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3.
BMC Health Serv Res ; 19(1): 918, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31783852

RESUMO

BACKGROUND: The health and social care sector (HCS) is currently facing multiple challenges across Europe: against the background of ageing societies, more people are in need of care. Simultaneously, several countries report a lack of skilled personnel. Due to its structural characteristics, including a high share of part-time workers, an ageing workforce, and challenging working conditions, the HCS requires measures and strategies to deal with these challenges. METHODS: This qualitative study analyses if and how organisations in three countries (Germany, Finland, and the UK) report similar challenges and how they support longer working careers in the HCS. Therefore, we conducted multiple case studies in care organisations. Altogether 54 semi-structured interviews with employees and representatives of management were carried out and analysed thematically. RESULTS: Analysis of the interviews revealed that there are similar challenges reported across the countries. Multiple organisational measures and strategies to improve the work ability and working life participation of (ageing) workers were identified. We identified similar challenges across our cases but different strategies in responding to them. With respect to the organisational measures, our results showed that the studied organisations did not implement any age-specific management strategies but realised different reactive and proactive human relation measures aiming at maintaining and improving employees' work ability (i.e., health, competence and motivation) and longer working careers. CONCLUSIONS: Organisations within the HCS tend to focus on the recruitment of younger workers and/or migrant workers to address the current lack of skilled personnel. The idea of explicitly focusing on ageing workers and the concept of age management as a possible solution seems to lack awareness and/or popularity among organisations in the sector. The concept of age management offers a broad range of measures, which could be beneficial for both, employees and employers/organisations. Employees could benefit from a better occupational well-being and more meaningful careers, while employers could benefit from more committed employees with enhanced productivity, work ability and possibly a longer career.


Assuntos
Assistência à Saúde/organização & administração , Setor de Assistência à Saúde/organização & administração , Admissão e Escalonamento de Pessoal/tendências , Reorganização de Recursos Humanos/tendências , Aposentadoria/estatística & dados numéricos , Recursos Humanos/organização & administração , Finlândia , Alemanha , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Aposentadoria/tendências , Reino Unido , Recursos Humanos/tendências
4.
J Nurs Adm ; 49(9): 436-440, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31436742

RESUMO

OBJECTIVE: The purpose of this study was to describe current practices for onboarding travel nurses (TRNs) and identify TRNs' specific onboarding needs. BACKGROUND: Onboarding must be streamlined and organized for TRNs to provide safe patient care. METHODS: Cross-sectional descriptive survey was used with 306 TRNs throughout United States who were recruited electronically from a closed social media group page. RESULTS: The TRNs identified critical information, including unit patient ratios, onboarding schedule 7 to 14 days before travel assignment start, and login IDs/accesses on day 1. Travel nurse onboarding and competency assessment checklists should be specific to the unit/facility where they will work. CONCLUSION: Findings from this study have the potential to support hospitals in the development of streamlined and tailored TRN onboarding to support regulatory compliance and patient safety as well as realize significant cost savings for TRN onboarding.


Assuntos
Capacitação em Serviço/organização & administração , Recursos Humanos de Enfermagem no Hospital/normas , Segurança do Paciente/normas , Seleção de Pessoal/normas , Admissão e Escalonamento de Pessoal/normas , Enfermagem de Viagem/estatística & dados numéricos , Enfermagem de Viagem/normas , Adulto , Estudos Transversais , Feminino , Previsões , Humanos , Capacitação em Serviço/tendências , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/tendências , Segurança do Paciente/estatística & dados numéricos , Seleção de Pessoal/tendências , Admissão e Escalonamento de Pessoal/tendências , Enfermagem de Viagem/tendências , Estados Unidos
5.
Res Nurs Health ; 42(5): 410-415, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31429481

