Effectiveness of primary care gatekeeping: difference-in-differences evaluation of a pilot scheme in China

IntroductionThis paper evaluates the effectiveness of a gatekeeping pilot in shifting resources and patient visits from hospitals to primary care facilities under the Chinese New Rural Cooperative Medical Scheme.MethodsWe applied a difference-in-differences regression analysis using claims data from a pilot district in northern China. The study covered 200 685 enrollees in 17 townships in 2012 and followed-up the townships over 12 year-quarters until the end of 2014.ResultsThe gatekeeping pilot led to significantly more patients visiting primary care facilities (55.3%, p=0.001), but there was little evidence of increased ambulatory spending on primary care (1.6%, p=0.884). The pilot reduced hospital visits by 23.9% (p=0.048) and ambulatory spending at the hospitals by 22.4% (p=0.011).ConclusionsThis first impact evaluation of gatekeeping outside high-income countries found that gatekeeping policy did not seem to have expanded the care provided by primary care facilities, despite an increased volume of claimed visits. Although claimed patient visits and expenditure at hospitals reduced, we suspect this may have been because patients found it either cumbersome or difficult to obtain reimbursement for their care.

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Geographic Evaluation of Georgia Vaccination Disparity Among Laboratory-Confirmed Influenza Cases in a Children’s Hospital

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.795 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s239-s239

Author(s):

Dorian Hoskins ◽

Cynthia Kaplan ◽

Andrea Pruitt ◽

Andrea McCarter

Keyword(s):

Primary Care ◽

Positive Relationship ◽

Vaccination Rate ◽

Care Physician ◽

Urgent Care ◽

Peak Period ◽

Vaccination Rates ◽

Care Facilities ◽

Flu Vaccine ◽

Hospital Visits

Background: Vaccination coverage among children aged ≤18 years in Georgia remains one of the lowest in the nation with 39.3% coverage. During the 2018–2019 influenza season, the CDC reported 142 pediatric deaths, 3 of which occurred in Georgia. In a time of increasing complexity of immunization schedules, increase severity with a high level of flu-related deaths and hospitalization, it is important to understand localized factors that contribute to decrease influenza immunization and increased flu-related hospital visits among children. Methods: Data include electronic medical record chart review of 5,827 laboratory confirmed Children’s Healthcare of Atlanta visitor cases from October 1, 2016, to September 24, 2019. System-wide county level data included 3 pediatric hospitals, 5 primary care facilities, 8 urgent care facilities, and 2 outpatient clinics. Characteristics associated with disparities in vaccine were explored using univariate and multiple regressions analysis. Of those children with a primary care physician (PCP), 30% had flu vaccinations, whereas only 16.5% of those without a PCP had been vaccinated (P ≤ .00001). There was a positive relationship between increased county influenza rate and percentage of children in county who were preschoolers <5 years old (r = 0.93; P ≤ .05). Moreover, 78% of children who received the flu vaccine ≤ 2 weeks prior to a confirmed flu diagnosis got the flu during peak flu periods (r = 0.29; P ≤ .05). Predictors of increased flu rate per 1,000 children were associated with flu vaccines given ≤2 weeks before a lab confirmed flu diagnosis (P ≤ .02). Children in counties that had a higher rate of flu during the peak period also had an overall higher rate of flu (P ≤ .005). The higher the percentage of children who got flu during peak flu period, the lower the vaccination rate for the county (P ≤ .001). The percentage of children ≤18 years old with no health insurance was associated with lower vaccination rates in the county (P ≤ .004). There appears to be a positive relationship between receiving flu vaccine 2 weeks prior to lab-confirmed flu diagnosis and onset of illness during the peak flu periods. Missed opportunities to obtain a flu vaccine by a PCP were associated with increased flu-related hospital visits and lower vaccination rates. Results may support predischarge hospital vaccinations and the promotion of flu vaccination education. Pediatric research is needed to facilitate localized PCP vaccination or predischarge hospital vaccinations prior to peak flu periods when hospital-related flu visits increase.Funding: NoneDisclosures: None

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What Drives Utilization of Primary Care Facilities in Vietnam?

