scholarly journals To which non-physician health professionals do French general practitioners refer their patients to and what factors are associated with these referrals? Secondary analysis of the French national cross-sectional ECOGEN study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Matthieu Peurois ◽  
Matthieu Chopin ◽  
Gaëlle Texier-Legendre ◽  
Cécile Angoulvant ◽  
William Bellanger ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Secondary Analysis ◽  
Patient Characteristics ◽  
Professional Activity ◽  
Related Factors ◽  
Cross Sectional ◽  
Referral Rates ◽  
Physician Health ◽  
Annual Consultation

Abstract Background Multiprofessional practice is a key component in primary care. Examining general practitioner (GP) referral frequency to non-physician health professionals (NPHP) can provide information about how primary care is organised and works which is useful for policymakers. Our study aimed to describe French GP referral frequency to various NPHPs in France and identify associated factors. Methods This is an ancillary study to the observational, cross-sectional (ECOGEN) study conducted in 2011/2012 in France among 128 GPs. Data about consultations using the standardised International Classification of Primary Care (ICPC-2), and patient and GP characteristics were collected from 20,613 GP consultations. Referrals were identified through inductive and deductive approaches using ICPC-2 codes, keywords, and deep, open manual searches. Referral frequency was described overall and per NPHP. Patient, GP, and consultation-related factors associated with referral rates were described for the three most frequently identified NPHPs. To minimise potential sources of bias, this observational study followed the STROBE guidelines. Results French GPs referred 6.8% of patients to NPHPs, with physiotherapists, podiatrists, and nurses accounting for 85.2% of referrals. Older patients, retired patients, multiple health problems managed, and longer consultation durations were found to be associated with higher referral rates (p < 0.001). Specific trends were observed for nurse, physiotherapist, and podiatrist referrals. Women (p < 0.001) and regular patients (p = 0.002) were more likely to receive physiotherapy referrals while people with no professional activity were less likely (p < 0.001). Female GPs and those working in urban practices were more likely to issue a physiotherapy referral (p < 0.001), while GPs working in rural practices (p < 0.001) and those with higher annual consultation numbers (p = 0.002) were more likely to refer to a nurse. Working in multiprofessional centres appeared to have little impact on referral rates, being only slightly associated with podiatrist referrals (p = 0.003). Conclusions Referral frequency is more associated with patient characteristics and clinical situations than GP-related factors suggesting patients needing referral most are most often referred. Furthermore, the three NPHPs that GPs refer to the most are those for which a referral is required for reimbursement in France, suggesting that health system legislation and NPHP reimbursement are strong determinants for referrals.

scholarly journals Promoting rational antibiotics prescribing for non-complicated infections: Understanding social influence in primary care networks in Germany

2019 ◽  
Author(s):  
Regina Poss-Doering ◽  
Martina Kamradt ◽  
Katharina Glassen ◽  
Edith Andres ◽  
Petra Kaufmann-Kolle ◽  
...  
Keyword(s):  
Social Support ◽  
Primary Care ◽  
Social Influence ◽  
Health Professionals ◽  
Best Practice ◽  
Care Providers ◽  
Self Reflection ◽  
Physician Health ◽  
Depth Analysis ◽  
Improvement Programs

Abstract Primary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified. Methods For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories ‘social support’, ‘social learning’, ‘social normative pressures’ and ‘social contagion’ to reflect social influence processes. To foster understanding of the networks’ potential impact on antibiotics prescribing, data generated through surveys with physicians and non-physician health professionals were analyzed descriptively. Results : Social influence processes proved to be relevant regarding knowledge transfer, manifestation of best-practice care and self-reflection. Peer communication was seen as great asset, main reason for membership and affirmative for own perspectives. All interviewed physicians (n=27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflected management of antibiotics prescribing. Non-physician health professionals (n=11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders (n=7) expected networks and their members to be drivers for care optimization. Conclusion: Primary care networks play a crucial role in providing a platform for professional peer exchange, social support and reassurance. With regards to their impact on antibiotics prescribing for acute non-complicated infections, networks seem to facilitate and amplify quality improvement programs by providing a platform for refreshing awareness, knowledge and self-reflection among care providers. They are well suited to promote a rational use of antibiotics. .