RESUMO

The purpose of this study was to examine national trends and variation in nurse staffing on inpatient psychiatric units in US general hospitals from 2005-2017. The National Database of Nursing Quality Indicators® provided data on nurse staffing from 1,143 psychiatric units in 610 US hospitals. A weighted linear mixed model was fitted for each of two staffing measures: Registered nurse (RN) hours per patient day (HPPD) and non-RN HPPD. Monthly staffing levels were modeled as a function of study year, unit type, and hospital bed size, teaching status, government ownership, for-profit status, metropolitan location, and US census division. Very gradual upward trends in staffing were observed. Compared with adult units, child/adolescent units had lower RN staffing and higher non-RN staffing. Levels of both types of staffing were lower in for-profit facilities. The Pacific census division had higher RN staffing than every other census division by an estimated margin of 0.52-1.54 HPPD, and census divisions with the lowest levels of RN staffing had the highest levels of non-RN staffing. Despite concerns expressed over the past 15 years about patient violence, staffing levels, and use of seclusion and restraint on psychiatric units, average staffing levels have apparently increased only modestly since 2005, and increases in RN staffing on psychiatric units have not kept pace with increases in general care units. Marked regional differences in staffing merit further investigation.


Assuntos
Hospitais Psiquiátricos/estatística & dados numéricos , Hospitais Psiquiátricos/tendências , Recursos Humanos de Enfermagem no Hospital/provisão & distribução , Recursos Humanos de Enfermagem no Hospital/tendências , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/tendências , Adulto , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Estados Unidos
6.
PLoS Med ; 16(7): e1002860, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31335869

RESUMO

BACKGROUND: The Indian government supports both public- and private-sector provision of hospital care for neonates: neonatal intensive care is offered in public facilities alongside a rising number of private-for-profit providers. However, there are few published reports about mortality levels and care practices in these facilities. We aimed to assess care practices, causes of admission, and outcomes from neonatal intensive care units (NICUs) in public secondary and private tertiary hospitals and both public and private medical colleges enrolled in a quality improvement collaborative in Telangana and Andhra Pradesh-2 Indian states with a respective population of 35 and 50 million. METHODS AND FINDINGS: We conducted a cross-sectional study between 30 May and 26 August 2016 as part of a baseline evaluation in 52 consenting hospitals (26 public secondary hospitals, 5 public medical colleges, 15 private tertiary hospitals, and 6 private medical colleges) offering neonatal intensive care. We assessed the availability of staff and services, adherence to evidence-based practices at admission, and case fatality after admission to the NICU using a range of tools, including facility assessment, observations of admission, and abstraction of registers and telephone interviews after discharge. Our analysis is adjusted for clustering and weighted for caseload at the hospital level and presents findings stratified by type and ownership of hospitals. In total, the NICUs included just over 3,000 admissions per month. Staffing and infrastructure provision were largely according to government guidelines, except that only a mean of 1 but not the recommended 4 paediatricians were working in public secondary NICUs per 10 beds. On admission, all neonates admitted to private hospitals had auscultation (100%, 19 of 19 observations) but only 42% (95% confidence interval [CI] 25%-62%, p-value for difference is 0.361) in public secondary hospitals. The most common single cause of admission was preterm birth (25%) followed by jaundice (23%). Case-fatality rates at age 28 days after admission to a NICU were 4% (95% CI 2%-8%), 15% (9%-24%), 4% (2%-8%) and 2% (1%-5%) (Chi-squared p = 0.001) in public secondary hospitals, public medical colleges, private tertiary hospitals, and private medical colleges, respectively, according to facility registers. Case fatality according to postdischarge telephone interviews found rates of 12% (95% CI 7%-18%) for public secondary hospitals. Roughly 6% of admitted neonates were referred to another facility. Outcome data were missing for 27% and 8% of admissions to private tertiary hospitals and private medical colleges. Our study faced the limitation of missing data due to incomplete documentation. Further generalizability was limited due to the small sample size among private facilities. CONCLUSIONS: Our findings suggest differences in quality of neonatal intensive care and 28-day survival between the different types of hospitals, although comparison of outcomes is complicated by differences in the case mix and referral practices between hospitals. Uniform reporting of outcomes and risk factors across the private and public sectors is required to assess the benefits for the population of mixed-care provision.


