Assuntos
Médicos de Família , Salários e Benefícios , Humanos , Salários e Benefícios/estatística & dados numéricos , Médicos de Família/economia , Médicos de Família/estatística & dados numéricos , Medicina de Família e Comunidade/economia , Medicina de Família e Comunidade/estatística & dados numéricos , Estados UnidosRESUMO
PURPOSE: Numerous studies have documented salary differences between male and female physicians. For many specialties, this wage gap has been explored by controlling for measurable factors that influence pay such as productivity, work-life balance, and practice patterns. In family medicine where practice activities differ widely between physicians, it is important to understand what measurable factors may be contributing to the gender wage gap, so that employers and policymakers and can address unjust disparities. METHODS: We used data from the 2017 to 2020 American Board of Family Medicine (ABFM) National Graduate Survey (NGS) which is administered to family physicians 3 years after residency (n = 8608; response rate = 63.9%, 56.2% female). The survey collects clinical income and practice patterns. Multiple linear regression analysis was performed, which included variables on hours worked, degree type, principal professional activity, rural/urban, and region. RESULTS: Although early-career family physician incomes averaged $225,278, female respondents reported incomes that were $43,566 (17%) lower than those of male respondents (P = .001). Generally, female respondents tended toward lower-earning principal professional activities and US regions; worked fewer hours (2.9 per week); and tended to work more frequently in urban settings. However, in adjusted models, this gap in income only fell to $31,804 (13% lower than male respondents, P = .001). CONCLUSION: Even after controlling for measurable factors such as hours worked, degree type, principal professional activity, population density, and region, a significant wage gap persists. Interventions should be taken to eliminate gender bias in wage determinations for family physicians.
Assuntos
Medicina de Família e Comunidade , Médicos de Família , Médicas , Salários e Benefícios , Humanos , Salários e Benefícios/estatística & dados numéricos , Feminino , Masculino , Médicos de Família/estatística & dados numéricos , Médicos de Família/economia , Estados Unidos , Medicina de Família e Comunidade/economia , Medicina de Família e Comunidade/estatística & dados numéricos , Médicas/economia , Médicas/estatística & dados numéricos , Fatores Sexuais , Inquéritos e Questionários/estatística & dados numéricos , Adulto , Renda/estatística & dados numéricosRESUMO
This issue highlights changes in medical care delivery since the start of the COVID-19 pandemic and features research to advance the delivery of primary care. Several articles report on the effectiveness of telehealth, including its use for hospital follow-up, medication abortion, management of diabetes, and as a potential tool for reducing health disparities. Other articles detail innovations in clinical practice, from the use of artificial intelligence and machine learning to a validated simple risk score that can support outpatient triage decisions for patients with COVID-19. Notably one article reports the impact of a voluntary program using scribes in a large health system on physician documentation behaviors and performance. One article addresses the wage gap between early-career female and male family physicians. Several articles report on inappropriate testing for common health problems; are you following recommendations for ordering Pulmonary Function Tests, mt-sDNA for colon cancer screening, and HIV testing?
Assuntos
COVID-19 , Atenção à Saúde , Medicina de Família e Comunidade , Pandemias , Medicina de Família e Comunidade/métodos , Big Data , Telemedicina , Inteligência Artificial , Atenção à Saúde/tendências , COVID-19/epidemiologia , Médicos de Família/economia , Salários e BenefíciosRESUMO
BACKGROUND: Nearly 30 years post legalisation and introduction, midwifery is still not optimally integrated within the health system of Canada's largest province, Ontario. Funding models have been identified as one of the main barriers. METHODS: Using a constructivist perspective, we conducted a qualitative descriptive study to examine how antepartum, intrapartum, and postpartum funding arrangements in Ontario impact midwifery integration. We conceptualized optimal 'integration' as circumstances in which midwives' knowledge, skills, and model of care are broadly respected and fully utilized, interprofessional collaboration and referral support the best possible care for patients, and midwives feel a sense of belonging within hospitals and the greater health system. We collected data through semi-structured telephone interviews with midwives, obstetricians, family physicians, and nurses. The data was examined using thematic analysis. RESULTS: We interviewed 20 participants, including 5 obstetricians, 5 family physicians, 5 midwives, 4 nurses, and 1 policy expert. We found that while course-of-care-based midwifery funding is perceived to support high levels of midwifery client satisfaction and excellent clinical outcomes, it lacks flexibility. This limits opportunities for interprofessional collaboration and for midwives to use their knowledge and skills to respond to health system gaps. The physician fee-for-service funding model creates competition for births, has unintended consequences that limit midwives' scope and access to hospital privileges, and fails to appropriately compensate physician consultants, particularly as midwifery volumes grow. Siloing of midwifery funding from hospital funding further restricts innovative contributions from midwives to respond to community healthcare needs. CONCLUSIONS: Significant policy changes, such as adequate remuneration for consultants, possibly including salary-based physician funding; flexibility to compensate midwives for care beyond the existing course of care model; and a clearly articulated health human resource plan for sexual and reproductive care are needed to improve midwifery integration.
