After-hours service models in Queensland Australia: A framework for sustainability

2005 ◽  
Vol 11 (2) ◽  
pp. 9
Author(s):  
Lisa Crossland ◽  
Craig Veitch
Keyword(s):  
Medical Care ◽  
Service Providers ◽  
Care Service ◽  
Service Development ◽  
Key Factors ◽  
Primary Medical Care ◽  
Care Services ◽  
Management Procedures ◽  
Service Models ◽  
After Hours

This paper outlines the key features of after-hours primary medical care service sustainability in Queensland. It describes the development of these into a practical framework designed to assist either those in the early stages of service development or the evaluation of existing service models. A representative sample was drawn from over 120 separate formal after-hours services identified across Queensland. Semi-structured interviews were held with staff and key informants from 16 services and other local service providers in Queensland. Reviews of documents relating to operating and management procedures and protocols were also completed. Data were assembled and thematically analysed using the QSR NUD.IST qualitative data analysis package. Five key factors related to sustainability commonly featured in the after-hours primary medical care services studied: business management and promotion; collaborative service arrangements; effective protocols and guidelines; recruitment and retention strategies; and remuneration. These issues can be summarised in a table format that demonstrates the interaction between the identified key factors of sustainability and the various model types. The purpose of the diagram is to illustrate the interplay of factors which impact on the development and sustainability of after-hours primary medical care services currently extant in Queensland. It is the complex interaction of all these factors that ultimately determines the sustainability of an after-hours service model.

PP19 Primary care streaming in emergency departments- contexts and mechanisms associated with perceived effectiveness outcomes: a realist evaluation

2021 ◽  
Vol 38 (9) ◽  
pp. A9.1-A9
Author(s):  
Michelle Edwards ◽  
Alison Cooper ◽  
Freya Davies ◽  
Andrew Carson Stevens ◽  
Adrian Edwards ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Care Service ◽  
Realist Evaluation ◽  
Primary Care Service ◽  
Evaluation Methodology ◽  
Service Development ◽  
Service Models

BackgroundRecent policy has encouraged emergency departments (EDs) to deploy nurses to stream patients from the ED front door to GPs working in a separate GP service operating within or alongside an ED. We aimed to describe mechanisms relating to effectiveness of streaming in different primary care service models identified in EDs. We explored perceptions of whether patients were perceived to be appropriately streamed to emergency care, primary care, other hospital services or community primary care services; and effects on patient flow (waiting times and length of stay in the ED); and safe streaming outcomes.MethodsWe used realist evaluation methodology to explore perceived streaming effectiveness. We visited 13 EDs with different primary care service models (purposively selected across England & Wales; 8 streamed primary care patients to a primary care clinician) and carried out observations of triage/streaming and patient flow and interviews with key members of staff (consultants, GPs, nurses). Field notes and audio-recorded interviews were transcribed and analysed by creating context, mechanism and outcome configurations to refine and develop theories relating to streaming effectiveness.ResultsWe identified five contexts (nurses’ knowledge and experience, streaming guidance, teamwork and communication, operational management and strategic management) that facilitated mechanisms that influenced the effectiveness of streaming (streaming to an appropriate service, patient flow, delivering safe care). We integrated a middle range psychological theory (cognitive continuum theory) with our findings to recommend a focus for training nurses in streaming and service improvements.ConclusionsWe identified key mechanisms relating to the effectiveness of primary care streaming in different models of service. We recommend a collaborative approach to service development, guidance and training (including input from ED clinicians and primary care clinicians) and a range of training strategies that are suitable for less experienced junior nurses and more experienced senior nurses and nurse practitioners.

Giving support and getting help: Informal caregivers' experiences with palliative care services

2004 ◽  
Vol 2 (3) ◽  
pp. 265-272 ◽  
Author(s):  
ROY CAIN ◽  
MICHAEL MACLEAN ◽  
SCOTT SELLICK
Keyword(s):  
Palliative Care ◽  
Service Providers ◽  
Care Service ◽  
Informal Caregivers ◽  
Palliative Care Service ◽  
Later Life ◽  
Care Services ◽  
Thunder Bay ◽  
Palliative Care Services ◽  
The Common

Objective: Palliative care services have made significant contributions to those needing end-of-life care, but the effect of these services on informal caregivers is less clear. This article reviews the literature and examines the influences of palliative care services on caregivers of people who are dying of cancer, HIV-related illnesses, and illnesses of later life.Methods: Based on questions that we developed from the literature review, we conducted six focus groups in Toronto, Thunder Bay, and Ottawa, Canada, with informal caregivers about their experiences with caregiving and with palliative care services.Results: We outline the major themes relating to the 42 focus group participants' experiences of giving support and getting help.Significance of results: Our findings help us better understand the common concerns of caregivers of terminally ill seniors, people with HIV/AIDS, and people with cancer. The article discusses the implications of participants' experiences for palliative care service providers.

scholarly journals A Qualitative Exploration of the Needs of Community-Dwelling Patients Living with Moderate Dementia

2021 ◽  
Vol 18 (17) ◽  
pp. 8901
Author(s):  
Tzu-Pei Yeh ◽  
Hsing-Chia Chen ◽  
Wei-Fen Ma
Keyword(s):  
Home Care ◽  
Service Providers ◽  
Care Service ◽  
Home Care Services ◽  
Community Dwelling ◽  
End Of Life Decisions ◽  
Face To Face ◽  
Care Services ◽  
Moderate Dementia ◽  
Qualitative Exploration

