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1.
Health Res Policy Syst ; 22(1): 76, 2024 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-38965544

RESUMO

Healthcare professionals have first-hand experience with patients in clinical practice and the dynamics in the healthcare system, which can be of great value in the design, implementation, data analysis and dissemination of research study results. Primary care professionals are particularly important as they provide first contact, accessible, coordinated, comprehensive and continuous people-focused care. However, in-depth examination of the engagement of health professionals in health system research and planning activities-how professionals are engaged and how this varies across national contexts- is limited, particularly in international initiatives. There is a need to identify gaps in the planning of engagement activities to inform the design and successful implementation of future international efforts to improve the responsiveness of health systems to the changing needs of patients and professionals. The aim of this study was to explore how primary care professionals were engaged in the design and implementation plans of an international health policy study led by the Organisation for Economic Co-operation and Development (OECD). The OECD's international PaRIS survey measures and disseminates information on patient-reported outcome and experience measures (PROMs and PREMs) of people living with chronic conditions who are managed in primary care. A documentary analysis of 17 written national implementation plans (country roadmaps) was conducted between January and June 2023. Two reviewers independently performed the screening and data abstraction and resolved disagreements by discussion. We reported the intended target primary care professionals, phase of the study, channel of engagement, level of engagement, and purpose of engagement. All 17 countries aimed to engage primary care professionals in the execution plans for the international PaRIS survey. While organisations of primary care professionals, particularly of family doctors, were the most commonly targeted group, variation was found in the timing of engagement activities during the different phases of the study and in the level of engagement, ranging from co-development (half of the countries co-developed the survey together with primary care professionals) to one-off consultations with whom. International guidance facilitated the participation of primary care professionals. Continuous collaborative efforts at the international and national levels can foster a culture of engagement with primary care organisations and individual professionals and enhance meaningful engagement of primary care professionals.


Assuntos
Pessoal de Saúde , Política de Saúde , Organização para a Cooperação e Desenvolvimento Econômico , Atenção Primária à Saúde , Humanos , Atenção Primária à Saúde/organização & administração , Inquéritos e Questionários , Atenção à Saúde , Doença Crônica/terapia
2.
Hum Resour Health ; 18(1): 76, 2020 10 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066776

RESUMO

BACKGROUND: The workload of general practitioners (GPs) and dissatisfaction with work have been increasing in various Western countries over the past decades. In this study, we evaluate the relation between the workload of GPs and patients' experiences with care. METHODS: We collected data through a cross-sectional survey among 7031 GPs and 67,873 patients in 33 countries. Dependent variables are the patient experiences on doctor-patient communication, accessibility, continuity, and comprehensiveness of care. Independent variables concern the workload measured as the GP-reported work hours per week, average consultation times, job satisfaction (an indicator of subjective workload), and the difference between the workload measures of every GP and the average in their own country. Finally, we evaluated interaction effects between workload measures and what patients find important in a country and the presence of a patient-list system. Relationships were determined through multilevel regression models. RESULTS: Patients of GPs who are happier with their work were found to experience better communication, continuity, access, and comprehensiveness. When GPs are more satisfied compared to others in their country, patients also experience better quality. When GPs work more hours per week, patients also experience better quality of care, but not in the area of accessibility. A longer consultation time, also when compared to the national average, is only related to more comprehensive care. There are no differences in the relationships between countries with and without a patient list system and in countries where patients find the different quality aspects more important. CONCLUSIONS: Patients experience better care when their GP has more work hours, longer consultation times, and especially, a higher job satisfaction.


Assuntos
Clínicos Gerais , Estudos Transversais , Humanos , Satisfação no Emprego , Avaliação de Resultados da Assistência ao Paciente , Inquéritos e Questionários , Carga de Trabalho
3.
BMC Health Serv Res ; 20(1): 828, 2020 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-32883306

RESUMO

BACKGROUND: Health Services Research findings (HSR) reported in scientific publications may become part of the decision-making process on healthcare. This study aimed to explore associations between researcher's individual, institutional, and scientific environment factors and the occurrence of questionable research practices (QRPs) in the reporting of messages and conclusions in scientific HSR publications. METHODS: We employed a mixed-methods study design. We identified factors possibly contributing to QRPs in the reporting of messages and conclusions through a literature review, 14 semi-structured interviews with HSR institutional leaders, and 13 focus-groups amongst researchers. A survey corresponding with these factors was developed and shared with 172 authors of 116 scientific HSR publications produced by Dutch research institutes in 2016. We assessed the included publications for the occurrence of QRPs. An exploratory factor analysis was conducted to identify factors within individual, institutional, and environmental domains. Next, we conducted bivariate analyses using simple Poisson regression to explore factors' association with the number of QRPs in the assessed HSR publications. Factors related to QRPs with a p-value < .30 were included in four multivariate models tested through a multiple Poisson regression. RESULTS: In total, 78 (45%) participants completed the survey (51.3% first authors and 48.7% last authors). Twelve factors were included in the multivariate analyses. In all four multivariate models, a higher score of "pressure to create societal impact" (Exp B = 1.28, 95% CI [1.11, 1.47]), was associated with higher number of QRPs. Higher scores on "specific training" (Exp B = 0.85, 95% CI [0.77-0.94]) and "co-author conflict of interest" (Exp B = 0.85, 95% CI [0.75-0.97]) factors were associated with a lower number of QRPs. Stratification between first and last authors indicated different factors were related to the occurrence of QRPs for these groups. CONCLUSION: Experienced pressure to create societal impact is associated with more QRPs in the reporting of messages and conclusions in HSR publications. Specific training in reporting messages and conclusions and awareness of co-author conflict of interests are related to fewer QRPs. Our results should stimulate awareness within the field of HSR internationally on opportunities to better support reporting in scientific HSR publications.


