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1.
Rev Bras Epidemiol ; 23: e200014, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32159625

RESUMEN

INTRODUCTION: Primary health care must assume the centrality of care so that health systems address and solve the health needs of the population. OBJECTIVE: To evaluate the quality of primary health care from the perspective of health professionals, including those associated with the Mais Médicos Brasil Program, verifying associations between quality of services and professional qualification. METHODOLOGY: A cross-sectional study where interviews with health professionals were carried out. The quality of care was measured by means of interviews about the experience of doctors and nurses with the services, using the Primary Care Assessment Tool (PCATool-Brasil). The presence and the extension of the primary health care attributes of the Southwest II region of Goiás state, constituted by 10 municipalities, were investigated. RESULTS: The lowest APS Overall Score was for the first contact access attribute (3.71). The bivariate analysis showed statistical difference between the variables profession and the essential, derived and general scores. Doctors of the More Doctors Program had higher average scores (7,68 essential; 9,11 derivative; 8,04 general) when compared to other medical professionals and nurses. CONCLUSIONS: The findings highlight the importance of permanent evaluation of health services, especially primary care, due to its importance and centrality to the organization of other levels of care. Only from this monitoring is possible a better management orientation for strategic and resolutive investments.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Atención Primaria de Salud/normas , Garantía de la Calidad de Atención de Salud/métodos , Calidad de la Atención de Salud , Educación Vocacional , Brasil , Estudios Transversales , Humanos , Médicos
3.
Support Care Cancer ; 28(1): 317-327, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31049670

RESUMEN

PURPOSE: The role of general practitioners in cancer care has expanded in recent years. However, little is known about utilization of primary health care (PHC) services by patients with cancer, particularly among socio-economically disadvantaged groups. We describe utilization of PHC services by patients with cancer, and the nature of the care provided. The study focuses on a disadvantaged group in Australia, namely Indigenous Australians. METHODS: A retrospective audit of clinical records in ten PHC services in Queensland, Australia. Demographic and clinical data of Indigenous Australians diagnosed with cancer during 2010-2016 were abstracted from patient's medical records at the PHC services. The rates of cancer-related visits were calculated using person years at risk as a denominator. RESULTS: A total of 138 patients' records were audited. During 12 months following the cancer diagnosis, patients visited the PHC service on average 5.95 times per year. Frequency of visits were relatively high in remote areas and among socioeconomic disadvantaged patients (IRR = 1.87, 95%CI 1.61-2.17; IRR = 1.79, 95%CI 1.45-2.21, respectively). Over 80% of visits were for seeking attention for symptoms, wound care, and emotional or social support. Patients who did not undergo surgery, had greater comorbidity, received chemotherapy and/or radiotherapy, and male gender had significantly greater rate of visits than their counterparts. CONCLUSION: The frequency of utilization of PHC services, especially by patients with comorbidities, and the range of reasons for attendance highlights the important role of PHC services in providing cancer care. The reliance on PHC services, particularly by patients in remote and disadvantaged communities, has important implications for appropriate resourcing and support for services in these locations.


Asunto(s)
Servicios de Salud del Indígena/estadística & datos numéricos , Neoplasias/terapia , Grupo de Ascendencia Oceánica , Médicos de Atención Primaria/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Australia/epidemiología , Auditoría Clínica , Femenino , Médicos Generales/normas , Médicos Generales/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/normas , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/etnología , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Pautas de la Práctica en Medicina/normas , Atención Primaria de Salud/normas , Queensland/epidemiología , Derivación y Consulta/normas , Derivación y Consulta/estadística & datos numéricos , Estudios Retrospectivos , Adulto Joven
4.
Med Clin North Am ; 104(1): 15-24, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31757233

RESUMEN

Urticaria is a common presenting problem to the primary care provider. Acute urticaria lasting less than 6 weeks may be associated with a drug or food allergens. Chronic urticaria lasting more than 6 weeks is often associated without a known underlying cause. Inducible stimuli causing hives should be excluded using specific provocation testing. Treatment follows a standardized algorithmic approach as outlined by the Joint Task Force Practice Parameter and/or International Urticaria guidelines. Patients not responsive to steps 1 or 2 should be referred to an urticaria specialist for further evaluation and treatment. The prognosis and outcome of urticaria is generally very favorable for most patients.


