scholarly journals Coordination of care for multimorbid patients from the perspective of general practitioners – a qualitative study

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Judith Stumm ◽  
Cornelia Thierbach ◽  
Lisa Peter ◽  
Susanne Schnitzer ◽  
Lorena Dini ◽  
...  
Keyword(s):  
General Practice ◽  
Healthcare System ◽  
General Practitioners ◽  
Health Care Professionals ◽  
Healthcare Providers ◽  
Care Process ◽  
Framework Analysis ◽  
Number Of Patients ◽  
Wide Range ◽  
Multimorbid Patients

Abstract Background In Germany, a decreasing number of general practitioners (GPs) face a growing number of patients with multimorbidity. Whilst care for patients with multimorbidity involves various healthcare providers, the coordination of this care is one of the many responsibilities of GPs. The aims of this study are to identify the barriers to the successful coordination of multimorbid patient care and these patients’ complex needs, and to explore the support needed by GPs in the care of multimorbid patients. Interviewees were asked for their opinion on concepts which involve the support by additional employees within the practice or, alternatively, external health care professionals, providing patient navigation. Methods Thirty-two semi-structured, qualitative interviews were conducted with 16 GPs and 16 medical practice assistants (MPAs) from 16 different practices in Berlin. A MPA is a qualified non-physician practice employee. He or she undergoes a three years vocational training which qualifies him or her to provide administrative and clinical support. The interviews were digitally recorded, transcribed and analysed using the framework analysis methodology. Results The results of this paper predominantly focus on GPs’ perspectives of coordination within and external to general practice. Coordination in the context of care for multimorbid patients consists of a wide range of different tasks. Organisational and administrative obstacles under the regulatory framework of the German healthcare system, and insufficient communication with other healthcare providers constitute barriers described by the interviewed GPs and MPAs. In order to ensure optimal care for patients with multimorbidity, GPs may have to delegate responsibilities associated with coordinating tasks. GPs consider the deployment of an additional specifically qualified employee inside the general practice to take on coordinative and social and legal duties to be a viable option. Conclusions The cross-sectoral cooperation between all involved key players working within the healthcare system, as well as the coordination of the whole care process, is seemingly challenging for GPs within the complex care system of multimorbid patients. GPs are generally open to the assignment of a person to support them in coordination tasks, preferably situated within the practice team.

scholarly journals Relational Coordination and Organisational Social Capital Association with Characteristics of General Practice

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Sanne Lykke Lundstrøm ◽  
Kasper Edwards ◽  
Thomas Bøllingtoft Knudsen ◽  
Pia Veldt Larsen ◽  
Susanne Reventlow ◽  
...  
Keyword(s):  
Social Capital ◽  
General Practice ◽  
General Practitioners ◽  
Questionnaire Survey ◽  
Response Rate ◽  
The Self ◽  
Survey Study ◽  
Relational Coordination ◽  
Number Of Patients

Background. Relational coordination (RC) and organisational social capital (OSC) are measures of novel aspects of an organisation’s performance, which have not previously been analysed together, in general practice. Objectives. The aim of this study was to analyse the associations between RC and OSC, and characteristics of general practice. Methods. Questionnaire survey study comprising 2074 practices in Denmark. Results. General practitioners (GPs) rated both RC and OSC in their general practice higher than their secretaries and nurses. The practice form was statistically significantly associated with high RC and OSC. RC was positively associated with the number of patients listed with a practice per staff, where staff is defined as all members of a practice including both owners and employees. Conclusion. The study showed that RC and OSC were significantly associated with type of profession and practice type. RC was also found to be significantly positively associated with number of patients per staff. However, the low response rate must be taken into consideration when interpreting the self-reported results of this study.

scholarly journals Healthcare financing in Egypt: a systematic literature review.