Assuntos
Atenção à Saúde , Serviços de Saúde Materna , Tocologia , Médicos de Família , Feminino , Humanos , Gravidez , Serviços de Saúde Materna/economia , Serviços de Saúde Materna/organização & administração , Tocologia/economia , Tocologia/organização & administração , Ontário , Médicos de Família/economia , Médicos de Família/organização & administração , Pesquisa Qualitativa , Conhecimentos, Atitudes e Prática em Saúde , Atenção à Saúde/economia , Atenção à Saúde/organização & administraçãoRESUMO
BACKGROUND: Rurality strongly correlates with higher pay-for-performance access bonuses, despite higher emergency department use and fewer primary care services than in urban settings. We sought to evaluate the relation between patient-reported access to primary care and access bonus payments in urban settings. METHODS: We conducted a cross-sectional, secondary data analysis using Ontario survey and health administrative data from 2013 to 2017. We used administrative data to calculate annual access bonuses for eligible urban family physicians. We linked this payment data to adult (≥ 16 yr) patient data from the Health Care Experiences Survey to examine the relation between access bonus achievement (in quintiles of the proportion of bonus achieved, from lowest [Q1, reference category] to highest [Q5]) and 4 patient-reported access outcomes. The average survey response rate to the patient survey during the study period was 51%. We stratified urban geography into large, medium and small settings. In a multilevel regression model, we adjusted for patient-, physician- and practice-level covariates. We tested linear trends, adjusted for clustering, for each outcome. RESULTS: We linked 18 893 respondents to 3940 physicians in 414 bonus-eligible practices. Physicians in small urban settings earned the highest proportion of their maximum potential access bonuses. Access bonus achievement was positively associated with telephone access (Q2 odds ratio [OR] 1.18, 95% confidence interval [CI] 0.98-1.42; Q3 OR 1.34, 95% CI 1.10-1.63; Q4 OR 1.46, 95% CI 1.19-1.79; Q5 OR 1.87, 95% CI 1.50-2.33), after hours access (Q2 OR 1.26, 95% CI 1.09-1.47; Q3 OR 1.46, 95% CI 1.23-1.74; Q4 OR 1.77, 95% CI 1.46-2.15; Q5 OR 1.88, 95% CI 1.52-2.32), wait time for care (Q2 OR 1.01, 95% CI 0.85-1.20; Q3 OR 1.17, 95% CI 0.97-1.41; Q4 OR 1.27, 95% CI 1.05-1.55; Q5 OR 1.63, 95% CI 1.32-2.00) and timeliness (Q2 OR 1.29, 95% CI 0.98-1.69; Q3 OR 1.29, 95% CI 0.94-1.77; Q4 OR 1.58, 95% CI 1.16-2.13; Q5 OR 1.98, 95% CI 1.38-2.82). When stratified by geography, we observed several of these associations in large urban settings, but not in small urban settings. Trend tests were statistically significant for all 4 outcomes. INTERPRETATION: Although the access bonus correlated with access in larger urban settings, it did not in smaller settings, aligning with previous research questioning its utility in smaller geographies. The access bonus may benefit from a redesign that considers geography and patient experience.