Asunto(s)
Atención Primaria de Salud/métodos , Urticaria/diagnóstico , Enfermedad Aguda , Comités Consultivos/normas , Enfermedad Crónica , Hipersensibilidad a las Drogas/complicaciones , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/diagnóstico , Humanos , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/normas , Pronóstico , Derivación y Consulta , Urticaria/etiología
6.
Interface (Botucatu, Online) ; 24: e190159, 2020.
Artículo en Portugués | LILACS | ID: biblio-1040193

RESUMEN

As Diretrizes Curriculares do curso de graduação em Medicina de 2014 incluem a Saúde Mental (SM) como uma das áreas obrigatórias do internato. O objetivo deste trabalho é apresentar o internato integrado de SM e de Medicina de Família e Comunidade (MFC) da Universidade Federal do Rio de Janeiro (UFRJ) e a fundamentação da escolha da Atenção Primária à Saúde (APS) como cenário de formação dos internos. Trata-se do relato da experiência do internato integrado de SM e MFC da UFRJ e da discussão de seus marcos teóricos. A alta prevalência de sofrimento psíquico e transtornos mentais na APS, o fato de ela ser a porta de entrada do Sistema Único de Saúde (SUS) e o fato de que a faculdade de Medicina deve formar médicos generalistas fazem deste cenário lócus privilegiado para o treinamento dos internos de Medicina em SM.(AU)


Las Directrices Curriculares del Curso de Graduación en Medicina de Curso de 2014 incluyen la salud mental (SM) como una de las áreas obligatorias del internado. El objetivo de este trabajo es presentar el internado integrado de SM y Medicina de Familia y Comunidad (MFC) de la UFRJ y la fundamentación de la Escuela de Atención Primaria de la Salud (APS) como escenario de formación de los internos. Se trata del relato del internado integrado de SM y MFC de la UFRJ y de la discusión de sus marcos teóricos. La alta prevalencia de sufrimiento psíquico y trastornos mentales en la APS, el hecho de que la APS es la puerta de entrada del sistema único de salud (SUS) y el hecho de que la facultad de medicina debe formar a médicos generalistas, hace que este escenario sea un locus privilegiado para el entrenamiento de los internos de medicina en salud mental.(AU)


The 2014 Curricular Guidelines of the medical undergraduate courses include Mental Health (MH) as one of the required areas of internship. The objective of this paper is to present the integrated internship for MH and Family and Community Medicine (FCM) of UFRJ, as well as the rationale for choosing Primary Health Care (PHC) as the setting for the internship training. It presents a report of the experience of the integrated internship for MH and FCM of UFRJ and the discussion of its theoretical frameworks. The high prevalence of psychological distress and mental disorders in PHC, the fact that PHC is the gateway to the unified national health system (SUS) and the fact that the medical school must train general practitioners, make PHC a privileged locus for the training of medical interns in mental health.(AU)


Asunto(s)
Atención Primaria de Salud/normas , Salud Mental/educación , Educación Médica/legislación & jurisprudencia , Internado y Residencia/tendencias , Medicina Familiar y Comunitaria
7.
Int J Med Inform ; 134: 104030, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31864097

RESUMEN

BACKGROUND: A recent review of primary care serious incidents suggests that diagnosis and assessment problems, underpinned by communication failures, involving the UK telephone triage service, NHS 111, may contribute to patient harm. METHODS: The present study utilised conversation analysis to address the lack of evaluative research examining the NHS 111 system and in particular interactions between system components (call handler, computerized decision support system, patients/caller). RESULTS: Analysis of audio recorded call interactions revealed interactional misalignment across four mapped call phases (eliciting caller details, establishing reason for call, completing the Pathways assessment, and agreeing the outcome). This misalignment has the capacity to increase the risk of system failure, particularly in relation to assessment problems and issues related to the accurate transfer of care advice. Our analysis suggests that efforts to enhance the NHS 111 system, similar telehealth services, and patient safety management more generally, should shift their focus from a limited set of individual components towards a system-specific interactionist perspective encompassing all elements. CONCLUSIONS: Further evaluative research is required in order to build a comprehensive evidence-base concerning the multiple interacting factors influencing patient safety in the NHS 111 system.


