Something old, something new, something borrowed, something blue? Reviewing the evidence on commissioning and health services

2016 ◽  
Vol 22 (1) ◽  
pp. 9 ◽  
Author(s):  
Suzanne Robinson ◽  
Helen Dickinson ◽  
Learne Durrington
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Health Reform ◽  
International Literature ◽  
Health Networks ◽  
Technical Aspects ◽  
Australian Health ◽  
Primary Health ◽  
Evidenced Based ◽  
Is Value

The concept of commissioning is starting to gain traction in the Australian health system. Primary Care Networks began operations in July 2015 with a remit around commissioning health services. Despite the centrality of this concept, we know relatively little about commissioning in Australia. Other systems have experimented with it for some time, and this paper reviews the evidence and lessons inherent within the international literature. The study defines commissioning, and explores experiences of others who have adopted commissioning approaches and the evidence concerning the outcomes of these experiments. Commissioning is a difficult topic in many senses and its application to a complex area such as health reform can make it even more challenging. Ultimately, this evidence suggests that commissioning is more than simply a technical or operational process, but one that is value-based and relational. This is not to downplay the technical aspects, which in many jurisdictions have resulted in explicit and evidenced-based approaches to planning and priority setting. However, if new commissioning organisations, such as Primary Health Networks, are to have an impact, they need to balance the operational and relational elements of commissioning.

Governance, transparency and alignment in the Council of Australian Governments (COAG) 2011 National Health Reform Agreement

2014 ◽  
Vol 38 (3) ◽  
pp. 288 ◽  
Author(s):  
Gianluca Veronesi ◽  
Kirsten Harley ◽  
Paul Dugdale ◽  
Stephanie D. Short
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Chronic Disease ◽  
Policy Analysis ◽  
Health System ◽  
Health Reform ◽  
Care Providers ◽  
Australian Health ◽  
Primary Health ◽  
Governance Arrangements

Objective This article provides a policy analysis of the Australian government’s National Health Reform Agreement (NHRA) by bringing to the foreground the governance arrangements underpinning the two arms of the national reforms, to primary health care and hospital services. Methods The article analyses the NHRA document and mandate, and contextualises the changes introduced vis-à-vis the complex characteristics of the Australian health care system. Specifically, it discusses the coherence of the agreement and its underlying objectives, and the consistency and logic of the governance arrangements introduced. Results The policy analysis highlights the rationalisation of the responsibilities between the Commonwealth and states and territories, the commitment towards a funding arrangement based on uniform measures of performance and the troubled emergence of a more decentralised nation-wide homogenisation of governance arrangements, plus efforts to improve transparency, accountability and statutory support to increase the standards of quality of care and safety. Conclusions It is suggested that the NHRA falls short of adequately supporting integration between primary, secondary and tertiary health care provision and facilitating greater integration in chronic disease management in primary care. Successfully addressing this will unlock further value from the reforms. What is known about the topic? The Council of Australian Governments (COAG) 2011 health reforms have introduced governance structures and transparency mechanisms that are unprecedented in the Australian context. There is still a gap in knowledge and overall understanding in relation to their significance and how they will fare given the complex characteristics of the Australian health system. What does this paper add? This article discusses the positive changes introduced, such as the rationalisation of the relationships between the Commonwealth and states and territories, the introduction of more transparent funding arrangements, the provision of unified governance templates and the potential gains in reducing waiting lists. It also highlights the most glaring shortcoming of the health reforms, which is the missed opportunity to strengthen integration between primary, secondary and tertiary care providers. What are the implications for practitioners? More effective integration between care providers appears to be one of the greatest challenges ahead. Further changes are needed to make the primary care and secondary and tertiary arms of the health system work together more effectively. Moreover, general practice needs to be brought into a closer working relationship with non-medical primary health and community care to tackle the growing burden of chronic disease.

scholarly journals Driving digital transformation of comprehensive primary health services at scale in India: an enterprise architecture framework

2021 ◽  
Vol 6 (Suppl 5) ◽  
pp. e005242
Author(s):  
Sunita Nadhamuni ◽  
Oommen John ◽  
Mallari Kulkarni ◽  
Eshan Nanda ◽  
Sethuraman Venkatraman ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Primary Healthcare ◽  
Enterprise Architecture ◽  
Digital Health ◽  
Security And Privacy ◽  
Primary Health ◽  
Architecture Framework ◽  
Primary Health Services ◽  
Enterprise Architecture Framework

