scholarly journals How to engage French professionals to undertake social responsibility at a local level?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
S Gautier ◽  
Y Bourgueil
Keyword(s):  
Primary Care ◽  
Access To Care ◽  
Health Professionals ◽  
Local Level ◽  
Radical Change ◽  
Team Work ◽  
Professional Commitment ◽  
Fee For Service ◽  
Structured Interviews ◽  
Integration Of Care

Abstract Background In France, primary care is organised according to the principles of private practice: independent providers, payment by fee for service, freedom of settlement... Successive reforms have introduced more regulation i.e. gatekeeping role for GPs, better recognition of professional groups, new forms of payment and promotion of team work and multi-professional practices. Today, the concept of Health Territorial and Professional Communities (HTPC) is becoming a key element of health care reform encouraging primary care professionals to meet with specialists and social workers at a larger level than practice. HTPC should address issues such as access to services, coordination of care and promoting of preventive actions toward populations. This implies change in the roles, skills, methods and resources needed on both professional and regulatory sides. This study explores levers of the professional commitment in the HTPC and resources necessary for it. Methods We conducted a qualitative multiple case study in three French regions. Data was collected from thirty semi-structured interviews with key national informants, regional regulators and health professionals themselves. Results Professional commitment emerges at a local level on a territory defined by the collaboration practices and habits following a bottom-up process. The integration of care relies on the size of the HTPC which allows them to know each other and to work together to improve access to care and patient’s disease management. In order to achieve that, professionals claim to have access to administrative health data and to be able to analyze it. They need to develop news skills in management and group animation. The function and training of coordination professionals appear to be essential. Conclusions The professional commitment in HTPC relies on professional empowerment toward collective activities. This requires autonomy, skills and new roles both for professionals and regulatory authorities. Key messages French government relies on professionals’ investment at the territorial level by implementing HTPC to guarantee access to care and respond to population needs in primary care. HTPC implementation implies radical change for the professionals to undertake social and populational responsibility for which public health professionals should help to meet the challenge.

scholarly journals How primary care and public health interact in local health contracts in France?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M s Kendir ◽  
Mr Le Bodo ◽  
M r Breton ◽  
M r Bourgueil
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Access To Care ◽  
Health Care Services ◽  
Local Level ◽  
Rapid Decline ◽  
Local Health ◽  
Epidemiological Changes ◽  
The Impact ◽  
Primary Care Professionals

Abstract The demographic and epidemiological changes orient health care services towards communities with a focus on prevention and health promotion. Moreover, in France, the rapid decline of General Practitioners affect access to care in certain areas. Thus, it has made a call for interaction of primary care (PC) services and public health which can be strengthened by the actions at the local level. In 2009, the local health contracts (Contract local de santé; CLS) were developed to foster collaborative actions on the social determinants of health and to improve access to care. Considering the critical contribution of PC in these issues, one may ask how CLS mobilized PC and facilitate linkages between actions oriented toward population and primary care. The objective of this ancillary study (part of the CloterreS project), is to explore how often and how CLS involve PC in access to care and public health related actions. A mixed-method study based on document analysis, with a random sample of 17 CLSs (N = 165) from all French regions, was developed. A quantitative analysis of the 440 forms identified in 17 CLS computed frequency of involvement of PC actors and/or PC organizations and a qualitative analysis defined typology of interactions. All CLS and 20.1% (n = 86) of the forms involved PC actors and 43.2% (n = 185) concerned access to care. Of the access to care forms, 35.7% (n = 66) concerned PC. The most common strategies related to actions on the health workforce and on planning of services. The role of primary care professionals was as the target of the action and rarely as leader and partner. PC, mostly GP’s involvement, had a big place and access to care was at the core of local health contracts. The impact of CLS as an instrument to invite interaction public health and healthcare at the local level should be further assessed. Key messages Many of the local access to care actions involved primary care professionals. The local level appears strategic to integrate public health and health services yet more evidence is needed on its role.

scholarly journals An implementation history of primary health care transformation: Alberta’s primary care networks and the people, time and culture of change

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Myles Leslie ◽  
Akram Khayatzadeh-Mahani ◽  
Judy Birdsell ◽  
P. G. Forest ◽  
Rita Henderson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Improvement ◽  
Primary Health Care ◽  
Fee For Service ◽  
Structured Interviews ◽  
Policy Documents ◽  
Incremental Change ◽  
Primary Health ◽  
History Of