Asunto(s)
Comunicación , Prestación de Atención de Salud/organización & administración , Accesibilidad a los Servicios de Salud/normas , Necesidades y Demandas de Servicios de Salud/normas , Medicina Estatal/normas , Teléfono/normas , Triaje/normas , Humanos , Atención Primaria de Salud/normas , Teléfono/estadística & datos numéricos , Triaje/métodos , Reino Unido
8.
Rev. Esc. Enferm. USP ; 53: e03512, Jan.-Dez. 2019. graf
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1020387

RESUMEN

OBJETIVO: Desvelar as práticas de Educação Permanente em Saúde desenvolvidas pelo Núcleo de Apoio à Saúde da Família na atenção ao idoso. MÉTODO: Estudo qualitativo e exploratório-descritivo, desenvolvido em um município do estado do Paraná, com profissionais do Núcleo de Apoio à Saúde da Família. Os dados foram obtidos pela técnica de Grupo Focal e submetidos à Classificação Hierárquica Descendente utilizando o software IRaMuTeQ. Os referenciais teórico-analíticos foram a Política Nacional de Educação Permanente em Saúde e a Teoria Dialógica. RESULTADOS: Participaram 46 profissionais. Surgiram cinco classes que permitiram desvelar que as práticas de educação permanente na atenção ao idoso ocorrem durante os momentos de discussão de casos, no matriciamento, nas visitas domiciliares, nos grupos operativos e no cotidiano do trabalho de modo informal. CONCLUSÃO: As práticas de educação permanente desenvolvidas pelos profissionais na atenção ao idoso ocorrem em distintos momentos da atuação profissional e são permeadas pela prática


OBJETIVO: Desvelar las prácticas de Educación Permanente en Salud desarrolladas por el Núcleo de Apoyo a la Salud de la Familia en la atención a la persona mayor. MÉTODO: Estudio cualitativo y exploratorio descriptivo, desarrollado en un municipio del Estado de Paraná, con profesionales del Núcleo de Apoyo a la Salud de la Familia. Los datos fueron obtenidos por la técnica de Grupo Focal y sometidos a la Clasificación Jerárquica Descendiente utilizando el software IRaMuTeQ. Los marcos de referencia teóricos analíticos fueron la Política Nacional de Educación Permanente en Salud y la Teoría Dialógica. RESULTADOS: Participaron 46 profesionales. Surgieron cinco clases que permitieron desvelar que las prácticas de educación permanente en la atención a la persona mayor ocurren durante los momentos de discusión de casos, en el matriciamiento, las visitas domiciliarias, los grupos operativos y el cotidiano del trabajo de modo informal. CONCLUSIÓN: Las prácticas de educación permanente desarrolladas por los profesionales en la atención a la persona mayor ocurren en distintos momentos de la actuación profesional y traen consigo la práctica


OBJECTIVE: To unveil the Permanent Education in Health practices developed by the Family Health Support Center in the care provided to older adults. METHOD: A qualitative and exploratory-descriptive study developed in a municipality in the state of Paraná with professionals from the Family Health Support Center. Data were obtained by the Focus Group technique and submitted to the Descending Hierarchical Classification using IRaMuTeQ software. The implemented theoretical-analytical references were the National Policy of Permanent Education in Healthcare and the Dialogical Theory. RESULTS: Forty-six (46) professionals participated. Five classes emerged which revealed that the practices of permanent education in care provided to older adults occur during the moments of discussion of cases, in collaborative care planning (matriciamento ), in the home visits, in the operative groups and in the daily life of the informal work. CONCLUSION: The permanent education practices developed by the professionals in the care provided to older adults occur at different moments of professional performance and are permeated by the practice


Asunto(s)
Humanos , Masculino , Femenino , Anciano , Atención Primaria de Salud/normas , Educación Continua/métodos , Enfermería de Atención Primaria/normas , Servicios de Salud para Ancianos/normas , Personal de Salud , Grupos Focales , Investigación Cualitativa
9.
Rev Med Chil ; 147(5): 589-601, 2019 May.
Artículo en Español | MEDLINE | ID: mdl-31859891

RESUMEN

BACKGROUND: The Family and Community Health Model (MAIS) establishes the continuity of care as an essential principle. The Family Study, as a clinical strategy, allows to have sufficient and timely information and knowledge about users of health care services, facilitates their accompaniment and is a source of information to improve the quality of care and the management of health centers. AIM: To develop a tool to conduct family studies, devised by experts in Primary Health Care. MATERIAL AND METHODS: Using a qualitative method, an electronic Delphi was conducted on 24 experts on primary health care. Afterwards, the content validation was carried out with the participation of judges. RESULTS: The resulting tool considers two levels of family assessment. It allows to distinguish those families that would benefit from interventions of greater complexity than those derived from the usual care of health centers. CONCLUSIONS: The tool to perform family studies responds to the informational and continuity component of Continuity of Patient Care principle. It may be a proposal for the continuous improvement of Chilean primary care.