Assuntos
Pesquisa sobre Serviços de Saúde/normas , Projetos de Pesquisa/normas , Adulto , Humanos , Pessoa de Meia-Idade , Publicações , Pesquisadores , Inquéritos e Questionários
4.
Health Res Policy Syst ; 18(1): 102, 2020 Sep 15.
Artigo em Inglês | MEDLINE | ID: mdl-32933555

RESUMO

BACKGROUND: Irrational prescribing has received increasing attention among policy-makers to improve drug safety and effectiveness while avoiding economic waste. The policies intended to rationalise prescribing have been grouped by WHO under a taxonomy, classifying them into two types of strategies - (1) targeted approaches (micro level) and (2) system-oriented approaches (macro level). The extent to which countries implement strategies and the existing types is currently unknown. This paper explores the following research question via expert opinions: to what extent have European countries implemented strategies to support rational prescribing (targeted and system oriented) and what are the types implemented? METHODS: We assessed the available information on policies intended to promote rational prescribing. We used the WHO taxonomy to explore our research question as the basis for a standardised questionnaire. The data were collected between August 2018 and April 2019. The questionnaire consisted of questions that solicited the opinion of experts on the implementation of prescribing control mechanisms in primary care in their respective countries. Experts were identified through the literature and relevant networks. The questionnaire was sent to 17 identified country experts from 17 different countries; 15 responded and 13 were used in our analysis. Answers were validated through follow-up correspondence, interviews and presentation at an OECD meeting. RESULTS: Expert-reported data shows that all 13 countries included in our study have several mechanisms in place for enhancing rational prescribing in primary care. All approaches were reported to have been implemented in at least two countries. We identified two groups of countries, namely a small group of countries (n = 3) with fewer mechanisms in place and a larger group of countries (n = 10) with a large number of strategies with accompanying instruments at both the micro and macro levels. CONCLUSIONS: The data reported by the experts suggests that all 13 countries included in our study have several mechanisms in place for enhancing rational prescribing in primary care on both the micro and macro levels. With respect to the extent of mechanisms being in place, two groups of countries were identified. This initial mapping of strategies forms a basis for more in-depth research to be able to assess the impact of bundles of strategies on system and targeted level on rational drug prescribing in primary care in Europe.


Assuntos
Prescrições de Medicamentos , Atenção Primária à Saúde , Pessoal Administrativo , Atenção à Saúde , Europa (Continente) , Humanos
5.
BMC Med Res Methodol ; 19(1): 160, 2019 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337354

RESUMO

BACKGROUND: Statistics are frequently used in health advocacy to attract attention, but are often misinterpreted. The Figure Interpretation Assessment Tool-Health (FIAT-Health) 1.0 was developed to support systematic assessment of the interpretation of figures on health and health care. This study aimed to test and evaluate the FIAT-Health 1.0 amongst its intended user groups, and further refine the tool based on our results. METHODS: Potential users (N = 32) were asked to assess one publicly reported figure using the FIAT-Health 1.0, and to justify their assessments and share their experience in using the FIAT-Health. In total four figures were assessed. For each figure, an expert on the specific topic (N = 4) provided a comparative assessment. The consistency of the answers was calculated, and answers to the evaluation questions were qualitatively analysed. A qualitative comparative analysis of the justifications for assessment by the experts and potential users was made. Based on the results, a new version of the FIAT-Health was developed and tested by employees (N = 27) of the National Institute for Public Health and the Environment (RIVM), and approved by the project's advisory group. In total sixty-three participants contributed. RESULTS: Potential users using the FIAT-Health 1.0 and experts gave similar justifications for their assessments. The justifications provided by experts aligned with the items of the FIAT-Health. Seventeen out of twenty-six dichotomous questions were consistently answered by the potential users. Numerical assessment questions showed inconsistencies in how potential users responded. In the evaluation, potential users most frequently mentioned that thanks to its structured approach, the FIAT-Health contributed to their awareness of the main characteristics of the figure (n = 14), but they did find the tool complex (n = 11). The FIAT-Health 1.0 was revised from a scoring instrument into a critical appraisal tool: the FIAT-Health 2.0, which was tested and approved by employees of the RIVM and the advisory group. CONCLUSION: The tool was refined according to the results of the test and evaluation, transforming the FIAT-Health from a quantitative scoring instrument into an online qualitative appraisal tool that has the potential to aid the better interpretation and public reporting of statistics on health and healthcare.


