PP090 Reducing Low-Value Practices In Catalonia: Essencial Project

2017 ◽  
Vol 33 (S1) ◽  
pp. 112-113
Author(s):  
Cari Almazan ◽  
Johanna Caro
Keyword(s):  
Primary Care ◽  
Health Care Services ◽  
Implementation Process ◽  
Healthcare Services ◽  
Care Level ◽  
Primary Care Level ◽  
Care Services ◽  
Baseline Status ◽  
The Impact

INTRODUCTION:In 2013 the Essencial Project launched in Catalonia promotes the identification of low-value practices (LVP) by healthcare professionals and elaborates recommendations to avoid them. This project aims to reduce unnecessary care of health care services which harm outweighs the benefits, resulting in physical, psychological to the patients and wasteful healthcare services. The main objectives are to describe the implementation process at the primary care level and to evaluate the impact of recommendations on general practitioners (GPs) practice.METHODS:The implementation process consists in:(i) Nomination of clinical leaders to promote the project among their primary care teams (PCT) and to lead the implementation activities by identification of barriers and enablers for change in clinical practice towards avoiding LVP.(ii) Selection of recommendations to be implemented and definition of corresponding activities to be carried out by each PCT according to the specific characteristics of their organizations.(iii) Development of related indicators and comparison between baseline statusRESULTS:One hundred and sixteen PCT (covering 30 percent of the Catalan population) participated in the pilot experience of implementation. Twenty-one recommendations were selected such as: bisphosphonates in post-menopausal women with low risk of fracture, PSA screening and statins for primary prevention of cardiovascular disease, among others. At 12 month follow-up, use of bisphosphonates were reduced by 21 percent (p = .0005), PSA was reduced by 14 percent (p = .0009). The use of other treatments such as antidepressants, benzodiazepines for some specific clinical conditions decreases with no statistically significant changes.CONCLUSIONS:This is the first experience in Catalonia and Spain of implementation of the recommendations to avoid LVP with early involvement of target professionals. Follow-up results provide information about the early impact of recommendations at primary care level. Our challenge is to implement the recommendations at hospital level.

scholarly journals The impact of the Affordable Care Act on patient coverage and access to care: perspectives from FQHC administrators in Arizona, California and Texas

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Angelo Ercia
Keyword(s):  
Access To Care ◽  
Affordable Care Act ◽  
Health Care Services ◽  
Healthcare Services ◽  
Structured Interviews ◽  
Care Services ◽  
Healthcare Needs ◽  
The Affordable Care Act ◽  
Insured Patients ◽  
The Impact

Abstract Background The Affordable Care Act (ACA) enabled millions of people to gain coverage that was expected to improve access to healthcare services. However, it is unclear the extent of the policy’s impact on Federally Qualified Health Centers (FQHC) and the patients they served. This study sought to understand FQHC administrators’ views on the ACA’s impact on their patient population and organization. It specifically explores FQHC administrators’ perspective on 1) patients’ experience with gaining coverage 2) their ability to meet patients’ healthcare needs. Methods Twenty-two semi-structured interviews were conducted with administrators from FQHCs in urban counties in 2 Medicaid-expanded states (Arizona and California) and 1 non-expanded state (Texas). An inductive thematic analysis approach was used to analyze the interview data. Results All FQHC administrators reported uninsured patients were more likely to gain coverage from Medicaid than from private health insurance. Insured patients generally experienced an improvement in accessing healthcare services but depended on their plan’s covered services, FQHCs’ capacity to meet demand, and specialist providers’ willingness to accept their coverage type. Conclusion Gaining coverage helped improved newly insured patients’ access to care, but limitations remained. Additional policies are required to better address the gaps in the depth of covered services in Medicaid and the most affordable PHI plans and capacity of providers to meet demand to ensure beneficiaries can fully access the health care services they need.

scholarly journals Influenza H1N1 2009 in Canterbury: a case study in pandemic response co-ordination

2010 ◽  
Vol 2 (4) ◽  
pp. 323 ◽  
Author(s):  
Daniel Williams ◽  
Annabel Begg ◽  
Kim Burgess ◽  
Michele Hider ◽  
Lance Jennings ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Care ◽  
Influenza A ◽  
Health Care Services ◽  
Call Centre ◽  
Care Services ◽  
Influenza A H1n1 ◽  
Civil Defence ◽  
The Impact

