scholarly journals Facilitators and barriers to implement the family doctor contracting services in China: findings from a qualitative study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e032444 ◽  
Author(s):  
Shasha Yuan ◽  
Fang Wang ◽  
Xi Li ◽  
Meng Jia ◽  
Miaomiao Tian
Keyword(s):  
Family Doctor ◽  
Family Doctors ◽  
Individual Interviews ◽  
Primary Health ◽  
Quality Of Primary Care ◽  
Outer Setting ◽  
Health Institutions ◽  
Facilitators And Barriers ◽  
Inner Setting

ObjectiveTo identify the facilitators and barriers to implement family doctor contracting services in China by using Consolidated Framework for Implementation Research (CFIR) to shed new light on establishing family doctor systems in developing countries.DesignA qualitative study conducted from June to August 2017 using semistructured interview guides for focus group discussions (FGDs) and individual interviews. CFIR was used to guide data coding, data analysis and reporting of findings.Setting19 primary health institutions in nine provinces purposively selected from the eastern, middle and western areas of China.ParticipantsFrom the nine sampled provinces in China, 62 policy makers from health related departments at the province, city and county/district levels participated in 9 FGDs; 19 leaders of primary health institutions participated in individual interviews; and 48 family doctor team members participated in 15 FGDs.ResultsBased on CFIR constructs, notable facilitators included national reform involving both top-down and bottom-up policy making (Intervention); support from essential public health funds, fiscal subsidies and health insurance (Outer setting); extra performance-based payments for family doctor teams based on evaluation (Inner setting); and positive engagement of health administrators (Process). Notable barriers included a lack of essential matching mechanisms at national level (Intervention); distrust in the quality of primary care, a lack of government subsidies and health insurance reimbursement and performance ceiling policy (Outer setting); the low competency of family doctors and weak influence of evaluations on performance-based salary (Inner setting); and misunderstandings about family doctor contracting services (Process).ConclusionsThe national design with essential features including financing, incentive mechanisms and multidepartment cooperation, was vital for implementing family doctor contracting services in China. More attention should be paid to the quality of primary care and competency of family doctors. All stakeholders must be informed, be involved and participate before and during the process.

scholarly journals The algorithm for providing paliative care by general practitioners - family doctors

2021 ◽  
Vol 10 (3) ◽  
pp. 92-97
Author(s):  
О.P. Bratsyun
Keyword(s):  
Quality Of Life ◽  
Palliative Care ◽  
General Practitioners ◽  
Family Doctor ◽  
Timely Manner ◽  
Family Doctors ◽  
Primary Health ◽  
Eortc Qlq C30 ◽  
Eortc Qlq

Background. In Ukraine, as in the rest of the world, the majority of people who face life-threatening or life-limiting illnesses and who need palliative care are at home [1]. It is estimated that palliative care is needed in 40–60 % of all deaths [2]. According to the State Statistics Service of Ukraine, 616 840 persons died in 2020 [3], respectively, approximately 250 to 370 thousand patients needed palliative care in Ukraine. The management of patients throughout the progression/development of the disease and the final phase of life is assigned to the doctors who are closest to the patient – general practitioners – family doctors. The main goal of palliative care is to ensure the most attainable quality of life for patients. At the same time, the doctor must determine in a timely manner when the volume of palliative care provided exclusively from a general practitioner – family doctor is not enough and in a timely manner to involve specialized palliative care services. Purpose of the research: to develop an algorithm for the providing of palliative care by gene­ral practitioners – family doctors with the definition of patients for whom the volume of palliative care goes beyond primary health care. Materials and methods. The current legal framework governing the provision of palliative care by general practitioners – family doctors, scientific literature, questionnaires of sociological research of patients (n = 25). Methods of system analysis, synthesis, abstraction, sociological and medical-statistical methods were used. Results. The current orders of the Ministry of Health of Ukraine and sectoral standards for the provision of medical care, which are guided by general practitioners – family doctors in the provision of palliative care, were studied and the lack of consistency in the implementation of the norms determined by different standards was revealed. It was found that the use of tools to determine the level of quality of life (QOL) as the main purpose of palliative care is not proposed. The duty of the general practitioner – family doctor is the timely involvement of specialized services in the provision of palliative care. At the same time, there is no specific indicator or criterion that may indicate an insufficient provision of palliative care at the level of primary health care. Questionnaires have been proposed for determining the QOL of patients (EORTC QLQ-C30) and self-assessment of depression (PHQ-9). It has been shown that indicators of less than 50 points on the functional scales of the EORTC QLQ-C30 questionnaire and / or 10 or more points on the PHQ-9 depression scale are evidence of the need to accompany the patient by a psychologist, clergyman and social worker, that is the basis for the involvement of a multidisciplinary team of mobile palliative care. A unified algorithm of actions for the provision of palliative care by general practitioners – family doctors has been developed. Conclusions. To ensure the implementation of the rules and regulations defined for general practitioners – family doctors by various regulatory documents, instructions and sectoral standards, it is necessary to introduce an algorithm (unified scheme) of doctor's actions in the provision of palliative care. Therefore, general practitioners – family doctors need to timely apply an algorithm for identifying patients for whom the provision of palliative care provided exclusively by general practitioners – family doctors is insufficient and to establish interaction with mobile palliative services.

