scholarly journals What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vivian Nystrøm ◽  
Hilde Lurås ◽  
Patrik Midlöv ◽  
Ann-Chatrin Linqvist Leonardsen
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Healthcare Services ◽  
User Participation ◽  
Hospital Emergency ◽  
Nurses And Physicians ◽  
Hospital Emergency Departments ◽  
Medical Competence ◽  
Selection Of Patients ◽  
Selection Of

Abstract Background Due to demographic changes, hospital emergency departments in many countries are overcrowded. Internationally, several primary healthcare models have been introduced as alternatives to hospitalisation. In Norway, municipal acute wards (MAWs) have been implemented as primary care wards that provide observation and medical treatment for 24 h. The intention is to replace hospitalisation for patients who require acute admission but not specialist healthcare services. The aim of this study was to explore primary care physicians’ (PCPs’) perspectives on admission to a MAW as an alternative to hospitalisation. Methods The study had a qualitative design, including interviews with 21 PCPs in a county in southeastern Norway. Data were analysed with a thematic approach. Results The PCPs described uncertainty when referring patients to the MAW because of the fewer diagnostic opportunities there than in the hospital. Admission of patients to the MAW was assumed to be unsafe for both PCPs, MAW nurses and physicians. The PCPs assumed that medical competence was lower at the MAW than in the hospital, which led to scepticism about whether their tentative diagnoses would be reconsidered if needed and whether a deterioration of the patients’ condition would be detected. When referring patients to a MAW, the PCPs experienced disagreements with MAW personnel about the suitability of the patient. The PCPs emphasised the importance of patients’ and relatives’ participation in decisions about the level of treatment. Nevertheless, such participation was not always possible, especially when patients’ wishes conflicted with what PCPs considered professionally sound. Conclusions The PCPs reported concerns regarding the use of MAWs as an alternative to hospitalisation. These concerns were related to fewer diagnostic opportunities, lower medical expertise throughout the day, uncertainty about the selection of patients and challenges with user participation. Consequently, these concerns had an impact on how the PCPs utilised MAW services.

scholarly journals The provision of promotive and preventative healthcare services by private primary care physicians in the era of the national health insurance program

2017 ◽  
Vol 5 (2) ◽  
pp. 140
Author(s):  
Ketut Ary Diana Artha ◽  
Ketut Suarjana ◽  
Pande Putu Januraga
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
National Health Insurance ◽  
National Health ◽  
Primary Care Physicians ◽  
Healthcare Services ◽  
Qualitative Approaches ◽  
Inhibiting Factors ◽  
Preventative Healthcare ◽  
Preventative Services

Background and purpose: In addition to their duties in addressing the curative and rehabilitative needs of the community, private primary care physicians (PCP) play an important role in providing promotive and preventative healthcare services. This study aims to determine the behaviours, enabling and inhibiting factors involved with the provision of promotive and preventative services by PCP in the era of national health insurance (JKN) implementation.Methods: This research is a mix method study using a combination of quantitative and qualitative approaches. Quantitative surveys were conducted with all PCPs already in working collaboration with the Social Security Administering Agency (BPJS) in the Denpasar City area (61 people). Data analysis techniques used descriptive techniques in order to explore the kinds of promotion and preventative services provided by PCPs. Qualitative research was conducted through in-depth interviews of 8 informants selected by purposive sampling and analyzed thematically to discover the enabling and inhibiting factors of the provision of promotive and preventative services by PCPs.Results: The results showed that 91.8% of PCPs did perform promotive and preventative services in their practice site. PCPs who did not carry out promotive and preventative services demonstrate perceptions, beliefs and motivations categorized as low and weak as well as attitudes that do not support the implementation of such services. Enabling factors of promotion and preventative services by PCPs, include among others, quality of facilities and infrastructure, the receipt of awards from BPJS and capitation systems that benefit physicians financially. Inhibiting factors include a low willingness of the patient to carry out doctor's advice, limitations in the PCPs work time and limited funds to perform preventative/promotive services.Conclusions: Promotive and preventative services are not being optimally carried out by PCPs in Denpasar. This is due to the low willingness of the patients, the limited time of the doctor, and the limited allocated funds for promotive and preventative services and low capitation.

scholarly journals Characteristics of frequently attending children in hospital emergency departments: a systematic review

BMJ Open ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. e051409
Author(s):  
Geva Greenfield ◽  
Olivia Okoli ◽  
Harumi Quezada-Yamamoto ◽  
Mitch Blair ◽  
Sonia Saxena ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Hospital Emergency ◽  
Long Term Conditions ◽  
Frequent Users ◽  
Frequent Attendance ◽  
Wide Range ◽  
The Usa ◽  
Common Policies ◽  
Hospital Emergency Departments