Assuntos
Prestação Integrada de Cuidados de Saúde/tendências , Mortalidade Hospitalar/tendências , Hospitais Privados/tendências , Hospitais Públicos/tendências , Mortalidade Infantil/tendências , Unidades de Terapia Intensiva Neonatal/tendências , Terapia Intensiva Neonatal/tendências , Indicadores de Qualidade em Assistência à Saúde/tendências , Estudos Transversais , Fidelidade a Diretrizes/tendências , Disparidades em Assistência à Saúde/tendências , Humanos , Índia , Lactente , Admissão do Paciente/tendências , Admissão e Escalonamento de Pessoal/tendências , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
7.
J Nurs Manag ; 27(5): 896-917, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30801808

RESUMO

AIMS: To evaluate and summarize current evidence on the relationship between the patient-nurse ratio staffing method and nurse employee outcomes. BACKGROUND: Evidence-based decision-making linking nurse staffing with staff-related outcomes is a much needed research area. Although multiple studies have investigated this phenomenon, the evidence is mixed and fragmented. EVALUATION: A systematic literature search was conducted using PubMed, Embase, Web of Science, Cinahl, Cochrane Library and the ERIC databases. Thirty studies were identified, analysing eight selected key nurse outcomes. KEY ISSUE(S): Future research should focus on unit-level data, incorporate other methodologies and aim for comparability between different types of clinical settings as well as different health care systems. CONCLUSION: A relationship between the patient-nurse ratio and specific staff-related outcomes is confirmed by various studies. However, apart from the patient-nurse ratio other variables have to be taken into consideration to ensure quality of care (e.g., skill mix, the work environment and patient acuity). IMPLICATIONS FOR NURSING MANAGEMENT: Hospital management should pursue the access and use of reliable data so that the validity and generalizability of evidence-based research can be assessed, which in turn can be converted into policy guidelines.


Assuntos
Recursos Humanos de Enfermagem no Hospital/provisão & distribução , Avaliação de Resultados em Cuidados de Saúde/normas , Admissão e Escalonamento de Pessoal/normas , Hospitais/normas , Hospitais/tendências , Humanos , Relações Enfermeiro-Paciente , Recursos Humanos de Enfermagem no Hospital/psicologia , Recursos Humanos de Enfermagem no Hospital/tendências , Avaliação de Resultados em Cuidados de Saúde/métodos , Admissão e Escalonamento de Pessoal/tendências , Indicadores de Qualidade em Assistência à Saúde , Carga de Trabalho/psicologia , Carga de Trabalho/normas , Local de Trabalho/psicologia , Local de Trabalho/normas
8.
Isr J Health Policy Res ; 8(1): 26, 2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30786931

RESUMO

BACKGROUND: Shared-housing arrangements (SHAs) in Germany are an alternative care arrangement for people with dementia. They are disconnected from traditional nursing homes and are often situated in ordinary apartment buildings. Community health care providers serve persons with dementia in SHAs, and there is no official regulation regarding the staff-resident ratio. The association between the staff-resident ratio and the quality of life (QoL) of persons with dementia has not yet been investigated in SHAs. METHOD: A cross-sectional study was performed in SHAs in Berlin, Germany, using ANCOVA models to analyse whether residents' QoL (QUALIDEM), as assessed by staff in SHAs, can be explained by the staff-resident ratio, adjusted for residents' sex, age, length of stay, challenging behaviour (CMAI), cognitive impairment (GDS) and level of care dependency according to the German statutory health care insurance. RESULTS: In this study, 58 SHAs with 396 residents (mean age 78.4 years, 69.4% female) participated. The staff-resident ratio was 0.2 and 0.6 for registered nurses and certified nursing assistants, respectively. Associations with QoL were found predominantly for challenging behaviour and cognitive impairment. The analysis showed that there was no significant effect of the total staff-resident ratio (p > 0.05) in explaining the variation in residents' QoL (total and subdomains). In general, the proportion of explained variance was weak (R2 <  0.216). CONCLUSIONS: The present study did not show a significant association between staffing and residents' QoL in SHAs. However, further investigation is required regarding the direct interaction between staff and residents. A main focus should be to educate users about the benefits and disadvantages of shared-housing arrangements.