scholarly journals Promoting rational antibiotic prescribing for non-complicated infections: Understanding social influence in primary care networks in Germany

2020 ◽  
Author(s):  
Regina Poss-Doering ◽  
Martina Kamradt ◽  
Katharina Glassen ◽  
Edith Andres ◽  
Petra Kaufmann-Kolle ◽  
...  
Keyword(s):  
Social Support ◽  
Primary Care ◽  
Social Influence ◽  
Health Professionals ◽  
Best Practice ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Self Reflection ◽  
Physician Health ◽  
Improvement Programs

Abstract Background Primary care networks in Germany are formalized regional collaborations of physicians and other healthcare providers. Common goals are optimized healthcare processes and services for patients, enhanced communication, agency for professional concerns and strengthened economic power. In the ARena study (Sustainable reduction of antibiotic-induced antimicrobial resistance), 14 primary care networks in two federal German states aimed to promote appropriate antibiotics use for acute non-complicated infections by fostering awareness and understanding. Factors related to the role of primary care networks were to be identified. Methods For this study, audio-recorded telephone interviews were conducted with physicians, non-physician health professionals and stakeholder representatives. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was based on the inductive categories ‘social support’, ‘social learning’, ‘social normative pressures’ and ‘social contagion’ to reflect social influence processes. Data generated through a survey with physicians and non-physician health professionals were analyzed descriptively to foster understanding of the networks’ potential impact on antibiotic prescribing. Results Social influence processes proved to be relevant regarding knowledge transfer, manifestation of best-practice care and self-reflection. Peer communication was seen as great asset, main reason for membership and affirmative for own perspectives. All interviewed physicians (n=27) considered their network to be a strong support factor for daily routines, introduction of new routines, and continuity of care. They utilized network-offered training programs focusing on best practice guideline-oriented use of antibiotics and considered their networks supportive in dealing with patient expectations. A shared attitude combined with ARena intervention components facilitated reflected management of antibiotic prescribing. Non-physician health professionals (n=11) also valued network peer exchange. They assumed their employers joined networks to offer improved and continuous care. Stakeholders (n=7) expected networks and their members to be drivers for care optimization. Conclusion Primary care networks play a crucial role in providing a platform for professional peer exchange, social support and reassurance. With regards to their impact on antibiotic prescribing for acute non-complicated infections, networks seem to facilitate and amplify quality improvement programs by providing a platform for refreshing awareness, knowledge and self-reflection among care providers. They are well suited to promote a rational use of antibiotics.

scholarly journals Adjacent Primary Care May Reduce Less Urgent Pediatric Emergency Department Visits

2020 ◽  
Vol 11 ◽  
pp. 215013272092627
Author(s):  
Julia Ellbrant ◽  
Jonas Åkeson ◽  
Helena Sletten ◽  
Jenny Eckner ◽  
Pia Karlsland Åkeson
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Patient Characteristics ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
University Hospital ◽  
Pediatric Emergency Department ◽  
Hospital Data ◽  
Cross Sectional ◽  
Ed Visits

