scholarly journals Revisiting the four core functions (4Cs) of primary care: operational definitions and complexities

2021 ◽  
Vol 22 ◽  
Author(s):  
Geronimo Jimenez ◽  
David Matchar ◽  
Gerald Choon Huat Koh ◽  
Shilpa Tyagi ◽  
Rianne M. J. J. van der Kleij ◽  
...  
Keyword(s):  
Primary Care ◽  
Digital Health ◽  
Descriptive Analysis ◽  
Community Based ◽  
Social Community ◽  
Health Technologies ◽  
Levels Of Care ◽  
Electronic Search ◽  
First Contact ◽  
Community Based Services

Abstract Background: The four primary care (PC) core functions (the ‘4Cs’, ie, first contact, comprehensiveness, coordination and continuity) are essential for good quality primary healthcare and their achievement leads to lower costs, less inequality and better population health. However, their broad definitions have led to variations in their assessment, in the innovations implemented to improve these functions and ultimately in their performance. Objectives: To update and operationalise the 4Cs’ definitions by using a literature review and analysis of enhancement strategies, and to identify innovations that may lead to their enhancement. Methods: Narrative, descriptive analysis of the 4Cs definitions, coming from PC international reports and organisations, to identify measurable features for each of these functions. Additionally, we performed an electronic search and analysis of enhancement strategies to improve these four Cs, to explore how the 4Cs inter-relate. Results: Specific operational elements for first contact include modality of contact, and conditions for which PC should be approached; for comprehensiveness, scope of services and spectrum of population needs; for coordination, links between PC and higher levels of care and social/community-based services, and workforce managing transitions and for continuity, type, level and context of continuity. Several innovations like enrolment, digital health technologies and new or enhanced PC provider’s roles, simultaneously influenced two or more of the 4Cs. Conclusion: Providing clear, well-defined operational elements for these 4Cs to measure their achievement and improve the way they function, and identifying the complex network of interactions among them, should contribute to the field in a way that supports efforts at practice innovation to optimise the processes and outcomes in PC.

Exclusion by Design: Lack of Information about Community Participation in COVID-19-related Mobile Apps and its Relationship to Digital Health Disparities (Preprint)

2021 ◽  
Author(s):  
Muhammed Yassin Idris ◽  
Maya Korin ◽  
Faven Araya ◽  
Sayeeda Chowdhury ◽  
Humberto Brown ◽  
...  
Keyword(s):  
Community Participation ◽  
Mobile Health ◽  
Medical Information ◽  
Mobile Apps ◽  
Digital Health ◽  
Community Based ◽  
Health Technologies ◽  
Community Needs ◽  
App Development ◽  
Communities Of Color

UNSTRUCTURED The rate and scale of transmission of COVID-19 overwhelmed healthcare systems worldwide, particularly in under-resourced communities of color that already faced a high prevalence of pre-existing health conditions. One way the health ecosystem has tried to address the pandemic is by creating mobile apps for telemedicine, dissemination of medical information, and disease tracking. As these new mobile health tools continue to be a primary format for healthcare, more attention needs to be given to their equitable distribution, usage, and accessibility. In this viewpoint collaboratively written by a community-based organization and a health app development research team, we present results of our systematic search and analysis of community engagement in mobile apps released between February and December 2020 to address the COVID-19 pandemic. We provide an overview of apps’ features and functionalities but could not find any publicly available information regarding whether these apps incorporated participation from communities of color disproportionately impacted by the pandemic. We argue that while mobile health technologies are a form of intellectual property, app developers should make public the steps taken to include community participation in app development. These steps could include community needs assessment, community feedback solicited and incorporated, and community participation in evaluation. These are factors that community-based organizations look for when assessing whether to promote digital health tools among the communities they serve. Transparency about the participation of community organizations in the process of app development would increase buy-in, trust, and usage of mobile health apps in communities where they are needed most.

scholarly journals Utilization of a Cardiometabolic Health Nurse – a Novel Strategy to Manage Comorbid Physical and Mental Illness

