General practitioners: Between integration and co-location. The case of primary care centers in Tuscany, Italy

2018 ◽  
Vol 32 (1) ◽  
pp. 2-15 ◽  
Author(s):  
Sara Barsanti ◽  
Manila Bonciani
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
System Integration ◽  
Positive Impact ◽  
Unintended Consequences ◽  
Care Services ◽  
Primary Care Services ◽  
The Usa ◽  
Italian Model ◽  
The Impact

Healthcare systems have followed several strategies aimed at integrating primary care services and professionals. Medical homes in the USA and Canada, and primary care centres across Europe have collocated general practitioners and other health and social professionals in the same building in order to boost coordination among services and the continuity of care for patients. However, in the literature, the impact of co-location on primary care has led to controversial results. This article analyses the possible benefits of the co-location of services in primary care focusing on the Italian model of primary care centres (Case della Salute) in terms of general practitioners’ perception. We used the results of a web survey of general practitioners in Tuscany to compare the experiences and satisfaction of those general practitioners involved and not involved in a primary care centre, performed a MONAVA and ANOVA analysis. Our case study highlights the positive impact of co-location on the integration of professionals, especially with nurses and social workers, and on organizational integration, in terms of frequency of meeting to discuss about quality of care. Conversely, no significant differences were found in terms of either clinical or system integration. Furthermore, the collaboration with specialists is still weak. Considering the general practitioners’ perspective in terms of experience and satisfaction towards primary care, co-location strategies is a necessary step in order to facilitate the collaboration among professionals and to prevent unintended consequences in terms of an even possible isolation of primary care as an involuntary ‘disintegration of the integration’.

scholarly journals The impact of general practitioners working in or alongside emergency departments: a rapid realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e024501 ◽  
Author(s):  
Alison Cooper ◽  
Freya Davies ◽  
Michelle Edwards ◽  
Pippa Anderson ◽  
Andrew Carson-Stevens ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practitioners ◽  
Patient Experience ◽  
Emergency Departments ◽  
Care Facility ◽  
Patient Choice ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact

ObjectivesWorldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%–43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are ‘free to care for the sickest patients’. However, the research evidence to support this initiative is weak.DesignRapid realist literature review.SettingEmergency departments.Inclusion criteriaArticles describing general practitioners working in or alongside emergency departments.AimTo develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system.ResultsNinety-six articles contributed data to theory development sourced from earlier systematic reviews, updated database searches (Medline, Embase, CINAHL, Cochrane DSR & CRCT, DARE, HTA Database, BSC, PsycINFO and SCOPUS) and citation tracking. We developed theories to explain: how staff interpret the streaming system; different roles general practitioners adopt in the emergency department setting (traditional, extended, gatekeeper or emergency clinician) and how these factors influence patient (experience and safety) and organisational (demand and cost-effectiveness) outcomes.ConclusionsMultiple factors influence the effectiveness of emergency department streaming to general practitioners; caution is needed in embedding the policy until further research and evaluation are available. Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients; however, there is little evidence that this frees up emergency department staff to care for the sickest patients. Distinct primary care services offering increased patient choice may result in provider-induced demand. Economic evaluation and safety requires further research.PROSPERO registration numberCRD42017069741.

Effect of a Reduced Postpartum Length of Stay Program on Primary Care Services Use by Mothers and Infants

PEDIATRICS ◽  
2000 ◽  
Vol 106 (Supplement_3) ◽  
pp. 937-941
Author(s):  
Kenneth D. Mandl ◽  
Charles J. Homer ◽  
Oren Harary ◽  
Jonathan A. Finkelstein
Keyword(s):  
Primary Care ◽  
Length Of Stay ◽  
Early Discharge ◽  
Urgent Care ◽  
Care Utilization ◽  
Care Services ◽  
Primary Care Services ◽  
Ambulatory Services ◽  
The Impact ◽  
Services Use