2022 ◽  
Vol 97 (1) ◽  
Author(s):  
Ahmad Fasseeh ◽  
Baher ElEzbawy ◽  
Wessam Adly ◽  
Rawda ElShahawy ◽  
Mohsen George ◽  
...  
Keyword(s):  
Healthcare System ◽  
Health Expenditure ◽  
Healthcare Providers ◽  
Pharmaceutical Expenditure ◽  
Absolute Number ◽  
Total Health Expenditure ◽  
Healthcare Financing ◽  
Public And Private ◽  
Wide Range ◽  
Google Search

Abstract Background The Egyptian healthcare system has multiple stakeholders, including a wide range of public and private healthcare providers and several financing agents. This study sheds light on the healthcare system’s financing mechanisms and the flow of funds in Egypt. It also explores the expected challenges facing the system with the upcoming changes. Methods We conducted a systematic review of relevant papers through the PubMed and Scopus search engines, in addition to searching gray literature through the ISPOR presentations database and the Google search engine. Articles related to Egypt’s healthcare system financing from 2009 to 2019 were chosen for full-text review. Data were aggregated to estimate budgets and financing routes. Results We analyzed the data of 56 out of 454 identified records. Governmental health expenditure represented approximately one-third of the total health expenditure (THE). Total health expenditure as a percent of gross domestic product (GDP) was almost stagnant in the last 12 years, with a median of 5.5%. The primary healthcare financing source is out-of-pocket (OOP) expenditure, representing more than 60% of THE, followed by government spending through the Ministry of Finance, around 37% of THE. The pharmaceutical expenditure as a percent of THE ranged from 26.0 to 37.0%. Conclusions Although THE as an absolute number is increasing, total health expenditure as a percentage of GDP is declining. The Egyptian healthcare market is based mainly on OOP expenditures and the next period anticipates a shift toward more public spending after Universal Health Insurance gets implemented.

scholarly journals General practitioners’ barriers and facilitators towards new provider-initiated HIV testing strategies: a qualitative study

2016 ◽  
Vol 28 (5) ◽  
pp. 459-466 ◽  
Author(s):  
Ivo K Joore ◽  
Sanne LC van Roosmalen ◽  
Jan EAM van Bergen ◽  
Nynke van Dijk
Keyword(s):  
General Practice ◽  
Focus Groups ◽  
Hiv Testing ◽  
General Practitioners ◽  
Framework Analysis ◽  
Transmitted Infection ◽  
European Guidelines ◽  
Testing Strategies ◽  
Hiv Test ◽  
The Right

European guidelines recommend offering an HIV test to individuals who display HIV indicator conditions (ICs). UK guidelines recommend performing a ‘routine offer of HIV testing’ in primary care where HIV prevalence exceeds 2 in 1000. Implementation of new provider-initiated HIV testing strategies in general practice is limited, while the numbers of undiagnosed and late for care HIV patients remain high. We have explored Dutch general practitioners’ barriers to and facilitators of both strategies. We combined semi-structured in-depth interviews with focus groups. Nine general practitioners – key informants of sexually transmitted infection/HIV prevention and control – were selected for the interviews. Additionally, we organised focus groups with a broad sample of general practitioners (n = 81). Framework analysis was used to analyse the data. Various barriers were found, related to (1) the content of the guidelines (testing the right group and competing priorities in general practice), (2) their organisational implementation (lack of time, unclear when to repeat the HIV test and overlong list of ICs) and (3) the patient population (creating fear among patients, stigmatising them and fear regarding financial costs). Multiple general practitioners stated that performing a sexual risk assessment of patients is important before applying either strategy. Also, they recommended implementing the IC-guided approach only in high-prevalence areas and combining HIV tests with other laboratory blood tests. General practitioners tend to cling to old patterns of risk-based testing. Promoting awareness of HIV testing and educating general practitioners about the benefits of new provider-initiated HIV testing strategies is important for the actual uptake of HIV testing.

Review: The Doctor, His Patient and the Illness

2016 ◽  
pp. 401-404
Author(s):  
Donald W. Winnicott
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Number Of Patients ◽  
Good Medium

Winnicott’s review of Michael Balint’s The Doctor, His Patient and the Illness discusses Balint’s work in the Tavistock Clinic as pertaining to general practice and as a good medium for the spread of psychotherapy along psycho-analytic lines. Winnicott notes that it is possible that analysts are not well aware of the tremendous number of patients who are dealt with successfully by general practitioners without being in analysis at all.

scholarly journals Audit of a psychiatric liaison service – the value of general practice casenotes

1990 ◽  
Vol 14 (12) ◽  
pp. 727-729 ◽  
Author(s):  
Sheila M. Curran ◽  
Ian M. Pullen
Keyword(s):  
Primary Care ◽  
General Practice ◽  
General Practitioners ◽  
Care Setting ◽  
Primary Care Setting ◽  
Number Of Patients