In its commitment towards Sustainable Development Goals, India envisages comprehensive primary health services as a key pillar in achieving universal health coverage. Embedded in siloed vertical programmes, their lack of interoperability and standardisation limits sustainability and hence their benefits have not been realised yet. We propose an enterprise architecture framework that overcomes these challenges and outline a robust futuristic digital health infrastructure for delivery of efficient and effective comprehensive primary healthcare. Core principles of an enterprise platform architecture covering four platform levers to facilitate seamless service delivery, monitor programmatic performance and facilitate research in the context of primary healthcare are listed. A federated architecture supports the custom needs of states and health programmes through standardisation and decentralisation techniques. Interoperability design principles enable integration between disparate information technology systems to ensure continuum of care across referral pathways. A responsive data architecture meets high volume and quality requirements of data accessibility in compliance with regulatory requirements. Security and privacy by design underscore the importance of building trust through role-based access, strong user authentication mechanisms, robust data management practices and consent. The proposed framework will empower programme managers with a ready reference toolkit for designing, implementing and evaluating primary care platforms for large-scale deployment. In the context of health and wellness centres, building a responsive, resilient and reliable enterprise architecture would be a fundamental path towards strengthening health systems leveraging digital health interventions. An enterprise architecture for primary care is the foundational building block for an efficient national digital health ecosystem. As citizens take ownership of their health, futuristic digital infrastructure at the primary care level will determine the health-seeking behaviour and utilisation trajectory of the nation.

scholarly journals A Qualitative Study of Patients’ Perceptions of Dental Care in Primary Health Care

2020 ◽  
Author(s):  
Heriberto F. Sanchez ◽  
Andrea Maria D. Vargas ◽  
Marcos Azeredo F. Werneck ◽  
Efigênia F. Ferreira
Keyword(s):  
Primary Care ◽  
Oral Health ◽  
Qualitative Study ◽  
Health Services ◽  
Citizen Participation ◽  
Care Services ◽  
Primary Health ◽  
Primary Care Services ◽  
Belo Horizonte ◽  
The City

Knowledge of patients' views can contribute to the strengthening of health services. The aim of this study is to describe the patients' perception of a public oral health service, contributing to evaluations in health services. This is a qualitative study in which a focus group was conducted, with the participation of six patients of the oral health system in the city of Belo Horizonte, MG, Brazil, all with a minimum experience of three years of using the service. A theoretical model with dimensions aimed at assessing integrality and primary care services was used. In conducting the research, a semi-structured script was used. The data were analyzed by content analysis. The most representative categories for evaluating oral health actions in primary care are the health unit; the welcoming and its relation with the creation of the bond; service with a strong emphasis on the humanized relationship between professional and patient and on teamwork and; as a highlight, citizen participation, based on the recognition of a “system” that prevents the proper functioning of services and that must be fought with citizenship. Patients’ perceptions can be used to assess oral health in primary care from the perspective of those who actually use health services, seeking ultimately to constantly improve them. Knowledge of patients' perceptions may enable organizations to know their performance, through assessment methodologies based on the established perceptions.

Factors Influencing Access to Primary Health Care via School Health Services

PEDIATRICS ◽  
1980 ◽  
Vol 65 (3) ◽  
pp. 585-591
Author(s):  
Philip R. Nader ◽  
Susan Gilman ◽  
David E. Bee
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
School Health ◽  
Preventive Health Care ◽  
School Health Services ◽  
Family Status ◽  
Primary Health ◽  
Poor Access

The school health and community primary health care contacts were studied for a group of elementary school children who have sociodemographic characteristics often associated with poor access to primary health services. The school system is engaged in a demonstration project that attempts to link the home with community and school services. Visits to the school health room accounted for 85% of all contacts. A visit rate of 1.13 visits/child/year occurred at primary care sites. Ethnicity is the single most important predictor of use of school health services, followed by family status and number of visits for primary health care in the community. In contrast, use of community primary care facilities is best predicted by socioeconomic status (SES), family status, and sex. The patterns of care received by the population were characterized. Children whose care was initiated, referred, or facilitated by the school were designated as receiving "interactive" care, which occurred mostly among minority and lower SES children. The data suggest that the school provides access to preventive health care for all children and facilitates care for segments of the population that usually have difficulty achieving access to the health care system.