Assuntos
Técnicas de Apoio para a Decisão , Medicina Baseada em Evidências , Estatística como Assunto , Interpretação Estatística de Dados , Humanos
6.
BMC Health Serv Res ; 19(1): 1018, 2019 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-31888614

RESUMO

BACKGROUND: Poor communication between general practitioners (GPs) and medical specialists can lead to poorer quality, and continuity, of care. Our study aims to assess patients' perceptions of communication at the interface between primary and secondary care in 34 countries. It will analyse, too, whether this communication is associated with the organisation of primary care within a country, and with the characteristics of GPs and their patients. METHODS: We conducted a cross-sectional survey among patients in 34 countries. Following a GP consultation, patients were asked two questions. Did they take to understand that their GP had informed medical specialists about their illness upon referral? And, secondly, did their GP know the results of the treatment by a medical specialist? We used multi-response logistic multilevel models to investigate the association of factors related to primary care, the GP, and the patient, with the patients' perceptions of communication at the interface between primary and secondary care. RESULTS: In total, 61,931 patients completed the questionnaire. We found large differences between countries, in both the patients' perceptions of information shared by GPs with medical specialists, and the patients' perceptions of the GPs' awareness of the results of treatment by medical specialists. Patients whose GPs stated that they 'seldom or never' send referral letters, also less frequently perceived that their GP communicated with their medical specialists about their illness. Patients with GPs indicating they 'seldom or never' receive feedback from medical specialists, indicated less frequently that their GP would know the results of treatment by a medical specialist. Moreover, patients with a personal doctor perceived higher rates of communication in both directions at the interface between primary and secondary care. CONCLUSION: Generally, patients perceive there to be high rates of communication at the interface between primary and secondary care, but there are large differences between countries. Policies aimed at stimulating personal doctor arrangements could, potentially, enhance the continuity of care between primary and secondary care.


Assuntos
Atitude Frente a Saúde , Comunicação , Relações Interprofissionais , Pacientes/psicologia , Atenção Primária à Saúde , Atenção Secundária à Saúde , Adulto , Idoso , Estudos Transversais , Feminino , Clínicos Gerais/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes/estatística & dados numéricos , Encaminhamento e Consulta , Especialização , Inquéritos e Questionários
7.
Health Res Policy Syst ; 17(1): 55, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159828

RESUMO

BACKGROUND: The notion of 'fact-free politics' is debated in Europe and the United States of America and has particular relevance for the use of evidence to underpin health and healthcare policies. To better understand how evidence on health and healthcare is used in the national policy-making process in the Netherlands, we explore how different statistics are used in various policy debates on health and healthcare in the Dutch government and parliament. METHODS: We chose eight ongoing policy debates as case studies representing the subject categories of morbidity, lifestyle, healthcare expenditure and healthcare outcomes, including (1) breast cancer screening rates, prevalence and incidence, (2) dementia prevalence and incidence, (3) prevalence of alcohol use by pregnant women, (4) mobility and school sports participation in children, (5) costs of smoking, (6) Dutch national healthcare expenditure, (7) hospital mortality rates, and (8) bedsore prevalence. Using selected keywords for each policy debate case, we performed a document search to identify documentation of the debates (2014-2016) on the websites of the Dutch government and parliament. We retrieved 163 documents and examined the policy debate cases through a content analyses approach. RESULTS: Sources of the statistics used in policy debates were primarily government funded. We identified two distinct functions, i.e. rhetorical and managerial use of statistics. The function of the debate is rhetorical when the specific statistic is used for agenda-setting or to convince the reader of the importance of a topic. The function of the debate is managerial when statistics determine planning, monitoring or evaluation of policy. When evaluating a specific policy, applied statistics were mostly the result of routine or standardised data collection. When policy-makers use statistics for a managerial function, the policy debate mirrors terms derived from scientific debates. CONCLUSION: While statistics used for rhetorical functions do not seem to invite critical reflection, when the function of the debate is managerial, i.e. to plan, monitor or evaluate healthcare, their construction does receive attention. Considering the current role of statistics in rhetorical and managerial debates, there is a need to be cautious of too much leniency towards the technocratic process in exchange for the democratic debate.


Assuntos
Coleta de Dados , Atenção à Saúde , Medicina Baseada em Evidências/estatística & dados numéricos , Governo , Planejamento em Saúde/estatística & dados numéricos , Política de Saúde , Formulação de Políticas , Pessoal Administrativo , Criança , Comunicação , Gerenciamento de Dados , Dissidências e Disputas , Estudos de Avaliação como Assunto , Feminino , Humanos , Masculino , Países Baixos , Saúde da População , Gravidez , Estatística como Assunto
8.
Health Res Policy Syst ; 16(1): 20, 2018 Mar 07.
Artigo em Inglês | MEDLINE | ID: mdl-29514711