The practice of out-patient psychiatry has undergone a number of significant developments in recent years: the number of patients referred by general practitioners has steadily increased: a large number of psychiatrists are now seeing patients in the primary care setting and more patients are being seen on one occasion only.

scholarly journals The Capacity of the Indonesian Healthcare System to Respond to COVID-19

2021 ◽  
Vol 9 ◽  
Author(s):  
Yodi Mahendradhata ◽  
Ni Luh Putu Eka Andayani ◽  
Eva Tirtabayu Hasri ◽  
Mohammad Dzulfikar Arifi ◽  
Renova Glorya Montesori Siahaan ◽  
...  
Keyword(s):  
Healthcare System ◽  
Essential Elements ◽  
Limited Capacity ◽  
Surge Capacity ◽  
Indonesian Government ◽  
Medical Supplies ◽  
Number Of Patients ◽  
Wide Range ◽  
Response Equation ◽  
Pandemic Response

The Indonesian Government has issued various policies to fight Coronavirus Disease (COVID-19). However, cases have continued to fluctuate over a year into the pandemic. There is a need to assess the country's healthcare system's capacity to absorb and accommodate the varying healthcare demands. We reviewed the current capacity of Indonesia's healthcare system to respond to COVID-19 based on the four essential elements of surge capacity: staff, stuff, structure, and system. Currently available medical staffs are insufficient to deal with potentially increasing demands as the pandemic highlighted the human resources challenges the healthcare system has been struggling with. The pandemic has exposed the fragility of medical supply chains. Surges in the number of patients requiring hospitalization have led to depleted medical supplies. The existing healthcare infrastructure is still inadequate to deal with the rise of COVID-19 cases, which has also exposed the limited capacity of the healthcare infrastructure to manage medical waste. The COVID-19 pandemic has further exposed the weakness of the patient referral system and the limited capacity of the healthcare system to deliver essential health services under prolonged emergencies. The Indonesian Government needs to ramp up the country's healthcare capacity. A wide range of strategies has been proposed to address those mounting challenges. Notwithstanding, the challenges of increasing healthcare capacity highlight that such efforts could represent only one part of the pandemic response equation. Effective pandemic response ultimately requires governments' commitment to increase healthcare capacity and flatten the curve concurrently.

General practitioners’ considerations of and experiences with multimorbidity patients: A qualitative study

2019 ◽  
Vol 22 (3-4) ◽  
pp. 117-126 ◽  
Author(s):  
Lisbeth Ørtenblad ◽  
Nina Konstantin Nissen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Participant Observation ◽  
Analytical Framework ◽  
Holistic View ◽  
Subject Field ◽  
General Practices ◽  
The Subject ◽  
Multimorbid Patients ◽  
Core Characteristics

Introduction General practitioners’ management of multimorbid patients is mostly described as a burden, although it is also indicated that fundamental characteristics of general practice are well-suited to accommodate appropriate management of multimorbidity. However, little is known about actual practices among general practitioners. This study explores general practitioners’ management of their multimorbid patients. Methods A qualitative methodological design using participant observation and interviews. Interpretive description was used as the analytical framework. The study took place in a provincial town in Denmark. Three general practices with a total of 12 general practitioners participated. Results ‘Multimorbidity’ as general terminology does not reflect the practice of the general practitioners. Their approach is based on the functional capacity of individual patients. The heterogeneity of the group was classified into three categories determining the general practitioners’ approach: the well-functioning patients, the surprising patients and the fragile patients. Three core characteristics were identified as pivotal for the general practitioners’ approach: holistic view of the patient’s situation, patient-centred focus and coordinator and facilitator. These are fundamental characteristics of general practice, but become especially significant because they accommodate the complexity and heterogeneity of multimorbid patients. Discussion This study expands the subject field by exploring the general practitioners’ actual practices, thereby providing new perspectives into features that support appropriate management of multimorbid patients. General practitioners balance administrative and clinical regulations in their considerations of accommodating the heterogeneity and complexity of multimorbid patients. This suggests that better possibilities must be provided to realize the fundamental characteristics of general practice to support their management of multimorbid patients.

scholarly journals Who Wants To Improve Collaboration in Services for Individuals with Chronic Conditions? Specialists and Rural General Practitioners Taking Action in a Fragmented Health Care System