2014 ◽  
Vol 4 (1) ◽  
pp. 22-28 ◽  
Author(s):  
Brenda Happell ◽  
Robert Stanton ◽  
David Scott
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Physical Health ◽  
Allied Health ◽  
Cardiometabolic Health ◽  
Community Based ◽  
Mental Health Consumers ◽  
Health Nurse ◽  
Health Consumers ◽  
Community Based Services

Background Comorbid chronic illnesses, such as cardiovascular disease, respiratory conditions, and type 2 diabetes are common among people with serious mental illness. Management of comorbid illness in the mental health setting is sometimes ad hoc and poorly delivered. Use of a cardiometabolic health nurse (CHN) is proposed as one strategy to improve the delivery of physical health care to this vulnerable population. Objective To report the CHN's utilization of primary care and allied health referrals from a trial carried out in a regional community mental health service. Design Feasibility study. Mental health consumers were referred by their case manager or mental health nurse to the CHN. The CHN coordinated the physical health care of community-based mental health consumers by identifying the need for, and providing referrals to, additional services, including primary care, allied health, and community-based services. Results Sixty-two percent of participants referred to the CHN received referrals for primary care, allied health, and community-based services. Almost all referrals received follow-up by the CHN. Referrals were most commonly directed to a general practitioner and for nurse-delivered services. Conclusion The CHN role shows promise in coordinating the physical health of community-based mental health consumers. More studies on role integration and development of specific outcome measurement tools are needed.

scholarly journals Admission profile: towards community based services

1992 ◽  
Vol 16 (6) ◽  
pp. 336-337
Author(s):  
R. S. Augustine ◽  
P. N. Kurian ◽  
A. Michael
Keyword(s):  
Mental Illness ◽  
Psychiatric Hospital ◽  
General Practitioners ◽  
Psychiatric Care ◽  
Total Population ◽  
Mentally Handicapped ◽  
Community Based ◽  
Special Groups ◽  
First Contact ◽  
Community Based Services

This audit examined 65 consecutive admissions to a psychiatric hospital in the Irish Midlands over six months. The admissions came from a defined sector with a total population of 39,000. In the year prior to the study major changes in the delivery of psychiatric care in the sector were instituted. These changes included the introduction of admission guidelines and extra resources in the community. The general practitioners who see mental illness at first contact were informed of these changes. Attempts were made by the sector psychiatrist team to screen for appropriateness of admission with regard to the special groups such as alcoholics, the aged and the mentally handicapped.

scholarly journals EFFECTIVENESS OF HOME- AND COMMUNITY-BASED SERVICES IN DECREASING HEALTH CARE EXPENDITURE IN TAIWAN

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S159-S159
Author(s):  
Ya-Mei Chen ◽  
Hsiao-Wei Yu ◽  
Ying-Chieh Wang
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Long Term Care ◽  
Community Based ◽  
Term Care ◽  
Care Recipients ◽  
Home Based ◽  
Number Of Visits ◽  
Community Based Services

Abstract Ideally, continuum of care involves wide-ranging health and long-term care (LTC) services. Taiwan’s National Health Insurance scheme and 10-Year Long-term Care Plan attempts to provide universal and fundamental services of continuum care. However, the accessibility of these services for care recipients remains unclear. This study aims to examine the effectiveness of continuum care in decreasing the healthcare expenditure of LTC recipients using home- and community-based services (HCBS). Data collated from the 2010–2013 Long-Term Care Service Management System (N = 77,251) were subjected to latent class analysis to identify subgroups of recipients using HCBS. Subsequently, the 1-year primary care expenditure after receiving HCBS was compared through generalized linear modeling. Three discrete HCBS subgroups were found: home-based personal care (HP), home-based health care (HH), and community-based care (CC). No difference in the number of visits to doctors and the average primary care expenses was observed between the HP and HH subgroups. However, considering physical and psychosocial confounders, care recipients in the CC subgroup recorded a higher number of visits to doctors (β = 3.05, SD = 0.25, p < 0.05) and lower primary care expenditure (β = -98.15, SD = 43.17, p = 0.02) than the other two subgroups. These findings suggest that LTC recipients in Taiwan may obtain better continuum care only for CC service recipients. Additionally, community-based LTC services may lower the cost of health expenditure after 1 year.