scholarly journals Compromised quality of maternal healthcare in a market economy: Medellín, Colombia 2008-2009

2011 ◽  
pp. 294-302 ◽  
Author(s):  
Gloria Molina ◽  
Gilma Vargas ◽  
Alina Shaw
Keyword(s):  
Health Services ◽  
Maternal Care ◽  
Maternal Health Services ◽  
Labor Costs ◽  
Individual Interviews ◽  
The Social ◽  
Municipal Policies ◽  
Obstetric Services ◽  
Health Institutions

Objective: To analyze the quality of the maternal health services in Medellín city, Colombia within the context of the Social Security System in Health from the perspective of the mothers, physicians and nurses involved in the provision of these services. Methodology: A qualitative study was carried out, during which 24 individual interviews were conducted to key doctors and nurses, who work in health institutions that providing maternal care. Also three focus groups with mothers were conducted. The data analysis was carried out using a systematic and carefully coding and categorization process. Findings: In spite of the fact that municipal policies have been put in place to improve maternity care, mother and pregnant women face problems with health services. Findings suggests that the strategies put in place by these health institutions to decrease labor costs, the administrative barriers, the low tariffs of the obstetric services paid by the health insurers within and competitive market, and the focus on getting financial profitability, are aspects that affecting quality of maternal care.

scholarly journals What Has Changed in the Dental Prosthesis Procedures in Primary Health Care In Brazil?

2019 ◽  
Vol 30 (5) ◽  
pp. 519-522
Author(s):  
Mauro Henrique Nogueira Guimarães de Abreu ◽  
Amanda de Lima Franca Neumann Morato ◽  
Angélica Maria Cupertino Lopes Marinho ◽  
Maria Aparecida Melo Cunha ◽  
Suellen da Rocha Mendes
Keyword(s):  
Primary Care ◽  
Secondary Data ◽  
Dental Prosthesis ◽  
National Programme ◽  
Dental Prostheses ◽  
Primary Health ◽  
Quality Of Primary Care ◽  
Access And Quality ◽  
Dental Prosthetics

Abstract The study aimed to identify the changes in the provision of dental prosthetics procedures in the Brazilian primary care. Secondary data from the Brazilian “National Programme for Improving Access and Quality of Primary Care” was assessed and three similar questions related to dental prostheses execution that were answered by the same 9,698 oral health teams, in 2011/2012 and 2013/2014, were compared. There was a 4.3% increase in the number of teams that identified individuals with prosthetic needs; a 0.8% increase in the number of teams that performed impression for prosthetic purposes; and the number of teams that reported performing dental prostheses consultations increased by 0.6%. Overall, there was a small modification in the number of teams that provided dental prosthesis procedures in Brazil.

scholarly journals Effect of family doctor contract services on patient perceived quality of primary care in southern China

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Shanshan Feng ◽  
Aiyun Cheng ◽  
Zhenni Luo ◽  
Yao Xiao ◽  
Luwen Zhang
Keyword(s):  
Primary Care ◽  
Linear Regression ◽  
Service Utilization ◽  
Family Doctor ◽  
Perceived Quality ◽  
Community Orientation ◽  
Quality Of Primary Care ◽  
Family Centeredness ◽  
First Contact