BACKGROUND AND CONTEXT: Reviews of overseas pandemic responses have suggested that stronger links between primary care and other parts of the health sector are required. The influenza A (H1N1) 2009 (‘H1N1 09’) pandemic was the first real test of New Zealand’s pandemic preparedness. ASSESSMENT OF PROBLEM: In the six months from May to October 2009, there were 595 confirmed cases of H1N1 09 in Canterbury, with 187 hospitalisations and three deaths. This paper describes the way a range of Canterbury agencies worked together in a co-ordinated health-led response aimed at minimising the impact of H1N1 09 in the community and maintaining effective health care services for both influenza and non-influenza patients. STRATEGIES FOR IMPROVEMENT: Key strategies included sector-wide response co-ordination, intelligence and communications, a combined public health/primary care response during the ‘containment’ phase, and universal red/green streaming supported by dedicated ’flu centres and an 0800 call centre during the ‘manage it’ phase. LESSONS: Despite the considerable impact of the H1N1 09 virus in Canterbury, health care services were not overwhelmed. The key lesson learned from the Canterbury H1N1 09 response has been the importance of preparing and working together across the sector. KEYWORDS: Influenza, human; pandemic; primary health care; public health; mass media; civil defence

scholarly journals Stroke follow-up in primary care: a discourse study on the discharge summary as a tool for knowledge transfer and collaboration

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rune Aakvik Pedersen ◽  
Halfdan Petursson ◽  
Irene Hetlevik ◽  
Henriette Thune
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Discourse Analysis ◽  
Knowledge Transfer ◽  
Health Care Services ◽  
Discharge Summary ◽  
Care Services ◽  
Discharge Summaries

Abstract Background The acute treatment for stroke takes place in hospitals and in Norway follow-up of stroke survivors residing in the communities largely takes place in general practice. In order to provide continuous post stroke care, these two levels of care must collaborate, and information and knowledge must be transferred between them. The discharge summary, a written report from the hospital, is central to this communication. Norwegian national guidelines for treatment of stroke, issued in 2010, therefore give recommendations on the content of the discharge summaries. One ambition is to achieve collaboration and knowledge transfer, contributing to integration of the health care services. However, studies suggest that adherence to guidelines in general practice is weak, that collaboration within the health care services does not work the way the authorities intend, and that health care services are fragmented. This study aims to assess to what degree the discharge summaries adhere to the guideline recommendations on content and to what degree they are used as tools for knowledge transfer and collaboration between secondary and primary care. Methods The study was an analysis of 54 discharge summaries for home-dwelling stroke patients. The patients had been discharged from two Norwegian local hospitals in 2011 and 2012 and followed up in primary care. We examined whether content was according to guidelines’ recommendations and performed a descriptive and interpretative discourse analysis, using tools adapted from an established integrated approach to discourse analysis.  Results We found a varying degree of adherence to the different advice for the contents of the discharge summaries. One tendency was clear: topics relevant here and now, i.e. at the hospital, were included, while topics most relevant for the later follow-up in primary care were to a larger degree omitted. In most discharge summaries, we did not find anything indicating that the doctors at the hospital made themselves available for collaboration with primary care after dischargeof the patient. Conclusions The discharge summaries did not fulfill their potential to serve as tools for collaboration, knowledge transfer, and guideline implementation. Instead, they may contribute to sustain the gap between hospital medicine and general practice.

scholarly journals Mobile Communications, physical distance and access to follow-up healthcare service in Lagos Metropolis

2018 ◽  
Vol 42 (42) ◽  
pp. 7-18
Author(s):  
Femi Ola Aiyegbajeje ◽  
Dickson Dare Ajayi
Keyword(s):  
Health Care ◽  
Mobile Communications ◽  
Health Care Services ◽  
Healthcare Services ◽  
Physical Distance ◽  
Mobile Telephone ◽  
Care Services ◽  
Telephone Calls ◽  
The Relationship