Assuntos
Admissão e Escalonamento de Pessoal/normas , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Estudos Transversais , Demência/terapia , Feminino , Alemanha , Habitação , Humanos , Masculino , Pessoa de Meia-Idade , Casas de Saúde/organização & administração , Casas de Saúde/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/tendências , Local de Trabalho/psicologia , Local de Trabalho/normas
10.
Congenit Heart Dis ; 14(3): 419-426, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30604918

RESUMO

BACKGROUND: The Pediatric Acute Care Cardiology Collaborative (PAC3 ) was established in 2014 to improve the quality, value, and experience of hospital-based cardiac acute care outside of the intensive care unit. An initial PAC3 project was a comprehensive survey to understand unit structure, practices, and resource utilization across the collaborative. This report aims to describe the previously unknown degree of practice variation across member institutions. METHODS: A 126-stem question survey was developed with a total of 412 possible response fields across nine domains including demographics, staffing, available resources and therapies, and standard care practices. Five supplemental questions addressed surgical case volume and number of cardiac acute care unit (CACU) admissions. Responses were recorded and stored in Research Electronic Data Capture (REDCap). RESULTS: Surveys were completed by 31 out of 34 centers (91%) with minimal incomplete fields. A majority (61%) of centers have a single dedicated CACU, which is contiguous or adjacent to the intensive care unit in 48%. A nurse staffing ratio of 3:1 is most common (71%) and most (84%) centers employed a resource nurse. Centralized wireless rhythm monitoring is used in 84% of centers with 54% staffed continuously. There was significant variation in the use of noninvasive respiratory support, vasoactive infusions, and ventricular assist devices across the collaborative. Approximately half of the surveyed centers had lesion-specific postoperative pathways and approximately two-thirds had protocols for single-ventricle patients. CONCLUSIONS: The PAC3 hospital survey is the most comprehensive description of systems and care practices unique to CACUs to date. There exists considerable heterogeneity among unit composition and variation in care practices. These variations may allow for identification of best practices and improved quality of care for patients.


Assuntos
Serviço Hospitalar de Cardiologia/tendências , Cardiologia/tendências , Disparidades em Assistência à Saúde/tendências , Pediatria/tendências , Padrões de Prática Médica/tendências , Melhoria de Qualidade/tendências , Indicadores de Qualidade em Assistência à Saúde/tendências , Cardiologistas/tendências , Fármacos Cardiovasculares/uso terapêutico , Pesquisas sobre Serviços de Saúde , Coração Auxiliar/tendências , Humanos , Ventilação não Invasiva/tendências , Recursos Humanos de Enfermagem no Hospital/tendências , Pediatras/tendências , Admissão e Escalonamento de Pessoal/tendências , Estados Unidos , Tecnologia sem Fio/tendências
12.
J Nurs Manag ; 27(3): 502-508, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30461112

RESUMO

AIM: To evaluate whether ≥12-hr shifts are associated with a decrease in resource use, in terms of care hours per patient day and staffing costs per patient day. BACKGROUND: Nurses working long shifts may become less productive and no research has investigated whether potential cost savings are realized. METHOD: A retrospective longitudinal study using routinely collected data from 32 wards within an English hospital across 3 years (1 April 2012-31 March 2015). There were 24,005 ward-days. Hierarchical linear mixed models measured the association between the proportion of ≥12-hr shifts worked on a ward-day, care hours per patient day and staffing costs per patient day. RESULTS: Compared with days with no ≥12-hr shifts, days with between 50% and 75% ≥12-hr shifts had more care hours per patient day and higher costs (estimate for care hours per patient day: 0.32; 95% CI: 0.28-0.36; estimate for staffing costs per patient day: £8.86; 95% CI: 7.59-10.12). CONCLUSIONS: We did not find reductions in total care hours and costs associated with the use of ≥12-hr shifts. The reason why mixed shift patterns are associated with increased cost needs further exploration. IMPLICATIONS FOR NURSING MANAGEMENT: Increases in resource use could result in additional costs or loss of productivity for hospitals. Implementation of long shifts should be questioned.


