatric patients with complex diseases. New patterns of coordinated health care delivery for children should be considered. Currently, there is a debate about whether or not we are training too many or too few pediatricians to meet the health needs of children in the United States. The following facts should be considered: A. A large number of American children receive no health care. With better access to care, there will be an increased demand for practicing pediatricians. B. The management of increasingly complex biomedical and psychosocial disorders by pediatricians requires extended professional time and knowledge. C. An increasing number of adolescents will be seen by pediatricians. D. Increased knowledge and technological support for diagnosis and treatment of complex pediatric diseases will require the services of pediatric subspecialists in addition to pediatricians providing primary care. E. The increasing demand for a healthier lifestyle for both men and women will result in more realistic working hours for pediatricians. Consideration of these factors leads to the conclusion that there will be a need for increasing numbers of pediatricians involved in pediatric care in the next decade. Pediatricians and pediatric subspecialists have a common interest in the health and welfare of children. This should be the basis for further discussion by all pediatricians about child health needs and the type of delivery system that will provide quality health care to all children. Professional organizations interested in child health, such as the American Academy of Pediatrics and the pediatric research societies, should continue to monitor all issues related to children's access to health care, the quality of care, and the practice of pediatrics. With such monitoring and evaluation, rational decisions can be made about the number of pediatricians and subspecialists needed to provide comprehensive, quality health care. Dialogue must continue between practicing pediatricians and the academic community to ensure the relevancy of pediatric training programs in preparing pediatricians to deliver high-quality care to all children. Ongoing evaluation and research will be needed to define the role of the pediatrician and pediatric subspecialist further in meeting the future health needs of children of this nation.

Evaluating the impact of COVID-19 on the adoption of virtual care in general practice in 20 countries (inSIGHT): rationale and study protocol (Preprint)

2021 ◽  
Author(s):  
Ana Luísa Neves ◽  
Edmond Li ◽  
Alice Serafini ◽  
Geronimo Larrain Gimenez ◽  
Heidrun Lingner ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Care Delivery ◽  
Quality And Safety ◽  
High Quality ◽  
Virtual Care ◽  
The Future ◽  
Perceived Impact ◽  
Remote Care ◽  
The Impact

BACKGROUND In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role. OBJECTIVE This study aims to explore the perspectives of General Practitioners / Family Doctors (GPs/FDs) on a.) use of virtual care during the COVID-19 pandemic; b.) perceived impact on quality and safety of care; c.) essential factors for high-quality and sustainable use of virtual care in the future. METHODS Online cross-sectional questionnaire of GPs/FDs, distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers’ personal contact networks. General Practitioners were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and subgroup analyses will be conducted to explore the relationships between the use of virtual care and perceptions on impact on quality and safety of care, and participants’ characteristics. Qualitative data (free-text responses) will be analysed using framework analysis. RESULTS N/A CONCLUSIONS The study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP/FD characteristics, and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design.

scholarly journals Essential Indicators of Quality in Primary Care Settings: An Evidence-Based, Structured, Expert Approach

2021 ◽  
Author(s):  
Sylvia J Hysong ◽  
Arredondo J Kelley ◽  
Ashley M Hughes ◽  
Houston Lester ◽  
Frederick L Oswald ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Performance Measures ◽  
Performance Measure ◽  
Evidence Based ◽  
Design Team ◽  
Productivity Measurement ◽  
High Quality ◽  
Care Clinic ◽  
Care System

Backgrond and Objective: Primary health care has a central role in the workings of the health care system and health of the American public. Thus, a high-performing, high-quality primary care system is essential. As a result, measurement frameworks are needed to assess the quality of the infrastructure, workforce configurations, and processes available in primary care practices due to the complexity of primary care. As part of a larger project supported by AHRQ (grant no. 1 R01 HS 025982), our research team reports the use of an evidence-based approach to compile a targeted set of existing care measures. These measures are prioritized according to their overall contribution and value to primary care. Within this paper, we describe the process by which the performance measures were selected and present the final set of measures resulting from the process. Methods and Results: We adapted The Productivity Measurement and Enhancement System, or ProMES, to select and rank existing primary care measures according to value to the primary care clinic. ProMES is a comprehensive performance measure development approach firmly grounded in motivational theory and performance measurement that uses expert elicitation to identify objectives of performance, corresponding measures and priority rankings. A design team of Nine subject matter experts (SMEs) identified three fundamental objectives for delivery of high-quality primary care, themed around access, patient-healthcare team partnerships, and technical quality. The SMEs also selected sixteen performance indicators from the 44 pre-vetted measures that already exist in three different data sources for primary care. One indicator, Team 2 Day Post Discharge Contact Ratio, was selected as an indicator for both Objective 2 and 3. Indicators were prioritized according to value using the contingency functions developed by the design team. Finally, the SMEs proposed nine new indicators of quality not currently in existence to address critical gaps in measuring the primary care domain. Implications and Future Directions: Performance measures selected as part of our modified-ProMES process assist in the implementation of targeted care quality measures prioritized in accordance to their value in primary care . Our measure set provides an actionable catalogue of measures that can serve as a first step toward interoperability of electronic health record systems. Future work toward this goal should address both logistical considerations (e.g., data capture, common data/programming language) and lingering measurement challenges, such as the best way to operationalize these measures for teams working in complex and shifting situations (e.g., rotating team members).

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