10.1596/32186 ◽

2019 ◽

Author(s):

Lan TH Vu ◽

Sarah Bales ◽

Caryn Bredenkamp

Keyword(s):

Primary Care ◽

Care Facilities

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Understanding the dynamics of HIV testing services in South African primary care facilities

10.31899/hiv5.1022 ◽

2018 ◽

Cited By ~ 1

Author(s):

Tonderai Mabuto ◽

Bhakti Hansoti ◽

Salome Charalambous ◽

Christopher Hoffman

Keyword(s):

Primary Care ◽

Hiv Testing ◽

South African ◽

Care Facilities ◽

Hiv Testing Services

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

Health Systems & Reform ◽

10.1080/23288604.2020.1846844 ◽

2020 ◽

Vol 6 (1) ◽

pp. e1846844

Author(s):

Anwen Zhang ◽

Zlatko Nikoloski ◽

Sarah Averi Albala ◽

Winnie Yip ◽

Jin Xu ◽

...

Keyword(s):

Primary Care ◽

Health Care ◽

Health Care Providers ◽

Patient Choice ◽

Care Providers ◽

Care Facilities

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Linkage to primary-care public health facilities for cardiovascular disease prevention: a community-based cohort study from urban slums in India

BMJ Open ◽

10.1136/bmjopen-2020-045997 ◽

2021 ◽

Vol 11 (8) ◽

pp. e045997

Author(s):

Abhijit Pakhare ◽

Ankur Joshi ◽

Rasha Anwar ◽

Khushbu Dubey ◽

Sanjeev Kumar ◽

...

Keyword(s):

Public Health ◽

Primary Care ◽

Multivariate Analysis ◽

Urban Slum ◽

Primary Care Providers ◽

Health Facilities ◽

Care Providers ◽

Community Based ◽

Public Health Facilities ◽

Care Facilities

ObjectivesHypertension and diabetes mellitus are important risk factors for cardiovascular diseases (CVDs). Once identified with these conditions, individuals need to be linked to primary healthcare system for initiation of lifestyle modifications, pharmacotherapy and maintenance of therapies to achieve optimal blood pressure and glycaemic control. In the current study, we evaluated predictors and barriers for non-linkage to primary-care public health facilities for CVD risk reduction.MethodsWe conducted a community-based longitudinal study in 16 urban slum clusters in central India. Community health workers (CHWs) in each urban slum cluster screened all adults, aged 30 years or more for hypertension and diabetes, and those positively screened were sought to be linked to urban primary health centres (UPHCs). We performed univariate and multivariate analysis to identify independent predictors for non-linkage to primary-care providers. We conducted in-depth assessment in 10% of all positively screened, to identify key barriers that potentially prevented linkages to primary-care facilities.ResultsOf 6174 individuals screened, 1451 (23.5%; 95% CI 22.5 to 24.6) were identified as high risk and required linkage to primary-care facilities. Out of these, 544 (37.5%) were linked to public primary-care facilities and 259 (17.8%) to private providers. Of the remaining, 506 (34.9%) did not get linked to any provider and 142 (9.8%) defaulted after initial linkages (treatment interrupters). On multivariate analysis, as compared with those linked to public primary-care facilities, those who were not linked had age less than 45 years (OR 2.2 (95% CI 1.3 to 3.5)), were in lowest wealth quintile (OR 1.8 (95% CI 1.1 to 2.9), resided beyond a kilometre from UPHC (OR 1.7 (95% CI 1.2 to 2.4) and were engaged late by CHWs (OR 2.6 (95% CI 1.8 to 3.7)). Despite having comparable knowledge level, denial about their risk status and lack of family support were key barriers in this group.ConclusionsThis study demonstrates feasibility of CHW-based strategy in promoting linkages to primary-care facilities.

