scholarly journals Development and validation of an algorithm using health administrative data to define patient attachment to primary care providers

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Liisa Jaakkimainen ◽  
Imaan Bayoumi ◽  
Richard H. Glazier ◽  
Kamila Premji ◽  
Tara Kiran ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Administrative Data ◽  
Care Provider ◽  
Care Providers ◽  
Reference Standard ◽  
Health Administrative Data ◽  
Content Type ◽  
Primary Care Access ◽  
Care Access

PurposeThe authors developed and validated an algorithm using health administrative data to identify patients who are attached or uncertainly attached to a primary care provider (PCP) using patient responses to a survey conducted in Ontario, Canada.Design/methodology/approachThe authors conducted a validation study using as a reference standard respondents to a community-based survey who indicated they did or did not have a PCP. The authors developed and tested health administrative algorithms against this reference standard. The authors calculated the sensitivity, specificity positive predictive value (PPV) and negative predictive value (NPV) on the final patient attachment algorithm. The authors then applied the attachment algorithm to the 2017 Ontario population.FindingsThe patient attachment algorithm had an excellent sensitivity (90.5%) and PPV (96.8%), though modest specificity (46.1%) and a low NPV (21.3%). This means that the algorithm assigned survey respondents as being attached to a PCP and when in fact they said they had a PCP, yet a significant proportion of those found to be uncertainly attached had indicated they did have a PCP. In 2017, most people in Ontario, Canada (85.4%) were attached to a PCP but 14.6% were uncertainly attached.Research limitations/implicationsAdministrative data for nurse practitioner's encounters and other interprofessional care providers are not currently available. The authors also cannot separately identify primary care visits conducted in walk in clinics using our health administrative data. Finally, the definition of hospital-based healthcare use did not include outpatient specialty care.Practical implicationsUncertain attachment to a primary health care provider is a recurrent problem that results in inequitable access in health services delivery. Providing annual reports on uncertainly attached patients can help evaluate primary care system changes developed to improve access. This algorithm can be used by health care planners and policy makers to examine the geographic variability and time trends of the uncertainly attached population to inform the development of programs to improve primary care access.Social implicationsAs primary care is an essential component of a person's medical home, identifying regions or high need populations that have higher levels of uncertainly attached patients will help target programs to support their primary care access and needs. Furthermore, this approach will be useful in future research to determine the health impacts of uncertain attachment to primary care, especially in view of a growing body of the literature highlighting the importance of primary care continuity.Originality/valueThis patient attachment algorithm is the first to use existing health administrative data validated with responses from a patient survey. Using patient surveys alone to assess attachment levels is expensive and time consuming to complete. They can also be subject to poor response rates and recall bias. Utilizing existing health administrative data provides more accurate, timely estimates of patient attachment for everyone in the population.

Human rights-based conceptions of deservingness: health and precarity

2020 ◽  
Vol 16 (3) ◽  
pp. 279-292
Author(s):  
Sarah Marshall
Keyword(s):  
Health Care ◽  
Human Rights ◽  
Health Care Providers ◽  
Health Care Access ◽  
Migrant Health ◽  
Dominant Negative ◽  
Care Providers ◽  
Content Type ◽  
Care Access ◽  
Health Related

Purpose Ideas of health-related deservingness in theory and practise have largely been attached to humanitarian notions of compassion and care for vulnerable persons, in contrast to rights-based approaches involving a moral-legal obligation to care based on universal citizenship principles. This paper aims to provide an alternative to these frames, seeking to explore ideas of a human rights-based deservingness framework to understand health care access and entitlement amongst precarious status persons in Canada. Design/methodology/approach Drawing from theoretical conceptualizations of deservingness, this paper aims to bring deservingness frameworks into the language of human rights discourses as these ideas relate to inequalities based on noncitizenship. Findings Deservingness frameworks have been used in public discourses to both perpetuate and diminish health-related inequalities around access and entitlement. Although, movements based on human rights have the potential to be co-opted and used to re-frame precarious status migrants as “undeserving”, movements driven by frames of human rights-based deservingness can subvert these dominant, negative discourses. Originality/value To date, deservingness theory has primarily been used to speak to issues relating to deservingness to welfare services. In relation to deservingness and precarious status migrants, much of the literature focuses on humanitarian notions of the “deserving” migrant. Health-related deservingness based on human rights has been under-theorized in the literature and the authors can learn from activist movements, precarious status migrants and health care providers that have taken on this approach to mobilize for rights based on being “human”.