Abstract Background Family doctor contract service is an important service item in China’s primary care reform. This research was designed to evaluate the impact of the provision of family doctor contract services on the patient-perceived quality of primary care, and therefore give evidence-based policy suggestions. Methods This cross-sectional study of family doctor contract service policy was conducted in three pilot cities in the Pearl River Delta, South China, using a multistage stratified sampling method. The validated Primary Care Assessment Tool-Adult Edition (PCAT-AS) was used to measure the quality of primary care services. PCAT-AS assesses each of the unique characteristics of primary care including first contact, continuity, comprehensiveness, coordination, family-centeredness, community orientation, culture orientation. Data was collected through face-to-face interviews held from July to November, 2015. Covariate analysis and multivariate Linear Regression were adopted to explore the effect of contract on the quality of primary care by controlling for the socio-demographic status and health care service utilization factors. Results A total of 828 valid questionnaires were collected. Among the interviewees, 453 patients signed the contract (54.7%) and 375 did not (45.3%). Multivariate linear regression showed that contracted patients reported higher scores in dimensions of PCAT total score (β = − 8.98, P < 0.000), first contact-utilization(β = − 0.71,P < 0.001), first contact-accessibility(β = − 1.49, P < 0.001), continuity (β = 1.27, P < 0.001), coordination (referral) (β = − 1.42, P < 0.001), comprehensiveness (utilization) (β = − 1.70, P < 0.001), comprehensiveness (provision) (β = − 0.99, P < 0.001),family-centeredness(β = − 0.52, P < 0.01), community orientation(β = − 1.78, P < 0.001), than un- contracted after controlling socio-demographic and service utilization factors. There were no statistically significant differences in the dimensions of coordination (information system) (β = − 0.25, P = 0.137) and culture orientation (β = − 0.264, P = 0.056) between the two both groups. Conclusions This study demonstrates that the pilot implementation of family doctor contract services has significantly improved patients’ perceived primary care quality in the pilot cities, and could help solve the quality problem of primary care. It needs further promotion across the province.

scholarly journals The Quality of Primary Care in Community Health Centers: Comparison among Urban, Suburban and Rural Users in Shanghai, China

2020 ◽  
Author(s):  
Jianwei Shi ◽  
Hua Jin ◽  
Leiyu Shi ◽  
Chen Chen ◽  
Xuhua Ge ◽  
...  
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Assessment Tool ◽  
Family Doctor ◽  
Care Quality ◽  
World Health ◽  
Care Experience ◽  
Quality Of Primary Care ◽  
Care Assessment

Abstract Background Following World Health Organization’s initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. This study used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions. Methods Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience. Results A total of 2,404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß=1.57, P < 0.001). The older users, more frequent users, and those in better health condition reported higher PCAT scores. Conclusions CHC users generally reported high quality primary care experience especially in the domain of first-contact (utilization), family centeredness, and comprehensiveness (services provided). That suburban and rural CHC residents reported better primary care experience than urban CHCs demonstrates the unique value of CHCs in relatively medical underserved areas.

scholarly journals The Quality of Primary Care in Community Health Centers: Comparison among Urban, Suburban and Rural Users in Shanghai, China

2020 ◽  
Author(s):  
Jianwei Shi ◽  
Hua Jin ◽  
Leiyu Shi ◽  
Chen Chen ◽  
Xuhua Ge ◽  
...  
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Family Doctor ◽  
Care Quality ◽  
World Health ◽  
Care Experience ◽  
Quality Of Primary Care ◽  
Care Assessment ◽  
First Contact

Abstract Objective: Following World Health Organization’s initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions.Methods: Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience.Findings: A total of 2,404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß=1.57, P<0.001) compared with those from urban CHCs.Conclusion: That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).

scholarly journals Considerations Regarding The Quality Of Rehabilitation And Physical Medicine Services From Patients Perspective

2017 ◽  
Vol 23 (1) ◽  
pp. 5-12
Author(s):  
Carmen Oprea ◽  
P. Armean ◽  
Nicoleta Calota ◽  
Elena Roxana Almasan ◽  
Elena Valentina Ionescu ◽  
...  
Keyword(s):  
Family Doctor ◽  
Life Quality ◽  
Medical Rehabilitation ◽  
Physical Medicine ◽  
Dependence Relation ◽  
Family Doctors ◽  
Patient’S Satisfaction ◽  
Time Of Admission ◽  
Patients Perspective

Abstract The research study aims to assess the quality of physical medicine and rehabilitation (MFR) services offered to the population by specialized sanatoriums and hospitals in Dobrogea, in order to identify some appropriate measures to improve the quality of such services. The target group (593 respondents) consisted of 6 independent batches, different in number, selected from 6 medical units. The patients responded to a specific questionnaire regarding the quality of MFR services and the collected data were analyzed statistically. According to the patients′ answers, the medical staff meets their expectations in terms of the information provided at the time of admission, promptitude, kindness, availability, which reflects just one segment of the quality of medical rehabilitation services. As regards the entity recommending the medical rehabilitation physician, of the total answers, the lowest ratio in the study is held by the answer “family doctor / another doctor”. It thus highlights the poor knowledge of family doctors or other doctors on the therapy benefits specific to medical rehabilitation and therefore the access to such services is not facilitated, a disservice to the patients′ life quality. There is a dependence relation between the level of education and the reason of admission. We see that is not prevention taking the first position, but the pain, which reflects a deficient education for health in all social levels. Assessing the patient’s satisfaction regarding the mobility facilities in the sanatorium / hospital a percentage of 6.6% patient responded that they are not satisfied. It results that all the 6 partner institutions in the study must evolve to provide decent conditions ensuring the mobility independence to the patients.

