scholarly journals Patients, primary care, and policy: Agent-based simulation modeling for health care decision support

2021 ◽  
Author(s):  
Martin Comis ◽  
Catherine Cleophas ◽  
Christina Büsing
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physicians ◽  
Waiting Times ◽  
Discrete Event ◽  
Agent Based Simulation ◽  
Agent Based ◽  
Individual Level ◽  
Rural Primary Care ◽  
Care Systems

AbstractPrimary care systems are a cornerstone of universally accessible health care. The planning, analysis, and adaptation of primary care systems is a highly non-trivial problem due to the systems’ inherent complexity, unforeseen future events, and scarcity of data. To support the search for solutions, this paper introduces the hybrid agent-based simulation model SiM-Care. SiM-Care models and tracks the micro-interactions of patients and primary care physicians on an individual level. At the same time, it models the progression of time via the discrete-event paradigm. Thereby, it enables modelers to analyze multiple key indicators such as patient waiting times and physician utilization to assess and compare primary care systems. Moreover, SiM-Care can evaluate changes in the infrastructure, patient behavior, and service design. To showcase SiM-Care and its validation through expert input and empirical data, we present a case study for a primary care system in Germany. Specifically, we study the immanent implications of demographic change on rural primary care and investigate the effects of an aging population and a decrease in the number of physicians, as well as their combined effects.

Likelihood of Normal ABI Increases With Physiologic Testing Referrals From Rural Primary Care Physicians

2019 ◽  
Vol 43 (3) ◽  
pp. 123-127
Author(s):  
Robert P. Scissons ◽  
Abraham Ettaher ◽  
Sophia Afridi
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Bypass Graft ◽  
Ankle Brachial Index ◽  
Care Physician ◽  
Health Care Facilities ◽  
Rural Primary Care ◽  
And Gender

Disparities in diagnostic capabilities have been noted between rural and urban health care facilities. We believe the clinical evaluation of peripheral arterial disease (PAD) by rural physicians may be similarly affected. Patients referred for arterial physiologic testing in an urban and rural regional health care network for a consecutive 7-month period were reviewed. Patients were classified into 3 groups based on referring physician specialty: (1) vascular surgeon or vascular medicine specialist (Vasc), (2) urban primary care physician (Urban), and (3) rural primary care physician (Rural). Normal patients were defined by a posterior tibial (PT) or dorsalis pedis (DP) ankle-brachial index (ABI) of ⩾0.90, bilaterally. Abnormal patients had both PT and DP ABI <0.90 in one or both extremities. Group comparisons were made for normal and abnormal patients, age (⩾65 years old), and gender. Patients with history of amputations, angioplasty, bypass graft, stent, calcification (PT or DP ABI ⩾1.30), and previous physiologic testing outside the designated period of analysis were considered a separate subclassification and analyzed separately. Emergency room referrals, inpatients, and patients with incomplete examination data were excluded from the analysis. A total of 430 patient exams were evaluated. Group-Rural had significantly greater numbers of normal ABI patients compared with Group-Urban ( P = .0028) and Group-Vasc ( P = .0000). No significant differences were noted between all groups for age and gender. Substantial disparities were noted in normal and abnormal ABI patients between rural health care physicians and their urban primary care and vascular specialist counterparts. Significantly greater numbers of normal ABI referrals by rural primary care physicians may warrant enhanced PAD diagnosis education or telemedicine alternatives.

scholarly journals Work stress of primary care physicians in the US, UK and German health care systems

2010 ◽  
Vol 71 (2) ◽  
pp. 298-304 ◽  
Author(s):  
Johannes Siegrist ◽  
Rebecca Shackelton ◽  
Carol Link ◽  
Lisa Marceau ◽  
Olaf von dem Knesebeck ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Work Stress ◽  
Primary Care Physicians ◽  
Health Care Systems ◽  
German Health ◽  
The Us ◽  
Care Systems

scholarly journals Personal Formularies of Primary Care Physicians Across 4 Health Care Systems

2021 ◽  
Vol 4 (7) ◽  
pp. e2117038
Author(s):  
William Galanter ◽  
Tewodros Eguale ◽  
Walid Gellad ◽  
Bruce Lambert ◽  
Maria Mirica ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Care Physicians ◽  
Health Care Systems ◽  
Care Systems

scholarly journals COMPARING SCHEDULING APPOINTMENT RULES PERFORMANCE IN HEALTH CARE UNITS: A DISCRETE EVENT SIMULATION APPROACH

