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1.
BMC Public Health ; 19(1): 1471, 2019 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-31699063

RESUMEN

BACKGROUND: The recently increased access to antiretroviral therapy (ART) in South Africa has placed additional strain on human and infrastructure resources of the public health sector. Capacity from private-sector General Practitioners (GPs) could be leveraged to ease the current burden on the public health sector. METHODS: We conducted a retrospective record review of routine electronic medical record data on a systematic sample of HIV-infected adults (≥18 years old) initiated on ART at a tertiary hospital outpatient HIV clinic in Johannesburg, South Africa and down-referred to private-GPs for continued care after stabilization on ART. We compared these patients ("GP down-referred") to a control-cohort who remained at the referring site ("Clinic A") and patients from a regional hospital outpatient HIV clinic not offering down-referral to GPs ("Clinic B"). Study outcomes assessed are viral load suppression (VL < 50 copies/ml) and attrition from care (all-cause-mortality or > 90-days late for a last-scheduled visit) by 12 months of follow-up following down-referral or eligibility. RESULTS: A total of 3685 patients, comprising 373 (10.1%) GP down-referred, 2599 (70.5%) clinic A controls, and 713 (19.4%) clinic B controls were included in the analysis. Overall, 1535 patients (53.3%) had a suppressed viral load. A higher portion of GP down-referred patients had a suppressed viral load compared to clinic A and B patients (65.7% vs 49.1% vs 58.9%). After adjusting for demographic and baseline clinical covariates, we found no difference in viral load suppression between GP down-referred and control patients (adjusted relative risk [aRR] for clinic A vs GP down-referred 1.0; 95% CI: 0.9-1.1), (aRR for clinic B vs GP down-referred 1.0; 95% CI: 0.9-1.2). Clinic B controls experienced the highest attrition compared to GP down-referred and clinic A controls (33.2% vs 11.3% vs 5.9%) and had a higher risk of attrition compared to GP down-referred patients (adjusted hazard ratio [aHR] 4.2; 95% CI: 2.8-6.5), whereas clinic B controls had a lower risk of attrition (aHR 0.5; 95% CI: 0.3-0.7). CONCLUSIONS AND RECOMMENDATIONS: Our results show that private-GPs can contribute to caring for stabilized public sector HIV patients on life-long ART. However, they require special efforts to improve retention in care.


Asunto(s)
Antirretrovirales/uso terapéutico , Medicina General/organización & administración , Infecciones por VIH/tratamiento farmacológico , Asociación entre el Sector Público-Privado/organización & administración , Derivación y Consulta/organización & administración , Adolescente , Adulto , Instituciones de Atención Ambulatoria/organización & administración , Femenino , Recursos en Salud , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Sudáfrica , Carga Viral , Adulto Joven
2.
BMC Health Serv Res ; 19(1): 811, 2019 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-31699091

RESUMEN

BACKGROUND: The number of people living with chronic health conditions is increasing in Australia. The Chronic Disease Management program was introduced to Medicare Benefits Schedule (MBS) to provide a more structured approach to managing patients with chronic conditions and complex care needs. The program supports General Practitioners (GP)s claiming for up to one general practice management plan (GPMP) and one team care arrangement (TCA) every year and the patient claiming for up to five private allied health visits. We describe the profile of participants who claimed for GPMPs and/or TCAs in Central and Eastern Sydney (CES) and explore if GPMPs and/or TCAs are associated with fewer emergency hospitalisations (EH)s or potentially preventable hospitalisations (PPH)s over the following 5 years. METHODS: This research used the CES Primary and Community Health Cohort/Linkage Resource (CES-P&CH) based on the 45 and Up Study to identify a community-dwelling population in the CES region. There were 30,645 participants recruited within the CES area at baseline. The CES-P&CH includes 45 and Up Study questionnaire data linked to MBS data for the period 2006-2014. It also includes data from the Admitted Patient Data Collection, Emergency Department Data Collection and Deaths Registry linked by the NSW Centre for Health Record Linkage. RESULTS: Within a two-year health service utilisation baseline period 22% (5771) of CES participants had at least one claim for a GPMP and/or TCA. Having at least one claim for a GPMP and/or TCA was closely related to the socio-demographic and health needs of participants with higher EHs and PPHs in the 5 years that followed. However, after controlling for confounding factors such as socio-demographic need, health risk, health status and health care utilization no significant difference was found between having claimed for a GPMP and/or TCA during the two-year health service utilisation baseline period and EHs or PPHs in the subsequent 5 years. CONCLUSIONS: The use of GPMPs and/or TCAs in the CES area appears well-targeted towards those with chronic and complex care needs. There was no evidence to suggest that the use of GPMPs and /or TCAs has prevented hospitalisations in the CES region.