Asunto(s)
Técnica Delfos , Salud de la Familia/normas , Atención Primaria de Salud/normas , Encuestas y Cuestionarios/normas , Adulto , Chile , Continuidad de la Atención al Paciente/normas , Femenino , Personal de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Calidad de la Atención de Salud/normas , Reproducibilidad de los Resultados , Factores Socioeconómicos
10.
Rev Med Chil ; 147(5): 602-611, 2019 May.
Artículo en Español | MEDLINE | ID: mdl-31859892

RESUMEN

BACKGROUND: Clinical practice guidelines (CPGs) promote better quality and equity in health care and potentially they could improve patients' outcomes. However, their implementation is hindered by a number of factors including some related to health care professionals. AIM: To assess the perceptions and attitudes of primary care physicians regarding CPGs developed by the Chilean Ministry of Health in the context of the Health Sector Reform. MATERIAL AND METHODS: An adaptation of the survey "Knowledge, perceptions and attitudes towards Clinical Practice Guidelines" was sent to 1,264 primary care physicians in Chile and answered completely by 354. The analysis assessed the attitudes towards CPG, their use in primary care and their relationship with socio demographic features of respondents. RESULTS: Eighty two percent of respondents reviewed the flowcharts of the guidelines, 85% consulted their online version. The classification of evidence levels and the strength of recommendations generated a high level of confidence with the guidelines in 70 and 64% of respondents. Eighty five percent considered that CPG could help to standardize clinical practice. The most relevant barrier hindering CPG use was the lack of a brief, simple and easy to access format in 63% of respondents. The three dimensions of the theory of planned behavior (attitude toward behavior, subjective norms, and perceived behavioral control) were associated with a greater frequency of guideline use. A higher age and not being Chilean were associated with a lower frequency of use. CONCLUSIONS: The identified factors associated with CPG use should be considered in future guideline design.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Médicos de Atención Primaria/normas , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Atención Primaria de Salud/normas , Adulto , Actitud del Personal de Salud , Chile , Estudios Transversales , Femenino , Adhesión a Directriz/normas , Adhesión a Directriz/estadística & datos numéricos , Humanos , Masculino , Médicos de Atención Primaria/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Encuestas y Cuestionarios
11.
J Opioid Manag ; 15(6): 445-453, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31850506

RESUMEN

OBJECTIVE: Guidelines for appropriate management of chronic opioid therapy are underutilized by primary care physicians (PCPs). The authors hypothesized that developing a multicomponent, team-based opioid management system with electronic health record (EHR) support would allow our clinicians to improve adherence to chronic opioid prescribing and monitoring guidelines. DESIGN: This was a retrospective pre-post study. SETTING: The authors performed this intervention at our large, urban, academic primary care practice. PATIENTS, PARTICIPANTS: All patients with the diagnosis of "chronic pain, opioid requiring (ICD-10 F11.20)" on their primary care EHR problem lists were included in this study. INTERVENTION: The authors implemented a five-pronged strategy to improve our system of opioid prescribing, including (1) a patient registry with regular dissemination of reports to PCPs; (2) standardization of policies regarding opioid prescribing and monitoring; (3) development of a risk-assessment algorithm and riskstratified monitoring guidelines; (4) a team-based approach to care with physician assistant care managers; and (5) an EHR innovation to facilitate communication and guideline adherence. MAIN OUTCOME MEASURES: The authors measured percent adherence to opioid prescribing guidelines, including annual patient-provider agreements, biannual urine drug screens (UDSs), and prescription monitoring program (PMP) verification. RESULTS: Between September 2015 and September 2016, the percentage of patients on chronic opioid therapy with a signed controlled substances agreement within the preceding year increased from 46 to 76 percent (p < 0.0001), while the percentage of patients with a UDS done within the past 6 months rose from 23 to 79 percent (p < 0.0001). The percentage of patients whose state PMPs profile had been checked by a primary care team member in the past year rose from 45 to 97 percent (p < 0.0001). CONCLUSION: A comprehensive strategy to standardize chronic opioid prescribing in our primary care practice coincided with an increase in adherence to opioid management guidelines.