RESUMO

BACKGROUND: Policy-makers, managers, scientists, patients and the general public are confronted daily with figures on health and healthcare through public reporting in newspapers, webpages and press releases. However, information on the key characteristics of these figures necessary for their correct interpretation is often not adequately communicated, which can lead to misinterpretation and misinformed decision-making. The objective of this research was to map the key characteristics relevant to the interpretation of figures on health and healthcare, and to develop a Figure Interpretation Assessment Tool-Health (FIAT-Health) through which figures on health and healthcare can be systematically assessed, allowing for a better interpretation of these figures. METHODS: The abovementioned key characteristics of figures on health and healthcare were identified through systematic expert consultations in the Netherlands on four topic categories of figures, namely morbidity, healthcare expenditure, healthcare outcomes and lifestyle. The identified characteristics were used as a frame for the development of the FIAT-Health. Development of the tool and its content was supported and validated through regular review by a sounding board of potential users. RESULTS: Identified characteristics relevant for the interpretation of figures in the four categories relate to the figures' origin, credibility, expression, subject matter, population and geographical focus, time period, and underlying data collection methods. The characteristics were translated into a set of 13 dichotomous and 4-point Likert scale questions constituting the FIAT-Health, and two final assessment statements. Users of the FIAT-Health were provided with a summary overview of their answers to support a final assessment of the correctness of a figure and the appropriateness of its reporting. CONCLUSIONS: FIAT-Health can support policy-makers, managers, scientists, patients and the general public to systematically assess the quality of publicly reported figures on health and healthcare. It also has the potential to support the producers of health and healthcare data in clearly communicating their data to different audiences. Future research should focus on the further validation of the tool in practice.


Assuntos
Comunicação , Compreensão , Interpretação Estatística de Dados , Tomada de Decisões , Atenção à Saúde/estatística & dados numéricos , Medicina Baseada em Evidências , Saúde/estatística & dados numéricos , Técnicas de Apoio para a Decisão , Gastos em Saúde , Humanos , Estilo de Vida , Morbidade , Países Baixos , Avaliação de Resultados em Cuidados de Saúde , Melhoria de Qualidade , Relatório de Pesquisa , Estatística como Assunto
9.
BMC Health Serv Res ; 17(1): 768, 2017 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-29166897

RESUMO

BACKGROUND: Many survey studies in health care adjust for demographic characteristics such as age, gender, educational attainment and general health when performing statistical analyses. Whether the effects of these demographic characteristics are consistent between patient groups remains to be determined. This is important as the rationale for adjustment is often that demographic sub-groups differ in their so-called 'response tendency'. This rationale may be less convincing if the effects of response tendencies vary across patient groups. The present paper examines whether the impact of these characteristics on patients' global rating of care varies across patient groups. METHODS: Secondary analyses using multi-level regression models were performed on a dataset including 32 different patient groups and 145,578 observations. For each demographic variable, the 95% expected range of case-mix coefficients across patient groups is presented. In addition, we report whether the variance of coefficients for demographic variables across patient groups is significant. RESULTS: Overall, men, elderly, lower educated people and people in good health tend to give higher global ratings. However, these effects varied significantly across patient groups and included the possibility of no effect or an opposite effect in some patient groups. CONCLUSION: The response tendency attributed to demographic characteristics - such as older respondents being milder, or higher educated respondents being more critical - is not general or universal. As such, the mechanism linking demographic characteristics to survey results on patient experiences with quality of care is more complicated than a general response tendency. It is possible that the response tendency interacts with patient group, but it is also possible that other mechanisms are at play.


Assuntos
Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde , Risco Ajustado , Adulto , Idoso , Grupos Diagnósticos Relacionados , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores Sexuais , Inquéritos e Questionários
10.
Fam Pract ; 33(1): 42-50, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26511726

RESUMO

BACKGROUND: Part of the visits to emergency departments (EDs) is related to complaints that may well be treated in primary care. OBJECTIVES: (i) To investigate how the likelihood of attending an ED is related to accessibility and continuity of primary care. (ii) To investigate the reasons for patients to visit EDs in different countries. METHODS: Data were collected within the EU Seventh Framework project Quality and Costs in Primary Care (QUALICOPC) in 31 European countries, Australia, New Zealand and Canada. The data were collected between 2011 and 2013 and contain survey data from 60991 patients and 7005 GPs, within 7005 general practices. OUTCOME MEASURE: whether the patient visited the ED in the previous year (yes/no). Multilevel logistic regression analyses were carried out to analyse the data. RESULTS: Some 29.4% had visited the ED in the past year. Between countries, the percentages varied between 18% and 40%. ED visits show a significant and negative relation with better accessibility of primary care. Patients with a regular doctor who knows them personally were less likely to attend EDs. Only one-third of all patients who visited an ED indicated that the main reason for this was that their complaint could not be treated by a GP. CONCLUSIONS: Good accessibility and continuity of primary care may well reduce ED use. In some countries, it may be worthwhile to invest in more continuous relationships between patients and GPs or to eliminate factors that hamper people to use primary care (e.g. for costs or travelling).