2021 ◽  
Author(s):  
Rebecca Tomaschek ◽  
Armin Gemperli ◽  
Stefan Essig
Keyword(s):  
Health Care ◽  
General Practitioners ◽  
Health Care Professionals ◽  
Chronic Conditions ◽  
Intervention Study ◽  
Number Of Patients ◽  
Cord Injury ◽  
Collaboration Quality ◽  
Specific Care ◽  
Taking Action

Abstract Introduction Strategies to improve fragmented care for individuals with chronic conditions can be futile if those health care professionals who would have benefited are not engaged. We aimed to explore motivation and previous collaboration quality of general practitioners (GPs) and specialists who participate in an intervention study to improve their collaboration, and GPs who do not participate. Methods Explorative survey among rural GPs and specialists for spinal cord injury (SCI) participating in an intervention to improve collaboration, and non-participating GPs, from August to October 2020, in Switzerland. Results Eight GPs and 13 specialists of the intervention study and 23 non-participating GPs took part. Specialists were from various medical disciplines. Participating GPs were located farther away from a hospital and consulted a higher number of patients. Overall, the collaboration quality at the primary-secondary care interface was good. Whereas specialists and participating GPs were mostly satisfied with their collaboration, non-participating GPs’ reported a lower quality regarding some aspects of collaboration. Furthermore, differences in collaboration quality between general chronic care and SCI specific care could be observed. Conclusion The collaboration quality was rather high in participating physicians. The benefit of the intervention would have been higher in non-participating than participating GPs. When participation is optional, interventions to improve collaboration likely do not achieve the effect that would actually be possible.

Assessing Efficiency in General Practice: An Application of Data Envelopment Analysis

1998 ◽  
Vol 11 (2) ◽  
pp. 103-108 ◽  
Author(s):  
J. M. Bates ◽  
D. L. Baines ◽  
D. K. Whynes
Keyword(s):  
Health Care ◽  
General Practice ◽  
Data Envelopment Analysis ◽  
Performance Indicators ◽  
Care Process ◽  
Considerable Importance ◽  
Data Envelopment ◽  
Number Of Patients ◽  
Efficiency Ranking ◽  
Using Data

As with any health care process, the efficiency with which outputs are produced in general practice is of considerable importance. Using data from Lincolnshire, this study utilizes data envelopment analysis to examine the relationships between practice costs and outputs, measured not only as the number of patients treated, but also on the basis of performance indicators. The technique permits the construction of an efficiency ranking, facilitating the accurate targeting of monitoring resources.

scholarly journals General Practitioners� Attitudes Toward a Web-Based Mental Health Service for Adolescents: Implications for Service Design and Delivery (Preprint)

2017 ◽  
Author(s):  
Mirjana Subotic-Kerry ◽  
Catherine King ◽  
Kathleen O'Moore ◽  
Melinda Achilles ◽  
Bridianne O'Dea
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
General Practitioners ◽  
Health Care Professionals ◽  
Strong Support ◽  
Service Design ◽  
Web Based ◽  
Wide Range

BACKGROUND Anxiety disorders and depression are prevalent among youth. General practitioners (GPs) are often the first point of professional contact for treating health problems in young people. A Web-based mental health service delivered in partnership with schools may facilitate increased access to psychological care among adolescents. However, for such a model to be implemented successfully, GPs’ views need to be measured. OBJECTIVE This study aimed to examine the needs and attitudes of GPs toward a Web-based mental health service for adolescents, and to identify the factors that may affect the provision of this type of service and likelihood of integration. Findings will inform the content and overall service design. METHODS GPs were interviewed individually about the proposed Web-based service. Qualitative analysis of transcripts was performed using thematic coding. A short follow-up questionnaire was delivered to assess background characteristics, level of acceptability, and likelihood of integration of the Web-based mental health service. RESULTS A total of 13 GPs participated in the interview and 11 completed a follow-up online questionnaire. Findings suggest strong support for the proposed Web-based mental health service. A wide range of factors were found to influence the likelihood of GPs integrating a Web-based service into their clinical practice. Coordinated collaboration with parents, students, school counselors, and other mental health care professionals were considered important by nearly all GPs. Confidence in Web-based care, noncompliance of adolescents and GPs, accessibility, privacy, and confidentiality were identified as potential barriers to adopting the proposed Web-based service. CONCLUSIONS GPs were open to a proposed Web-based service for the monitoring and management of anxiety and depression in adolescents, provided that a collaborative approach to care is used, the feedback regarding the client is clear, and privacy and security provisions are assured.

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