2021 ◽  
Vol 16 (1) ◽  
pp. 28-41
Author(s):  
Thiago Nunes Klojda ◽  
Antônio Pedro de Britto Pereira Fortuna ◽  
Bianca Menezes Araujo ◽  
Daniel Bouzon Nagem Assad ◽  
Thaís Spiegel
Keyword(s):  
Health Care ◽  
Discrete Event Simulation ◽  
Health Care Systems ◽  
Waiting Times ◽  
Discrete Event ◽  
Idle Time ◽  
Event Simulation ◽  
Care Systems ◽  
Demand Scenario ◽  
Patient Waiting

Health care systems are affected by sudden increases in demand that can be generated by factors such as natural disasters, terrorist attacks, epidemics, among others. Patient demand can be divided between scheduled and walk-in and, in pandemic scenarios, both of them must be managed in order to avoid higher patient waiting times or number in queue. A discrete event simulation model is proposed in order to evaluate critical indicators like: patient waiting times, number in queue, resource utilization (doctors), using four different patient schedule appointment rules. In this study it was also considered patients impunctuality, walk-in patients and no-show in different scenarios. The best schedule appointment rules for each demand scenario were evaluated. After comparing six performance indicators, four schedule appointment rules in nine different scenarios it was found that the most known scheduling rule had the lowest queue sizes at scenarios with low or no walk-in patients, whereas, as the unpredictability of the scenarios rose, other rules outperformed it. It was also presented to exist an inverse relation between queue size and the physician idle time. Keywords: discrete event simulation, idle-time, queue management, appointment scheduling, health care.

PTSD symptom clusters associated with physical health and health care utilization in rural primary care patients exposed to natural disaster

2008 ◽  
Vol 21 (1) ◽  
pp. 75-82 ◽  
Author(s):  
Melissa A. Polusny ◽  
Barry J. Ries ◽  
Jessica R. Schultz ◽  
Patrick Calhoun ◽  
Lisa Clemensen ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Utilization ◽  
Physical Health ◽  
Natural Disaster ◽  
Ptsd Symptom ◽  
Symptom Clusters ◽  
Care Utilization ◽  
Rural Primary Care ◽  
Primary Care Patients

scholarly journals Online Ratings of Primary Care Physicians: Comparison of Gender, Training, and Specialty

2021 ◽  
Vol 8 ◽  
pp. 237437352110077
Author(s):  
Daliah Wachs ◽  
Victoria Lorah ◽  
Allison Boynton ◽  
Amanda Hertzler ◽  
Brandon Nichols ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Waiting Times ◽  
Wait Time ◽  
Primary Care Providers ◽  
Wait Times ◽  
Care Providers ◽  
Female Physicians ◽  
Online Ratings ◽  
And Gender

The purpose of this study was to explore patient perceptions of primary care providers and their offices relative to their physician’s philosophy (medical degree [MD] vs doctorate in osteopathic medicine [DO]), specialty (internal medicine vs family medicine), US region, and gender (male vs female). Using the Healthgrades website, the average satisfaction rating for the physician, office parameters, and wait time were collected and analyzed for 1267 physicians. We found female doctors tended to have lower ratings in the Midwest, and staff friendliness of female physicians were rated lower in the northwest. In the northeast, male and female MDs were rated more highly than DOs. Wait times varied regionally, with northeast and northwest regions having the shortest wait times. Overall satisfaction was generally high for most physicians. Regional differences in perception of a physician based on gender or degree may have roots in local culture, including proximity to a DO school, comfort with female physicians, and expectations for waiting times.

scholarly journals Primary Care Physicians’ Perceptions of Barriers To Preventive Reproductive Health Care In Rural Communities

2012 ◽  
Vol 44 (2) ◽  
pp. 78-83 ◽  
Author(s):  
Cynthia H. Chuang ◽  
Sandra W. Hwang ◽  
Jennifer S. McCall-Hosenfeld ◽  
Lara Rosenwasser ◽  
Marianne M. Hillemeier ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Rural Communities ◽  
Reproductive Health ◽  
Primary Care Physicians ◽  
Reproductive Health Care
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