Asunto(s)
Enfermedad Crónica/terapia , Medicina General/organización & administración , Hospitalización/estadística & datos numéricos , Grupo de Atención al Paciente/organización & administración , Anciano , Anciano de 80 o más Años , Australia , Estudios de Cohortes , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Investigación sobre Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/organización & administración
4.
BMJ ; 367: l5205, 2019 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-31578187

RESUMEN

OBJECTIVES: To determine how clinicians vary in their response to new guidance on existing or new interventions, by measuring the timing and magnitude of change at healthcare institutions. DESIGN: Automated change detection in longitudinal prescribing data. SETTING: Prescribing data in English primary care. PARTICIPANTS: English general practices. MAIN OUTCOME MEASURES: In each practice the following were measured: the timing of the largest changes, steepness of the change slope (change in proportion per month), and magnitude of the change for two example time series (expiry of the Cerazette patent in 2012, leading to cheaper generic desogestrel alternatives becoming available; and a change in antibiotic prescribing guidelines after 2014, favouring nitrofurantoin over trimethoprim for uncomplicated urinary tract infection (UTI)). RESULTS: Substantial heterogeneity was found between institutions in both timing and steepness of change. The range of time delay before a change was implemented was large (interquartile range 2-14 months (median 8) for Cerazette, and 5-29 months (18) for UTI). Substantial heterogeneity was also seen in slope following a detected change (interquartile range 2-28% absolute reduction per month (median 9%) for Cerazette, and 1-8% (2%) for UTI). When changes were implemented, the magnitude of change showed substantially less heterogeneity (interquartile range 44-85% (median 66%) for Cerazette and 28-47% (38%) for UTI). CONCLUSIONS: Substantial variation was observed in the speed with which individual NHS general practices responded to warranted changes in clinical practice. Changes in prescribing behaviour were detected automatically and robustly. Detection of structural breaks using indicator saturation methods opens up new opportunities to improve patient care through audit and feedback by moving away from cross sectional analyses, and automatically identifying institutions that respond rapidly, or slowly, to warranted changes in clinical practice.


Asunto(s)
Prescripciones de Medicamentos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Medicina Estatal/estadística & datos numéricos , Antiinfecciosos/uso terapéutico , Conjuntos de Datos como Asunto , Sustitución de Medicamentos/estadística & datos numéricos , Medicamentos Genéricos/uso terapéutico , Inglaterra , Medicina General/organización & administración , Medicina General/normas , Medicina General/estadística & datos numéricos , Humanos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Medicina Estatal/normas , Factores de Tiempo , Infecciones Urinarias/tratamiento farmacológico
5.
Aust N Z J Public Health ; 43(6): 563-569, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31535420

RESUMEN

OBJECTIVE: To identify behavioural barriers of service provision within general practice that may be impacting the vaccination coverage rates of Aboriginal children in Perth, Western Australia (WA). METHODS: A purposive developed survey was distributed to 316 general practices across Perth and three key informant interviews were conducted using a mixed-methods approach. RESULTS: Of the surveyed participants (n=101), 67.4% were unaware of the low vaccination coverage in Aboriginal children; 64.8% had not received cultural sensitivity training in their workplace and 46.8% reported having inadequate time to follow up overdue child vaccinations. Opportunistic vaccination was not routinely performed by 30.8% of participants. Key themes identified in the interviews were awareness, inclusion and cultural safety. CONCLUSION: Inadequate awareness of the current rates, in association with a lack of cultural safety training, follow-up and opportunistic practice, may be preventing greater vaccination uptake in Aboriginal children in Perth. Cultural safety is a critical component of the acceptability and accessibility of services; lack of awareness may restrict the development of strategies designed to equitably address low coverage. IMPLICATIONS: The findings of this study provide an opportunity to raise awareness among clinicians in general practice and inform future strategies to equitably deliver targeted vaccination services to Aboriginal children.


