Patient Choice of Health Care Providers in China: Primary Care Facilities versus Hospitals

Purpose: A modified Delphi process was used to identify key features of interdisciplinary nutrition services, including provider roles and responsibilities for Ontario Family Health Networks (FHNs), a family physician-based type of primary care. Methods: Twenty-three representatives from interested professional organizations, including three FHN demonstration sites, completed a modified Delphi process. Participants reviewed evidence from a systematic literature review, a patient survey, a costing analysis, and key informant interview results before undertaking the Delphi process. Statements describing various options for services were developed at an in-person meeting, which was followed by two rounds of e-mail questionnaires. Teleconference discussions were held between rounds. Results: An interdisciplinary model with differing and complementary roles for health care providers emerged from the process. Additional key features addressing screening for nutrition problems, health promotion and disease prevention, team collaboration, planning and evaluation, administrative support, access to care, and medical directives/delegated acts were identified. Under the proposed model, the registered dietitian is the team member responsible for managing all aspects of nutrition services, from needs assessment to program delivery, as well as for supporting all providers’ nutrition services. Conclusions: The proposed interdisciplinary nutrition services model merits evaluation of cost, effectiveness, applicability, and sustainability in team-based primary care service settings.

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Patient Suffering in Chronic Digestive Diseases: Will Primary Care-Specialist Collaboration With Effective Interactive Communication and Integrative Medicine in the Plan of Care Improve Quality of Life?

Journal of Patient Experience ◽

10.1177/2374373520967798 ◽

2020 ◽

Vol 7 (6) ◽

pp. 989-993

Author(s):

Andrew Thomas ◽

Annie Thomas

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Health Care ◽

Health Care Providers ◽

The United States ◽

Care Providers ◽

Physician Visits ◽

Digestive Diseases ◽

Care Specialist

Acute and chronic digestive diseases are causing increased burden to patients and are increasing the United States health care spending. The purpose of this case report was to present how nonconfirmatory and conflicting diagnoses led to increased burden and suffering for a patient thus affecting quality of life. There were many physician visits and multiple tests performed on the patient. However, the primary care physician and specialists could not reach a confirmatory diagnosis. The treatment plans did not offer relief of symptoms, and the patient continues to experience digestive symptoms, enduring this burden for over 2 years. The central theme of this paper is to inform health care providers the importance of utilizing evidence-based primary care specialist collaboration models for better digestive disease outcomes. Consistent with patient’s experience, the authors propose to pilot/adopt the integrative health care approaches that are proven effective for treating digestive diseases.

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Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals (Preprint)

10.2196/preprints.24157 ◽

2020 ◽

Author(s):

Inga Hunter ◽

Phoebe Elers ◽

Caroline Lockhart ◽

Hans Guesgen ◽

Amardeep Singh ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Older People ◽

Health Care Providers ◽

Health Care Professionals ◽

Information Needs ◽

Sensor Data ◽

Care Providers ◽

Community Based ◽

Age In Place

BACKGROUND Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. OBJECTIVE The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being. METHODS Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. RESULTS The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns. CONCLUSIONS The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

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Providing gender-affirming hormone therapy through primary care: Service users' and health professionals' experiences of a pilot clinic

10.26686/wgtn.12693110.v1 ◽

2020 ◽

Author(s):

A Ker ◽

Gloria Fraser ◽

Antonia Lyons ◽

C Stephenson ◽

T Fleming

Keyword(s):

Primary Care ◽

Health Care ◽

New Zealand ◽

Hormone Therapy ◽

Health Care Providers ◽

Health Professionals ◽

Care Service ◽

Gender Diversity ◽

Service Users ◽

Care Providers

© 2020 CSIRO Publishing Journal Compilation © Royal New Zealand College of General Practitioners 2020 This is an open access article licensed under a. INTRODUCTION: Primary health care providers are playing an increasingly important role in providing gender-affirming health care for gender diverse people. This article explores the experiences of a primary care-based pilot clinic providing gender-affirming hormone therapy in Wellington, New Zealand. AIM: To evaluate service users' and health professionals' experiences of a pilot clinic at Mauri Ora (Victoria University of Wellington's Student Health and Counselling Service) that provided gender-affirming hormones through primary care. METHODS: In-depth interviews were conducted with four (out of six) service users and four health professionals about their perspectives on the clinic. Interviews were transcribed verbatim and analysed using thematic analysis. RESULTS: Three themes were identified in service users' interviews, who discussed receiving affirming care due to the clinic's accessibility, relationship-centred care and timeliness. Three themes were identified in the health professionals' interviews, who described how the clinic involves partnership, affirms users' gender and agency, and is adaptable to other primary care settings. Both service users and health professionals discussed concerns about the lack of adequate funding for primary care services and the tensions between addressing mental health needs and accessing timely care. DISCUSSION: The experiences of service users and health professionals confirm the value of providing gender-affirming hormone therapy in primary care. Models based in primary care are likely to increase accessibility, depathologise gender diversity and reduce wait times.

