Primary care patients’ preferences for reproductive health service needs assessment and service availability in New York Federally Qualified Health Centers

IntroductionOur project follows community requests for health service incorporation into conservation collaborations in the rainforests of Papua New Guinea (PNG). This protocol is for health needs assessments, our first step in coplanning medical provision in communities with no existing health data.Methods and analysisThe study includes clinical assessments and rapid anthropological assessment procedures (RAP) exploring the health needs and perspectives of partner communities in two areas, conducted over 6 weeks fieldwork. First, in Wanang village (population c.200), which is set in lowland rainforest. Second, in six communities (population c.3000) along an altitudinal transect up the highest mountain in PNG, Mount Wilhelm. Individual primary care assessments incorporate physical examinations and questioning (providing qualitative and quantitative data) while RAP includes focus groups, interviews and field observations (providing qualitative data). Given absence of in-community primary care, treatments are offered alongside research activity but will not form part of the study. Data are collected by a research fellow, primary care clinician and two PNG research technicians. After quantitative and qualitative analyses, we will report: ethnoclassifications of disease, causes, symptoms and perceived appropriate treatment; community rankings of disease importance and service needs; attitudes regarding health service provision; disease burdens and associations with altitudinal-related variables and cultural practices. To aid wider use study tools are in online supplemental file, and paper and ODK versions are available free from the corresponding author.Ethics and disseminationChallenges include supporting informed consent in communities with low literacy and diverse cultures, moral duties to provide treatment alongside research in medically underserved areas while minimising risks of therapeutic misconception and inappropriate inducement, and PNG research capacity building. Brighton and Sussex Medical School (UK), PNG Institute of Medical Research and PNG Medical Research Advisory Committee have approved the study. Dissemination will be via journals, village meetings and plain language summaries.

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Evaluation of a learning collaborative to advance team-based care in Federally Qualified Health Centers

BMJ Open Quality ◽

10.1136/bmjoq-2019-000794 ◽

2020 ◽

Vol 9 (3) ◽

pp. e000794

Author(s):

Kathleen Thies ◽

Amanda Schiessl ◽

Nashwa Khalid ◽

Anne Marie Hess ◽

Kasey Harding ◽

...

Keyword(s):

Primary Care ◽

Care Delivery ◽

Service Level ◽

Practice Change ◽

Health Centers ◽

Federally Qualified Health Centers ◽

Learning Collaborative ◽

Primary Care Teams ◽

The Usa ◽

Team Based Care

Practising team-based primary care allows Federally Qualified Health Centers (FQHC) in the USA to be accredited as patient-centred medical homes, positioning them for value-based models of shared savings in healthcare costs. Team-based care (TBC) involves redesign of staff roles and care delivery processes to improve efficiency and effectiveness, which requires a systematic and supportive approach to practice change over time. Thirteen FQHC primary care teams participated in an 8-month learning collaborative with a goal of providing teams with the knowledge, skills and coaching support needed to advance TBC in their organisations. The primary aim was to evaluate self-reported changes in FQHC teams’ assessment of their practice relative to key concepts of TBC. The secondary aim was to evaluate how teams used the collaborative to develop new skills to advance TBC, and the implementation, service and patient outcomes they achieved. Site visits were conducted with three teams 6 months postcollaborative. Results: Two teams withdrew. The remaining teams embarked on 15 TBC improvement initiatives. Nine teams submitted a total of 11 playbooks to guide other staff in changes to their practice. Three teams reported improved efficiencies at the service level (screening and scheduling), and one improved outcomes in patients with diabetes. The nine teams that completed precollaborative and postcollaborative self-assessments reported improvements in their practice and in coach and team skills. Site visits revealed that actionable data were a barrier to improvement, coaching support from the collaborative was highly valued and FQHC leadership support was critical to improvement. Leadership investment in developing their primary care teams’ quality improvement, coaching and data analytical skills can advance TBC in their organisations.

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Variations in health services utilization by primary care patients

Health Services Management Research ◽

10.1258/0951484021912888 ◽

2002 ◽

Vol 15 (2) ◽

pp. 116-125 ◽

Cited By ~ 8

Author(s):

Victoria Bolaños-Carmona ◽

Ricardo Ocaña-Riola ◽

Alexandra Prados-Torres ◽

Pilar Gutiérrez-Cuadra

Keyword(s):

Primary Care ◽

Health Service ◽

Primary Care Physicians ◽

Service Use ◽

Patient Characteristics ◽

Important Variable ◽

Services Utilization ◽

Care Groups ◽

Physician Characteristics ◽

Primary Care Patients

This study analyses how both ambulatory care groups (ACGs) and physician characteristics explain the variability in health-service use among primary care patients in Spain. During the period 1996-1997, data derived from 52 152 patients and their 38 respective primary care physicians were collected. The response variables were as follows: number of visits; diagnostic tests requested; and referrals to a specialist. ACGs are an important variable that should be taken into account in order to explain health-service utilization. As for professionals, age and the post they hold are essential factors. Most of the unexplained variability is caused by patient characteristics.

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