Asunto(s)
Competencia Cultural , Prestación de Atención de Salud/métodos , Enfermeras de Familia/psicología , Medicina General/organización & administración , Servicios de Salud del Indígena/organización & administración , Médicos/psicología , Cobertura de Vacunación/estadística & datos numéricos , Adulto , Niño , Salud del Niño , Brotes de Enfermedades/prevención & control , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Grupo de Ascendencia Oceánica , Vacunación , Cobertura de Vacunación/tendencias , Vacunas/administración & dosificación , Australia Occidental
6.
BMC Health Serv Res ; 19(1): 648, 2019 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-31492139

RESUMEN

BACKGROUND: Commissioning innovative health technologies is typically complex and multi-faceted. Drawing on the negotiated order perspective, we explore the process by which commissioning organisations make their decisions to commission innovative health technologies. The empirical backdrop to this discussion is provided by a case study exploring the commissioning considerations for a new photoplethysmography-based diagnostic technology for peripheral arterial disease in primary care in the UK. METHODS: The research involved an empirical case study of four Clinical Commissioning Groups (CCGs) involved in the commissioning of services in primary and secondary care. Semi-structured in-depth interviews (16 in total) and two focus groups (a total of eight people participated, four in each group) were conducted with key individuals involved in commissioning services in the NHS including (i) senior NHS clinical leaders and directors (ii) commissioners and health care managers across CCGs and (iii) local general practitioners. RESULTS: Commissioning of a new diagnostic technology for peripheral arterial disease in primary care involves high levels of protracted negotiations over funding between providers and commissioners, alliance building, conflict resolution and compromise of objectives where the outcomes of change are highly contingent upon interventions made across different care settings. Our evidence illustrates how reconfigurations of inter-organisational relations, and of clinical and related work practices required for the successful implementation of a new technology could become the major challenge in commissioning negotiations. CONCLUSIONS: Innovative health technologies such as the diagnostic technology for peripheral arterial disease are commissioned in care pathways where the value of such technology is realised by those delivering care to patients. The detail of how care pathways are commissioned is complex and involves high degrees of uncertainty concerning such issues as prioritisation decisions, patient benefits, clinical buy-in, value for money and unintended consequences. Recent developments in the new care models and integrated care systems (ICSs) in the UK offer a unique opportunity for the successful commissioning arrangements of innovative health technologies in primary care such as the new diagnostic technology for peripheral arterial disease.


Asunto(s)
Tecnología Biomédica/estadística & datos numéricos , Medicina General/estadística & datos numéricos , Invenciones , Tecnología Biomédica/organización & administración , Difusión de Innovaciones , Grupos Focales , Medicina General/organización & administración , Médicos Generales/organización & administración , Médicos Generales/estadística & datos numéricos , Administración de los Servicios de Salud , Humanos , Negociación , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/estadística & datos numéricos , Medicina Estatal
7.
Int J Health Care Qual Assur ; 32(7): 1055-1071, 2019 Aug 12.
Artículo en Inglés | MEDLINE | ID: mdl-31411094

RESUMEN

PURPOSE: The purposes of this paper are two-fold: first, to introduce a new concept of primary care consultation system at a mainland Chinese hospital in response to healthcare reform; and second, to explore the factors associated with change resistance and acceptance from both patients' and medical staff's perspectives. DESIGN/METHODOLOGY/APPROACH: A survey design study, with two questionnaires developed and distributed to patients and medical staff. Convenience and stratified random sampling methods were applied to patient and medical staff samples. FINDINGS: A 5-dimension, 21-item patient questionnaire and a 4-dimension, 16-item staff questionnaire were identified and confirmed, with 1020 patients (91.07 percent) and 202 staff (90.18 percent) as effective survey participants. The results revealed that patient resistance mainly stems from a lack of personal experiences with visiting general practice (GP) and being educated or having lived overseas; while staff resistance came from occupation, education, GP training certificate, and knowledge and experience with specialists. Living in overseas and knowledge of GP concepts, gender and education are associated with resistance of accepting the new practice model for both patients and staff. ORIGINALITY/VALUE: There are few Chinese studies on process reengineering in the medical sector; this is the first study to adopt this medical consultation model and change in patients' consultation culture in Mainland China. Applying organizational change and process reengineering theories to medical and healthcare services not only extends and expands hospital management theory but also allows investigation of modern hospital management practice. The experience from this study can serve as a reference to promote this new consultation model in Chinese healthcare reform.