Objective. To determine the impact of reduced postpartum length of stay (LOS) on primary care services use. Methods. Design: Retrospective quasiexperimental study, comparing 3 periods before and 1 period after introducing an intervention and adjusting for time trends.Setting: A managed care plan.Intervention: A reduced obstetrical LOS program (ROLOS), offering enhanced education and services.Participants: mother-infant dyads, delivered during 4 time periods: February through May 1992, 1993, and 1994, before ROLOS, and 1995, while ROLOS was in effect.Independent Measures: Pre-ROLOS or the post-ROLOS year.Outcome Measures: Telephone calls, visits, and urgent care events during the first 3 weeks postpartum summed as total utilization events. Results. Before ROLOS, LOS decreased gradually (from 51.6 to 44.3 hours) and after, sharply to 36.5 hours. Although primary care use did not increase before ROLOS, utilization for dyads increased during ROLOS. Before ROLOS, there were between 2.37 and 2.72 utilization events per dyad; after, there were 4.60. Well-child visits increased slightly to .98 visits per dyad, but urgent visits did not. Conclusion. This program resulted in shortened stays and more primary care use. There was no increase in infant urgent primary care utilization. Early discharge programs that incorporate and reimburse for enhanced ambulatory services may be safe for infants; these findings should not be extrapolated to mandatory reduced LOS initiatives without enhancement of care.

scholarly journals 46 Primary Care Practitioners Have A High Level of Satisfaction with The Current Breast Referral Pathway but The Majority Would Support A Change to Patient Self-Referral

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Russell ◽  
J Cooper ◽  
M McIntyre ◽  
S Ramzi
Keyword(s):  
Primary Care ◽  
Free Text ◽  
Referral Rates ◽  
Care Services ◽  
Primary Care Services ◽  
Level Of Satisfaction ◽  
And Gender ◽  
Primary Care Practitioners ◽  
High Level ◽  
The Impact

Abstract Aim Currently, patients must consult with a primary care practitioner (PCP) prior to being referred to secondary care breast services. A change to patient self-referral would arguably reduce primary care workload, improve access for patients, and allow breast units to allocate resources more appropriately; no data currently supports this. This study aims to explore PCP's views on breast referral, evaluate the community breast workload, and to investigate the impact of COVID-19 on referral rates. Method An electronic survey was designed on SurveyMonkey.com which aimed to collect both quantitative and qualitative data. The weblink to the survey was sent out via two electronic newsletters. Participants were asked: their role and gender, their level of confidence surrounding breast care, details surrounding their breast workload, how they felt COVID-19 had affected their referral rates, their level of satisfaction with the current pathway, and their opinions on a potential change to patient self-referral. Results 79 responses were received. PCPs estimated that 7.0% (median) of their total consultations were regarding a breast-related issue and that COVID-19 had not had a significant impact on the rate of referral to breast units (P = 0.75). 84.8% of PCPs were satisfied with the current referral pathway. Whilst 74.5% felt a change to patient self-referral would benefit patients and primary care services, their free text comments highlighted some of their reservations. Conclusions PCPs have a high level of satisfaction with the current breast referral pathway, but the majority would be open to a change to patient self-referral to specialist breast units.

scholarly journals SP8.1.3 Primary care practitioners have a high level of satisfaction with the current breast referral pathway but the majority would support a change to patient self-referral

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Thomas Russell ◽  
Jemma Cooper ◽  
Mairead McIntyre ◽  
Sa'ed Ramzi
Keyword(s):  
Primary Care ◽  
Free Text ◽  
Referral Rates ◽  
Care Services ◽  
Primary Care Services ◽  
Level Of Satisfaction ◽  
And Gender ◽  
Primary Care Practitioners ◽  
High Level ◽  
The Impact