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Canadá , Europa (Continente) , Feminino , Medicina Geral , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multinível , Nova Zelândia , Inquéritos e Questionários , Adulto Jovem
11.
Int J Qual Health Care ; 28(3): 398-404, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26983686

RESUMO

QUALITY PROBLEM OR ISSUE: OECD member states are involved since 2003 in a project coordinated by the OECD on Health Care Quality Indicators (HCQI). All OECD countries are biennially requested by the OECD to deliver national data on the quality indicators for international benchmarking purposes. INITIAL ASSESSMENT: Currently, there is no knowledge whether the OECD HCQI information is used by the countries themselves for healthcare system accountability and improvement purposes. CHOICE OF SOLUTION: The objective of the study is to explore the reporting and use of OECD HCQI in OECD member-states. IMPLEMENTATION: Data were collected through a questionnaire sent to all OECD member-states containing factual questions on the reporting on all OECD HCQ-indicators. Responses were received between June and December 2014. In this timeframe, two reminders were sent to the participants. The work progress was presented during HCQI Meetings in November 2014 and May 2015. EVALUATION: Fifteen countries reported to have a total of 163 reports in which one or more HCQIs were reported. One hundred and sixteen were national and 47 were regional reports. Forty-nine reports had a general system focus, 80 were disease specific, 10 referred to a specific type of care setting, 22 were thematic and 2 were a combination of two (disease specific for a particular type of care and thematic for a specific type of care). Most reports were from Canada: 49. All 15 countries use one or more OECD indicators. LESSONS LEARNED: The OECD quality indicators have acquired a clear place in national and regional monitoring activities. Some indicators are reported more often than others. These differences partly reflect differences between healthcare systems. Whereas some indicators have become very common, such as cancer care indicators, others, such as mental healthcare and patient experience indicators are relatively new and require some more time to be adopted more widely.


Assuntos
Países Desenvolvidos/estatística & dados numéricos , Organização para a Cooperação e Desenvolvimento Econômico/normas , Qualidade da Assistência à Saúde/organização & administração , Humanos , Indicadores de Qualidade em Assistência à Saúde/normas , Qualidade da Assistência à Saúde/normas
12.
BMC Fam Pract ; 17: 59, 2016 05 28.
Artigo em Inglês | MEDLINE | ID: mdl-27233498

RESUMO

BACKGROUND: Strong primary care systems are believed to have an important role in dealing with healthcare challenges. Strengthening primary care systems is therefore a common policy goal for many countries. This study aims to investigate whether the Netherlands, the UK and Germany have strengthened their primary care systems in 2006-2012. METHOD: For this cross-sectional study, data from the International Health Policy surveys of the Commonwealth Fund in 2006, 2009 and 2012 were used. The surveys represent the experiences and perspectives of primary care physicians with their primary care system. The changes over time were researched in three areas: organization of primary care processes, use of IT in primary care and use of benchmarking and financial incentives for performance improvement. RESULTS: Regarding organization of primary care processes, in all countries the use of supporting personnel in general practice increased, but at the same time practice accessibility decreased. IT services were most advanced in the UK. The UK and the Netherlands showed increased use of performance feedback information. German GPs were least satisfied with how their system works across the 2006-2012 timeframe. CONCLUSION: All three countries show trends towards stronger primary care systems, although in different areas. Coordination and comprehensive care through the assignment of assisting personnel and use of disease management programs improved in all countries. In the Netherlands and the UK, informational continuity is in part ensured through better IT services. All countries showed increasing difficulties upholding primary care accessibility.


Assuntos
Medicina Geral/tendências , Acessibilidade aos Serviços de Saúde/tendências , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/tendências , Adulto , Atitude do Pessoal de Saúde , Doença Crônica , Estudos Transversais , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Alemanha , Pesquisas sobre Atenção à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/tendências , Avaliação de Processos em Cuidados de Saúde , Reembolso de Incentivo , Reino Unido
13.
Scand J Prim Health Care ; 34(1): 5-12, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26849246

RESUMO

OBJECTIVE: Diabetes is a so-called ambulatory care sensitive condition. It is assumed that by appropriate and timely primary care, hospital admissions for complications of such conditions can be avoided. This study examines whether differences between countries in diabetes-related hospitalization rates can be attributed to differences in the organization of primary care in these countries. DESIGN: Data on characteristics of primary care systems were obtained from the QUALICOPC study that includes surveys held among general practitioners and their patients in 34 countries. Data on avoidable hospitalizations were obtained from the OECD Health Care Quality Indicator project. Negative binomial regressions were carried out to investigate the association between characteristics of primary care and diabetes-related hospitalizations. SETTING: A total of 23 countries. SUBJECTS: General practitioners and patients. MAIN OUTCOME MEASURES: Diabetes-related avoidable hospitalizations. RESULTS: Continuity of care was associated with lower rates of diabetes-related hospitalization. Broader task profiles for general practitioners and more medical equipment in general practice were associated with higher rates of admissions for uncontrolled diabetes. Countries where patients perceive better access to care had higher rates of hospital admissions for long-term diabetes complications. There was no association between disease management programmes and rates of diabetes-related hospitalization. Hospital bed supply was strongly associated with admission rates for uncontrolled diabetes and long-term complications. CONCLUSIONS: Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related hospitalizations. Hospital bed supply appeared to be a very important factor in this relationship. Apparently, it takes more than strong primary care to avoid hospitalizations. KEY POINTS: Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related avoidable hospitalization. Hospital bed supply is strongly associated with admission rates for uncontrolled diabetes and long-term complications. Continuity of care was associated with lower rates of diabetes-related hospitalization. Better access to care, broader task profiles for general practitioners, and more medical equipment in general practice was associated with higher rates of admissions for diabetes.