Asunto(s)
Medicina General/organización & administración , Innovación Organizacional , Pacientes/psicología , Personal de Hospital/psicología , Adolescente , Adulto , Anciano , China , Eficiencia Organizacional , Femenino , Reforma de la Atención de Salud/organización & administración , Humanos , Masculino , Persona de Mediana Edad , Estudios de Casos Organizacionales , Atención Primaria de Salud/organización & administración , Opinión Pública , Especialización , Confianza , Adulto Joven
8.
BMC Health Serv Res ; 19(1): 567, 2019 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-31412854

RESUMEN

BACKGROUND: Australian Aboriginal and Torres Strait Islander (Indigenous) peoples face major health disadvantage across many conditions. Recording of patients' Indigenous status in general practice records supports equitable delivery of effective clinical services. National policy and accreditation standards mandate recording of Indigenous status in patient records, however for a large proportion of general practice patient records it remains incomplete. We assessed the completeness of Indigenous status in general practice patient records, and compared the patient self-reported Indigenous status to general practice medical records. METHODS: A cross sectional analysis of Indigenous status recorded at 95 Australian general practices, participating in the Australian Chlamydia Control Effectiveness Pilot (ACCEPt) in 2011. Demographic data were collected from medical records and patient surveys from 16 to 29 year old patients at general practices, and population composition from the 2011 Australian census. General practitioners (GPs) at the same practices were also surveyed. Completeness of Indigenous status in general practice patient records was measured with a 75% benchmark used in accreditation standards. Indigenous population composition from a patient self-reported survey was compared to Indigenous population composition in general practice records, and Australian census data. RESULTS: Indigenous status was complete in 56% (median 60%, IQR 7-81%) of general practice records for 109,970 patients aged 16-29 years, and Indigenous status was complete for 92.5% of the 3355 patients aged 16-29 years who completed the survey at the same clinics. The median proportion per clinic of patients identified as Indigenous was 0.9%, lower than the 1.8% from the patient surveys and the 1.7% in clinic postcodes (ABS). Correlations between the proportion of Indigenous people self-reporting in the patient survey (5.2%) compared to status recorded in all patient records (2.1%) showed a fair association (r = 0.6468; p < 0.01). After excluding unknown /missing data, correlations weakened. CONCLUSIONS: Incomplete Indigenous status records may under-estimate the true proportion of Indigenous people attending clinics but have higher association with self-reported status than estimates which exclude missing/unknown data. The reasons for incomplete Indigenous status recording in general practice should be explored so efforts to improve recording can be targeted and strengthened. TRIAL REGISTRATION: ACTRN12610000297022 . Registered 13th April 2010.


Asunto(s)
Medicina General/organización & administración , Grupo de Ascendencia Oceánica/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Adulto , Australia/epidemiología , Estudios Transversales , Femenino , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Masculino , Registro Médico Coordinado , Registros Médicos , Adulto Joven
9.
Nurs Manag (Harrow) ; 26(3): 27-35, 2019 May 28.
Artículo en Inglés | MEDLINE | ID: mdl-31468839

RESUMEN

Digital healthcare provision in England has been driven mainly by a 'top-down' approach and a focus on digital infrastructure rather than front-line delivery. This has laid the foundation, but digital care delivery still has a long way to go. This article describes an action learning programme to create digitally ready nurses. The programme, which underpins action six of NHS England's ten-point plan for general practice nursing, shows that a 'ground-up' approach to upskill and empower front-line clinicians is central to embedding technology-enabled care services (TECS). Following completion of the action learning sets (ALSs), 24 general practice nursing digital champions across Staffordshire have used TECS to deliver a range of benefits for their practice teams. This has informed the introduction and extension of the programme, with national funding for a further 12 regional pilot ALSs across England in 2018-19. Importantly, the active learning individualised approach provides a digitally ready workforce with the ability and support to adopt TECS in areas of clinical need. This ability is central to the next stage in the digital transformation of healthcare.


Asunto(s)
Medicina General/organización & administración , Personal de Enfermería/educación , Telemedicina/organización & administración , Inglaterra , Humanos , Investigación en Educación de Enfermería , Investigación en Evaluación de Enfermería , Personal de Enfermería/psicología , Aprendizaje Basado en Problemas , Medicina Estatal
10.
Br J Gen Pract ; 69(685): e526-e536, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31307999