Abstract The widespread use of mobile communications has resulted in a new practice in family and social life, with significant implications for physical distance. This is because mobile communication allows users to overcome spatial issues such as distance to healthcare services, shift to person-to-person connectivity, and the blur boundaries between one point and another. The uneven distribution of healthcare facilities and distances among them has compounded the provision of follow-up care services to healthcare seekers. Therefore, this paper examined the relationship between the use of mobile telephone to access follow-up health-care services and physical distance separating out-patients from healthcare centres. The unified theory of acceptance and use of technology (UTAUT) model provided the framework for the study. Using a systematic random sampling technique, a structured questionnaire focusing on socio-demographic characteristics (gender, age, and income), mobile telephone usage for follow-up healthcare services and its effect on physical distance, was administered on 370 respondents at Lagos University Teaching Hospital (LUTH) Idi-Araba, Lagos. Pearson correlation was used to determine the relationship between the physical distance of patients from the hospital and mobile telephone calls for follow-up healthcare services, and the result revealed a strong positive relationship between them (r = 0.898, p ≤ 0.05). The result indicates that 134 patients used mobile telephone to access follow-up health-care services. It was also found that physical distance is responsible for 89.8% of mobile telephone calls for follow-up healthcare services. Continuous use of mobile telephone technology to improve the quality of follow-up health care service provision for patient satisfaction is recommended.

scholarly journals Access to Health Care Services by Individuals Who Are Deaf or Hard of Hearing (Dhh) in Botswana: Francistown and Tati

2020 ◽  
Author(s):  
Gorgeous Sarah Chinkonono ◽  
Vivian Namuli ◽  
Catherine Atuhaire ◽  
Hamida Massaquoi ◽  
Sourav Mukhopadhyay ◽  
...  
Keyword(s):  
Health Care ◽  
Hard Of Hearing ◽  
Access To Health Care ◽  
Health Care Services ◽  
Healthcare Professionals ◽  
Healthcare Services ◽  
Structured Interview ◽  
Care Services ◽  
Main Challenge ◽  
The Impact

Abstract Background: Individuals who are Deaf or hard of hearing (DHH) face a lot of challenges when accessing health care services. The main barrier that they face is communication. Despite this, not much research had been carried out in Africa to understand how individuals who are DHH access healthcare services. This study sought to explore experiences of individuals who are DHH in Botswana when accessing healthcare services to propose recommendations towards improving their situation.Methods: This is a qualitative research study using phenomenological approach. Participants were observed at one point in time. Face-to-face in-depth interviews were conducted with 22 DHH individuals living in Francistown and Tati, using a semi-structured interview guide and an interpreter. Participants age range was between 18years to 40years. Purposive sampling and snowballing sampling techniques were used to select the participants.Results: The main challenge that individuals who are DHH in Botswana face is communication barrier which has culminated in their reception of poor healthcare services as the healthcare professionals fail to effectively attain to their health needs. This is evident through wrong prescriptions and treatment; poor counselling services, lack of confidentiality; poor maternal health services especially during child delivery; and limited health information. However, individuals who are DHH in Botswana continues to utilise healthcare services.Conclusion: Poor communication between healthcare professionals and individuals who are DHH act as an impediment to acquiring proper healthcare services by individuals who are DHH. This can lead to poor health outcomes for the DHH population as they are not well informed about health issues that they are at risk of and at times do not know where to seek specific healthcare services pertaining to the health problems they are experiencing. Therefore, there is a need to provide sign language interpreters in the healthcare centres to reduce the impact of this problem.

scholarly journals Continuity of care in heart failure patients

2021 ◽  
Vol 20 (Supplement_1) ◽  
Author(s):  
K Olsen ◽  
NF Falun ◽  
HK Keilegavlen
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Health Care ◽  
Continuity Of Care ◽  
Secondary Care ◽  
Health Care Services ◽  
Care Services ◽  
Discharge From Hospital ◽  
Patients Experience