Assuntos
Acessibilidade aos Serviços de Saúde , Atenção Primária à Saúde , Reembolso de Incentivo/estatística & dados numéricos , Serviços Urbanos de Saúde , Adulto , Plantão Médico/estatística & dados numéricos , Estudos Transversais , Feminino , Acessibilidade aos Serviços de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/normas , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Ontário/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Médicos de Família/economia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Telemedicina/estatística & dados numéricos , Serviços Urbanos de Saúde/organização & administração , Serviços Urbanos de Saúde/estatística & dados numéricos , Listas de EsperaRESUMO
In 2008, the Ontario Ministry of Health and Long-Term Care (MOHLTC) implemented an incentive payment, Q050A billing code, to family physicians for provision of comprehensive guideline-based care for patients with heart failure in the community. Our objective was to report on the uptake of this program from fiscal years 2008-2014. We determined the numbers of claims billed per year and the proportion of eligible patients with congestive heart failure (CHF) for whom a physician billed. The code was billed by 10.4% of all family physicians in 2008-2009, which increased to 15.1% in 2014-2015. The code was claimed for 4.1% of all identified patients with CHF in 2008-2009 and 5.9% of patients with CHF in 2014-2015. Given these findings, it is estimated that MOHLTC paid an additional CAD$10,118,514 to family physicians managing patients with CHF. This is the first study to examine the uptake of a CHF-specific incentive program, which will help to inform health policy makers in implementing such programs in Ontario.
Assuntos
Efeitos Psicossociais da Doença , Insuficiência Cardíaca/economia , Motivação , Médicos de Família/economia , Qualidade da Assistência à Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Ontário/epidemiologia , Estudos RetrospectivosRESUMO
OBJECTIVES: In the middle to late 2000s, many family physicians switched from a Family Health Group (FHG; a blended fee-for-service model) to a Family Health Organization (FHO; a blended capitation model) in Ontario, Canada. The evidence on the link between physician remuneration schemes and quality of diabetes care is mixed in the literature. We examined whether physicians who switched from the FHG to FHO model provided better care for individuals living with diabetes relative to those who remained in the FHG model. METHODS: Using longitudinal health administrative data from 2006 to 2016, we investigated the impact of physicians switching from FHG to FHO on 8 quality indicators related to diabetes care. Because FHO physicians are likely to be systematically different from FHGs, we employed propensity-score-based inverse probability-weighted fixed-effects regression models. All analyses were conducted at the physician level. RESULTS: We found that FHO physicians were more likely to provide glycated hemoglobin testing by 2.75% (95% confidence interval [CI], 1.89% to 3.60%), lipid assessment by 2.76% (CI, 1.95% to 3.57%), nephropathy screening by 1.08% (95% CI, 0.51% to 1.66%) and statin prescription by 1.08% (95% CI, 0.51% to 1.66%). Patients under FHOs had a lower estimated risk of mortality by 0.0124% (95% CI, 0.0123% to 0.0126%) per physician per year. However, FHG and FHO physicians were similar for annual eye examination, prescription of angiotensin-converting enzyme inhibitors (or angiotensin II receptor blockers) and patients' risk of avoidable diabetes-related hospitalizations. CONCLUSIONS: Compared with blended fee-for-service, blended capitation payment is associated with a small, but statistically significant, improvement in some aspects of diabetes care.
Assuntos
Capitação/normas , Planos de Pagamento por Serviço Prestado/normas , Médicos de Família/normas , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde/normas , Adulto , Estudos de Coortes , Planos de Pagamento por Serviço Prestado/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Médicos de Família/economia , Atenção Primária à Saúde/economia , Qualidade da Assistência à Saúde/economia , Estudos RetrospectivosRESUMO
BACKGROUND: Family practice and family doctors are critical part of China's primary healthcare delivery in a constantly evolving society. As the first point of contact with the medical system, family practices require physically and psychologically sound and a well-motivated family doctors at all times. This is because an error can lead to loss of lives as gatekeepers of the medical system. Our study explored the extent to which positive psychological capital promotes higher performance among family doctors. METHODS: A questionnaire was used to collect data from family doctors in Shanghai, Nanjing, and Beijing. We applied a structural equation analysis to analyze the causal relationship among the variables. RESULTS: We found out that psychological well-being and job involvement significantly influences the performance of family doctors in China. The study also noted that psychological capital moderates the relationship between psychological well-being attainment, job involvement, and performance. CONCLUSIONS: Studies have shown that these pressures affect their well-being considerably. For this reason, a healthcare professional who experiences positive emotions affects the total behavior which culminates into performance.