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Impact of mental health and addiction NIMHANS ECHO on primary care physicians: study from a rural state of India

BJPsych Open ◽

10.1192/bjo.2021.438 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S157-S157

Author(s):

Shabinabegam A M Sheth ◽

Bhavya Bairy ◽

Aurobind Ganesh ◽

Sumi Jain ◽

Prabhat Chand ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Primary Health Care ◽

Health Care Providers ◽

Mental Health Problems ◽

Health Problems ◽

Care Providers ◽

Primary Health ◽

Secondary Outcomes

AimsAs per National Mental Health Survey-2015-16, 83 out of 100 people having mental health problems do not have access to care in India. Further, primary health care providers (PCPs) have not been adequately trained in the screening, diagnosis, and initial management of common mental health conditions. There is thus a need to train health care providers at the State level to incorporate mental health into primary health care. In this paper, we report the findings of a collaborative project between the National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore India, and the state of Chhattisgarh incorporating mental health into primary care and addressing urban-rural disparities through tele-mentoring.MethodWe assessed the impact of the NIMHANS Extended Community Health Care Outcome (ECHO), an online, blended training program on participants' knowledge and competence (primary outcome) and commitment, satisfaction, and performance (Secondary outcomes) using Moore's evaluation framework. Primary and secondary outcomes were determined through a pre-post evaluation, assessment of trainee participation in the quarterly tele ECHO clinic as well as periodic assignments, respectively.ResultOver ten months of the NIMHANS ECHO program, there was a significant improvement in the participants' knowledge post-ECHO (p < 0.05, t = −3.52). Self-efficacy in diagnosis and management of mental health problems approached significance; p < 0.001. Increased engagement in tele-ECHO sessions was associated with better performance for declarative and procedural knowledge. The attrition rate was low (5 out of 30 dropped out), and satisfaction ratings of the course were high across all fields. The participants reported a 10- fold increase in the number of patients with mental health problems they had seen, following the training. A statistically significant increase in the number of psychotropic drugs prescribed post ECHO with t = −3.295, p = 0.01.ConclusionThe outcomes indicate that the NIMHANS ECHO with high participant commitment is a model with capacity building potential in mental health and addiction for remote and rural areas by leveraging technology. This model has the potential to be expanded to other states in the country in providing mental health care to persons in need of care.

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Issues Associated With the Management and Governance of Sensor Data and Information to Assist Aging in Place: Focus Group Study With Health Care Professionals

JMIR mhealth and uhealth ◽

10.2196/24157 ◽

2020 ◽

Vol 8 (12) ◽

pp. e24157

Author(s):

Inga Hunter ◽

Phoebe Elers ◽

Caroline Lockhart ◽

Hans Guesgen ◽

Amardeep Singh ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Older People ◽

Health Care Providers ◽

Health Care Professionals ◽

Information Needs ◽

Sensor Data ◽

Care Providers ◽

Community Based ◽

Age In Place

Background Smart home and telemonitoring technologies have often been suggested to assist health care workers in supporting older people to age in place. However, there is limited research examining diverse information needs of different groups of health care workers and their access to appropriate information technologies. Objective The aim of this study was to investigate the issues associated with using technologies that connect older people to their health care providers to support aging in place and enhance older people’s health and well-being. Methods Seven focus group discussions were conducted comprising 44 health care professionals who provided clinic-based or in-home services to community-dwelling older people. Participants were asked about their information needs and how technology could help them support older people to age in place. The recordings of the sessions were transcribed and thematically analyzed. Results The perspectives varied between the respondents who worked in primary care clinics and those who worked in community-based services. Three overarching themes were identified. The first theme was “access to technology and systems,” which examined the different levels of technology in use and the problems that various groups of health care professionals had in accessing information about their patients. Primary care professionals had access to good internal information systems but they experienced poor integration with other health care providers. The community-based teams had poor access to technology. The second theme was “collecting and sharing of information,” which focused on how technology might be used to provide them with more information about their patients. Primary care teams were interested in telemonitoring for specific clinical indicators but they wanted the information to be preprocessed. Community-based teams were more concerned about gaining information on the patients’ social environment. The third theme was that all respondents identified similar “barriers to uptake”: cost and funding issues, usability of systems by older people, and information security and privacy concerns. Conclusions The participants perceived the potential benefits of technologies, but they were concerned that the information they received should be preprocessed and integrated with current information systems and tailored to the older people’s unique and changing situations. Several management and governance issues were identified, which needed to be resolved to enable the widespread integration of these technologies into the health care system. The disconnected nature of the current information architecture means that there is no clear way for sensor data from telemonitoring and smart home devices to be integrated with other patient information. Furthermore, cost, privacy, security, and usability barriers also need to be resolved. This study highlights the importance and the complexity of management and governance of systems to collect and disseminate such information. Further research into the requirements of all stakeholder groups and how the information can be processed and disseminated is required.