Assuntos
Continuidade da Assistência ao Paciente , Diabetes Mellitus/terapia , Medicina Geral , Recursos em Saúde/provisão & distribuição , Acessibilidade aos Serviços de Saúde , Hospitalização , Atenção Primária à Saúde/organização & administração , Leitos/provisão & distribuição , Comparação Transcultural , Complicações do Diabetes/terapia , Gerenciamento Clínico , Equipamentos e Provisões/provisão & distribuição , Feminino , Clínicos Gerais , Saúde Global , Humanos , Masculino , Admissão do Paciente , Análise de Regressão
14.
BMC Health Serv Res ; 15: 580, 2015 Dec 30.
Artigo em Inglês | MEDLINE | ID: mdl-26715151

RESUMO

BACKGROUND: In several countries, health care policies gear toward strengthening the position of primary care physicians. Primary care physicians are increasingly expected to take accountability for overall spending and quality. Yet traditional models of paying physicians do not provide adequate incentives for taking on this new role. Under a so-called shared savings program physicians are instead incentivized to take accountability for spending and quality, as the program lets them share in cost savings when quality targets are met. We provide a structured approach to designing a shared savings program for primary care, and apply this approach to the design of a shared savings program for a Dutch chain of primary care providers, which is currently being piloted. METHODS: Based on the literature, we defined five building blocks of shared savings models that encompass the definition of the scope of the program, the calculation of health care expenditures, the construction of a savings benchmark, the assessment of savings and the rules and conditions under which savings are shared. We apply insights from a variety of literatures to assess the relative merits of alternative design choices within these building blocks. The shared savings program uses an econometric model of provider expenditures as an input to calculating a casemix-corrected benchmark. RESULTS: The minimization of risk and uncertainty for both payer and provider is pertinent to the design of a shared savings program. In that respect, the primary care setting provides a number of unique opportunities for achieving cost and quality targets. Accountability can more readily be assumed due to the relatively long-lasting relationships between primary care physicians and patients. A stable population furthermore improves the confidence with which savings can be attributed to changes in population management. Challenges arise from the institutional context. The Dutch health care system has a fragmented structure and providers are typically small in size. CONCLUSION: Shared savings programs fit the concept of enhanced primary care. Incorporating a shared savings program into existing payment models could therefore contribute to the financial sustainability of this organizational form.


Assuntos
Redução de Custos/economia , Atenção Primária à Saúde/economia , Benchmarking/economia , Atenção à Saúde/economia , Reforma dos Serviços de Saúde/economia , Gastos em Saúde , Pessoal de Saúde/economia , Política de Saúde/economia , Humanos , Países Baixos , Médicos de Atenção Primária/economia , Projetos Piloto , Atenção Primária à Saúde/organização & administração , Estudos Prospectivos , Medição de Risco
15.
BMC Health Serv Res ; 15: 465, 2015 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-26453459

RESUMO

BACKGROUND: Some people have a lower threshold to seek care for certain symptoms than others. This study aims to investigate what factors are associated with patients' propensity to seek care. In addition, this study explores whether patients' propensity to seek care is associated with their actual health care utilization. We hypothesized that higher scores for propensity to seek care will lead to more general practitioners (GP) consultations, but to lower rates of avoidable hospitalization. METHODS: Propensity to seek care and GP utilization were measured by the Patient Experience Questionnaire of the QUALICOPC study, a survey among 61,931 patients that recently visited GP services in 34 countries. Propensity to seek care was estimated by two questions: one question focusing on health care seeking behavior for serious symptoms and the other question focused minor complaints. Data on country level rates of avoidable hospitalization for CHF, COPD, asthma and diabetes were obtained from the OECD health care quality indicators project. RESULTS: Beside patient characteristics, various organizational factors, such as better accessible and continuous primary care, and better experienced communication between patient and GPs was associated with a higher propensity to seek care for both severe and minor complaints. A higher propensity to seek care was associated with a slightly higher health care utilization in terms of GP visits, with no differences between the severity of the experienced symptoms (OR 1.08 for severe complaints and OR 1.05 for minor complaints). At country level, no association was found between propensity to seek care and rates of avoidable hospitalization for CHF, COPD, asthma and diabetes, possibly due to low statistical power at country level. CONCLUSIONS: The organization of primary care and patients' perceived communication with their GP were found to be highly correlated with patients' decision to seek health care for minor or severe complaints, suggesting that characteristics of healthcare systems directly influence patients' care seeking behavior, potentially leading to overuse or underuse of health services. However, we also observed that patients' propensity to seek care is only weakly associated with more GP use.