scholarly journals Informal and formal care infrastructure and perceived need for caregiver training for frail US veterans referred to home and community-based services

2010 ◽  
Vol 6 (1) ◽  
pp. 57-66 ◽  
Author(s):  
Courtney Harold Van Houtven ◽  
Eugene Z. Oddone ◽  
Morris Weinberger
Keyword(s):  
Primary Care ◽  
Informal Care ◽  
Medical Center ◽  
Caregiver Training ◽  
Community Based ◽  
Home Health Services ◽  
Home Based ◽  
Chi Squared ◽  
Us Veterans ◽  
Community Based Services

Objectives: To describe the informal care network of US veterans referred to home and community-based services (Homemaker Home Health services, H/HHA, or Home-Based Primary Care, HBPC) at the Durham Veterans Affairs Medical Center (VAMC), including: quantity and types of tasks provided and desired content for caregiver training programs. Methods: All primary care patients referred to H/HHA or HBPC during the preceding 3 months were sent questionnaires in May 2007. Additionally, caregivers were sent questionnaires if a patient gave permission. Descriptive statistics and chi-squared tests were performed. Results: On average, patients received 5.6 hours of VA care and 47 hours of informal care per week. 26% of patients (38% of patients with caregiver proxy respondents) and 59% of caregivers indicated the caregiver would be interested in participating in a training program by phone or on-site. Significant barriers to participation existed. The most common barriers were: transportation; no time due to caregiving or work demands; caregiver’s own health limitations; and no need. Conclusions: Caregiver training needs to be tailored to overcome barriers to participate. Overcoming these barriers may be possible through in-home phone or internet training outside traditional business hours, and by tailoring training to accommodate limiting health problems among caregivers.

scholarly journals Integration of eMental health technologies into traditional community-based interventions

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
K Turmaine ◽  
C Picot Ngo ◽  
A Le Jeannic ◽  
J L Roelandt ◽  
K Chevreul ◽  
...  
Keyword(s):  
Mental Health ◽  
Digital Technology ◽  
Digital Health ◽  
Local Level ◽  
World Health ◽  
Local Network ◽  
Local Health ◽  
Community Based ◽  
Health Technologies ◽  
Health Programmes

Abstract Background Very little research has been conducted to appraise the merits of including municipalities and their local health providers in the promotion of digital health programmes. While more and more municipalities have locally implemented a health strategic plan and have focused on building local network of professionals, how do the latter react to the implementation of innovative e-mental health community-based programmes? Methods In 2018, 42 French municipalities volunteered to promote StopBlues, a digital health tool aimed at preventing mental distress and suicide. In each municipality, a local delegate was responsible for the promotion of the tool. Using observations, questionnaires and interviews with the delegates, we analysed how the promotion of StopBlues® was conducted in each setting. 2/3 of these municipalities started the promotion directly, and in 2019, a second wave of municipalities launched the promotion with a stronger support from the research team backed by the French World Health Organization Collaborating Centre for Research and Training in Mental Health (WHOCC). Results The use of digital technology in the implementation of a mental health programme received a mixed reception from the local health professionals because of its innovative aspect. 2/3 of the delegates declared that they were struggling to create a stronger network of local partners including private medical practioners. 63% of the respondents stated that their municipalities got involved in the programme for networking purposes. Conclusions Digital technologies have initiated a paradigm shift in the way community-based health programmes are set up but need to strengthen their territorial anchorage in order to be accepted and used at the local level. Key messages Digital technology can be a strong lever against health inequities but its effectiveness has to be studied carefully. Digital technolgy has to be implemented in local settings with the collaboration of local actors in order to be accepted and used.