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Antibiotic prescribing practice in residential aged care facilities — health care providers' perspectives

The Medical Journal of Australia ◽

10.5694/mja14.01422 ◽

2015 ◽

Vol 202 (4) ◽

pp. 180-180 ◽

Cited By ~ 2

Author(s):

Ching Jou Lim ◽

Megan W‐L Kwong ◽

David C M Kong

Keyword(s):

Health Care ◽

Health Care Providers ◽

Aged Care ◽

Residential Aged Care ◽

Antibiotic Prescribing ◽

Care Providers ◽

Care Facilities ◽

Prescribing Practice ◽

Aged Care Facilities ◽

Residential Aged Care Facilities

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Two Alternatives to Intensive Care

Ethics & Medics ◽

10.5840/em20174212 ◽

2017 ◽

Vol 42 (1) ◽

pp. 3-4

Author(s):

Alex Fleming ◽

Keyword(s):

Health Care ◽

Intensive Care ◽

Health Care Providers ◽

Hospice Care ◽

Treatment Options ◽

Care Providers ◽

Health Care Decisions ◽

Care Facilities ◽

The Many

The overall quality of life in palliative and hospice care facilities differs greatly from that in intensive care units. For example, the use of mechanical ventilation and powerful anesthetics and sedatives in the ICU can often leave otherwise informed patients incapacitated and unable to make their own health care decisions. Thus, discussions between patients and families about treatment options can be difficult, and families and surrogates are often left to do this on their own Treatments performed in the ICU are likely to be disproportionate to their needs, adding to suffering and distrust on the part of family members. To avoid this, it is important for health care providers to assess patients early and often and to discuss the proportionality of different treatments with their families and surrogates. Additionally, providers should encourage palliative and hospice care as alternatives to the many costly and likely disproportionate interventions taken in the ICU.

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Tinkering at the margins: evaluating the pace and direction of primary care reform in Ontario, Canada

BMC Family Practice ◽

10.1186/s12875-019-1014-8 ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Monica Aggarwal ◽

A. Paul Williams

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Providers ◽

Quantitative Methods ◽

Audit And Feedback ◽

Political Agenda ◽

Care Providers ◽

System Transformation ◽

Primary Care Reform ◽

Care Assessment

Abstract Background Primary care reform has been on the political agenda in Canada and many industrialized countries for several decades; it is widely seen as the foundation for broader health system transformation. Federal investments in primary care, including major cash transfers to provinces and territories as part of a 10-year health care funding agreement in 2004, triggered waves of primary care reform across Canada. Nevertheless, Commonwealth Fund surveys show, Canada continues to lag behind other industrialized nations with respect to timely access to care, electronic medical record use and audit and feedback for quality improvement in primary care. This paper evaluates the pace and direction of primary care reform as well as the extent of resulting change in the organization and delivery of primary care in Ontario, Canada’s most populous province. Methods Qualitative and quantitative methods were used for this study. A literature review was conducted to analyze the core dimensions of primary care reform, the history of reform in Ontario, and the extent to which different dimensions are integrated into Ontario’s models. Quantitative data on the number of family physicians/general practitioners and patients enrolled in these models was examined over a 10-year period to determine the degree of change that has taken place in the organization and delivery of primary care in Ontario. Results There are 11 core reform dimensions that individually and collectively shift from conventional primary care toward the more expansive vision of primary health care. Assessment of Ontario’s models against these core dimensions demonstrate that there has been little substantive change in the organization and delivery of primary care over 10 years in Ontario. Conclusions Primary care reform is a multi-dimensional construct with different reform models bundling core dimensions in different ways. This understanding is important to move beyond the rhetoric of “reform” and to critically assess the pace and direction of change in primary care in Ontario and in other jurisdictions. The conceptual framework developed in this paper can assist decision-makers, academics and health care providers in all jurisdictions in evaluating the pace of change in the primary care sector, as well as other sectors.

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