Whom Should We Profile? Examining Diabetes Care Practice Variation among Primary Care Providers, Provider Groups, and Health Care Facilities

The practice of community pharmacy in low and middle-income countries, including in Indonesia, is often described as in the state of infancy with several intractable barriers that have been substantially and continuously hampering the practice. Such description might be valid in highlighting how pharmacy is practiced and the conditions within and beyond community pharmacy organizations. Therefore, it is not surprising that the concept of integrating community pharmacy into the primary care system may not be considered in the contemporary discourse despite the fact that community pharmacy has been operating within communities for years. However, in the case of Indonesia, we argue that changes in the health care system within the past decade particularly with the introduction of the universal health coverage (UHC) in 2014, may have significantly amplified the role of pharmacists. There is good evidence which highlights the contribution of pharmacist as a substantial health care element in primary care practice. The initiative for employing pharmacist, identified in this article as primary care pharmacist, in the setting of community health center [puskesmas] and the introduction of affiliated or contracted community pharmacy under the UHC have enabled pharmacist to work together with other primary care providers. Moreover, government agenda under the “Smart Use of Medicines” program [Gema Cermat] recognizes pharmacists as the agent of change for improving the rational use of medicines in the community. Community pharmacy is developing, albeit slowly, and is able to grasp a novel position to deliver pharmacy-related primary care services to the general public through new services, for example drug monitoring and home care. Nevertheless, integrating community pharmacy into primary care is relatively a new notion in the Indonesian setting, and is a challenging process given the presence of barriers in the macro, meso- and micro-level of practice.

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Health Care Disparities and Diabetes Care: Practical Considerations for Primary Care Providers

Clinical Diabetes ◽

10.2337/diaclin.27.3.105 ◽

2009 ◽

Vol 27 (3) ◽

pp. 105-112 ◽

Cited By ~ 8

Author(s):

R. O. White ◽

B. M. Beech ◽

S. Miller

Keyword(s):

Primary Care ◽

Health Care ◽

Diabetes Care ◽

Health Care Disparities ◽

Primary Care Providers ◽

Care Providers

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A Systems-Wide Approach for Early Detection and Management of Dementia in Primary Care

Innovation in Aging ◽

10.1093/geroni/igab046.1335 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. 346-346

Author(s):

Annette Fitzpatrick ◽

Basia Belza

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Providers ◽

Signs And Symptoms ◽

Primary Care Providers ◽

Population Increase ◽

Community Advisory Board ◽

Care Practice ◽

Care Providers ◽

Cognitive Changes

Abstract Dementia is frequently unrecognized and under-reported by health care providers. The needs of an aging population increase the burden on an already over-worked primary care system that is often without the appropriate training, resources, and reimbursement to address the growing number of people with cognitive decline in the US. In this symposium we present a systems-wide approach within University of Washington (UW) Primary Care to increase awareness of early signs and symptoms, detection of cognitive impairment, and support of providers, patients and caregivers that will ultimately improve outcomes of care. This quality improvement (QI) program integrates stakeholder-selected components of the GSA KAER (Kickstart-Assess-Evaluate and Refer) Model and Toolkit (2020 Edition), developed by the Gerontological Society of America (GSA), into primary care practice. We describe content and logistics of a continuing education intervention for primary care providers and clinical staff to increase skills for evaluation and management of dementia. Working with UW clinic managers and information technology (IT), we have developed a pragmatic system for streamlining operations and documenting care utilizing newly developed interdisciplinary workflows and electronic health record order sets. Using input from our Community Advisory Board, we explain development of a web-based resource directory to be used in-clinic and at home to support providers, staff, patients, families, and caregivers across cognitive changes. Strategies presented here are aimed to help other health care systems initiate steps to integrate KAER and other tools into a practical QI program for improving detection and management of dementia through support of primary care.

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Discontinuity in Care: Practice Closures among Primary Care Providers and Patient Health Care Utilization

Journal of Health Economics ◽

10.1016/j.jhealeco.2021.102551 ◽

2021 ◽

pp. 102551

Author(s):

Marianne Simonsen ◽

Lars Skipper ◽

Niels Skipper ◽

Peter Rønø Thingholm

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Utilization ◽

Primary Care Providers ◽

Care Utilization ◽

Care Practice ◽

Care Providers ◽

Patient Health

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Adolescents’ Views on Barriers to Health Care

Journal of Primary Care & Community Health ◽

10.1177/2150131911422533 ◽

2011 ◽

Vol 3 (2) ◽

pp. 99-103 ◽

Cited By ~ 13

Author(s):

Sylvia W. Lim ◽

Rosy Chhabra ◽

Ayelet Rosen ◽

Andrew D. Racine ◽

Elizabeth M. Alderman

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Health Services ◽

Waiting Times ◽

Primary Care Providers ◽

Care Practice ◽

Care Providers ◽

Group Interviews ◽

Key Barrier

Objectives: To determine from adolescents using health care their: 1) perceptions of barriers to obtaining health services, 2) views on how to overcome the barriers and 3) views on how to create an adolescent-friendly primary care practice. Design: Six focus group interviews. Methods: Adolescents 11-21 years old from three health centers in the Bronx were recruited. Main Outcome Measures: 1) barriers to accessing health care such as insurance, language barriers, transportation, making an appointment; 2) identifying barriers related to issues of consent and confidentiality; 3) exploring barriers to accessing mental health and related issues; and 4) their visions of an adolescent-friendly office. Results: Thirty-one adolescents, aged 11-21 years old, participated. The majority were Hispanic and 52% were female. Fifty percent of adolescents had a routine visit within the past month. Most adolescents reported experiencing barriers to making an appointment. Additionally, they complained about long waiting times to be seen by providers on the day of their scheduled appointment. Another key barrier was related to knowledge and perceptions about consent and confidentiality. Further, in regard to mental health, many adolescents from focus groups reported that they felt that their primary providers had little interest in this topic and limited knowledge about it. Most of the adolescents reported no barriers with insurance, language or transportation. Their visions of an adolescent-friendly office would include a separate adolescent waiting area equipped with entertainment units. Conclusion: In this study of adolescents who already have primary care providers and are seemingly well-connected to the health care system, there remained significant reported barriers to accessing necessary health services.