Asunto(s)
Analgésicos Opioides , Dolor Crónico , Pautas de la Práctica en Medicina , Atención Primaria de Salud/normas , Analgésicos Opioides/administración & dosificación , Dolor Crónico/tratamiento farmacológico , Adhesión a Directriz , Humanos , Estudios Retrospectivos
12.
BMC Health Serv Res ; 19(1): 819, 2019 Nov 08.
Artículo en Inglés | MEDLINE | ID: mdl-31703670

RESUMEN

BACKGROUND: The Transmural Trauma Care Model (TTCM) is a refined post-clinical rehabilitation approach, in which a multidisciplinary hospital-based team guides a network of primary care physical therapists in the treatment of trauma patients. The objective of this study was to assess the effectiveness of the TTCM compared to regular care. METHODS: A controlled-before-and-after study was performed in a level 1 trauma center. The TTCM includes four elements: 1) a multidisciplinary team at the outpatient clinic, 2) coordination and individual goal setting for each patient by this team, 3) a network of primary care physical therapists, 4) E-health support for transmural communication. Intervention group patients were prospectively followed (3, 6 and 9 months). The control group consisted of 4 clusters of patients who either had their first consultation at the outpatient clinic 0, 3, 6 or 9 months ago. Outcomes included generic- and disease-specific health-related quality of life (HR-QOL), pain, functional status, patient satisfaction, and perceived recovery. Between-group comparisons were made using linear regression analyses. The recovery pattern of intervention group patients was identified using longitudinal data analysis methods. RESULTS: A total of 83 participants were included in the intervention group. In the control group, 202 participants were included (68 in the baseline cluster, 26 in the 3-month cluster, 51 in the 6-month cluster, 57 in the 9-month cluster). Between-group differences were statistically significant in favor of the intervention group for disease-specific HR-QOL at 9 months, pain at 6 and 9 months, functional status at 6 and 9 months, patient satisfaction at 3, 6 and 9 months, and perceived recovery at 6 months. No significant differences were found between groups for generic HR-QOL at any time point. Generic HR-QOL, disease-specific HR-QOL, pain, and functional status significantly improved in a linear fashion among intervention group patients during the nine-month follow-up period. CONCLUSIONS: This study provides preliminary evidence that the TTCM is effective in improving patient related outcome measures, such as disease-specific HR-QOL, pain and functional status. A multicenter, and ideally randomized controlled trial, is required to confirm these results. TRIAL REGISTRATION: The trial is registered at the Dutch Trial Register (NTR5474). Registered 12 October 2015. Retrospectively registered.


Asunto(s)
Satisfacción del Paciente , Modalidades de Fisioterapia/normas , Heridas y Traumatismos/rehabilitación , Adulto , Estudios Controlados Antes y Después , Femenino , Metas , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/normas , Medición de Resultados Informados por el Paciente , Atención Primaria de Salud/normas , Atención Primaria de Salud/estadística & datos numéricos , Estudios Prospectivos , Mejoramiento de la Calidad , Calidad de Vida , Estudios Retrospectivos , Centros Traumatológicos/normas
13.
BMC Health Serv Res ; 19(1): 848, 2019 Nov 20.
Artículo en Inglés | MEDLINE | ID: mdl-31747932

RESUMEN

BACKGROUND: Universal Health Coverage only leads to the desired health outcomes if quality of health services is ensured. In Tanzania, quality has been a major concern for many years, including the problem of ineffective and inadequate routine supportive supervision of healthcare providers by council health management teams. To address this, we developed and assessed an approach to improve quality of primary healthcare through enhanced routine supportive supervision. METHODS: Mixed methods were used, combining trends of quantitative quality of care measurements with qualitative data mainly collected through in-depth interviews. The former allowed for identification of drivers of quality improvements and the latter investigated the perceived contribution of the new supportive supervision approach to these improvements. RESULTS: The results showed that the new approach managed to address quality issues that could be solved either solely by the healthcare provider, or in collaboration with the council. The new approach was able to improve and maintain crucial primary healthcare quality standards across different health facility level and owner categories in various contexts. CONCLUSION: Together with other findings reported in companion papers, we could show that the new supportive supervision approach not only served to assess quality of primary healthcare, but also to improve and maintain crucial primary healthcare quality standards. The new approach therefore presents a powerful tool to support, guide and drive quality improvement measures within council. It can thus be considered a suitable option to make routine supportive supervision more effective and adequate.