Few studies have focused on developing a better understanding of the needs of patients with moderate-stage dementia. This study aimed to explore the needs of people living with moderate dementia and receiving home-care services from a local mental hospital. The study adopted a descriptive qualitative approach with purposive sampling to recruit patients with moderate dementia and receiving home-care services. Data were collected by face-to-face interviews and content analysis was used to interpret the experiences in the dialogue data. The results showed that the needs of people living with moderate dementia receiving home-care services contained four themes: the demand for company and care, the wish to recall familiar images, the need of reaffirming life purpose and value through reflection and reminiscence, and the desire for making autonomous end-of-life decisions. In addition to daily care, people living with moderate dementia crave companionship, expect meaningful exchanges of experiences to share their life, and have demands to have a voice in going through the final stage of life. The participants tended to focus more on issues related to the connections between living and dying. The results provide caregivers and home-care service providers with some insights into offering better care for people living with moderate dementia.

scholarly journals Learning from diagnostic error when primary care services are located in or alongside emergency departments: a theory generating mixed-methods study

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703277
Author(s):  
Alison Cooper ◽  
Andrew Carson-Stevens ◽  
Niro Siriwardena ◽  
Adrian Edwards
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Emergency Departments ◽  
Care Service ◽  
Diagnostic Error ◽  
Learning System ◽  
Care Staff ◽  
Care Services ◽  
Primary Care Services ◽  
Service Models

BackgroundNew healthcare service models are being introduced to help manage increasing demand on emergency healthcare systems including the provision of primary care services in or alongside emergency departments. There is little research evidence to guide decisions about how service models can be most effective and safe.AimFocusing on diagnostic error, the aim was to learn why errors occur to identify priority interventions.MethodTwo data sources were used to identify diagnostic error reports including: coroners’ reports to prevent future deaths; and the National Reporting and Learning System (NRLS). A cross-sectional, mixed-methods theory-generating study which used a multi-axial PISA classification system based on the recursive model for incident analysis, was carried out.ResultsNine Coroners’ reports (from a total of 1347 community and hospital reports, 2013–2018) and 217 NRLS reports (from 13 million, 2005–2015) were identified describing diagnostic error with learning relevant to primary care services in or alongside emergency departments. Clinical presentations included musculoskeletal injuries; unwell infants; headaches; and chest pains. Findings highlighted a difficulty identifying appropriate patients for the primary care service; underinvestigation; misinterpretation of diagnostic tests; underuse of safeguarding protocols; and inadequate communication and referral pathways between the services.ConclusionPriority areas to minimise risk of diagnostic error when primary care services are located in or alongside emergency departments include clinical decision support to triage and stream patients to the appropriate care setting; contextualised, workplace-based education and training for primary care staff; and standardised computer systems, communication and referral pathways between emergency and primary care services.

scholarly journals Assessing the interrelationships between customer satisfaction, perceived value and behavioral intention among Maldivians seeking medical care within medical tourism services: Empirical evidence from the Maldives

2021 ◽  
pp. 1845-1854
Author(s):  
Ahmed Ali Jaleel ◽  
Mohd Shukri Ab Yajid ◽  
Ali Khatibi ◽  
S. M. Ferdous Azam
Keyword(s):  
Customer Satisfaction ◽  
Medical Care ◽  
Behavioral Intention ◽  
Medical Tourism ◽  
Service Providers ◽  
Care Service ◽  
Perceived Value ◽  
Mediating Effect ◽  
Cross Sectional ◽  
The Relationship

Empirical studies related to interrelationships between variables perceived value, customer satisfaction and behavioral intention conducted in the Maldives context and in the medical care industry is very rare. A quantitative cross-sectional study conducted in natural settings using a survey questionnaire to assess the interrelationships between above mentioned variables by utilizing a conceptual model created from three interrelationship models obtained from previous research. Data collected from willing participants across the 19 atolls resulting in a total of 385 responses obtained after data cleaning. A stratified proportionate random sampling method used. SPSS 25.00 and AMOS 23.00 used as analysis tools. The Sobel test applied to analyze the mediating effect of customer satisfaction on the relationship between perceived value and behavioral intention which confirmed a positive and significant relationship between perceived value, customer satisfaction and behavioral intention. Study rejected the hypothesis which test the mediation of customer satisfaction on the relationship between perceived value and behavioral intention. This study is first of its kind to generalize findings on Maldivian’s medical seeking behavior, and results helps policymakers, medical practitioners, medical institutions, and respective administrations to provide better customer perceived value towards providing higher customer satisfaction, which in effect improve customer behavioral intention towards medical care service providers.

scholarly journals Developing a funding model for an after-hours primary medical care service in a rural town

1998 ◽  
Vol 21 (3) ◽  
pp. 104
Author(s):  
Peter O'Meara ◽  
Robert H Hall ◽  
Roger Strasser
Keyword(s):  
Medical Care ◽  
Care Service ◽  
Business Development ◽  
Development Phase ◽  
Full Time ◽  
Incentive Scheme ◽  
Funding Model ◽  
Rural Town ◽  
Medical Care Service ◽  
After Hours

The study described in this paper aimed to determine a funding model for an after-hoursprimary medical care service in the rural town of Moe, a socioeconomicallydisadvantaged area of Victoria suffering the rigours of industry restructuring andprivatisation. It has 12.5 equivalent full-time general practitioners servicing 21- 966persons.A break-even analysis of the financial viability compared the expected costs ofproviding the service with the anticipated income. A mixed funding model isrecommended. This would incorporate a general practitioner incentive scheme andState Government underwriting of infrastructure and basic non-medical staffing costsduring the business development phase to supplement the income from the HealthInsurance Commission.

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