ObjectiveTo summarise the literature on frequent attendances to hospital emergency departments (EDs) and describe sociodemographic and clinical characteristics of children who attend EDs frequently.SettingHospital EDs.ParticipantsChildren <21 years, attending hospital EDs frequently.Primary outcome measuresOutcomes measures were defined separately in each study, and were predominantly the number of ED attendances per year.ResultsWe included 21 studies representing 6 513 627 children. Between 0.3% and 75% of all paediatric ED users were frequent users. Most studies defined four or more visits per year as a ‘frequent ED’ usage. Children who were frequent ED users were more likely to be less than 5 years old. In the USA, patients with public insurance were more likely to be frequent attenders. Frequent ED users more likely to be frequent users of primary care and have long-term conditions; the most common diagnoses were infections and gastroenteritis.ConclusionsThe review included a wide range of information across various health systems, however, children who were frequent ED users have some universal characteristics in common. Policies to reduce frequent attendance might usefully focus on preschool children and supporting primary care in responding to primary care oriented conditions.

Exploring Innovative, Alternative Healthcare Models in the US

2020 ◽  
pp. 21-42
Author(s):  
Raj Selladurai ◽  
Roshini Isabell Selladurai ◽  
George VandeWerken
Keyword(s):  
Primary Care ◽  
Healthcare Cost ◽  
Primary Care Physicians ◽  
Healthcare Services ◽  
Wellness Program ◽  
Faith Based ◽  
Partnership Model ◽  
The Us ◽  
Direct Primary ◽  
Patient Retention

This chapter explores, discusses, analyzes, and presents some recommendations for new, innovative alternative healthcare models to the traditional insurance and healthcare models that currently exist. These include a revised and enhanced hybrid model of healthcare; healthcare cost-sharing faith-based model; healthcare cost-reduction corporate partnership model (for example, Amazon, Berkshire Hathaway, and JPMorgan Chase partnership); direct primary care model; and wellness program model including subscription type payment services, concierge medicine services, networks of primary care physicians providing patient retention, personalized medicine, and preventive care (MD VIP for example). Significant outcomes such as lowering healthcare costs, enhancing the quality and delivery of healthcare services, improving patient satisfaction, and promoting overall sustainability are addressed, including their implications for various stakeholders.

scholarly journals Utilization of Services by Chronically Ill People in Managed Care and Indemnity Plans: Implications for Quality

2003 ◽  
Vol 40 (1) ◽  
pp. 57-70 ◽  
Author(s):  
Stephen M. Davidson ◽  
Harriet Davidson ◽  
Heidi Miracle-McMahill ◽  
J. Michael Oakes ◽  
Sybil Crawford ◽  
...  
Keyword(s):  
Primary Care ◽  
Managed Care ◽  
Chronic Conditions ◽  
Primary Care Physicians ◽  
Chronically Ill ◽  
Hospital Emergency Department ◽  
Hospital Emergency ◽  
Utilization Of Services ◽  
Managed Care Organizations

Because incentives for managed care organizations favor cost containment, concerns have been raised that quality of care has suffered, especially for chronically ill people. This study compares utilization rates of managed care and indemnity patients with three chronic conditions, using five years of claims records (1993–97) from private plans and Medicare in one market. Findings show that for all three conditions, managed care patients were more likely to see both primary care physicians and specialists within a year, but less likely to use a hospital emergency department or to be an inpatient. Assuming that patients with these illnesses should see a physician annually and that good primary care reduces the need for emergency and inpatient services, it appears that the patterns of care used by chronically ill managed care patients in this market do not reflect lower quality than that received by similar indemnity patients.

Quantitative comparisons of urgent care service providers

2015 ◽  
Vol 28 (6) ◽  
pp. 574-594 ◽  
Author(s):  
Hong Qin ◽  
Gayle L. Prybutok ◽  
Victor R. Prybutok ◽  
Bin Wang
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Service Quality ◽  
Primary Care Physicians ◽  
Service Providers ◽  
Survey Instrument ◽  
Urgent Care ◽  
Emergency Rooms ◽  
Hospital Emergency ◽  
Content Type

