scholarly journals Identifying important health system factors that influence primary care practitioners’ referrals for cancer suspicion: a European cross-sectional survey

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e022904 ◽  
Author(s):  
Michael Harris ◽  
Peter Vedsted ◽  
Magdalena Esteva ◽  
Peter Murchie ◽  
Isabelle Aubin-Auger ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Factor Analysis ◽  
Health System ◽  
Health Systems ◽  
European Countries ◽  
Cancer Symptoms ◽  
Referral Decision ◽  
System Factors ◽  
Primary Care Practitioners

ObjectivesCancer survival and stage of disease at diagnosis and treatment vary widely across Europe. These differences may be partly due to variations in access to investigations and specialists. However, evidence to explain how different national health systems influence primary care practitioners’ (PCPs’) referral decisions is lacking.This study analyses health system factors potentially influencing PCPs’ referral decision-making when consulting with patients who may have cancer, and how these vary between European countries.DesignBased on a content-validity consensus, a list of 45 items relating to a PCP’s decisions to refer patients with potential cancer symptoms for further investigation was reduced to 20 items. An online questionnaire with the 20 items was answered by PCPs on a five-point Likert scale, indicating how much each item affected their own decision-making in patients that could have cancer. An exploratory factor analysis identified the factors underlying PCPs’ referral decision-making.SettingA primary care study; 25 participating centres in 20 European countries.Participants1830 PCPs completed the survey. The median response rate for participating centres was 20.7%.Outcome measuresThe factors derived from items related to PCPs’ referral decision-making. Mean factor scores were produced for each country, allowing comparisons.ResultsFactor analysis identified five underlying factors: PCPs’ ability to refer; degree of direct patient access to secondary care; PCPs’ perceptions of being under pressure; expectations of PCPs’ role; and extent to which PCPs believe that quality comes before cost in their health systems. These accounted for 47.4% of the observed variance between individual responses.ConclusionsFive healthcare system factors influencing PCPs’ referral decision-making in 20 European countries were identified. The factors varied considerably between European countries. Knowledge of these factors could assist development of health service policies to produce better cancer outcomes, and inform future research to compare national cancer diagnostic pathways and outcomes.

scholarly journals Primary care practitioners’ diagnostic action when the patient may have cancer: an exploratory vignette study in 20 European countries

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e035678
Author(s):  
Michael Harris ◽  
Mette Brekke ◽  
Geert-Jan Dinant ◽  
Magdalena Esteva ◽  
Robert Hoffman ◽  
...  
Keyword(s):  
Primary Care ◽  
Diagnostic Test ◽  
Cancer Survival ◽  
Survival Rates ◽  
European Countries ◽  
Survey Question ◽  
Referral Decisions ◽  
Physician Characteristics ◽  
Care Survey ◽  
Primary Care Practitioners

ObjectivesCancer survival rates vary widely between European countries, with differences in timeliness of diagnosis thought to be one key reason. There is little evidence on the way in which different healthcare systems influence primary care practitioners’ (PCPs) referral decisions in patients who could have cancer.This study aimed to explore PCPs’ diagnostic actions (whether or not they perform a key diagnostic test and/or refer to a specialist) in patients with symptoms that could be due to cancer and how they vary across European countries.DesignA primary care survey. PCPs were given vignettes describing patients with symptoms that could indicate cancer and asked how they would manage these patients. The likelihood of taking immediate diagnostic action (a diagnostic test and/or referral) in the different participating countries was analysed. Comparisons between the likelihood of taking immediate diagnostic action and physician characteristics were calculated.SettingCentres in 20 European countries with widely varying cancer survival rates.ParticipantsA total of 2086 PCPs answered the survey question, with a median of 72 PCPs per country.ResultsPCPs’ likelihood of immediate diagnostic action at the first consultation varied from 50% to 82% between countries. PCPs who were more experienced were more likely to take immediate diagnostic action than their peers.ConclusionWhen given vignettes of patients with a low but significant possibility of cancer, more than half of PCPs across Europe would take diagnostic action, most often by ordering diagnostic tests. However, there are substantial between-country variations.