Assuntos
Satisfação no Emprego , Saúde Mental , Médicos de Família , Atenção Primária à Saúde , Desempenho Profissional/normas , Local de Trabalho , Atitude do Pessoal de Saúde , China/epidemiologia , Análise Fatorial , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Motivação , Médicos de Família/economia , Médicos de Família/psicologia , Médicos de Família/normas , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Reprodutibilidade dos Testes , Capital Social , Meio Social , Inquéritos e Questionários , Local de Trabalho/psicologia , Local de Trabalho/normasRESUMO
BACKGROUND: The National Health Insurance Administration of Taiwan has introduced several pay-for-performance programs to improve the quality of healthcare. This study aimed to provide government with evidence-based research findings to help primary care physicians to actively engage in pay-for-performance programs. METHODS: We conducted a questionnaire survey among family physicians with age-stratified sampling from September 2016 to December 2017. The structured questionnaire consisted of items including the basic demographics of the surveyee and their awareness of and attitudes toward the strengths and/or weaknesses of the pay-for-performance programs, as well as their subjective norms, and the willingness to participate in the pay-for-performance programs. Univariate analysis and multivariate logistic regression analysis were performed to compare the differences between family physicians who participate in the pay-for-performance programs versus those who did not. RESULTS: A total of 543 family physicians completed the questionnaire. Among family physicians who participated in the pay-for-performance programs, more had joined the Family Practice Integrated Care Project [Odds ratio (OR): 2.70; 95% Confidence interval (CI): 1.78 ~ 4.09], had a greater awareness of pay-for-performance programs (OR: 2.37; 95% CI: 1.50 ~ 3.83), and a less negative attitude to pay-for-performance programs (OR: 0.50; 95% CI: 0.31 ~ 0.80) after adjusting for age and gender. The major reasons for family physicians who decided to join the pay-for-performance programs included believing the programs help enhance the quality of healthcare (80.8%) and recognizing the benefit of saving health expenditure (63.4%). The causes of unwillingness to join in a pay-for-performance program among non-participants were increased load of administrative works (79.6%) and inadequate understanding of the contents of the pay-for-performance programs (62.9%). CONCLUSIONS: To better motivate family physicians into P4P participation, hosting effective training programs, developing a more transparent formula for assessing financial risk, providing sufficient budget for healthcare quality improvement, and designing a reasonable profit-sharing plan to promote collaboration between different levels of medical institutions are all imperative.
Assuntos
Programas Nacionais de Saúde , Médicos de Família , Reembolso de Incentivo , Adulto , Atitude do Pessoal de Saúde , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/tendências , Avaliação das Necessidades , Médicos de Família/economia , Médicos de Família/psicologia , Médicos de Família/estatística & dados numéricos , Melhoria de Qualidade/organização & administração , Inquéritos e Questionários , TaiwanRESUMO
PURPOSE: The use of telemedicine has grown in recent years. As a subset of telemedicine, e-visits typically involve the evaluation and management of a patient by a physician or other clinician through a Web-based or electronic communication system. The national prevalence of e-visits by primary care physicians is unclear as is what factors influence adoption. The purpose of this study was to examine the prevalence of family physicians providing e-visits and associated factors. METHODS: A national, cross-sectional practice demographic questionnaire for 7580 practicing family physicians was utilized. Bivariate statistics were calculated and logistic regression was conducted examining both physician level and practice level factors associated with offering e-visits. RESULTS: The overall prevalence of offering e-visits was 9.3% (n = 702). Compared with private practice physicians, other physicians were more likely to offer e-visits if their primary practice was an academic health center/faculty practice (odds ratio [OR], 1.73; 95% CI, 1.03 to 2.91), managed care/health maintenance organization (HMO) practice (OR, 9.79; 95% CI, 7.05 to 13.58), hospital-/health system-owned medical practice (not including managed care or HMO) (OR, 2.50; 95% CI, 1.83 to 3.41), workplace clinic (OR, 2.28; 95% CI, 1.43 to 3.63), or federal (military, Veterans Administration [VA]/Department of Defense) (OR, 4.49; 95% CI, 2.93 to 6.89). Physicians with no official ownership stake (OR, 0.44; 95% CI, 0.28 to 0.68) or other ownership arrangement (OR, 0.29; 95% CI, 0.12 to 0.71) had lower odds of offering e-visits compared with sole owners. CONCLUSION: Fewer than 10% of family physicians provided e-visits. Physicians in HMO and VA settings (ie, capitated vs noncapitated models) were more likely to provide e-visits, which suggests that reimbursement may be a major barrier.