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The Impact of B Corp Certification on Growth

Sustainability ◽

10.3390/su13137191 ◽

2021 ◽

Vol 13 (13) ◽

pp. 7191

Author(s):

Valerie Paelman ◽

Philippe Van Cauwenberge ◽

Heidi Vander Bauwhede

Keyword(s):

Regression Analysis ◽

Propensity Score ◽

Panel Regression ◽

Medium Term ◽

Difference In Differences ◽

Dual Purpose ◽

Full Effect ◽

The Impact ◽

Positive Effect ◽

Over Time

We empirically test whether B Corp certification affects the short- and medium-term growth rates of sustainable enterprises. These businesses are growing in popularity and prevalence but, due to their hybrid nature, often suffer from external credibility issues and competing internal logics. Because of the rigorous and time-involving audit procedure, B Corp certification potentially sends a credible signal about the sustainable nature of the enterprise to its stakeholders. In addition, the B Corp label could help to straighten out internal tensions and align the company towards its dual purpose. Hence, B Corp certification could contribute to company success. We observe 129 firms that were certified between 2013 and 2018 over a period between six years prior and five years post-certification. Using propensity score matching, we identify 129 non-certified matching companies. On this sample, we conduct a difference-in-differences panel regression analysis to investigate the effect of certification. Our dataset allows us to study how the effects of B Corp certification evolve over time, which was previously untested. Our study documents a positive effect of B Corp certification on turnover growth and also that this effect increases with the time since certification, implying that certification requires some time for its full effect to become apparent.

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Competency of health workers in detecting and managing gestational hypertension, pre-eclampsia, severe pre-eclampsia and eclampsia during antenatal check-ups in primary care health facilities in Bangladesh: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-046638 ◽

2021 ◽

Vol 11 (7) ◽

pp. e046638

Author(s):

Sk Masum Billah ◽

Abdullah Nurus Salam Khan ◽

S M Rokonuzzaman ◽

Nafisa Lira Huq ◽

Marufa Aziz Khan ◽

...

Keyword(s):

Primary Care ◽

Health Workers ◽

Gestational Hypertension ◽

Cross Sectional Study ◽

P Value ◽

Sectional Study ◽

Hypertensive Disorders Of Pregnancy ◽

Cross Sectional ◽

Hypertensive Disorders ◽

Care Facilities

Study objectiveTo evaluate the competency of trained health workers in detecting and managing hypertensive disorders of pregnancy during routine antenatal check-ups (ANCs) at primary care facilities in Bangladesh.Study design and settingsCross-sectional study; conducted in 26 primary care facilities.Outcome measuresAccurate diagnosis of the hypertensive disorders of pregnancy.MethodIn total 1560 ANC consultations provided by primary health workers, known as Family Welfare Visitors (FWVs), were observed using a structured checklist between October 2017 and February 2018. All consultations were reassessed by study physicians for validation.ResultOf the ‘true’ cases of gestational hypertension (n=32), pre-eclampsia (n=29) and severe pre-eclampsia (n=16), only 3%, 7% and 25%, respectively, were correctly diagnosed by FWVs. Per cent agreement for the diagnosed cases of any hypertensive disorders of pregnancy was 9% and kappa statistics was 0.50 (p value 0.0125). For identification of any hypertensive disorders by FWVs, sensitivity and positive predictive values were 14% and 50%, respectively. There was a moderate positive correlation between the blood pressure measurements taken by FWVs and study physicians. Only 27% of those who had ‘some protein’ in urine were correctly identified by FWVs. Women diagnosed with any of the hypertensive disorders of pregnancy by FWVs were more likely to be counselled on at least one danger sign of pre-eclampsia (severe headache, blurring of vision and upper abdominal pain) than those without any such diagnosis (41% vs 19%, p value 0.008). All four cases of severe pre-eclampsia diagnosed by FWVs were given a loading dose of intramuscular magnesium sulphate and three among them were referred to a higher facility.ConclusionThe FWVs should be appropriately trained on risk assessment of pregnant women with particular emphasis on accurately assessing the diagnostic criteria of hypertensive disorders of pregnancy and its management.