Fifteen Years After Katrina: Paving the Way for Health Care Transformation

2020 ◽  
Vol 110 (10) ◽  
pp. 1472-1475 ◽  
Author(s):  
Shelina Davis ◽  
Alexander Billioux ◽  
Jennifer L. Avegno ◽  
Tiffany Netters ◽  
Gerrelda Davis ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Hurricane Katrina ◽  
New Orleans ◽  
Public And Private ◽  
Primary Care Access ◽  
Care Access ◽  
Public And Private Stakeholders ◽  
Health Care Transformation ◽  
The Way

Following the devastation of the Greater New Orleans, Louisiana, region by Hurricane Katrina, 25 nonprofit health care organizations in partnership with public and private stakeholders worked to build a community-based primary care and behavioral health network. The work was made possible in large part by a $100 million federal award, the Primary Care Access Stabilization Grant, which paved the way for innovative and sustained public health and health care transformation across the Greater New Orleans area and the state of Louisiana.

scholarly journals An Agent-Based Model for Addressing the Impact of a Disaster on Access to Primary Care Services

2016 ◽  
Vol 10 (3) ◽  
pp. 386-393 ◽  
Author(s):  
Hasan Guclu ◽  
Supriya Kumar ◽  
David Galloway ◽  
Mary Krauland ◽  
Rishi Sood ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Hurricane Sandy ◽  
Care Providers ◽  
Agent Based Model ◽  
Agent Based ◽  
Primary Care Access ◽  
Care Access ◽  
Care Services ◽  
Primary Care Services

AbstractObjectiveHurricane Sandy in the Rockaways, Queens, forced residents to evacuate and primary care providers to close or curtail operations. A large deficit in primary care access was apparent in the immediate aftermath of the storm. Our objective was to build a computational model to aid responders in planning to situate primary care services in a disaster-affected area.MethodsUsing an agent-based modeling platform, HAZEL, we simulated the Rockaways population, its evacuation behavior, and primary care providers’ availability in the aftermath of Hurricane Sandy. Data sources for this model included post-storm and community health surveys from New York City, a survey of the Rockaways primary care providers, and research literature. The model then tested geospatially specific interventions to address storm-related access deficits.ResultsThe model revealed that areas of high primary care access deficit were concentrated in the eastern part of the Rockaways. Placing mobile health clinics in the most populous census tracts reduced the access deficit significantly, whereas increasing providers’ capacity by 50% reduced the deficit to a lesser degree.ConclusionsAn agent-based model may be a useful tool to have in place so that policy makers can conduct scenario-based analyses to plan interventions optimally in the event of a disaster. (Disaster Med Public Health Preparedness. 2016;10:386–393)

scholarly journals “I was trying to speak to their human side” coping responses of Belgium’s undocumented migrants to barriers in health-care access

2020 ◽  
Vol 16 (3) ◽  
pp. 253-267
Author(s):  
Dirk Lafaut ◽  
Gily Coene
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Access ◽  
Access To Health Care ◽  
Undocumented Migrants ◽  
Care Providers ◽  
Content Type ◽  
Coping Responses ◽  
Care Access ◽  
Access To Health

Purpose Undocumented migrants experience major legal constraints in their health-care access. Little is known on how undocumented migrants cope with these limitations in health-care access as individuals. The purpose of this study is to explore the coping responses of undocumented migrants when they experience limited health-care access in face-to-face encounters with health-care providers. Design/methodology/approach The authors conducted multi-site ethnographic observations and 25 semi-structured in-depth interviews with undocumented migrants in Belgium. They combined the “candidacy model” of health-care access with models from coping literature on racism as a framework. The candidacy model allowed them to understand access to health care as a dynamic and interactive negotiation process between health-care workers and undocumented migrants. Findings Responses to impaired health-care access can be divided into four main strategies: (1) individuals can react with a self-protective response withdrawing from seeking further care; (2) they can get around the obstacle; (3) they can influence the health-care worker involved by deploying discursive or performative skills; or (4) they can seek to confront the source of the obstacle. Research limitations/implications These findings point to the importance of care relations and social networks, as well as discursive and performative skills of undocumented migrants when negotiating barriers in access to health care. Originality/value This study refines the candidacy model by highlighting how individuals respond on a micro-level to shifts towards exclusionary health policies and, by doing so dynamically, change provision of health-care services.