The Primary Care Practice Improvement Tool (PC-PIT) process for organisational improvement in primary care: application by Australian Primary Health Networks

2019 ◽  
Vol 25 (2) ◽  
pp. 185 ◽  
Author(s):  
Samantha J. Borg ◽  
Lisa Crossland ◽  
Jo Risk ◽  
Julie Porritt ◽  
Claire L. Jackson
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Care Home ◽  
Care Practice ◽  
Theory Approach ◽  
Health Networks ◽  
Practice Improvement ◽  
Primary Health ◽  
General Practices ◽  
Improvement Programs

The Primary Care Practice Improvement Tool (PC-PIT) is an organisational performance improvement tool recently implemented by two Primary Health Networks (PHNs). This study explored barriers and facilitators to implementing the PC-PIT process at scale, from the initial introduction of the tool to completion of Plan-Do-Study-Act cycles with general practices. Using a qualitative design, in-depth, semi-structured interviews were conducted with 10 PHN staff to seek feedback on the delivery of the PC-PIT to general practices. Interview results were analysed using a grounded theory approach. The identification of barriers such as difficulty engaging practices and lack of report sharing with the PHNs will help streamline future implementation. The PC-PIT was highly compatible with existing quality improvement programs and offers enhanced opportunity to support capacity building and implementation of the Health Care Home model.

scholarly journals Reconceptualising specialisation: integrating refugee health in primary care

2020 ◽  
Vol 26 (6) ◽  
pp. 452 ◽  
Author(s):  
Donata Sackey ◽  
Meryl Jones ◽  
Rebecca Farley
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Health System ◽  
Health Professionals ◽  
Care Patient ◽  
Refugee Health ◽  
Health Networks ◽  
Geographic Coverage ◽  
Unmet Health Needs ◽  
High Degree

People from a refugee background have significant unmet health needs including complex physical and psycho-social presentations. They can experience low trust, unfamiliarity with the health system and reliance on family and friends to access care. To address these needs, Australia has specialised refugee health services in each state and territory. The majority of these services transition patients to primary care, but this transition, although necessary, is difficult. Most primary care and specialised health professionals share a high degree of commitment to refugee patients; however, despite best efforts, there are gaps. More integrated health services can start to address gaps and promote continuity of care. A previous study has described 10 principles that are associated with successful integration; this paper references five of those principles (continuum of care, patient focus, geographic coverage, information systems and governance) to describe and map out the outcomes of an integrated model of care designed to deliver specialist refugee health in primary care. The Co-location Model is a partnership between a refugee health service, Primary Health Networks, a settlement agency and general practices. It has the potential to deliver benefits for patients, greater satisfaction for health professionals and gains for the health system.

scholarly journals Commissioning and equity in primary care in Australia: Views from Primary Health Networks

2017 ◽  
Vol 26 (1) ◽  
pp. 80-89 ◽  
Author(s):  
Julie Henderson ◽  
Sara Javanparast ◽  
Tamara MacKean ◽  
Toby Freeman ◽  
Fran Baum ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Networks ◽  
Primary Health

scholarly journals The Role of Primary Health Care Toward Healthy Aging

2021 ◽  
Vol 4 (1SP) ◽  
pp. 10
Author(s):  
Dhanasari Vidiawati ◽  
Yuda Turana ◽  
Tonny Sundjaya
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Services ◽  
Health Care Services ◽  
Healthy Aging ◽  
The Elderly ◽  
Preventive Health ◽  
Care Services ◽  
Primary Health