Abstract Background Primary care, and its transformation into Primary Health Care (PHC), has become an area of intense policy interest around the world. As part of this trend Alberta, Canada, has implemented Primary Care Networks (PCNs). These are decentralized organizations, mandated with supporting the delivery of PHC, funded through capitation, and operating as partnerships between the province’s healthcare administration system and family physicians. This paper provides an implementation history of the PCNs, giving a detailed account of how people, time, and culture have interacted to implement bottom up, incremental change in a predominantly Fee-For-Service (FFS) environment. Methods Our implementation history is built out of an analysis of policy documents and qualitative interviews. We conducted an interpretive analysis of relevant policy documents (n = 20) published since the first PCN was established. We then grounded 12 semi-structured interviews in that initial policy analysis. These interviews explored 11 key stakeholders’ perceptions of PHC transformation in Alberta generally, and the formation and evolution of the PCNs specifically. The data from the policy review and the interviews were coded inductively, with participants checking our emerging analyses. Results Over time, the PCNs have shifted from an initial Frontier Era that emphasized local solutions to local problems and featured few rules, to a present Era of Accountability that features central demands for standardized measures, governance, and co-planning with other elements of the health system. Across both eras, the PCNs have been first and foremost instruments and supporters of family physician authority and autonomy. A core group of people emerged to create the PCNs and, over time, to develop a long-term Quality Improvement (QI) vision and governance plan for them as organizations. The continuing willingness of both these groups to work at understanding and aligning one another’s cultures to achieve the transformation towards PHC has been central to the PCNs’ survival and success. Conclusions Generalizable lessons from the implementation history of this emerging policy experiment include: The need for flexibility within a broad commitment to improving quality. The importance of time for individuals and organizations to learn about: quality improvement; one another’s cultures; and how best to support the transformation of a system while delivering care locally.

Clinical Judgment and the Influence of Screening on Decision Making

2009 ◽  
Author(s):  
Howard N. Garb
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Clinical Practice ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Clinical Judgment ◽  
Structured Interviews ◽  
Primary Care Settings ◽  
Broad Array ◽  
Clinically Depressed

How do clinicians arrive at diagnostic decisions? In most cases the decision is not made following formal criteria, but by intuition. In addition, routine interviews are often narrow and the feedback gleaned from patients is inadequate. Yet it is not clear if screening helps or hinders clinical judgment. It might be that only clinicians who have low confidence and interviewing and diagnostic skills are open to the use of and actually helped by diagnostic tools. To provide a theoretical framework for understanding why it is difficult for physicians to detect depression in primary care settings, a broad array of research in the mental health fields can be described. For example, more than 1,000 studies have been conducted on clinical judgment in the area of mental health practice, and the results from these studies can be used to illuminate the challenges physicians face in judging whether a patient is clinically depressed and can benefit from treatment. In this chapter, results on clinical judgment will be described. A second topic will also be briefly discussed. Results from research on clinical judgment would seem to indicate that screening should be of value. Yet, as noted in Chapter 7, stand-alone screening programs have added little or nothing to outcomes. Reasons for this unexpected result will be explored. Three topics will be discussed: (1) narrowness of interviews, (2) nature of patient feedback, and (3) the cognitive processes of clinicians. Depression goes undetected because in many cases physicians do not ask patients if they have symptoms of a depressive mood disorder.3 To place this in context, it can be noted that mental health professionals also often do not ask patients about important symptoms and behaviors. Failure to inquire about depression in primary care settings can be viewed in the broader context of failure to inquire about important symptoms and events in mental health settings. Research on clinical judgment has demonstrated that lack of comprehensiveness is often a problem for interviews made in clinical practice. For example, in one study,4 mental health professionals saw patients in routine clinical practice, and afterwards research investigators conducted semi-structured interviews with the patients. Remarkably, the mental health professionals had evaluated only about 50% of the symptoms that were recorded using the semi-structured interviews.

scholarly journals Factors affecting decisions to extend access to primary care: results of a qualitative evaluation of general practitioners’ views

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019084 ◽  
Author(s):  
Sally Fowler Davis ◽  
Hilary Piercy ◽  
Sarah Pearson ◽  
Ben Thomas ◽  
Shona Kelly
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Hospital Admissions ◽  
Local Level ◽  
Qualitative Evaluation ◽  
Urgent Care ◽  
Structured Interviews ◽  
Care Programme ◽  
Access To Primary Care ◽  
Programme Planning