Abstract Funding Acknowledgements Type of funding sources: None. Background  Heart failure (HF) requires follow-up over time and by several different health services. The positive effects of follow-up care in secondary care services is well known. However, there is a lack of knowledge in how HF patients experience continuity of care a through various health care services in secondary and primary care. Purpose To explore how HF patients experience continuity of care through secondary and primary health care services. Methods The study used an inductive design by performing four semi-structured focus group interviews. Overall, 17 patients, mean age of 71 years (range 42-95), 11 men and 6 women, All patients were receiving regular and individual follow-up by cardiac nurses in primary care after hospital discharge The interviews were analysed through qualitative content analysis. Results Gaps in continuity of care were described as challenging. Information about HF at the time of discharge from hospital were not always fully comprehended. Patients experienced physical strain of being lost and abandoned after discharge from hospital. They did not know whom to contact for follow-up.  Appointments with the GP was not agreed or scheduled weeks ahead. Patients appreciated home visit by a cardiac nurse in primary care who provided the patients with knowledge in self-care administration. When experiencing deterioration they could call the cardiac nurse, who could facilitate fast track to the hospital. Self-care was difficult to comprehend, especially for those experiencing comorbidities. Patients also  described the importance of sharing knowledge and experience of living with HF with other patients in a secondary care setting, organized by specialised cardiac nurses. Conclusions There are gaps in continuity in patients’ pathways, throughout both secondary and primary healthcare. Even though patients receive information at discharge from hospital, they felt insecure when returning home. Health care services in the primary care provided the patients with both knowledge and confidence as they regularly met the patients, both at home and in organized primary care meetings.

scholarly journals Exploring the Experiences of Changes to Support Access to Primary Health Care Services and the Impact on the Quality and Safety of Care for Homeless People During the COVID-19 Pandemic: A Study Protocol for A Qualitative Mixed Methods Approach.

2020 ◽  
Author(s):  
Kelly Howells ◽  
Martin Burrows ◽  
Mat Amp ◽  
Rachel Brennan ◽  
Wan-Ley Yeung ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Lived Experience ◽  
Health Care Services ◽  
Homeless People ◽  
Health Care Need ◽  
Seek Health Care ◽  
Care Services ◽  
High Level ◽  
The Impact

Abstract Background: Despite high level of health care need amongst people experiencing homelessness, poor access is a major concern. This is sometimes due to organisational and bureaucratic barriers, but also because they often feel stigmatised and treated badly when they do seek health care. The COVID-19 pandemic and the required social distancing measures have caused unprecedented disruption and change for the organisation of primary care, particularly for people experiencing homelessness. Against this back drop, there are many questions to address regarding whether the recent changes required to deliver services to people experiencing homelessness in the context of COVID-19 will help to address or compound problems in accessing care and inequalities in health outcomes. Methods: An action led and participatory research methodology will be employed to address the study objectives. Interviews with people experiencing homelessness were will be conducted by a researcher with lived experience of homelessness. Researchers with lived experience are able to engage with vulnerable communities in an empathetic, non-judgemental way as their shared experience promotes a sense of trust and integrity, which in turn encourages participation in research and may help people speak more openly about their experience. Interviews with health professionals and stakeholders exploring their experiences of delivering and facilitating care for homeless people during the pandemic will also be explored.Discussion: It is important to explore whether recent changes to the delivery of primary care in in response to the COVID-19 pandemic compromise the safety of homeless people and exacerbate existing health inequalities. This could have implications for how primary healthcare is delivered to those experiencing homelessness not only for the duration of the pandemic but in the future.

scholarly journals Telemedicine in the Management of Primary Headaches: A Critical Review

2019 ◽  
pp. 198-202
Author(s):  
Renan Barros Domingues ◽  
Cassio Batista Lacerda ◽  
Paulo Diego Santos Silva
Keyword(s):  
Health Care Services ◽  
Primary Headache ◽  
Communication Technologies ◽  
Primary Headaches ◽  
Headache Disorders ◽  
Primary Headache Disorders ◽  
Care Services ◽  
Services Delivery ◽  
The Impact

Telemedicine is a modality of health care services delivery with the use of communication technologies. Its use has grown in several medicine areas. Several studies evaluated the feasibility, acceptance, efficacy, cost-effectiveness, and safety of telemedicine in the diagnosis and management of primary headache disorders. Videoconsultations were shown to be effective, convenient, and safe for primary headache disorders and migraine follow up. Some mobile health devices were show to improve adherence favoring better outcomes. Handling health data is a major concern so that international compliance standards must be adopted in all telemedicine procedures. The impact in the health system and increased access to appropriate primary headache treatments with the use of these technologies has yet to be elucidated.

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