Assuntos
Visita a Consultório Médico/tendências , Médicos de Família/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Telemedicina/tendências , Estudos Transversais , Feminino , Humanos , Masculino , Visita a Consultório Médico/economia , Visita a Consultório Médico/estatística & dados numéricos , Médicos de Família/economia , Médicos de Família/tendências , Padrões de Prática Médica/economia , Padrões de Prática Médica/tendências , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências , Prática Privada/economia , Prática Privada/estatística & dados numéricos , Prática Privada/tendências , Mecanismo de Reembolso/economia , Mecanismo de Reembolso/estatística & dados numéricos , Telemedicina/economia , Telemedicina/estatística & dados numéricos , Estados UnidosRESUMO
We examine family physicians' responses to financial incentives for medical services in Ontario, Canada. We use administrative data covering 2003-2008, a period during which family physicians could choose between the traditional fee for service (FFS) and blended FFS known as the Family Health Group (FHG) model. Under FHG, FFS physicians are incentivized to provide comprehensive care and after-hours services. A two-stage estimation strategy teases out the impact of switching from FFS to FHG on service production. We account for the selection into FHG using a propensity score matching model, and then we use panel-data regression models to account for observed and unobserved heterogeneity. Our results reveal that switching from FFS to FHG increases comprehensive care, after-hours, and nonincentivized services by 3%, 15%, and 4% per annum. We also find that blended FFS physicians provide more services by working additional total days as well as the number of days during holidays and weekends. Our results are robust to a variety of specifications and alternative matching methods. We conclude that switching from FFS to blended FFS improves patients' access to after-hours care, but the incentive to nudge service production at the intensive margin is somewhat limited.
Assuntos
Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Planos de Incentivos Médicos/estatística & dados numéricos , Médicos de Família/economia , Padrões de Prática Médica/estatística & dados numéricos , Plantão Médico/estatística & dados numéricos , Fatores Etários , Acessibilidade aos Serviços de Saúde , Humanos , Renda , Ontário , Fatores SexuaisRESUMO
BACKGROUND AND PURPOSE: In the existing model of community health service in China, community general practitioners play important roles in health promotion as well as prehospital stroke recognition and management. We recently engineered Stroke 120 based on FAST for China. This investigation aimed to investigate its acceptance in community physicians and promote their stroke related knowledge. METHODS: We conducted an stroke education session to community physicians or family doctors (total of 435 participants), teaching both FAST and Stroke 120. Online survey was distributed to the participants before and after the education session to evaluate the awareness of stroke and the acceptance of the stroke recognition tool. RESULTS: Significant stroke knowledge deficiencies were found in community physicians. After the education session, percent of the participants knew that the thrombolytic therapeutic window (<4.5 hours) was improved from 54.0% to 91.6% (P < .001). A total of 88.5% of them would send their patients who had stroke to the nearest hospital with stroke center by emergency medical service, compared to baseline (64.4%, P < .001). In total, 95.2% of them would recommend thrombolytic therapy in the treatment of acute ischemic stroke compared to 82.7% (baseline P < .001). Although majority mastered both FAST (95.5%) and Stroke 120 (98.0%) through our education session, 96.3% of them believe that Stroke 120 is the most suitable for Chinese in stroke education. CONCLUSIONS: Stroke 120 strategy was well accepted by the community physicians in China and in the meantime improved knowledge regarding stroke was observed.