Purpose – The purpose of this paper is to develop, validate, and use a survey instrument to measure and compare the perceived quality of three types of US urgent care (UC) service providers: hospital emergency rooms, urgent care centres (UCC), and primary care physician offices. Design/methodology/approach – This study develops, validates, and uses a survey instrument to measure/compare differences in perceived service quality among three types of UC service providers. Six dimensions measured the components of service quality: tangibles, professionalism, interaction, accessibility, efficiency, and technical quality. Findings – Primary care physicians’ offices scored higher for service quality and perceived value, followed by UCC. Hospital emergency rooms scored lower in both quality and perceived value. No significant difference was identified between UCC and primary care physicians across all the perspectives, except for interactions. Research limitations/implications – The homogenous nature of the sample population (college students), and the fact that the respondents were recruited from a single university limits the generalizability of the findings. Practical implications – The patient’s choice of a health care provider influences not only the continuity of the care that he or she receives, but compliance with a medical regime, and the evolution of the health care landscape. Social implications – This work contributes to the understanding of how to provide cost effective and efficient UC services. Originality/value – This study developed and validated a survey instrument to measure/compare six dimensions of service quality for three types of UC service providers. The authors provide valuable data for UC service providers seeking to improve patient perceptions of service quality.

scholarly journals Primary care professionals providing non-urgent care in hospital emergency departments

2018 ◽  
Author(s):  
Daniela Gonçalves-Bradley ◽  
Jaspreet K Khangura ◽  
Gerd Flodgren ◽  
Rafael Perera ◽  
Brian H Rowe ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Departments ◽  
Urgent Care ◽  
Hospital Emergency ◽  
Hospital Emergency Departments ◽  
Primary Care Professionals

Consultation-Liaison Psychiatry Fellowship in Primary Care

1996 ◽  
Vol 26 (2) ◽  
pp. 135-143 ◽  
Author(s):  
Maurice D. Steinberg ◽  
Steven A. Cole ◽  
Stephen M. Saravay
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Liaison Psychiatry ◽  
Service Staff ◽  
Consultation Liaison Psychiatry ◽  
Primary Care Practitioners ◽  
Primary Care Medicine ◽  
Selection Of

Objective: This article describes the need for and development of an outpatient primary care psychiatry fellowship program. Method: The Department of Psychiatry at Hillside Hospital established a primary care fellowship for psychiatrists in 1994, through its consultation-liaison (C-L) service. Staff alliances established by the C-L service with primary care physicians provided the basis for identifying appropriate outpatient practices in the community. Knowledge and skills objectives were adapted from a traditional C-L fellowship to outpatient primary care medicine. Results: The selection of a psychologically minded primary care practitioners was crucial. Practitioners used an inclusive model in which fellows would see all patients with them, not just those with mental disorders. Fellows have felt comfortable working in the primary care setting and have been well received by practitioners, staff, and patients. The practitioners were clearly more interested in psychosocial aspects of their patient than were primary care residents. Conclusions: The gap in preparing U.S. psychiatrists to function in integrated primary care programs requires establishing a presence in the primary care setting. Skills and relationships from traditional C-L settings can be productively used to accomplish this goal.

scholarly journals Primary care during the transition to adult care for adolescents involved with pediatric specialty services: a scoping review protocol

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Kyleigh Schraeder ◽  
Brooke Allemang ◽  
Cathie Scott ◽  
Kerry McBrien ◽  
Gina Dimitropoulos ◽  
...  
Keyword(s):  
Primary Care ◽  
Scoping Review ◽  
Chronic Conditions ◽  
Primary Care Physicians ◽  
Neurodevelopmental Disorder ◽  
Healthcare Services ◽  
Chronic Health Condition ◽  
Transition To Adult Care ◽  
Adult Care ◽  
Specialist Services

Abstract Background Of the 15–20% of youth in North America affected by a chronic health condition (e.g., type 1 diabetes, cystic fibrosis) and/or mental health or neurodevelopmental disorder (e.g., depression, eating disorder, Attention Deficit-Hyperactivity Disorder), many often require lifelong specialist healthcare services. Ongoing primary care during childhood and into young adulthood is recommended by best practice guidelines. To date, it is largely unknown if, how, and when primary care physicians (PCPs; such as family physicians) collaborate with specialists as AYAs leave pediatric-oriented services. The proposed scoping review will synthesize the available literature on the roles of PCPs for AYAs with chronic conditions leaving pediatric specialty care and identify potential benefits and challenges of maintaining PCP involvement during transition. Methods Arksey and O’Malley’s original scoping review framework will be utilized with guidance from Levac and colleagues and the Joanna Briggs Institute. A search of databases including MEDLINE (OVID), EMBASE, PsycINFO, and CINAHL will be conducted following the development of a strategic search strategy. Eligible studies will (i) be published in English from January 2004 onwards, (ii) focus on AYAs (ages 12–25) with a chronic condition(s) who have received specialist services during childhood, and (iii) include relevant findings about the roles of PCPs during transition to adult services. A data extraction tool will be developed and piloted on a subset of studies. Both quantitative and qualitative data will be synthesized. Discussion Key themes about the roles of PCPs for AYAs involved with specialist services will be identified through this review. Findings will inform the development and evaluation of a primary-care based intervention to improve transition care for AYAs with chronic conditions.

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