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Evaluating the integration of palliative care in national health systems: an indicator rating process with EAPC task force members to measure advanced palliative care development

BMC Palliative Care ◽

10.1186/s12904-021-00728-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Natalia Arias-Casais ◽

Eduardo Garralda ◽

Miguel Antonio Sánchez-Cárdenas ◽

John Y. Rhee ◽

Carlos Centeno

Keyword(s):

Primary Care ◽

Palliative Care ◽

Long Term Care ◽

Task Force ◽

National Level ◽

Structured Interviews ◽

Term Care ◽

Care Facilities ◽

Rating Process

Abstract Background Palliative care (PC) development cannot only be assessed from a specialized provision perspective. Recently, PC integration into other health systems has been identified as a component of specialized development. Yet, there is a lack of indicators to assess PC integration for pediatrics, long-term care facilities, primary care, volunteering and cardiology. Aim To identify and design indicators capable of exploring national-level integration of PC into the areas mentioned above. Methods A process composed of a desk literature review, consultation and semi-structured interviews with EAPC task force members and a rating process was performed to create a list of indicators for the assessment of PC integration into pediatrics, long-term care facilities, primary care, cardiology, and volunteering. The new indicators were mapped onto the four domains of the WHO Public Health Strategy. Results The literature review identified experts with whom 11 semi-structured interviews were conducted. A total of 34 new indicators were identified for national-level monitoring of palliative care integration. Ten were for pediatrics, five for primary care, six for long-term care facilities, seven for volunteering, and six for cardiology. All indicators mapped onto the WHO domains of policy and education while only pediatrics had an indicator that mapped onto the domain of services. No indicators mapped onto the domain of use of medicines. Conclusion Meaningful contributions are being made in Europe towards the integration of PC into the explored fields. These efforts should be assessed in future regional mapping studies using indicators to deliver a more complete picture of PC development.

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Impact of a Telemedicine Program on the Reduction in the Emission of Atmospheric Pollutants and Journeys by Road

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16224366 ◽

2019 ◽

Vol 16 (22) ◽

pp. 4366 ◽

Cited By ~ 7

Author(s):

Josep Vidal-Alaball ◽

Jordi Franch-Parella ◽

Francesc Lopez Seguí ◽

Francesc Garcia Cuyàs ◽

Jacobo Mendioroz Peña

Keyword(s):

Nitric Oxide ◽

Primary Care ◽

Environmental Sustainability ◽

Atmospheric Pollutants ◽

Fuel Reduction ◽

Environmental Footprint ◽

Time Saving ◽

Face To Face ◽

Total Travel Time ◽

Hospital Visits

This retrospective study evaluates the effect of a telemedicine program developed in the central Catalan region in lowering the environmental footprint by reducing the emission of atmospheric pollutants, thanks to a reduction in the number of hospital visits involving journeys by road. Between January 2018 and June 2019, a total of 12,322 referrals were made to telemedicine services in the primary care centers, avoiding a total of 9034 face-to-face visits. In total, the distance saved was 192,682 km, with a total travel time saving of 3779 h and a total fuel reduction of 11,754 L with an associated cost of €15,664. This represents an average reduction of 3248.3 g of carbon dioxide, 4.05 g of carbon monoxide, 4.86 g of nitric oxide and 3.2 g of sulphur dioxide. This study confirms that telemedicine reduces the environmental impact of atmospheric pollutants emitted by vehicles by reducing the number of journeys made for face-to-face visits, and thus contributing to environmental sustainability.

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Relation of Fatigue with Alexithymia and Depression in Psychiatric Outpatients

Perceptual and Motor Skills ◽

10.2466/pms.105.2.539-545 ◽

2007 ◽

Vol 105 (2) ◽

pp. 539-545

Author(s):

Thomas N. Wise ◽

Michael J. Sheridan

Keyword(s):

Primary Care ◽

Regression Analysis ◽

Psychosocial Stress ◽

Multivariate Regression ◽

Multivariate Regression Analysis ◽

Psychiatric Outpatients ◽

The Mean

The complaint of fatigue is common in community, primary care, and psychiatric settings. Fatigue is often associated with depression and psychosocial stress. This report investigated the role of alexithymia and depression in fatigue as reported in a sample of 151 psychiatric outpatients (75 men and 76 women) who completed all scales. The mean age of the sample was 45.5 yr. ( SD = 12.5), and mean education was 16.2 yr. ( SD = 2.4). Fatigue was inversely correlated with education (–.16) and positively correlated with depression (.44), anxiety (.30), and alexithymia (.35). However, in a multivariate regression analysis, only depression and alexithymia remained significant ( p ≤ .01).

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