RESUMEN
Background: Not much is currently known about United States (US) physicians' opinions about healthcare financing, specifically subsequent to the creation and implementation of the Affordable Care Act (ACA). Objectives: A four state survey of practicing US based physicians' opinions about healthcare financing following ACA passage and implementation. Methods: Physician leaders practicing in the state of New York, Texas, Colorado and Mississippi were surveyed. Two factor analyses (FA) were conducted to understand the underlying constructs. Results: We determined the final response rate to be 26.7% after adjusting it for a variety of factors. Most physicians favored either a single payer system (43.8%) or individualized insurance coverage using health savings accounts (33.2%). For the single-payer system, FA revealed two underlying constructs: System orientation (how the physicians perceived the impact on the healthcare system or patients) and individual orientation (how the physicians perceived the impact on individual physicians). Subsequently, we found that physicians who were perceived neutral in their attitudes towards physician-patient relationship and patient conflict were also neutral in reference to system orientation and individual orientation. Physicians who were perceived as stronger on the physician-patient relationship were more supportive of a single-payer system. Conclusion: This study brings attention to the paradox of social responsibility (to provide quality healthcare) and professional autonomy (the potential impact of a healthcare financing structure to negatively affect income and workload). Efforts to further reform healthcare financing and delivery in the US may encounter resistance from healthcare providers (physicians, mid-level prescribers, pharmacists, or nurses) if the proposed reform interferes with their professional autonomy.
RESUMEN
The objective of this study was to perform a nationwide investigation of the financial performance of community pharmacies in the United States since the inception of Medicare Part D. A nationwide, cross-sectional survey of pharmacists was conducted in 2013. The 43-item online survey collected information about demographics, financial implications of Part D on community pharmacy and patients, provision of Medication Therapy Management (MTM) services and opinions about Medicare Part D 2010 updates. The adjusted response rate was 22.3% (419/1885). A majority of respondents (75.6%) reported a stable or increased prescription volume since 2006 but only 40.4% indicated that the financial performance of their pharmacy as either excellent or good during the same period. Owners and part-owners of rural independent pharmacies were more likely to report a below average or poor financial performance (75.0%). The provision of MTM services was not related to the financial performance of the pharmacy. Nearly half (44.7%) of pharmacy owners or part-owners indicated that they were considering selling their pharmacy, with most (94.1%) reporting that their decision to sell was due to the Part D financial pressures. However, the decision to sell was not related to the change in financial performance since 2006 or the volume of prescriptions dispensed.
RESUMEN
BACKGROUND: The patient-centred medical home (PCMH) and utilisation of a patient-centred care approach have been promoted as opportunities to improve healthcare quality while controlling expenditures. OBJECTIVES: To determine the penetration of PCMH within physician practices, and to evaluate physician attitudes towards patient-practitioner orientation. The ultimate objective was to explore relationships between the patient-practitioner orientation of respondents and the presence of PCMH elements within their practice. METHODS: A survey instrument was developed following a comprehensive literature review. Lead physicians practicing in four states were surveyed. RESULTS: The adjusted response rate was 26.7%. Responses indicated increased utilisation of PCMH elements (electronic medical records, e-mail and telephone consultations, and physician performance monitoring and feedback) compared with previous research. Within a logistic regression model, medical school graduation year (1990 or later >prior to 1990), practice size (group >solo), and percentage of time allocated to patient care (less >more) were significant predictors of working in a high PCMH alignment setting. Physician and practice characteristics did not predict the level of patient-practitioner orientation, though rural physicians were more patient-centred than urban physicians. A non-linear correlation between patient-practitioner orientation and the likelihood of practicing in a low or high PCMH-aligned practice was observed. CONCLUSIONS: There is a non-linear correlation between patient-practitioner orientation and the likelihood of a physician practicing in a low or high PCMH-aligned practice. The ability of a physician to work in a PCMH setting or practicing patient-centred care can go beyond a physician's aspirations to work and practice in that manner.