Assuntos
Serviços de Saúde Comunitária , Educação Médica Continuada/métodos , Conhecimentos, Atitudes e Prática em Saúde , Capacitação em Serviço/métodos , Médicos de Família/economia , Médicos de Atenção Primária/educação , Acidente Vascular Cerebral , Adulto , Atitude do Pessoal de Saúde , Conscientização , China , Competência Clínica , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos de Família/psicologia , Médicos de Atenção Primária/psicologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/terapia , Terapia Trombolítica , Tempo para o Tratamento , Adulto JovemRESUMO
Antecedentes: Más allá del pago por cápita, desde 2009 el Plan de Salud del Hospital Italiano de Buenos Aires reconoció a los médicos de familia el pago por prestación de intervenciones psicosociales de cuarenta minutos de duración realizadas para promover el bienestar y la autonomía de sus pacientes. Objetivos: Describir los problemas que motivaron estas intervenciones y las redefiniciones diagnósticas que realizaron estos profesionales. Métodos: Fueron revisadas las fichas estructuradas de registro de 482 intervenciones psicosociales realizadas durante 2011 y codificadas mediante la Clasificación Internacional de la Atención Primaria (CIAP-2). Resultados: Los motivos de consulta más frecuentes fueron los sentimientos depresivos y/o de ansiedad (33,25 %), problemas familiares y/o vinculados a crisis vitales (16 %), dolor (9,56 %) y cansancio (2,91 %). Entre las redefiniciones diagnósticas predominaron las crisis vitales (15,45 %), los problemas de la relación conyugal o con hijos (14,61 %), y los trastornos depresivos y/o de ansiedad (27 %). Conclusiones: nuestro modelo de trabajo contribuyó a que en una gran proporción de pacientes que había consultado por dolor u otros síntomas generales, detectáramos, abordáramos y documentáramos el proceso de atención de problemas de la esfera psicosocial, que suele ser subregistrado con el abordaje biomédico clásico. (AU)
Background: Beyond capitation payment, since 2009 Hospital Italiano de Buenos Aires Health Maintenance Organization incorporated "structured primary care psychosocial interventions" as a fee for service practice. They last 40 minutes and are undertaken by family physicians with the aim of improving the wellbeing of their patients and helping them to strengtheningtheir autonomy. Objectives: To identify chief complaints and problems (re)definitions carried out by family physicians. Methodology: 482 medical records written during 2011 were reviewed and coded according to the International Classification of Primary Care (ICPC-2). Results: Most frequent chief complaints were depressive and/or anxious feelings (33.25 %), family problems and/or phasesof adult life problems (16 %), pain (9.56 %) and fatigue (2.91 %). Most common problem (re)definitions were life events(15.45 %), followed by marital or childrelated problems (14.61 %), and depressive and/or anxiety disorders (27 %). Conclusions: Our working model enabled us to identify, address and document psychosocial problems which are often underreported within the classical biomedical approach in a large proportion of patients whose chief complaint were painor other general symptoms. (AU)
Assuntos
Médicos de Família/tendências , Atenção Primária à Saúde/métodos , Sistemas de Apoio Psicossocial , Ansiedade , Dor , Médicos de Família/economia , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/organização & administração , Impacto Psicossocial , Depressão , Conflito Familiar , Fadiga , Promoção da Saúde/provisão & distribuiçãoRESUMO
BACKGROUND: Noncommunicable diseases (NCDs) are a major threat to population health worldwide. In Shanghai, China, a new pattern of NCD management-self-management-has been developed in community health service centres (CHSCs). OBJECTIVE: To clarify how contracting with CHSC-based family doctors (FDs) influences the engagement in and effectiveness of self-management behaviour among NCD patients. METHOD: We conducted two waves of a questionnaire survey (in 2013 and 2016) to collect data on patients with NCDs. Separate logistic regression models and longitudinal analysis were performed to examine the effect of contracting with an FD on NCD self-management and the effectiveness of this self-management. RESULTS: Nearly all contracted patients (80.79%) had implemented NCD self-management, while only 55.57% of non-contracted patients did so. The self-management effectiveness rate was also higher among contracted patients than among non-contracted ones (86.66% vs. 54.79%). In the population-averaged models, contracted patients had 2.25 and 2.91 times greater odds of implementing self-management and reporting that the self-management was effective, respectively, after controlling for all related variables. Additionally, awareness of FD-contracted services, satisfaction with CHSCs, and experiencing first contact at CHSCs had positive impacts on the implementation and effectiveness of self-management. CONCLUSIONS: FDs were important for ensuring that NCD patients engaged in self-management behaviour, the most common form of which was focus group. Participation in NCD focus groups may be key for attaining the effects of self-management, including improved health knowledge, greater health awareness, more frequent engagement in health behaviour, and, most importantly, greater practice of self-monitoring. Self-management might help to achieve greater NCD control.