ObjectivesTo report general practitioners’ (GPs’) views and experiences of an Enhanced Primary Care programme (EPCP) funded as part of the Prime Minister’s Challenge Fund (second wave) for England which aimed to extend patient access to primary care.SettingPrimary care in Sheffield, England.ParticipantsSemi-structured interviews with a purposive sample of GPs working in 24 practices across the city.ResultsFour core themes were derived: GPs’ receptivity to the aims of the EPCP, their capacity to support integrated care teams, their capacity to manage urgent care and the value of some new community-based schemes to enhance locality-based primary care. GPs were aware of the policy initiatives associated with out-of-hours access that aimed to reduce emergency department and hospital admissions. Due to limited capacity to respond to the programme, they selected elements that directly related to local patient demand and did not increase their own workload.ConclusionsThe variation in practice engagement and capacity to manage changes in primary care services warrants a subtle and specialist approach to programme planning. The study makes the case for enhanced planning and organisational development with GPs as stakeholders within individual practices and groups. This would ensure that policy implementation is effective and sustained at local level. A failure to localise implementation may be associated with increased workloading in primary care without the sustained benefits to patients and the public. To enable GPs to become involved in systems transformation, further research is needed to identify the best methods to engage GPs in programme planning and evaluation.

Integrating behavioral health and primary care: a qualitative analysis of financial barriers and solutions

2020 ◽  
Vol 10 (3) ◽  
pp. 648-656
Author(s):  
Alison C Shmerling ◽  
Stephanie B Gold ◽  
Emma C Gilchrist ◽  
Benjamin F Miller
Keyword(s):  
Primary Care ◽  
Behavioral Health ◽  
Service System ◽  
Evidence Base ◽  
Fee For Service ◽  
Structured Interviews ◽  
Financial Barriers ◽  
Stakeholder Collaboration ◽  
Integrated Behavioral Health ◽  
Future Policy

Abstract The objective of this study was to characterize financial barriers and solutions for the integration of behavioral health in primary care at the practice and system levels. Semi-structured interviews were conducted March–August of 2015 with 77 key informants. Initially a broad thematic coding approach was used, and data coded as “financing” was further analyzed in ATLAS.ti using an inductive thematic approach by three coders. Themes identified included the following: fragmentation of payment and inadequate investment limit movement toward integration; the evidence base for integration is not well known and requires appropriately structured further study; fee-for-service limits the movement to integration—an alternative payment system is needed; there are financial considerations beyond specific models of payment, including incentivizing innovation, prevention, and practice transformation support; stakeholders need to be engaged and aligned to support this process. There was consensus that the current fragmented, fee-for-service system with inadequate baseline reimbursement significantly hinders progression toward integrated behavioral health and primary care. Funding is needed both to support integrated care and to facilitate the transition to a new model. Multiple suggestions were offered regarding interim solutions to move toward an integrated model and ultimately global payment. Payment, in terms of both adequate amount and model, is a significant obstacle to integrating behavioral health and primary care. Future policy efforts must focus on ensuring stakeholder collaboration, multi-payer alignment, increasing investment in behavioral health and primary care, and moving away from fee-for-service toward a global and value-based payment model.

scholarly journals An Implementation History of Primary Health Care Transformation: Alberta’s Primary Care Networks and the People, Time and Culture of change

2020 ◽  
Author(s):  
Myles Leslie ◽  
Akram Khayatzadeh-Mahani ◽  
Judy Birdsell ◽  
PG Forest ◽  
Rita Henderson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Improvement ◽  
Primary Health Care ◽  
Fee For Service ◽  
Structured Interviews ◽  
Policy Documents ◽  
Incremental Change ◽  
Primary Health ◽  
History Of

Abstract Background: Primary care, and its transformation into Primary Health Care (PHC), has become an area of intense policy interest around the world. As part of this trend Alberta, Canada, has implemented Primary Care Networks (PCNs). These are decentralized organizations, mandated with supporting the delivery of PHC, funded through capitation, and operating as partnerships between the province’s healthcare administration system and family physicians. This paper provides an implementationhistory of the PCNs, giving a detailed account of how people, time, and culture have interacted to implement bottom up, incremental change in a predominantly Fee-For-Service (FFS) environment.Methods: Our implementation history is built out of an analysis of policy documents and qualitative interviews. We conducted an interpretive analysis of relevant policy documents (n=20) published since the first PCN was established. We then grounded 12 semi-structured interviews in that initial policy analysis. These interviews explored 11 key stakeholders’ perceptions of PHC transformation in Alberta generally, and the formation and evolution of the PCNs specifically. The data from the policy review and the interviews were coded inductively, with participants checking our emerging analyses.Results: Over time, the PCNs have shifted from an initial Frontier Era that emphasized local solutions to local problems and featured few rules, to a present Era of Accountability that features central demands for standardized measures, governance, and co-planning with other elements of the health system. Across both eras, the PCNs have been first and foremost instruments and supporters of family physician authority and autonomy. A core group of people emerged to create the PCNs and, over time, to develop a long-term Quality Improvement (QI) vision and governance plan for them as organizations. The continuing willingness of both these groups to work at understanding and aligning one another’s cultures to achieve the transformation towards PHC has been central to the PCNs’ survival and success.Conclusions: Generalizable lessons from the implementation history of this emerging policy experiment include: The need for flexibility within a broad commitment to improving quality. The importance of time for individuals and organizations to learn about: quality improvement; one another’s cultures; and how best to support the transformation of a system while delivering care locally.