scholarly journals Actionable Analysis: Toward a Jurisdictional Evaluation of Primary Care Access in the Community Context

2019 ◽  
Vol 10 ◽  
pp. 215013271989197
Author(s):  
Mary M. Ford ◽  
Kirsten Weisbeck ◽  
Bonnie Kerker ◽  
Louise Cohen
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Health Care Systems ◽  
Care Facility ◽  
Primary Care Providers ◽  
City Council ◽  
Community Context ◽  
Care Providers ◽  
Primary Care Access ◽  
Care Access

Primary care is the foundation of health care systems and has potential to alleviate inequities in population health. We examined multiple measures of adult primary care access, health status, and socioeconomic position at the New York City Council District level—a unit of analysis both relevant to and actionable by local policymakers. The results showed significant associations between measures of primary care access and health status after adjustment for socioeconomic factors. We found that an increase of 1 provider per 10 000 people was associated with a 1% decrease in diabetes rates and a 5% decrease in rates of adults without an influenza immunization. Furthermore, higher rates of primary care providers in high-poverty districts accepted Medicaid and had Patient-Centered Medical Home recognition, increasing constituent accessibility. Our findings highlight the significant contribution of primary care access to community health; policies and resource allocation must prioritize primary care facility siting and provider recruitment in low-access areas.

Primer on Depression

Depression ◽  
2019 ◽  
pp. 459-474
Author(s):  
Robert S. Kinney ◽  
Radu Pop
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Access ◽  
Primary Care Providers ◽  
Depression Screening ◽  
Care Providers ◽  
Care Access ◽  
Measurement Based Care ◽  
New Guidelines ◽  
Guidelines And Recommendations

Depression is a commonly occurring illness in the general population. Existing systems for identifying and treating depression vary greatly, and the adoption of a universal, standardized method of addressing the disorder within primary care is lacking. New guidelines and recommendations by accrediting bodies have resulted in the development of some initiatives and the increased recognition of depression, yet treatments continue to rely on referrals to specialty psychiatric care providers. Given that primary care may be the only point of health care access for many individuals, this serves as an opportune setting to initiate treatment at the time that depression screening is completed. With adequate support, guidance, and a systemic approach (i.e., measurement-based care), primary care providers can be as effective as psychiatric specialty care in treating depression. This chapter providers evidence for this approach, along with direct recommendations to primary care providers.

scholarly journals Primary Care Access for New Patients on the Eve of Health Care Reform

2014 ◽  
Vol 174 (6) ◽  
pp. 861 ◽  
Author(s):  
Karin V. Rhodes ◽  
Genevieve M. Kenney ◽  
Ari B. Friedman ◽  
Brendan Saloner ◽  
Charlotte C. Lawson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Reform ◽  
Primary Care Access ◽  
Care Access

scholarly journals Medical Provider Recommendations to Massage Therapy: a Card Study

2019 ◽  
Vol 12 (3) ◽  
pp. 9-15 ◽  
Author(s):  
Diane Mastnardo, BS, LMT ◽  
Jeanmarie C. Rose, MPA ◽  
Jacqueline Dolata, MBA ◽  
James J. Werner, PhD, MSSA
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Primary Care Provider ◽  
Massage Therapy ◽  
Research Network ◽  
Care Providers ◽  
Medical Providers