Asunto(s)
Atención Primaria de Salud/normas , Mejoramiento de la Calidad/normas , Adolescente , Adulto , Anciano , Actitud del Personal de Salud , Niño , Preescolar , Femenino , Instituciones de Salud/normas , Personal de Salud/normas , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/organización & administración , Indicadores de Calidad de la Atención de Salud , Calidad de la Atención de Salud/normas , Servicios de Salud Rural/normas , Tanzanía , Cobertura Universal del Seguro de Salud/organización & administración , Adulto Joven
14.
S Afr Med J ; 109(10): 771-783, 2019 Sep 30.
Artículo en Inglés | MEDLINE | ID: mdl-31635576

RESUMEN

BACKGROUND: The proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) provision in South Africa, with strategic purchasing of services from both private and public sector providers by the NHI Fund. Currently, while access to the private sector is primarily restricted to high-income insured earners, an important proportion of the low-income segment is choosing to utilise private PHC providers over public sector clinics. In recent years, a number of private providers in SA have established innovative models of PHC delivery that aim to expand access beyond the insured population and provide affordable access to good-quality PHC services. OBJECTIVES: To describe the current landscape of private PHC clinic models targeting low-income, uninsured earners and the role they might play during the transition to NHI. METHODS: Key informant interviews were conducted with representatives of a sample of private PHC provider organisations providing services to low-income, uninsured earners with clinics - beyond the traditional private sector general practitioner model. Organisations were asked to describe their service delivery model, the population it serves, the PHC services offered and the financing model. Written responses were captured in Excel and coded manually, and the results were thematically analysed. RESULTS: Of the eight organisations identified, most have actively engaged strategies to ensure the provision of affordable quality care. Within these strategies, scale is an important pivot in spreading fixed costs across more paying patients as well as task shifting to lower cadres of healthcare workers. Access to government medicines and laboratory tests is an important factor in achieving lower costs per patient. Together, these strategies support the sustainability of these models. CONCLUSIONS: We have provided an exploratory analysis of private PHC service delivery models serving the low-income, uninsured patient population, establishing factors that increase the efficiency of such service delivery, and delineating combinations of strategies that could make these models successful both during the transition to NHI and during full-scale NHI implementation. A clear regulatory framework would act as a catalyst for further innovation and facilitate contracting. These existing models can enhance and complement government provision and could be scaled up to meet the needs of expanding PHC under NHI. Understanding these models and the space and parameters in which they operate is important.


Asunto(s)
Prestación de Atención de Salud/organización & administración , Pacientes no Asegurados , Programas Nacionales de Salud/organización & administración , Atención Primaria de Salud/organización & administración , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/normas , Médicos Generales/organización & administración , Accesibilidad a los Servicios de Salud , Humanos , Renta , Programas Nacionales de Salud/economía , Pobreza , Atención Primaria de Salud/economía , Atención Primaria de Salud/normas , Sector Privado/economía , Sector Público/economía , Calidad de la Atención de Salud , Sudáfrica
15.
Med Clin North Am ; 103(6): 967-976, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31582007

RESUMEN

Historically, both pretest and posttest genetic counseling has been standard of care for genetic testing. This model should be adapted for primary care providers (PCPs) willing to learn critical information about the test and key concepts that patients need to make an informed testing decision. It is helpful for PCPs to discuss a few initial patients with a genetic counselor to prepare for the key concepts of pretest and posttest counseling. This article provides guidance about the recommended level of involvement of PCPs based on the test indication, test complexity, disorder management, and the potential for psychosocial sequela.


Asunto(s)
Revelación , Asesoramiento Genético , Atención Primaria de Salud , Asesoramiento Genético/ética , Asesoramiento Genético/métodos , Asesoramiento Genético/psicología , Humanos , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/métodos , Atención Primaria de Salud/normas
16.
Zhonghua Nei Ke Za Zhi ; 58(10): 713-735, 2019 Oct 01.
Artículo en Chino | MEDLINE | ID: mdl-31594170

RESUMEN

National handbook for the prevention and control of diabetes in primary care (2019) is made for the use in combination with the national guidelines for the prevention and control of diabetes in primary care (2018). It provides detailed information and supplementary for the contents involved in the guidelines.