Assuntos
Enfermeiras e Enfermeiros/psicologia , Alocação de Recursos/métodos , Jornada de Trabalho em Turnos/efeitos adversos , Transtornos do Sono do Ritmo Circadiano/psicologia , Inglaterra , Humanos , Estudos Longitudinais , Enfermeiras e Enfermeiros/estatística & dados numéricos , Enfermeiras e Enfermeiros/provisão & distribução , Admissão e Escalonamento de Pessoal/normas , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/tendências , Alocação de Recursos/normas , Alocação de Recursos/estatística & dados numéricos , Estudos Retrospectivos , Jornada de Trabalho em Turnos/psicologia , Jornada de Trabalho em Turnos/estatística & dados numéricos , Transtornos do Sono do Ritmo Circadiano/etiologia
13.
Int Nurs Rev ; 66(2): 157-164, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30132851

RESUMO

BACKGROUND: The 2008 financial crisis exacerbated an already mounting workforce challenge faced by most health services in the western world, namely the recruitment and retention of qualified nurses. AIM: This paper examines two additional challenges of relevance to workforce planning in health care, an ageing nursing workforce and reliance upon migrant nurses to solve short-term workforce issues. METHODS: Using Ireland as a case exemplar of these issues, this paper argues that policy makers and service providers should seek not only to address the challenge of retaining trained newly qualified and younger nurses but also focus on supporting older nurses and migrant nurses to remain within the workforce. FINDINGS: The findings of this paper highlight the need for workforce planners, policy makers and service providers to take account of an ageing nursing workforce and reliance on foreign-trained nurses as a solution to short-term planning difficulties. CONCLUSION: Failure to address this need is likely to lead to significant workforce difficulties for health services into the future and undermine current efforts to increase the number and long-term retention of qualified nursing staff. IMPLICATIONS FOR NURSING POLICY: Policy makers and service providers should focus on the retention of trained older nurses as an important element of workforce planning.


Assuntos
Enfermeiras e Enfermeiros/provisão & distribução , Admissão e Escalonamento de Pessoal/tendências , Reorganização de Recursos Humanos/tendências , Aposentadoria/tendências , Recursos Humanos/tendências , Adulto , Idoso , Saúde Global , Humanos , Irlanda
14.
Nurs Forum ; 54(2): 227-231, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30566243

RESUMO

AIM: This commentary advocates a research agenda for studying how alternative work arrangements (AWAs) affect nurse management and leadership. BACKGROUND: AWAs mitigate burnout and the distributional imbalance of nurses. However, scholarship has shed limited light on how AWAs shape nurses' workplace communication and relationships. EVALUATION: Peer-reviewed nursing and management scholarship. KEY ISSUE: As healthcare systems in many countries move toward team-based care, communication becomes even more important for effective coordination and collaboration among healthcare team members. CONCLUSION: Researchers should invest greater resources to understand the influence that AWAs have on different organizational settings as well as on the relational coordination among nurses and their managers. IMPLICATIONS FOR NURSING MANAGEMENT: Because care delivery and workplace relations depend heavily upon effective collaboration, researchers must update scholarship on AWAs to inform nurses and their managers on how they may strategically and effectively adapt their communication to evolving work environments that undergo frequent changes in nursing staff and teams.


Assuntos
Relações Interprofissionais , Liderança , Recursos Humanos de Enfermagem no Hospital/organização & administração , Admissão e Escalonamento de Pessoal/tendências , Esgotamento Profissional/prevenção & controle , Humanos , Enfermeiras Administradoras/organização & administração , Pesquisa em Enfermagem , Reorganização de Recursos Humanos
16.
J Nurs Manag ; 26(7): 858-865, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30171648