Assuntos
Comportamento de Busca de Ajuda , Internacionalidade , Aceitação pelo Paciente de Cuidados de Saúde , Atenção Primária à Saúde , Adulto , Idoso , Asma , Comunicação , Bases de Dados Factuais , Feminino , Clínicos Gerais/estatística & dados numéricos , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Encaminhamento e Consulta , Inquéritos e Questionários
16.
Fam Pract ; 31(5): 502-16, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25216664

RESUMO

BACKGROUND: Often used indicators for the quality of primary care are hospital admissions rates for conditions which are potentially avoidable by well-functioning primary care. Such hospitalizations are frequently termed as ambulatory care sensitive conditions (ACSCs). OBJECTIVE: We aim to investigate which characteristics of primary care organization influence avoidable hospitalization for chronic ACSCs. METHODS: MEDLINE, Embase and SciSearch were searched for publications on avoidable hospitalization and primary care. Studies were included if peer reviewed, written in English, published between January 1997 and November 2013, conducted in high income countries, identified hospitalization for ACSC as outcome measures and researched organization characteristics of primary care. A risk of bias assessment was performed to assess the quality of the articles. FINDINGS: A total of 1778 publications were reviewed, of which 49 met inclusion criteria. Twenty-two primary care factors were found. Factors were clustered into four primary care clusters: system-level characteristics, accessibility, structural and organizational characteristics and organization of the care process. Adequate physician supply and better longitudinal continuity of care reduced avoidable hospitalizations. Furthermore, inconsistent results were found on the effectiveness of various disease management programs in reducing hospitalization rates. CONCLUSIONS: Available evidence suggests that strong primary care in terms of adequate primary care physician supply and long-term relationships between primary care physicians and patients reduces hospitalizations for chronic ACSCs. There is a lack of evidence for the positive effects of many other organizational primary care aspects, such as specific disease management programs.


Assuntos
Assistência Ambulatorial/organização & administração , Mau Uso de Serviços de Saúde , Hospitalização , Médicos de Atenção Primária/provisão & distribuição , Atenção Primária à Saúde/organização & administração , Continuidade da Assistência ao Paciente , Acessibilidade aos Serviços de Saúde , Humanos , Relações Médico-Paciente , Qualidade da Assistência à Saúde
17.
Health Res Policy Syst ; 12: 1, 2014 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-24405849

RESUMO

In 2006, the first edition of a monitoring tool for the performance of the Dutch health care system was released: the Dutch Health Care Performance Report (DHCPR). The Netherlands was among the first countries in the world developing such a comprehensive tool for reporting performance on quality, access, and affordability of health care. The tool contains 125 performance indicators; the choice for specific indicators resulted from a dialogue between researchers and policy makers. In the 'policy cycle', the DHCPR can rationally be placed between evaluation (accountability) and agenda-setting (for strategic decision making). In this paper, we reflect on important lessons learned after seven years of health care system performance assessment. These lessons entail the importance of a good conceptual framework for health system performance assessment, the importance of repeated measurement, the strength of combining multiple perspectives (e.g., patient, professional, objective, subjective) on the same issue, the importance of a central role for the patients' perspective in performance assessment, how to deal with the absence of data in relevant domains, the value of international benchmarking and the continuous exchange between researchers and policy makers.


Assuntos
Serviços de Saúde/normas , Avaliação de Processos em Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde , Medicina Estatal/normas , Tomada de Decisões , Gastos em Saúde , Política de Saúde , Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/normas , Países Baixos , Avaliação de Processos em Cuidados de Saúde/tendências , Medicina Estatal/economia
18.
BMC Prim Care ; 25(1): 168, 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38760733

RESUMO

BACKGROUND: The PaRIS survey, an initiative of the Organisation for Economic Co-operation and Development (OECD), aims to assess health systems performance in delivering primary care by measuring the care experiences and outcomes of people over 45 who used primary care services in the past six months. In addition, linked data from primary care practices are collected to analyse how the organisation of primary care practices and their care processes impact care experiences and outcomes. This article describes the development and validation of the primary care practice questionnaire for the PaRIS survey, the PaRIS-PCPQ. METHOD: The PaRIS-PCPQ was developed based on domains of primary care practice and professional characteristics included in the PaRIS conceptual framework. Questionnaire development was conducted in four phases: (1) a multi-step consensus-based development of the source questionnaire, (2) translation of the English source questionnaire into 17 languages, (3) cross-national cognitive testing with primary care professionals in participating countries, and (4) cross-national field-testing. RESULTS: 70 items were selected from 7 existing questionnaires on primary care characteristics, of which 49 were included in a first draft. Feedback from stakeholders resulted in a modified 34-item version (practice profile, care coordination, chronic care management, patient follow-up, and respondent characteristics) designed to be completed online by medical or non-medical staff working in a primary care practice. Cognitive testing led to changes in the source questionnaire as well as to country specific localisations. The resulting 32-item questionnaire was piloted in an online survey and field test. Data from 540 primary care practices from 17 countries were collected and analysed. Final revision resulted in a 34-item questionnaire. CONCLUSIONS: The cross-national development of a primary care practice questionnaire is challenging due to the differences in care delivery systems. Rigorous translation and cognitive testing as well as stakeholder engagement helped to overcome most challenges. The PaRIS-PCPQ will be used to assess how key characteristics of primary care practices relate to the care experiences and outcomes of people living with chronic conditions. As such, policymakers and care providers will be informed about the performance of primary care from the patient's perspective.