Fragmentation of Care Among Black Women With Breast Cancer and Comorbidities: The Role of Health Systems

2021 ◽  
Vol 17 (5) ◽  
pp. e637-e644 ◽  
Author(s):  
Michelle Doose ◽  
Janeth I. Sanchez ◽  
Joel C. Cantor ◽  
Jesse J. Plascak ◽  
Michael B. Steinberg ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Black Women ◽  
Health System ◽  
Health Systems ◽  
Care Coordination ◽  
Surgical Care ◽  
Primary Care Visit ◽  
Practice Setting ◽  
Care Fragmentation

PURPOSE: Black women are disproportionately burdened by comorbidities and breast cancer. The complexities of coordinating care for multiple health conditions can lead to adverse consequences. Care coordination may be exacerbated when care is received outside the same health system, defined as care fragmentation. We examine types of practice setting for primary and breast cancer care to assess care fragmentation. MATERIALS AND METHODS: We analyzed data from a prospective cohort of Black women diagnosed with breast cancer in New Jersey who also had a prior diagnosis of diabetes and/or hypertension (N = 228). Following breast cancer diagnosis, we examined types of practice setting for first primary care visit and primary breast surgery, through medical chart abstraction, and identified whether care was used within or outside the same health system. We used multivariable logistic regression to explore sociodemographic and clinical factors associated with care fragmentation. RESULTS: Diverse primary care settings were used: medical groups (32.0%), health systems (29.4%), solo practices (23.7%), Federally Qualified Health Centers (8.3%), and independent hospitals (6.1%). Surgical care predominately occurred in health systems (79.8%), with most hospitals being Commission on Cancer–accredited. Care fragmentation was experienced by 78.5% of Black women, and individual-level factors (age, health insurance, cancer stage, and comorbidity count) were not associated with care fragmentation ( P > .05). CONCLUSION: The majority of Black breast cancer survivors with comorbidities received primary care and surgical care in different health systems, illustrating care fragmentation. Strategies for care coordination and health care delivery across health systems and practice settings are needed for health equity.

scholarly journals IMPLEMENTING THE 4MS IN PRIMARY CARE: BUILDING AN AGE-FRIENDLY HEALTH SYSTEM

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S769-S769
Author(s):  
Ellen Flaherty ◽  
Terry Fulmer
Keyword(s):  
Primary Care ◽  
Health System ◽  
Health Systems ◽  
Clinical Training ◽  
Care Management ◽  
Transitional Care ◽  
Transfer Model ◽  
Term Care ◽  
Care Systems ◽  
Care Improvement

Abstract The Age Friendly Health Systems initiative is a culture change movement funded by the John A. Hartford Foundation in collaboration with the Institute for Health Care Improvement. Transforming clinical training environments into integrated geriatrics and primary care systems to become Age-Friendly Health Systems must incorporate the principles of value-based care and alternative-payment models. This symposium will discuss how the implementation of the Geriatric Interprofessional Team Transformation in Primary Care (GITT-PC) model and the Reducing Avoidable Facility Transfer Model (RAFT) in primary care will improve patient outcomes focused on the 4M’s of the Age Friendly Health System. The success of the GITT-PC model focuses on 4 Medicare reimbursable services including the Annual Wellness Visit, Transitional Care Management, Chronic Care Management and Advance Care Planning. The RAFT model focuses on What Matters Most to residents of long term care facilities and reduces ED visits and hospital transfers through elicitation of goals of care and 24 hour virtual support from an interprofessional geriatric team.

Barriers in access to cancer treatment in Europe: a systematic review of the European Literature

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Jachmann ◽  
K Klingberg ◽  
M C Zapata-Garcia ◽  
D S Srivastava ◽  
A Exadaktylos ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cancer Therapy ◽  
Health System ◽  
Cancer Treatment ◽  
Grey Literature ◽  
European Countries ◽  
Cancer Site ◽  
Cancer Drugs ◽  
System Factors