scholarly journals The Quality of Primary Care in Community Health Centers: Comparison among Urban, Suburban and Rural Users in Shanghai, China

2020 ◽  
Author(s):  
Jianwei Shi ◽  
Hua Jin ◽  
Leiyu Shi ◽  
Chen Chen ◽  
Xuhua Ge ◽  
...  
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Family Doctor ◽  
Care Quality ◽  
World Health ◽  
Care Experience ◽  
Quality Of Primary Care ◽  
Care Assessment ◽  
First Contact

Abstract Objective: Following World Health Organization’s initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions.Methods: Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience.Findings: A total of 2,404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß=1.57, P<0.001) compared with those from urban CHCs.Conclusion: That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).

PrioritÀ cliniche in sanitÀ: governare la domanda con il coinvolgimento dei professionisti

2009 ◽  
pp. 166-177
Author(s):  
Giuliano Mariotti
Keyword(s):  
Waiting Times ◽  
Family Doctor ◽  
Diagnostic Procedures ◽  
Healthcare Services ◽  
Public Healthcare ◽  
Management Technique ◽  
Specific Patient ◽  
Family Doctors ◽  
The Public

- Creating order: this is the first step needed to prevent the collapse of the public healthcare system. Clinical priority for the healthcare services is a model to create an explicit order based on patients' needs, to guarantee timely referrals. This supports the idea that, despite the general perception that health care is difficult to access, availability of out-patient diagnostic procedures may be sufficient to meet the requirements of patients with major diagnostic needs. In Italy, the Homogeneous Waiting Groups (Raggruppamenti di attesa omogenei, RAO) model is being applied. It involves all those who are part of the process of providing a referral: the family doctor, the booking service (Cup) and the specialist. The model is based on identifying categories for the access to referrals. These allow the prescribers to establish in advance the length of wait considered adequate for a specific patient. To manage a system as complex as this one, it may be useful the socalled "facilitation" management technique. The aim is to guarantee the ongoing improvement of the quality of services, to make waiting times adequate to the clinical needs of citizens and the patients themselves more satisfied. Our experience encourages us to organise educational initiatives and joint courses for family doctors and specialists to reinforce the former's ability to increase their knowledge of appropriateness. At the same time, the involvement of family doctors and specialists may increase the level of concordance regarding the attribution of priority levels and adherence to guidelines' keywords. This will need to be evaluated as such schemes are adopted more widely.Keywords: appropriateness; clinical priority; primary care; waiting lists; clinical needs.

scholarly journals THE ROLE OF THE FAMILY DOCTOR IN THE MANAGEMENT OF PATIENTS WITH PSORIASIS

2019 ◽  
Vol 4 (9-10) ◽  
pp. 83-92
Author(s):  
T. B. Bevzenko ◽  
A. A. Mantula
Keyword(s):  
Quality Of Life ◽  
Family Doctor ◽  
Care Facility ◽  
Local Therapy ◽  
Family Doctors ◽  
Diagnostic Measures ◽  
Treatment Measures ◽  
Medical Diagnostic ◽  
Systemic Nature

Psoriasis is a common multifactorial, immunoassociated disease. Approximately one-third of patients have the disease in a recurrent manner and have a moderate or severe course. In addition to dermatological manifestations and lesions of the musculoskeletal system systemic manifestations and certain comorbid conditions are often observed in psoriasis: diabetes mellitus, hypertension, obesity and others. A patient with psoriasis falls into the professional field of interest of doctors in the following specialties: family doctor, dermatologist, rheumatologist, traumatologist, endocrinologist, cardiologist. At the present phase of reforming of the health care system, in our opinion, the regulation of medical-diagnostic measures for GPs is especially relevant. The article presents in detail the route and management of a patient with psoriasis, psoriatic arthritis. Patients should be consulted annually by their GP, which includes documenting the severity of the disease using the DLQI scale, screening for depression, assessing cardiovascular risk, assessing joint symptoms, optimizing local therapy, evaluating the need for referral to a secondary care facility. Active intervention is needed to improve patients' quality of life and reduce the probability of psychosocial consequences. The problem of psoriasis is an relevant medical, social and economic challenge in Ukraine. Undoubtedly, сonsidering the systemic nature of psoriatic disease and comorbidities, a personalized and multidisciplinary approach is required. Forehanded diagnostic, treatment measures, as well as collaborations with related professionals by family doctors determine the prognosis for the health and quality of life of a patients with psoriasis.

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