Assuntos
Atenção Primária à Saúde , Humanos , Inquéritos e Questionários , Comparação Transcultural , Reprodutibilidade dos Testes , Feminino , Pesquisas sobre Atenção à Saúde , Pessoa de Meia-Idade
19.
Scand J Prim Health Care ; 31(1): 56-63, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23330604

RESUMO

BACKGROUND AND OBJECTIVE: Changes in the Dutch GP remuneration system provided the opportunity to study the effects of changes in financial incentives on the quality of care. Separate remuneration systems for publicly insured patients (capitation) and privately insured patients (fee-for-service) were replaced by a combined system of capitation and fee-for-service for all in 2006. The effects of these changes on the quality of care in terms of guideline adherence were investigated. DESIGN AND SETTING: A longitudinal study from 2002 to 2009 using data from patient electronic medical records in general practice. A multilevel (patient and practice) approach was applied to study the effect of changes in the remuneration system on guideline adherence. SUBJECTS: 21 421 to 39 828 patients from 32 to 52 general practices (dynamic panel of GPs). MAIN OUTCOME MEASURES: Sixteen guideline adherence indicators on prescriptions and referrals for acute and chronic conditions. RESULTS: Guideline adherence increased between 2002 and 2008 by 7% for (formerly) publicly insured patients and 10% for (formerly) privately insured patients. In general, no significant differences in the trends for guideline adherence were found between privately and publicly insured patients, indicating the absence of an effect of the remuneration system on guideline adherence. Adherence to guidelines involving more time investment in terms of follow-up contacts was affected by changes in the remuneration system. For publicly insured patients, GPs showed a higher trend for guideline adherence for guidelines involving more time investment in terms of follow-up contacts compared with privately insured patients. CONCLUSION: The change in the remuneration system had a limited impact on guideline adherence.


Assuntos
Medicina de Família e Comunidade/economia , Medicina de Família e Comunidade/normas , Fidelidade a Diretrizes/normas , Qualidade da Assistência à Saúde , Remuneração , Pesquisa Empírica , Fidelidade a Diretrizes/tendências , Humanos , Estudos Longitudinais , Países Baixos , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/normas
20.
Qual Prim Care ; 21(2): 67-79, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23735688

RESUMO

BACKGROUND: The Quality and Costs of Primary Care in Europe (QUALICOPC) study aims to analyse and compare how primary health care systems in 35 countries perform in terms of quality, costs and equity. This article answers the question 'How can the organisation and delivery of primary health care and its outcomes be measured through surveys of general practitioners (GPs) and patients?' It will also deal with the process of pooling questions and the subsequent development and application of exclusion criteria to arrive at a set of appropriate questions for a broad international comparative study. METHODS: The development of the questionnaires consisted of four phases: a search for existing validated questionnaires, the classification and selection of relevant questions, shortening of the questionnaires in three consensus rounds and the pilot survey. Consensus was reached on the basis of exclusion criteria (e.g. the applicability for international comparison). Based on the pilot survey, comprehensibility increased and the number of questions was further restricted, as the questionnaires were too long. RESULTS: Four questionnaires were developed: one for GPs, one for patients about their experiences with their GP, another for patients about what they consider important, and a practice questionnaire. The GP questionnaire mainly focused on the structural aspects (e.g. economic conditions) and care processes (e.g. comprehensiveness of services of primary care). The patient experiences questionnaire focused on the care processes and outcomes (e.g. how do patients experience access to care?). The questionnaire about what patients consider important was complementary to the experiences questionnaire, as it enabled weighing the answers from the latter. Finally, the practice questionnaire included questions on practice characteristics. DISCUSSION: The QUALICOPC researchers have developed four questionnaires to characterise the organisation and delivery of primary health care and to compare and analyse the outcomes. Data collected with these instruments will allow us not only to show in detail the variation in process and outcomes of primary health care, but also to explain the differences from features of the (primary) health care system.


Assuntos
Pesquisas sobre Atenção à Saúde/instrumentação , Avaliação de Resultados em Cuidados de Saúde/métodos , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde/normas , Comparação Transcultural , Europa (Continente) , Custos de Cuidados de Saúde , Pesquisas sobre Atenção à Saúde/economia , Pesquisas sobre Atenção à Saúde/métodos , Acessibilidade aos Serviços de Saúde , Pesquisa sobre Serviços de Saúde/métodos , Humanos , Participação do Paciente , Satisfação do Paciente , Atenção Primária à Saúde/economia , Qualidade da Assistência à Saúde/economia , Inquéritos e Questionários
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