scholarly journals An implementation history of primary health care transformation: Alberta’s primary care networks and the people, time and culture of change

2020 ◽  
Author(s):  
Myles Leslie ◽  
Akram Khayatzadeh-Mahani ◽  
Judy Birdsell ◽  
PG Forest ◽  
Rita Henderson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Improvement ◽  
Primary Health Care ◽  
Fee For Service ◽  
Structured Interviews ◽  
Policy Documents ◽  
Incremental Change ◽  
Primary Health ◽  
History Of

Abstract Background: Primary care, and its transformation into Primary Health Care (PHC), has become an area of intense policy interest around the world. As part of this trend Alberta, Canada, has implemented Primary Care Networks (PCNs). These are decentralized organizations, mandated with supporting the delivery of PHC, funded through capitation, and operating as partnerships between the province’s healthcare administration system and family physicians. This paper provides an implementationhistory of the PCNs, giving a detailed account of how people, time, and culture have interacted to implement bottom up, incremental change in a predominantly Fee-For-Service (FFS) environment.Methods: Our implementation history is built out of an analysis of policy documents and qualitative interviews. We conducted an interpretive analysis of relevant policy documents (n=20) published since the first PCN was established. We then grounded 12 semi-structured interviews in that initial policy analysis. These interviews explored 11 key stakeholders’ perceptions of PHC transformation in Alberta generally, and the formation and evolution of the PCNs specifically. The data from the policy review and the interviews were coded inductively, with participants checking our emerging analyses.Results: Over time, the PCNs have shifted from an initial Frontier Era that emphasized local solutions to local problems and featured few rules, to a present Era of Accountability that features central demands for standardized measures, governance, and co-planning with other elements of the health system. Across both eras, the PCNs have been first and foremost instruments and supporters of family physician authority and autonomy. A core group of people emerged to create the PCNs and, over time, to develop a long-term Quality Improvement (QI) vision and governance plan for them as organizations. The continuing willingness of both these groups to work at understanding and aligning one another’s cultures to achieve the transformation towards PHC has been central to the PCNs’ survival and success.Conclusions: Generalizable lessons from the implementation history of this emerging policy experiment include: The need for flexibility within a broad commitment to improving quality. The importance of time for individuals and organizations to learn about: quality improvement; one another’s cultures; and how best to support the transformation of a system while delivering care locally.

scholarly journals Connecting primary care patients to community-based physical activity: a qualitative study of health professional and patient views

BJGP Open ◽  
2020 ◽  
Vol 4 (3) ◽  
pp. bjgpopen20X101100
Author(s):  
Sharon Ann Carstairs ◽  
Rayna H Rogowsky ◽  
Kathryn B Cunningham ◽  
Frank Sullivan ◽  
Gozde Ozakinci
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Professionals ◽  
Theoretical Domains Framework ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Community Based ◽  
Healthcare Settings ◽  
Primary Care Patients ◽  
Exercise Programmes

BackgroundInconclusive evidence supporting referrals from health professionals to gym-based exercise programmes has raised concern for the roll-out of such schemes, and highlights the importance of developing links between healthcare settings and community-based opportunities to improve physical activity (PA) levels.AimThis study aimed to identify methods, and explore barriers and facilitators, of connecting primary care patients with PA opportunities from the perspectives of both health professionals (HPs) and patients, using the example of jogscotland.Design & settingAn exploratory study utilising semi-structured interviews with primary care patients (n = 14) and HPs (n = 14) from one UK NHS board was conducted.MethodPatient and HP transcripts were analysed separately using thematic analysis. Potential methods of connection were identified. The Capability, Opportunity, Motivation, behavioural (COM-B) model and theoretical domains framework (TDF) were employed to facilitate identification of barriers and facilitators for connecting primary care to community jogscotland groups.ResultsThree methods of connecting patients to community-based groups were identified: informal passive signposting, informal active signposting, and formal referral or prescribing. Barriers and facilitators for patient connection fell into five TDF domains for HPs and two COM-B model components for patients.ConclusionFor patients, HPs raising the topic of PA can help to justify, facilitate, and motivate action to change. The workload associated with connecting patients with community-based opportunities is central to implementation by HPs. Integrative resource solutions and social support for patients can provide a greater variety of PA options and the vital information and support for connecting with local opportunities, such as jogscotland.