Asunto(s)
Prestación de Atención de Salud/normas , Diabetes Mellitus Tipo 2/prevención & control , Guías de Práctica Clínica como Asunto/normas , Atención Primaria de Salud/normas , Humanos
17.
Artículo en Inglés | MEDLINE | ID: mdl-31569670

RESUMEN

Aboriginal and Torres Strait Islander women have significantly higher cervical cancer incidence and mortality than other Australian women. In this study, we assessed the documented delivery of cervical screening for women attending Indigenous Primary Health Care (PHC) centres across Australia and identified service-level factors associated with between-centre variation in screening coverage. We analysed 3801 clinical audit records for PHC clients aged 20-64 years from 135 Indigenous PHC centres participating in the Audit for Best Practice in Chronic Disease (ABCD) continuous quality improvement (CQI) program across five Australian states/territories during 2005 to 2014. Multilevel logistic regression models were used to identify service-level factors associated with screening, while accounting for differences in client-level factors. There was substantial variation in the proportion of clients who had a documented cervical screen in the previous two years across the participating PHC centres (median 50%, interquartile range (IQR): 29-67%), persisting over years and audit cycle. Centre-level factors explained 40% of the variation; client-level factors did not reduce the between-centre variation. Screening coverage was associated with longer time enrolled in the CQI program and very remote location. Indigenous PHC centres play an important role in providing cervical screening to Aboriginal and Torres Strait Islander women. Thus, their leadership is essential to ensure that Australia's public health commitment to the elimination of cervical cancer includes Aboriginal and Torres Strait Islander women. A sustained commitment to CQI may improve PHC centres delivery of cervical screening; however, factors that may impact on service delivery, such as organisational, geographical and environmental factors, warrant further investigation.


Asunto(s)
Detección Precóz del Cáncer/normas , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud del Indígena/normas , Disparidades en Atención de Salud/estadística & datos numéricos , Grupo de Ascendencia Oceánica , Atención Primaria de Salud/normas , Adulto , Australia/epidemiología , Auditoría Clínica , Detección Precóz del Cáncer/estadística & datos numéricos , Femenino , Estudios de Seguimiento , Servicios de Salud del Indígena/estadística & datos numéricos , Humanos , Modelos Logísticos , Persona de Mediana Edad , Atención Primaria de Salud/estadística & datos numéricos , Mejoramiento de la Calidad , Neoplasias del Cuello Uterino/etnología , Adulto Joven
18.
BMC Health Serv Res ; 19(1): 642, 2019 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-31492130

RESUMEN

BACKGROUND: Malnutrition is a comprehensive challenge for the nursing home, home care- and home nursing sector. Nutritional care and the subsequent documentation are a common and multifaceted healthcare practice that requires that the healthcare professionals possess complex combinations of competencies in order to deliver high-quality care and treatment. The purpose of this study was to investigate how a varied group of healthcare professionals' perceive their own competencies within nutrition and documentation and how organizational structures influence their daily work and the quality of care provided. METHODS: Two focus groups consisting of 14 healthcare professionals were conducted. The transcribed focus group interviews was analyzed using the qualitative content analysis approach. RESULTS: Six categories were identified: 1) Lack of uniform and systematic communication affect nutritional care practices 2) Experience-based knowledge among the primary workforce influences daily clinical decisions, 3) Different attitudes towards nutritional care lead to differences in the quality of care 4) Differences in organizational culture affect quality of care, 5) Lack of clear nutritional care responsibilities affect how daily care is performed and 6) Lack of clinical leadership and priorities makes nutritional care invisible. CONCLUSIONS: The six categories revealed two explanatory themes: 1) Absent inter- and intra-professional collaboration and communication obstructs optimal clinical decision-making and 2) quality deterioration due to poorly-established nutritional care structure. Overall, the two themes explain that from the healthcare professionals' point of view, a visible organization that allocates resources as well as prioritizing and articulating the need for daily nutritional care and documentation is a prerequisite for high-quality care and treatment. Furthermore, optimal clinical decision making among the healthcare professionals are compromised by imprecise and unclear language and terminology in the patients' healthcare records and also a lack of clinical guidelines and standards for collaboration between different healthcare professionals working in nursing homes, home care or home nursing. The findings of this study are beneficial to support organizations within these settings with strategies focusing on increasing nutritional care and documentation competencies among the healthcare professionals. Furthermore, the results advocate for the daily involvement and support of leaders and managers in articulating and structuring the importance of nutritional care and treatment and the subsequent documentation.