Towards a comprehensive telecardiology monitoring centre for community-based services

1997 ◽  
Vol 3 (1_suppl) ◽  
pp. 60-62 ◽  
Author(s):  
D Shanit ◽  
R A Greenbaum
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Primary Care ◽  
General Practitioner ◽  
Pilot Study ◽  
Community Based ◽  
Monitoring Centre ◽  
Accident And Emergency ◽  
Community Based Services

In a pilot study of primary-care telecardiology, 2563 consultations were carried out over 18 months. Following teleconsultation, 2076 patients (81%) were found to be suitable for management entirely by the general practitioner, without the need for referral to hospital. The system identified 487 patients (19%) with cardiac problems who required either admission to hospital or outpatient assessment. There was a resultant saving of referrals to hospital accident and emergency departments. Extension of the telecardiology service to include tele-echocardiography may result in faster access to diagnosis and better management of patients in heart failure, improving patients’ quality of life and reducing hospitalization.

scholarly journals Assimilation of Medical Appointment Scheduling Systems and Their Impact on the Accessibility of Primary Care: Mixed Methods Study

10.2196/30485 ◽  
2021 ◽  
Vol 9 (11) ◽  
pp. e30485
Author(s):  
Guy Paré ◽  
Louis Raymond ◽  
Alexandre Castonguay ◽  
Antoine Grenier Ouimet ◽  
Marie-Claude Trudel
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Medical Care ◽  
Digital Health ◽  
Appointment Scheduling ◽  
Survey Study ◽  
Equation Modeling ◽  
Valuable Insight ◽  
Health Technologies ◽  
Medical Appointment

Background The COVID-19 pandemic has prompted the adoption of digital health technologies to maximize the accessibility of medical care in primary care settings. Medical appointment scheduling (MAS) systems are among the most essential technologies. Prior studies on MAS systems have taken either a user-oriented perspective, focusing on perceived outcomes such as patient satisfaction, or a technical perspective, focusing on optimizing medical scheduling algorithms. Less attention has been given to the extent to which family medicine practices have assimilated these systems into their daily operations and achieved impacts. Objective This study aimed to fill this gap and provide answers to the following questions: (1) to what extent have primary care practices assimilated MAS systems into their daily operations? (2) what are the impacts of assimilating MAS systems on the accessibility and availability of primary care? and (3) what are the organizational and managerial factors associated with greater assimilation of MAS systems in family medicine clinics? Methods A survey study targeting all family medicine clinics in Quebec, Canada, was conducted. The questionnaire was addressed to the individual responsible for managing medical schedules and appointments at these clinics. Following basic descriptive statistics, component-based structural equation modeling was used to empirically explore the causal paths implied in the conceptual framework. A cluster analysis was also performed to complement the causal analysis. As a final step, 6 experts in MAS systems were interviewed. Qualitative data were then coded and extracted using standard content analysis methods. Results A total of 70 valid questionnaires were collected and analyzed. A large majority of the surveyed clinics had implemented MAS systems, with an average use of 1 or 2 functionalities, mainly “automated appointment confirmation and reminders” and “online appointment confirmation, modification, or cancellation by the patient.” More extensive use of MAS systems appears to contribute to improved availability of medical care in these clinics, notwithstanding the effect of their application of advanced access principles. Also, greater integration of MAS systems into the clinic’s electronic medical record system led to more extensive use. Our study further indicated that smaller clinics were less likely to undertake such integration and therefore showed less availability of medical care for their patients. Finally, our findings indicated that those clinics that showed a greater adoption rate and that used the provincial MAS system tended to be the highest-performing ones in terms of accessibility and availability of care. Conclusions The main contribution of this study lies in the empirical demonstration that greater integration and assimilation of MAS systems in family medicine clinics lead to greater accessibility and availability of care for their patients and the general population. Valuable insight has also been provided on how to identify the clinics that would benefit most from such digital health solutions.

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