RESUMEN

BACKGROUND: Anecdotal reports of people who are homeless being denied access and facing negative experiences of primary health care have often emerged. However, there is a dearth of research exploring this population's views and experiences of such services. AIM: To explore the perspectives of individuals who are homeless on the provision and accessibility of primary healthcare services. DESIGN AND SETTING: A qualitative study with individuals who are homeless recruited from three homeless shelters and a specialist primary healthcare centre for the homeless in the West Midlands, England. METHOD: Semi-structured interviews were audiorecorded, transcribed verbatim, and analysed using a thematic framework approach. The Theoretical Domains Framework (TDF) was used to map the identified barriers in framework analysis. RESULTS: A total of 22 people who were homeless were recruited. Although some participants described facing no barriers, accounts of being denied registration at general practices and being discharged from hospital onto the streets with no access or referral to primary care providers were described. Services offering support to those with substance misuse issues and mental health problems were deemed to be excluding those with the greatest need. A participant described committing crimes with the intention of going to prison to access health care. High satisfaction was expressed by participants about their experiences at the specialist primary healthcare centre for people who are homeless (SPHCPH). CONCLUSION: Participants perceived inequality in access, and mostly faced negative experiences, in their use of mainstream services. Changes are imperative to facilitate access to primary health care, improve patient experiences of mainstream services, and to share best practices identified by participants at the SPHCPH.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Medicina General/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Disparidades en Atención de Salud , Personas sin Hogar , Adulto , Anciano , Inglaterra/epidemiología , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Personas sin Hogar/psicología , Personas sin Hogar/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa
11.
Educ Prim Care ; 30(5): 295-300, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31315543

RESUMEN

The World Health Organisation reported that health-care systems worldwide have problems with the recruitment and retention of general practitioners (GPs) into clinical practice, particularly to rural and under-served areas. A recent survey of United Kingdom (UK) trainees found that they valued posts with good training conditions, were in desirable locations and gave opportunities for their partner. The Scottish Government has set a target to increase the number of GPs in Scotland by 800 in the next 10 years. In recent years, GP speciality training recruitment has been challenging with significant vacancies in some training programmes, primarily in rural areas, or urban areas with a history of poorer recruitment. Recruitment incentive schemes are in operation in different countries in the UK. The Scottish Government introduced a Targeted Enhanced Recruitment Scheme (TERS), offering a £20,000 payment to GPST trainees accepting a targeted post. This study aimed to evaluate awareness and influence of the TERS initiative on programme choice in Scotland in August 2017. A survey was developed and sent to GP trainees taking up a GPST post in August 2017. Ninety-five out of 245 doctors responded (response rate of 39%). Almost two-thirds (65.3%) were aware of TERS at the time of application and this was via word of mouth and from the National Recruitment Office website. Only 21% of GPSTs aware of TERS were influenced by it in their choice of training location. The locations of family, spouse or partner, and of pre-existing geographical preferences were more influential than TERS.


Asunto(s)
Selección de Profesión , Medicina General/organización & administración , Selección de Personal/métodos , Médicos Generales , Humanos , Ubicación de la Práctica Profesional , Escocia , Encuestas y Cuestionarios
12.
Eur J Gen Pract ; 25(3): 149-156, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31339386

RESUMEN

Background: A well-staffed and an efficient primary healthcare sector is beneficial for a healthcare system but some countries experience problems in recruitment to general practice. Objectives: This study explored factors influencing Danish junior doctors' choice of general practice as their specialty. Methods: This study is based on an online questionnaire collecting quantitative and qualitative data. Two focus-group interviews were conducted to inform the construction of the questionnaire to ensure high content validity. All Danish junior doctors participating in general practice specialist training in 2015 were invited to participate in the survey, from which both qualitative and quantitative data were collected. The data was analysed using systematic text condensation and descriptive statistics. Results: Of 1099 invited, 670 (61%) junior doctors completed the questionnaire. Qualitative data: junior doctors found educational environments and a feasible work-life balance were important. They valued patient-centred healthcare, doctor-patient relationships based on continuity, and the possibility of organizing their work in smaller, manageable units. Quantitative data: 90.8% stated that the set-up of Danish specialist-training programme positively influenced their choice of general practice as their specialty. Junior doctors (80.4%) found that their university curriculum had too little emphasis on general practice, 64.5% agreed that early basic postgraduate training in general practice had a high impact on their choice of general practice as their specialty. Conclusion: Several factors that might positively affect the choice of general practice were identified. These factors may hold the potential to guide recruitment strategies for general practice.