Abstract Aims Currently, patients must consult with a primary care practitioner (PCP) prior to being referred to specialist breast services. A change to patient self-referral would arguably reduce primary care workload, improve access for patients, and allow breast units to allocate resources more appropriately; no data currently supports this. This study aims to explore PCP’s views on breast referral, evaluate the community breast workload, and to investigate the impact of COVID-19 on referral rates. Methods An electronic survey was sent out to PCPs in South West England via two electronic newsletters. Participants were asked: their role and gender, their level of confidence surrounding breast care, details surrounding their breast workload, how they felt COVID-19 had affected their referral rates, their level of satisfaction with the current pathway, and their opinions on a potential change to patient self-referral. Results 79 responses were received. PCPs estimated that 7.0% (median) of their total consultations were regarding a breast-related issue and that COVID-19 had not had a significant impact on the rate of referral to breast units (P = 0.75). 84.8% of PCPs had a high level of satisfaction with the current referral pathway. Whilst 74.5% felt a change to patient self-referral would benefit patients and primary care services, their free text comments highlighted some of their reservations. Conclusions PCPs have a high level of satisfaction with the current breast referral pathway, but the majority would be open to a change to patient self-referral to specialist breast units.

scholarly journals Reducing the use of out-of-hours primary care services: A survey among Dutch general practitioners

2016 ◽  
Vol 22 (3) ◽  
pp. 189-195 ◽  
Author(s):  
Ellen Keizer ◽  
Irene Maassen ◽  
Marleen Smits ◽  
Michel Wensing ◽  
Paul Giesen
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Out Of Hours ◽  
Care Services ◽  
Primary Care Services

Contacts with health services during the year prior to suicide death in France (2013-2015)

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Laanani ◽  
C Imbaud ◽  
P Tuppin ◽  
C Poulalhon ◽  
F Jollant ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
General Population ◽  
Health Services ◽  
Emergency Room ◽  
General Practitioners ◽  
National Health ◽  
Physical Conditions ◽  
Care Services ◽  
Primary Care Services

Abstract Background This study was designed to describe contacts with health services during the year before suicide death in France, and to compare the prevalent mental and physical conditions in these people to those of the general population. Methods Data were extracted from the French National Health Data System (SNDS), which comprises comprehensive claims data for inpatient and outpatient care linked to the national causes-of-death registry. Individuals, national health insurance general scheme beneficiaries (i.e. 76% of the population living in France), aged 15 years or older, who died from suicide in France in 2013-2015 were included. Medical consultations, emergency room visits, and hospitalisations during the year preceding death were collected. Conditions were identified, and standardised prevalence ratios (SPRs) were estimated to compare prevalence rates in suicide decedents with those of the general population. Results The study included 19,144 suicide decedents. Overall, 8.5% of suicide decedents consulted a physician or attended an emergency room on the day of death, 34.1% during the week before death, 60.9% during the month before death. Most contacts involved a general practitioner or an emergency room (46.2% of suicide decedents consulted a general practitioner during the month before death, 16.7% attended an emergency room). During the month preceding suicide, 24.4% of individuals were hospitalised at least once. Mental conditions (36.8% of cases) were 7.9-fold (SPR 95% CI: 7.7-8.1) more prevalent in suicide decedents than in the general population. The highest SPRs among physical conditions were for liver/pancreatic diseases (SPR=3.3, 95% CI: 3.1-3.6) and epilepsy (SPR=2.7, 95% CI: 2.4-3.0). Conclusions General practitioners and emergency departments have frequent contacts with suicide decedents during the last weeks before death and are at the forefront of suicide risk identification and prevention in individuals with mental, but also physical conditions. Key messages Mental and physical conditions are more common among suicide decedents than in the general population, and contacts with primary care services are frequent in the last weeks prior to suicide. Primary care services (general practitioners and emergency rooms) should be targeted for suicide preventive interventions.

scholarly journals Development of a Research Tool to Document Self-Reported Chronic Conditions in Primary Care