Asunto(s)
Actitud del Personal de Salud , Conocimientos, Actitudes y Práctica en Salud , Desnutrición/enfermería , Casas de Salud/normas , Competencia Clínica/normas , Toma de Decisiones Clínicas , Comunicación , Estudios Transversales , Prestación de Atención de Salud/normas , Documentación , Femenino , Grupos Focales , Recursos en Salud/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio/normas , Atención Domiciliaria de Salud/normas , Humanos , Liderazgo , Desnutrición/prevención & control , Estado Nutricional , Cultura Organizacional , Atención Primaria de Salud/normas , Autoimagen
19.
Artículo en Inglés | MEDLINE | ID: mdl-31470573

RESUMEN

The performance of general practitioners (GPs) is frequently assessed without considering the factors causing variability among general medical practices (GMPs). Our cross-sectional national-based study was performed in Hungary to evaluate the influence of GMP characteristics on performance indicators. The relationship between patient's characteristics (age, gender, education) and GMP-specific parameters (practice size, vacancy of GP's position, settlement type, and county of GMP) and the quality of care was assessed by multilevel logistic regression models. The variations attributable to physicians were small (from 0.77% to 17.95%). The education of patients was associated with 10 performance indicators. Practicing in an urban settlement mostly increased the quality of care for hypertension and diabetes care related performance indicators, while the county was identified as one of the major determinants of variability among GPs' performance. Only a few indicators were affected by the vacancy and practice size. Thus, the observed variability in performance between GPs partially arose from demographic characteristics and education of patients, settlement type, and regional location of GMPs. Considering the real effect of these factors in evaluation would reflect better the personal performance of GPs.


Asunto(s)
Médicos Generales/normas , Atención Primaria de Salud/normas , Adulto , Estudios Transversales , Diabetes Mellitus , Femenino , Humanos , Hungría , Hipertensión , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Población Urbana
20.
Am J Occup Ther ; 73(5): 7305185010p1-7305185010p10, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31484020

RESUMEN

IMPORTANCE: Leaders in the occupational therapy profession have called for occupational therapy's inclusion in primary care, but little is known about the occupational needs of patients in this setting. OBJECTIVE: To explore the need for and potential role of occupational therapy in a team-based primary care clinic. DESIGN: A qualitative descriptive study using a convenience sample of clinicians and patients. Meetings and semistructured interviews were recorded, transcribed, and coded by multiple coders using a general immersion-crystallization approach to identify relevant themes. SETTING: Outpatient complex care clinic of an urban academic medical center. PARTICIPANTS: The study included a voluntary sample of clinicians and patients from the complex care clinic. Patients were recruited from a staff-provided list; eligible patients had attended the clinic for at least 1 yr. All patients had multiple chronic conditions and were uninsured or received Medicaid. RESULTS: Researchers attended 10 clinician team meetings and conducted 13 patient interviews and 10 clinician interviews. Four domains of patient need were identified by both patients and clinicians: complex medical management, patients' limited resources, mental health needs, and challenges to occupation. Clinicians also identified cognitive-behavioral challenges affecting care, including lack of engagement and poor problem solving. CONCLUSIONS AND RELEVANCE: The makeup of the clinic team reflected their intent to address medical, socioeconomic, and mental health domains. However, cognitive-behavioral challenges and patients' occupational limitations were not consistently addressed. Thus, patients had unmet needs that occupational therapy practitioners were qualified to address. WHAT THIS ARTICLE ADDS: This study adds to the available literature examining patient needs and clinician challenges in a primary care clinic. Patients have occupational needs that are not being addressed in primary care, indicating a need for occupational therapy in this setting.


Asunto(s)
Terapia Ocupacional , Atención Ambulatoria , Humanos , Grupo de Atención al Paciente/normas , Atención Dirigida al Paciente/normas , Atención Primaria de Salud/normas , Investigación Cualitativa
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