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Determinants of Medical Practice Variation Among Primary Care Physicians: Protocol for a Three Phase Study (Preprint)

10.2196/preprints.18673 ◽

2020 ◽

Author(s):

Sagi Shashar ◽

Shlomi Codish ◽

Moriah Ellen ◽

Ehud Davidson ◽

Victor Novack

Keyword(s):

Primary Care ◽

Health Care ◽

Risk Aversion ◽

Medical Practice ◽

Practice Variation ◽

Care Practice ◽

Care Providers ◽

Wide Range ◽

Unexplained Variance ◽

Research Grant

BACKGROUND One of the greatest challenges of modern health systems is the choice and use of resources needed to diagnose and treat patients. Medical practice variation (MPV) is a broad term which entails the differences between health care providers inclusive of both the overuse and underuse. In this paper, we describe a 3-phase research protocol examining MPV in primary care. OBJECTIVE We aim to identify the potential targets for behavioral modification interventions to reduce the variation in practice patterns and thus improve health care, decrease costs, and prevent disparities in care. METHODS The first phase will delineate the variation in primary care practice over a wide range of services and long follow-up period (2003-2017), the second will examine the 3 determinants of variation (ie, patient, physician, and clinic characteristics), and attempt to derive the unexplained variance. In the third phase, we will assess a novel component that might contribute to the previously unexplained variance - the physicians’ personal behavioral characteristics (such as risk aversion, fear of malpractice, stress from uncertainty, empathy, and burnout). RESULTS This work was supported by the research grant from Israel National Institute for Health Policy Research (Grant No. 2014/134). Soroka University Medical Center Institutional Ethics Committee has approved the updated version of the study protocol (SOR-14-0063) in February 2019. All relevant data for phases 1 and 2, including patient, physician, and clinic, were collected from the Clalit Health Services data set in 2019 and are currently being analyzed. The evaluation of the individual physician characteristics (eg, risk aversion) by the face-to-face questionnaires was started on 2018 and remains in progress. We intend to publish the results during 2020-2021. CONCLUSIONS Based on the results of our study, we aim to propose a list of potential targets for focused behavioral intervention. Identifying new targets for such an intervention can potentially lead to a decrease in the unwarranted variation in the medical practice. We suggest that such an intervention will result in optimization of the health system, improvement of health outcomes, reduction of disparities in care and savings in cost. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/18673

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Determinants of Medical Practice Variation Among Primary Care Physicians: Protocol for a Three Phase Study

JMIR Research Protocols ◽

10.2196/18673 ◽

2020 ◽

Vol 9 (10) ◽

pp. e18673

Author(s):

Sagi Shashar ◽

Shlomi Codish ◽

Moriah Ellen ◽

Ehud Davidson ◽

Victor Novack

Keyword(s):

Primary Care ◽

Health Care ◽

Risk Aversion ◽

Medical Practice ◽

Practice Variation ◽

Care Practice ◽

Care Providers ◽

Wide Range ◽

Unexplained Variance ◽

Research Grant

Background One of the greatest challenges of modern health systems is the choice and use of resources needed to diagnose and treat patients. Medical practice variation (MPV) is a broad term which entails the differences between health care providers inclusive of both the overuse and underuse. In this paper, we describe a 3-phase research protocol examining MPV in primary care. Objective We aim to identify the potential targets for behavioral modification interventions to reduce the variation in practice patterns and thus improve health care, decrease costs, and prevent disparities in care. Methods The first phase will delineate the variation in primary care practice over a wide range of services and long follow-up period (2003-2017), the second will examine the 3 determinants of variation (ie, patient, physician, and clinic characteristics), and attempt to derive the unexplained variance. In the third phase, we will assess a novel component that might contribute to the previously unexplained variance - the physicians’ personal behavioral characteristics (such as risk aversion, fear of malpractice, stress from uncertainty, empathy, and burnout). Results This work was supported by the research grant from Israel National Institute for Health Policy Research (Grant No. 2014/134). Soroka University Medical Center Institutional Ethics Committee has approved the updated version of the study protocol (SOR-14-0063) in February 2019. All relevant data for phases 1 and 2, including patient, physician, and clinic, were collected from the Clalit Health Services data set in 2019 and are currently being analyzed. The evaluation of the individual physician characteristics (eg, risk aversion) by the face-to-face questionnaires was started on 2018 and remains in progress. We intend to publish the results during 2020-2021. Conclusions Based on the results of our study, we aim to propose a list of potential targets for focused behavioral intervention. Identifying new targets for such an intervention can potentially lead to a decrease in the unwarranted variation in the medical practice. We suggest that such an intervention will result in optimization of the health system, improvement of health outcomes, reduction of disparities in care and savings in cost. International Registered Report Identifier (IRRID) DERR1-10.2196/18673

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