2017 ◽  
Vol 7 (1) ◽  
pp. 117-123 ◽  
Author(s):  
Martin Fortin ◽  
José Almirall ◽  
Kathryn Nicholson
Keyword(s):  
Primary Care ◽  
Scoping Review ◽  
Chronic Conditions ◽  
Operational Definition ◽  
Research Tool ◽  
The Self ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact ◽  
Research Studies

Background Researchers interested in multimorbidity often find themselves in the dilemma of identifying or creating an operational definition in order to generate data. Our team was invited to propose a tool for documenting the presence of chronic conditions in participants recruited for different research studies. Objective To describe the development of such a tool. Design A scoping review in which we identified relevant studies, selected studies, charted the data, and collated and summarized the results. The criteria considered for selecting chronic conditions were: (1) their relevance to primary care services; (2) the impact on affected patients; (3) their prevalence among the primary care users; and (4) how often the conditions were present among the lists retrieved from the scoping review. Results Taking into account the predefined criteria, we developed a list of 20 chronic conditions/categories of conditions that could be self-reported. A questionnaire was built using simple instructions and a table including the list of chronic conditions/categories of conditions. Conclusions We developed a questionnaire to document 20 self-reported chronic conditions/categories of conditions intended to be used for research purposes in primary care. Guided by previous literature, the purpose of this questionnaire is to evaluate the self-reported burden of multimorbidity by participants and to encourage comparability among research studies using the same measurement.

scholarly journals Primary care nurses in a local Belgian setting: Responding to healthcare needs of people with disabilities

2017 ◽  
Vol 7 (7) ◽  
pp. 44
Author(s):  
Hannelore Storms ◽  
Neree Claes
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Nursing Care ◽  
Healthcare Professionals ◽  
Informal Caregivers ◽  
Care Services ◽  
Healthcare Needs ◽  
Swallowing Problems ◽  
Primary Care Nurses ◽  
The Impact

Background: Given the worldwide evolution to deinstitutionalize care for people with a disability (PD), the importance of having care services, for instance as offered by primary care nurses (PCN), to deliver necessary care to PD can only be emphasized. European data (from 2014) show a relatively high percentage of PD in Belgium (16.2%) using home care services provided by primary health care providers (PCN, general practitioners…). Moreover, satisfaction levels regarding these services are among the highest in Europe. The objective of this research was to gain insight into the needs of PD regarding nursing care, based on PCN’s experiences.Methods: Between September and December 2015, a questionnaire – drawn up by a multidisciplinary team (4 general practitioners and 20 PCN) – was distributed electronically to 1547 PCN working in primary care in the Belgian region Limburg. Open-ended questions of this questionnaire were analyzed using techniques developed for qualitative data analysis. PCN were asked to report about (1) mental and behavioural problems, (2) medication policy, (3) swallowing problems, (4) monitoring of nutritional status and (5) any other needs arising in the care for PD.Results: Comments of 588 PCN were generated (response rate of 38%). Besides the (routine) tasks of PCN, the impact of PD’s and informal caregivers’ behaviour on PCN’s working environment were mentioned, particularly regarding medication policy, swallowing problems and nutrional status monitoring. PCN’s collaboration with PD and their informal caregivers is often reported about in relation to respectively PD’s limited ability to communicate or to understand PCN and informal caregivers behaving in a counteracting way, not following through PCN’s advice. Additionally, PCN report about consulting and activating other healthcare professionals in the interest of PD’s. Overall, PCN mentioned tasks in all facets of PD’s lives: from the expected nursing care and far beyond.Conclusions: Besides providing nursing care, PCN are also helping with different tasks related to daily living. This “beyond standard” - care enhances the likelihood of PD to keep on living in their homes for a longer period of time. PCN seem to play a crucial role in activating other healthcare professionals to meet the healthcare needs of PD. More extensive research should be carried out to gain insight in healthcare needs of PD and the challenges PCN come across in their care for this population. Findings can be used to align pre-qualification training and education of (future) PCN with the (unmet) needs of PD.

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