Background: According to the World Health Organization, healthy aging is the process of developing and maintaining functional abilities that make the elderly happy. The increase in the elderly population requires more attention. In particular, health services at the primary health care level face problems related to the limited capacity of overall health services, especially in terms of health promotion and preventive health issues. It is necessary to improve the quality of health care services for the elderly to prevent greater health problems among the elderly population.Objectives: Understand the need to provide holistic health services for healthy aging and use their capabilities, and strengthen cooperation among health professionals in achieving healthy aging.Discusion: Primary health care is pointed out that primary health care should provide comprehensive services in a holistic manner to support a healthy aging process. Therefore, a well-structured, integrated, and cross-industry collaborative primary care system is needed. The system should include changes in professional behavior, coordination of care, and participation of patients' families and communities in comprehensive health care. This can be achieved through inter-professional education, continuous training and education of primary health care professionals, as well as primary health care services and cross-level health care technology innovation.Conclusions: Healthy aging is not just the absence of disease. Everyone in health and social care at all levels can play a role to help improve healthy aging. To make the elderly healthy, starting from the prevention of young health problems, it requires collaboration between health workers, primary health care and other health service levels, and health care that cooperates with patients, families, and communities.Keywords: healthy aging, primary care, preventive, health worker

scholarly journals 'It's whanaungatanga and all that kind of stuff': Maori cancer patients’ experiences of health services

2013 ◽  
Vol 5 (4) ◽  
pp. 308 ◽  
Author(s):  
Tania Slater ◽  
Anna Matheson ◽  
Cheryl Davies ◽  
Huia Tavite ◽  
Triny Ruhe ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Services ◽  
Continuity Of Care ◽  
Cancer Care ◽  
Health Providers ◽  
Primary Health ◽  
Practical Support ◽  
Maori Health ◽  
The Impact

INTRODUCTION: There are unacceptable ethnic differences in cancer survival in Aotearoa/New Zealand. For people with cancer, quality of life and survival are shaped by access to care, but research on Maori access to, and through, cancer care is limited. Internationally, research has shown that primary care plays an important role in providing patient-centred, holistic care and information throughout the cancer care journey. Additionally, Maori health providers provide practical support and facilitate access to all levels of health care. Here we describe the cancer journeys of Maori patients and whanau and identify factors that may facilitate or inhibit access to and through cancer care services. METHODS: Twelve Maori patients affected by cancer and their whanau (family) in the lower North Island took part in face-to-face semi-structured interviews exploring their experiences of cancer screening, diagnosis, treatment, survival and palliative care. FINDINGS: Three key areas were identified that impacted upon the cancer care journey: the experience of support; continuity of care; and the impact of financial and geographic determinants. CONCLUSION: Primary care plays a key role in support and continuity of care across the cancer journey. Alongside interpersonal rapport, a long-term relationship with a primary health provider facilitated a more positive experience of the cancer care journey, suggesting that patients with a ‘medical home’ are happier with their care and report less problems with coordination between services. Positive, longstanding relationships with general practitioners and Maori health providers assisted patients and whanau with the provision and understanding of information, alongside practical support. KEYWORDS: Cancer; family; health services, indigenous; Maori health; primary health care cancer

Did Massachusetts Health Reform Affect Veterans Affairs Primary Care Use?

2016 ◽  
Vol 75 (1) ◽  
pp. 33-45 ◽  
Author(s):  
Edwin S. Wong ◽  
Matthew L. Maciejewski ◽  
Paul L. Hebert ◽  
Adam Batten ◽  
Karin M. Nelson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Health Services ◽  
New England ◽  
Healthcare System ◽  
Administrative Data ◽  
Health Reform ◽  
Veterans Affairs ◽  
Difference In Difference ◽  
Difference Methods

Massachusetts Health Reform (MHR), implemented in 2006, introduced new health insurance options that may have prompted some veterans already enrolled in the Veterans Affairs Healthcare System (VA) to reduce their reliance on VA health services. This study examined whether MHR was associated with changes in VA primary care (PC) use. Using VA administrative data, we identified 147,836 veterans residing in Massachusetts and neighboring New England (NE) states from October 2004 to September 2008. We applied difference-in-difference methods to compare pre–post changes in PC use among Massachusetts and other NE veterans. Among veterans not enrolled in Medicare, VA PC use was not significantly different following MHR for Massachusetts veterans relative to other NE veterans. Among VA–Medicare dual enrollees, MHR was associated with an increase of 24.5 PC visits per 1,000 veterans per quarter ( p = .048). Despite new non-VA health options through MHR, VA enrollees continued to rely on VA PC.

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