Asunto(s)
Selección de Profesión , Medicina General/estadística & datos numéricos , Médicos Generales/estadística & datos numéricos , Especialización/estadística & datos numéricos , Adulto , Actitud del Personal de Salud , Curriculum , Dinamarca , Educación de Postgrado en Medicina/métodos , Femenino , Grupos Focales , Medicina General/organización & administración , Médicos Generales/psicología , Humanos , Masculino , Encuestas y Cuestionarios
14.
BMC Health Serv Res ; 19(1): 464, 2019 Jul 08.
Artículo en Inglés | MEDLINE | ID: mdl-31286960

RESUMEN

BACKGROUND: The healthcare systems in the western world have in recent years faced major challenges caused by demographic changes and altered patterns of diseases as well as political decisions influencing the organisation of healthcare provisions. General practitioners are encouraged to delegate more clinical tasks to their staff in order to respond to the changing circumstances. Nevertheless, the degree of task delegation varies substantially between general practices, and how these different degrees affect the quality of care for the patients is currently not known. Using chronic obstructive pulmonary disease (COPD) as our case scenario, the aim of the study was to investigate associations between degrees of task delegation in general practice and spirometry testing as a measure of quality of care. METHODS: We carried out a cross-sectional study comprising all general practices in Denmark and patients suffering from chronic obstructive pulmonary disease. General practitioners (GPs) were invited to participate in a survey investigating degrees of task delegation in their clinics. Data were linked to national registers on spirometry testing among patients with COPD. We investigated associations using multilevel mixed-effects logit models and adjusted for practice and patient characteristics. RESULTS: GPs from 895 practices with staff managing COPD-related tasks responded, and 61,223 COPD patients were linked to these practices. Hereof, 24,685 (40.3%) had a spirometry performed within a year. Patients had a statistically significant higher odds ratio (OR) of having an annual spirometry performed in practices with medium or maximal degrees of task delegation compared to practices with a minimal degree (OR = 1.27 and OR = 1.33, respectively). CONCLUSION: Delegating more complex tasks to practice staff implies that COPD-patients are more likely to be treated according to evidence-based recommendations on spirometry testing.


Asunto(s)
Medicina General/organización & administración , Médicos Generales/psicología , Adhesión a Directriz/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Espirometría/normas , Anciano , Estudios Transversales , Dinamarca , Femenino , Médicos Generales/estadística & datos numéricos , Investigación sobre Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
16.
Rev Epidemiol Sante Publique ; 67(4): 213-221, 2019 Jul.
Artículo en Francés | MEDLINE | ID: mdl-31196581

RESUMEN

BACKGROUND: Since 2008, in France, hospital funding is determined by the nature of activities provided (activity-based funding). Quality control of hospital activity coding is essential to optimize hospital remuneration. There is a need for reliable tools to allocate human resources wisely in order to improve these controls. METHODS: The main objective of this study was to identify the determinants of time needed by medical information technicians to control hospital activity coding in a Regional Hospital Center. From March 2016 to the beginning of January 2017, medical information technicians reported the time they spent on each quality control, and the time they needed when they had to code the entire stay. Multiple linear regressions were performed to identify the determinants of quality control or coding duration. A split sample validation was used: model was created on one half of the sample and validated on the remaining half. RESULTS: Among the controls, 5431 were included in the analysis of determinants of control duration (2715 kept aside for model validation). Seven determinants have been identified (stay duration, level of complexity, month of control, type of control, medical information technician, rank of classing information, and major diagnostic category). The correlation coefficient between predicted and real control duration was 0.71 (P<10-4); 808 stays were included in the analysis of determinants of coding duration (404 kept aside for model validation). Two determinants have been identified. The correlation coefficient, between predicted and real coding duration, was 0.47 (P<10-3). We performed the same multiple regression, on 2017 activity data, to estimate the weight of each hospital activity pole, regarding quality control of hospital activity coding. CONCLUSION: We succeeded in modeling time needed for quality control of hospital stays. These results helped to estimate human resources required for quality control of each hospital pole. Nevertheless, the second analysis did not give satisfactory results: we failed in modeling time needed to code hospital stays.


Asunto(s)
Codificación Clínica , Medicina General , Cirugía General , Tiempo de Internación , Informática Médica , Obstetricia , Control de Calidad , Estudios de Casos y Controles , Codificación Clínica/organización & administración , Codificación Clínica/normas , Grupos Diagnósticos Relacionados/organización & administración , Grupos Diagnósticos Relacionados/normas , Registros Electrónicos de Salud/organización & administración , Registros Electrónicos de Salud/normas , Honorarios Médicos , Femenino , Francia , Medicina General/organización & administración , Medicina General/normas , Cirugía General/organización & administración , Cirugía General/normas , Humanos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Informática Médica/métodos , Informática Médica/organización & administración , Informática Médica/normas , Obstetricia/organización & administración , Obstetricia/normas , Indicadores de Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud , Programas Médicos Regionales/organización & administración , Programas Médicos Regionales/normas , Factores de Tiempo , Carga de Trabajo
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