RESUMO

AIM: To examine the effect of nurse staffing patterns (nursing staff skill mix and patient classification system) on patient satisfaction with the nursing care received. BACKGROUND: Evidence about the relationship between the nursing staff structures and patient outcomes in post-transitional countries is limited. METHODS: The research was conducted in three units of one secondary-care regional hospital in Slovenia over 1 month. This cross-sectional study used three main data elements exploring nursing staff levels (nursing hours per patient day and skill mix), patient needs (using a classification system), and patients' satisfaction with nursing care; 484 patients participated. RESULTS: Significant positive correlations were found between the patients' satisfaction and the realized percentage of the registered nurse personnel requirements, the level of nursing care hours per patient day, and the proportion of registered nurses in the nursing team. CONCLUSIONS: A significant association between the actual and needed staffing levels and patient satisfaction was found. Nurse staffing patterns affect patient outcomes. IMPLICATIONS FOR NURSING MANAGEMENT: This paper supports a higher proportion of registered nurses and an increased number of overall nursing staff working hours. Managers should consider the results of the patient needs categorization system and the workforce structure characteristics as predictors of patient satisfaction.


Assuntos
Satisfação do Paciente , Pacientes/psicologia , Admissão e Escalonamento de Pessoal/normas , Qualidade da Assistência à Saúde/normas , Estudos Transversais , Humanos , Admissão e Escalonamento de Pessoal/tendências , Eslovênia , Inquéritos e Questionários
18.
J Perianesth Nurs ; 33(4): 518-526, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30077296

RESUMO

Recruitment and retention of nurses into the perianesthesia environment remains an ongoing challenge in the face of a national nursing shortage. An insufficient supply of experienced critical care nurses exists to fulfill the staffing needs of perianesthesia departments. Literature describes the impact of successful orientation programs on retention and employee engagement. To compensate for the diminished candidate pool and to improve retention, a nurse residency program was created. The program develops non-critical care experienced nurses into postanesthesia care unit-specific critical care nurses over the course of 1 year. Eight months after implementation, the vacancy rate decreased to 0%. This article details the development and implementation of a perianesthesia nurse residency program.


Assuntos
Internato e Residência , Enfermagem Perioperatória , Admissão e Escalonamento de Pessoal/tendências , Previsões , Humanos , Recursos Humanos de Enfermagem no Hospital
19.
J Aging Soc Policy ; 30(5): 478-494, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30067464

RESUMO

This study investigates how flexibility in working hours affects retirement timing. It tests the assumption that decreasing weekly working hours delays retirement and extends working life. Using data from four waves of the Survey of Health, Ageing and Retirement in Europe (SHARE) and of the English Longitudinal Study of Ageing (ELSA), we analyze whether a shift from full-time to part-time work delays retirement. Results show that older workers who reduce their working hours retire earlier than those who stay in full-time employment. The effect is stronger in Central and Eastern Europe than in Scandinavian countries. No interaction effects for gender and work strain are found. We conclude that part-time work at the end of the career, as a means to extend working life, should be reevaluated.


Assuntos
Emprego/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/tendências , Aposentadoria/estatística & dados numéricos , Idoso , Europa (Continente) , Feminino , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
20.
Med Care ; 56(10): 818-821, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30036237

RESUMO

OBJECTIVES: Triage algorithms are ubiquitous in emergency care settings, but the extent of their use in primary care is unknown. This study asks whether primary care practices prioritize patients with more acute service needs. METHODS: We used an audit study in which simulated patients were randomized to 2 clinical scenarios-a new patient seeking a routine check-up or a new patient seeking treatment for newly diagnosed hypertension-and attempted to schedule appointments with thousands of randomly selected primary care physicians across 10 states. We estimated the difference in appointment availability by clinical scenario. For scheduled appointments, we also estimated the difference in wait times by clinical scenario. RESULTS: While there was no difference in appointment availability, the mean wait time for simulated patients seeking a routine check-up was nearly 5 days longer than the mean wait time for simulated patients with hypertension. CONCLUSIONS: As demand for primary care increases while the supply remains stable, it will be important for practices to identify and prioritize patients with more acute service needs. Our results show that primary care physicians are already adopting such practices.


Assuntos
Gravidade do Paciente , Admissão e Escalonamento de Pessoal/tendências , Atenção Primária à Saúde/métodos , Agendamento de Consultas , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Simulação de Paciente , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Complexo Repressor Polycomb 2 , Atenção Primária à Saúde/estatística & dados numéricos
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