scholarly journals An Implementation History of Primary Health Care Transformation: Alberta’s Primary Care Networks and the People, Time and Culture of change

2020 ◽  
Author(s):  
Myles Leslie ◽  
Akram Khayatzadeh-Mahani ◽  
Judy Birdsell ◽  
PG Forest ◽  
Rita Henderson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Quality Improvement ◽  
Primary Health Care ◽  
Qualitative Interviews ◽  
Fee For Service ◽  
Structured Interviews ◽  
Incremental Change ◽  
Primary Health ◽  
History Of

Abstract Background: Primary care, and its transformation into Primary Health Care (PHC), hasbecome an area of intense policy interest around the world. As part of this trendAlberta, Canada, has implemented Primary Care Networks (PCNs). These aredecentralized organizations, mandated with supporting the delivery of PHC, fundedthrough capitation, and operating as partnerships between the province’s healthcareadministration system and family physicians. This paper provides an implementationhistory of the PCNs, giving a detailed account of how people, time, and culturehave interacted to implement bottom up, incremental change in a predominantly Fee-For-Service (FFS) environment.Methods: Our implementation history is built out of an analysis of policy documentsand qualitative interviews. We conducted an interpretive analysis of relevant policydocuments (n=20) published since the first PCN was established. We then grounded12 semi-structured interviews in that initial policy analysis. These interviews explored11 key stakeholders’ perceptions of PHC transformation in Alberta generally, and theformation and evolution of the PCNs specifically. The data from the policy review andthe interviews were coded inductively, with participants checking our emerginganalyses.Results: Over time, the PCNs have shifted from an initial Frontier Era thatemphasized local solutions to local problems and featured few rules, to a present Eraof Accountability that features central demands for standardized measures,governance, and co-planning with other elements of the health system. A core groupof people – clinician and administration leaders – emerged to create the PCNs and,over time , to develop a long-term Quality Improvement (QI) vision and governanceplan for them as organizations. The continuing willingness of both these groups towork at understanding and aligning one another’s cultures to achieve thetransformation towards PHC has been central to the PCNs’ survival and success.Conclusions: Generalizable lessons from the implementation history of this emergingpolicy experiment include: The need for flexibility within a broad commitment toimproving quality. The importance of time for individuals and organizations to learnabout: quality improvement; one another’s cultures; and how best to support thetransformation of a system while delivering care locally.

scholarly journals Unintended consequences of online consultations: a qualitative study in UK primary care

2021 ◽  
pp. BJGP.2021.0426
Author(s):  
Andrew Turner ◽  
Rebecca Morris ◽  
Dylan Rakhra ◽  
Fiona Stevenson ◽  
Lorraine McDonagh ◽  
...  
Keyword(s):  
Primary Care ◽  
Access To Care ◽  
Information Exchange ◽  
Unintended Consequences ◽  
Patient Access ◽  
Structured Interviews ◽  
North West ◽  
Online Consultation ◽  
Trade Offs ◽  
Qualitative Interview Study

Background: Health services are increasingly using digital tools to deliver care and online consultations are being widely adopted in primary care settings. The intended consequences of online consultations are to increase patient access to care and increase the efficiency of care. Aim: To identify and understand the unintended consequences of online consultations in primary care. Design and Setting: Qualitative interview study in eight general practices using online consultation tools in South West and North West England. Method: Thematic analysis of semi-structured interviews with 19 patients and 18 general practice staff. Results: We identified consequences of online consultations that restricted patient access to care by making it difficult for some patients to communicate effectively with a GP and disadvantaging digitally-excluded patients. This stemmed from patient uncertainty about how their queries were dealt with and whether practices used online consultations as their preferred method for patients to contact the practice. We identified consequences that limited increases in practice efficiency by creating additional work, isolation and dissatisfaction for some staff. Conclusion: Unintended consequences often present operational challenges that are foreseeable and partly preventable. However these challenges must be recognised and solutions resourced sufficiently. Not everyone may benefit and local decisions will need to be made about trade-offs. Bespoke process change is critical to making effective use of online consultation tools. Unintended consequences also present clinical challenges that result from asynchronous communication. Online consultation tools favour simple, well-formulated, information exchange that leads to diffuse relationships and a more transactional style of medicine.

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