Abstract Background Within NCD`s, Cancer accounts for the 2nd most frequent cause after Cardiovascular diseases and in some European countries it´s the leading cause of premature deaths. One of the challenges within cancer therapy can be found in inequity in access to cancer treatment, because this causes worse health outcomes, which are attributable to the accessibility of health care and thus avoidable. The objective of the systematic review was to identify barriers in access to cancer treatment in Europe (inter-country) and within 6 European countries (intra-country): Spain, Germany, Switzerland, Finland, Bulgaria, UK. Methods To obtain data scientific (PubMed, CINAHL, Embase) and grey literature were searched using keywords relating to inequity in access to cancer therapy in Europe. Collected Abstracts of published articles in English between 01/2013 and 05/2018 were reviewed independently. Identified barriers in access to cancer therapy were grouped into 2 categories: patient and health system/provider factors, followed by thematic analysis for each category. Results Out of 786 unique articles, 14 were included in the systematic review. The most frequent cited barriers within Europe were patient socioeconomic status (n = 7, 50%), age (n = 4, 28.6%) and reimbursement and availability of cancer medicine (n = 4, 28.6%). Conclusions This review showed that different barriers in access to cancer therapy still exist in Europe and therefore demonstrated an urgent need for actions to reduce these disparities across all Europe. Additional to the known equity stratifiers the role of health system factors concerning different reimbursement processes and shortages in widely used cancer drugs was emphasized. The amount of available studies with main focus on barriers in access to cancer therapy in Europe varies by equity stratifier, cancer site and type of treatment and seems to be very limited, showing a need for future investigations upon this topic with possibly uniform scales. Key messages This review showed that different barriers in access to cancer therapy still exist in Europe and therefore demonstrated an urgent need for actions to reduce these disparities across all Europe. Additional to the known equity stratifiers the role of health system factors concerning different reimbursement processes and shortages in widely used cancer drugs was emphasized.

scholarly journals Primary care practitioners' views on test result management in EHR-enabled health systems: a national survey

2013 ◽  
Vol 20 (4) ◽  
pp. 727-735 ◽  
Author(s):  
Hardeep Singh ◽  
Christiane Spitzmueller ◽  
Nancy J Petersen ◽  
Mona K Sawhney ◽  
Michael W Smith ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
National Survey ◽  
Primary Care Practitioners ◽  
Result Management ◽  
Test Result

scholarly journals Staying afloat: community perspectives on health system resilience in the management of pregnancy and childbirth care during floods in Cambodia

2020 ◽  
Vol 5 (4) ◽  
pp. e002272 ◽  
Author(s):  
Dell D Saulnier ◽  
Hom Hean ◽  
Dawin Thol ◽  
Por Ir ◽  
Claudia Hanson ◽  
...  
Keyword(s):  
Public Health ◽  
Decision Making ◽  
Health System ◽  
Health Systems ◽  
Public Health System ◽  
Health Needs ◽  
Structured Interviews ◽  
The Public ◽  
Pregnancy And Childbirth ◽  
Childbirth Care

IntroductionResilient health systems have the capacity to continue providing health services to meet the community’s diverse health needs following floods. This capacity is related to how the community manages its own health needs and the community and health system’s joined capacities for resilience. Yet little is known about how community participation influences health systems resilience. The purpose of this study was to understand how community management of pregnancy and childbirth care during floods is contributing to the system’s capacity to absorb, adapt or transform as viewed through a framework on health systems resilience.MethodsEight focus group discussions and 17 semi-structured interviews were conducted with community members and leaders who experienced pregnancy or childbirth during recent flooding in rural Cambodia. The data were analysed by thematic analysis and discussed in relation to the resilience framework.ResultsThe theme ‘Responsible for the status quo’ reflected the community’s responsibility to find ways to manage pregnancy and childbirth care, when neither the expectations of the health system nor the available benefits changed during floods. The theme was informed by notions on: i) developmental changes, the unpredictable nature of floods and limited support for managing care, ii) how information promoted by the public health system led to a limited decision-making space for pregnancy and childbirth care, iii) a desire for security during floods that outweighed mistrust in the public health system and iv) the limits to the coping strategies that the community prepared in case of flooding.ConclusionsThe community mainly employed absorptive strategies to manage their care during floods, relieving the burden on the health system, yet restricted support and decision-making may risk their capacity. Further involvement in decision-making for care could help improve the health system’s resilience by creating room for the community to adapt and transform when experiencing floods.

Sign in / Sign up

Export Citation Format

Share Document