Assuntos
Serviços Contratados , Doenças não Transmissíveis/terapia , Médicos de Família/organização & administração , Autocuidado , Adolescente , Adulto , Idoso , China , Serviços Contratados/métodos , Serviços Contratados/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos de Família/economia , Médicos de Família/estatística & dados numéricos , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Despite increasing popularity among health organizations of pay for performance (P4P) for the provision of comprehensive care for chronic non-communicable diseases, evidence of its effectiveness in improving health system outcomes is weak. An important void in the evidence base is whether there are gendered differences in P4P uptake and in related outcomes amenable to healthcare improvement. This study assesses the gender-specific effects of P4P among family physicians on diabetes healthcare costs in a context of universal health coverage. METHODS: We use population-based linked longitudinal administrative datasets on chronic disease cases, physician billings, hospital discharge abstracts, and physician and resident registries in the province of New Brunswick, Canada. We estimate the effects of introduction of a P4P scheme on excess public healthcare costs among cohorts of adult diabetes patients using propensity score-adjusted difference-in-differences regressions stratified by physician's gender. RESULTS: We observed greater male physician uptake of incentive payments, seemingly exacerbating gender gaps in professional remuneration. Regression results indicated P4P did not lead to improved outcomes in terms of preventing hospitalization costs among patients, only measurable increases in compensation for both the male and female physician workforce. CONCLUSIONS: While P4P was not attributed in this study to reduced hospital burden and enhanced sustainability of healthcare financing, incentive payments were found to be related to earning gaps by physician's gender. Decision-makers should consider that benefits of P4P be monitored not only for patient metrics but also for provider metrics in terms of gender equality especially given feminization of primary care medical workforces.
Assuntos
Doença Crônica/terapia , Médicos de Família/economia , Reembolso de Incentivo/economia , Cobertura Universal do Seguro de Saúde/organização & administração , Adulto , Doença Crônica/economia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Novo Brunswick , Médicos de Família/organização & administração , Reembolso de Incentivo/organização & administração , Fatores Sexuais , Cobertura Universal do Seguro de Saúde/economiaRESUMO
OBJECTIVE: This study sought to identify knowledge gaps and attitudinal barriers to prescribing intrauterine contraception (IUC). METHODS: A national, Web-based survey of Canadian gynaecology (GYN) and family medicine (FM) physicians was conducted. The survey was distributed through several channels, including physicians' databases, invitations through a commercial email aggregating service, and contacting residency programs. For knowledge-based questions, correct answers were those consistent with Canadian practice guidelines. Ethics approval was granted through Queen's Health Sciences Research Ethics Board. Project funding was through a research grant from Bayer, Inc. (Canadian Task Force Classification III). RESULTS: A total of 600 responses were received. GYN physicians' knowledge about IUC (number correct / 40) was better than that of the FM and FM with additional women's health training (FMWH) groups (median [interquartile range] 39 [37-40], 36 [32-38], and 37 [35-39]; P < 0.0001). Factors associated with lower scores included rural practice location, lack of affiliation with medical trainees, extremes of practice duration, and self-perceived lack of knowledge about IUC. Most respondents prescribed IUC (93.7%). Among prescribers, 97.0% inserted IUC. The most common reasons for not prescribing or inserting IUC included lack of training, lack of comfort, and referral to other physicians to provide this service. Respondents indicated that they would be more likely to prescribe and/or insert IUC if cost barriers were removed, patient interest was increased, or if there was improved access to patient-centred educational materials and hands-on training modules. CONCLUSION: This study suggests that although many GYN and FM physicians are offering IUC, misconceptions regarding contraindications still exist, and several barriers are related to deficiencies in providers' knowledge. Therefore, educational efforts should be prioritized to increase the usage of IUC.