Background: Communication between massage therapy patients and their medical providers has not been widely described, especially with respect to health care in the United States. Purpose: To examine which type of medical providers recommend massage therapy (MT), and how often massage therapy patients tell their providers about their treatment. Setting: Independent massage therapy practices in a Practice-based Research Network (PBRN) in Northeast Ohio.Participants: 21 licensed massage therapists (LMT). Research Design: A cross-sectional descriptive study. For consecutive, nonrepeating visits to their practices, each LMT completed up to 20 cards with information on the patient and visit. Analysis compared visits for patients based on whether they reported telling their health provider about their use of MT or being recommended for massage by a health provider.Results: Among 403 visits to 21 LMTs, 51% of patients had told their primary care clinician about seeing an LMT, and for 23%, a health-care provider had recommended visiting an LMT for that visit. Patients who told their primary care provider that they use massage therapy were more likely to be established patients, or to be seen for chronic pain complaints. Visits recommended by a physi-cian were more likely to be for chronic conditions.Conclusion: Patients who are established in the massage practice and those receiving massage for a specific condition are more likely to tell their primary care provider that they use massage and are also more likely to have been recommended for massage by a health-care provider. This information will help LMTs target and inform patients about the importance of talking with their health-care providers about their use of massage, and provide LMTs with a starting point of which types of health-care providers already recommend massage. This information will further open the dialogue about the integration of massage therapy in conventional health care. 

scholarly journals The expectations of transgender people in the face of their health-care access difficulties and how they can be overcome. A qualitative study in France

2020 ◽  
Vol 21 ◽  
Author(s):  
Emmanuel Allory ◽  
Ellie Duval ◽  
Marion Caroff ◽  
Candan Kendir ◽  
Raphaël Magnan ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Health Care Access ◽  
Primary Care Providers ◽  
Care Providers ◽  
Transgender People ◽  
Care Access ◽  
Care Services ◽  
Primary Health

Abstract Aim: Our objective was to explore the difficulties experienced by transgender people in accessing primary health-care services and their expectations towards primary care providers to improve their health-care access. Background: Because transgender people are exposed to many discriminations, their health-care access is particularly poor. Guidelines recommend greater involvement of primary care providers in the processes because of the accessibility feature of primary care services. Methods: A qualitative study using semi-directed interviews was conducted among 27 transgender people (February 2018 – August 2018). These voluntary participants were recruited through different means: local trans or LGBTI (lesbian, gay, bisexual, trans, and/or intersex) associations, primary care providers, and social networks. The data analysis was based on reflexive thematic analysis in an inductive approach. Findings: Difficulties in accessing health-care occurred at all the levels of the primary health-care system: primary care providers – transgender people interaction, access to the primary care team facility (starting with the secretariat), access to secondary care specialists, and continuity of care. Transgender people report ill-adapted health-care services as a result of gender-based identification in health-care settings. Their main expectation was depsychiatrization and self-determination. They supported mixed health network comprising primary care providers and transgender people with a coordinating role for the general practitioner. These expectations should be priorities to consider in our primary health-care system to improve access to health-care for transgender people.

Transition tools and access to adult primary care

2017 ◽  
Vol 3 (3) ◽  
pp. 131-141 ◽  
Author(s):  
Marji Erickson Warfield ◽  
Morgan K. Crossman ◽  
Ann Martha Neumeyer ◽  
Julie O’Brien ◽  
Karen A. Kuhlthau
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Community Health Centers ◽  
Primary Care Providers ◽  
Autism Spectrum ◽  
Adult Health ◽  
Care Providers ◽  
Management Tools ◽  
Content Type ◽  
Primary Care Practices

Purpose The transition from pediatric to adult health care is challenging for youth with autism spectrum disorder (ASD). Many tools have been developed to facilitate transition but studies have not assessed their utility or readiness to be implemented in primary care practices. The purpose of this paper is to rate existing health care transition tools to identify tools ready for use in primary care clinics and develop a set of transition principles. Design/methodology/approach Four pediatric and family medicine providers from community health centers reviewed 12 transition tools and provided ratings and in-depth responses about the usefulness and feasibility of each tool through online surveys and telephone interviews. A conference call was used to discuss the findings and develop a set of transition principles. Findings The top rated tools included three youth self-management tools, two tools focused on ASD information and one tool focused on communication. No one tool was top rated by all providers and none of the tools was ready to be implemented without revisions. The transition principles developed focused on the use of selected tools to involve all youth in regular conversations about transition at every well child visit beginning at age 14 and adapting that process for youth with special needs. Originality/value This study is unique in asking primary care providers to assess the applicability of incorporating existing and publicly available transition tools in their own practices and developing a set of transition principles.

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