Assuntos
Atitude do Pessoal de Saúde , Ginecologia , Conhecimentos, Atitudes e Prática em Saúde , Acessibilidade aos Serviços de Saúde , Dispositivos Intrauterinos , Médicos de Família/psicologia , Canadá , Contraindicações , Feminino , Ginecologia/economia , Custos de Cuidados de Saúde , Inquéritos Epidemiológicos , Humanos , Internet , Dispositivos Intrauterinos/efeitos adversos , Dispositivos Intrauterinos/economia , Masculino , Educação de Pacientes como Assunto , Médicos de Família/economia , Padrões de Prática Médica , Encaminhamento e Consulta , AutorrelatoRESUMO
The Transforming Clinical Practice Initiative prioritized the delivery of free practice transformation assistance by Practice Transformation Networks (PTNs) to small and rural practices that may otherwise lack the resources needed to succeed in Medicare's value-based payment (VBP) programs. We assessed the enrollment of rural practices in PTNs using 2016 TCPI enrollment data and American Board of Family Medicine recertification examination registration data from 2013 to 2016. PTNs enrolled a higher proportion of rural family medicine practices than are represented across the general workforce (P < .0001). We await more comprehensive data releases to fully understand enrollment to this important initiative.
Assuntos
Medicina de Família e Comunidade/estatística & dados numéricos , Medicare/economia , Médicos de Família/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Serviços Urbanos de Saúde/estatística & dados numéricos , Medicina de Família e Comunidade/economia , Medicina de Família e Comunidade/organização & administração , Humanos , Medicare/estatística & dados numéricos , Médicos de Família/economia , Médicos de Família/organização & administração , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/organização & administração , Estados Unidos , Serviços Urbanos de Saúde/economia , Serviços Urbanos de Saúde/organização & administração , Seguro de Saúde Baseado em Valor/economia , Seguro de Saúde Baseado em Valor/estatística & dados numéricosRESUMO
OBJECTIVE: To determine the range of services and procedures offered by family physicians who define themselves as comprehensive practitioners and compare responses across 3 generations of alumni of a single family practice program. DESIGN: Cross-sectional survey. SETTING: Western University in London, Ont. PARTICIPANTS: All graduates of the family medicine program between 1985 and 2012. MAIN OUTCOME MEASURES: Self-reported provision of the following types of care: in-office care, in-hospital care, intrapartum obstetrics, housecalls, palliative care, after-hours care, nursing home care, minor surgery, emergency department care, sport medicine, and walk-in care. Sex, training site (urban or rural), size of community of practice, practice model, and satisfaction with practice were also reported. RESULTS: Participants practised in 7 provinces and 1 territory across Canada, but principally in Ontario. A small number were located in the United States. There was a decline in the number of services provided across 3 generations of graduates, with newer graduates providing fewer services than the older graduates. Significant decreases across the 3 groups were observed in provision of housecalls (P = .004), palliative care (P = .028), and nursing home care (P < .001). Non-significant changes were seen in provision of intrapartum obstetrics across the 3 alumni groups, with an initial decline and then increase in reported activity. Most respondents were in a family health organization or family health network practice model and those in such models reported offering significantly more services than those in family health group or salary models (P < .001). CONCLUSION: The normative definition of comprehensive care varies across 3 generations of graduates of this family medicine program, with newer physicians reporting fewer overall services and procedures than older graduates. Greater understanding of the forces (institutional, regulatory, economic, and personal) that determine the meaning of comprehensive primary care is necessary if this foundational element of family medicine is to be preserved.
Assuntos
Assistência Integral à Saúde/estatística & dados numéricos , Medicina de Família e Comunidade/educação , Médicos de Família/estatística & dados numéricos , Área de Atuação Profissional/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Modelos Lineares , Masculino , Ontário , Médicos de Família/economia , População Rural , Autorrelato , População UrbanaAssuntos
Renda , Médicos de Família/economia , Salários e Benefícios , Canadá , Competição Econômica , HumanosRESUMO
While salient features of the Affordable Care Act include insurance expansions and private coverage reforms, various other provisions are embedded within the law. We focus on a temporary 10 percent fee increase for primary care visits supplied to publicly insured (Medicare) beneficiaries. Using administrative and survey data, we assess the price shock's impact on service volume, physician labor supply, and quality of care. Primary care physicians (PCPs) in independent practices demonstrate, at most, a marginal 2 percent increase in new patient visits while horizontally and vertically integrated PCPs show no change. Both PCP organizational types witness declines in established patient visits, on average, but there is marked heterogeneity: established patient visits increase by 1 to 2 percent among PCPs with fewer Medicare claims in the pre-period. The Medicare fee bump did not observably impact other labor supply outcomes and quality of care margins. We estimate that the policy introduced a $1.5 billion transfer from taxpayers to providers during the initiative's first three years.