Aims: Pediatric emergency department (ED) overcrowding is a challenge. This study was designed to evaluate if a hospital-integrated primary care unit (HPCU) reduces less urgent visits at a pediatric ED. Methods: This retrospective cross-sectional study was carried out at a university hospital in Sweden, where the HPCU, open outside office hours, had been integrated next to the ED. Children seeking ED care during 4-week high- and low-load study periods before (2012) and after (2015) implementation of the HPCU were included. Information on patient characteristics, ED management, and length of ED stay was obtained from hospital data registers. Results: In total, 3216 and 3074 ED patient visits were recorded in 2012 and 2015, respectively. During opening hours of the HPCU, the proportions of pediatric ED visits (28% lower; P < .001), visits in the lowest triage group (36% lower; P < .001), patients presenting with fever ( P = .001) or ear pain ( P < .001), and nonadmitted ED patients ( P = .033), were significantly lower in 2015 than in 2012, whereas the proportion of infants ≤3 months was higher in 2015 ( P < .001). Conclusions: By enabling adjacent management of less urgent pediatric patients at adequate lower levels of medical care, implementation of a HPCU outside office hours may contribute to fewer and more appropriate pediatric ED visits.

scholarly journals Relevant patient characteristics for guiding tailored integrated diabetes primary care: a systematic review

2018 ◽  
Vol 19 (5) ◽  
pp. 424-447 ◽  
Author(s):  
Dorijn F.L. Hertroijs ◽  
Arianne M.J. Elissen ◽  
Martijn C.G.J. Brouwers ◽  
Nicolaas C. Schaper ◽  
Dirk Ruwaard
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Longitudinal Studies ◽  
Integrated Care ◽  
Patient Characteristics ◽  
Care Utilization ◽  
Related Effect ◽  
Care Needs ◽  
Cross Sectional

AimTo identify which patient-related effect modifiers influence the outcomes of integrated care programs for type 2 diabetes in primary care.BackgroundIntegrated care is a widespread management strategy for the treatment of type 2 diabetes. However, most integrated care programs are not tailored to patients’ needs, preferences and abilities. There is increasing consensus that such a patient-centered approach could improve the management of type 2 diabetes. Thus far, it remains unclear which patient-related effect modifiers should guide such an approach.MethodsPubMed, CINAHL and EMBASE were searched for empirical studies published after 1998. A systematic literature review was conducted according to the PRISMA guidelines.FindingsIn total, 23 out of 1015 studies were included. A total of 21 studies measured the effects of integrated diabetes care programs on hemoglobin A1c (HbA1c) and three on low-density lipoprotein cholesterol, systolic blood pressure and health-care utilization. In total, 49 patient characteristics were assessed as potential effect modifiers with HbA1c as an outcome, of which 46 were person or health-related and only three were context-related. Younger age, insulin therapy and longer disease duration were associated with higher HbA1c levels in cross-sectional and longitudinal studies. Higher baseline HbA1c was associated with higher HbA1c at follow-up in longitudinal studies. Information on context- and person-related characteristics was limited, but is necessary to help identify the care needs of individual patients and implement an effective integrated type 2 diabetes tailored care program.

scholarly journals Patient characteristics and frequency of bodily distress syndrome in primary care: a cross-sectional study

2015 ◽  
Vol 65 (638) ◽  
pp. e617-e623 ◽  
Author(s):  
Anna Budtz-Lilly ◽  
Mogens Vestergaard ◽  
Per Fink ◽  
Anders Helles Carlsen ◽  
Marianne Rosendal
Keyword(s):  
Primary Care ◽  
Distress Syndrome ◽  
Patient Characteristics ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Bodily Distress Syndrome

scholarly journals Assessment of access to first contact in the perspective of professionals

2020 ◽  
Vol 73 (3) ◽  
Author(s):  
Glaucia Margarida Bezerra Bispo ◽  
Eduarda Maria Duarte Rodrigues ◽  
Amanda Cordeiro de Oliveira Carvalho ◽  
Kenya Waleria de Siqueira Coêlho Lisboa ◽  
Roberto Wagner Júnior Freire Freitas ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Assessment Tool ◽  
Family Health ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Unified Health System ◽  
Basic Care ◽  
Care Assessment ◽  
First Contact

ABSTRACT Objectives: to evaluate the “access to first contact” attribute, from the perspective of Primary Care Health professionals. Methods: an evaluative and cross-sectional study, carried out from February to March 2017. The sample consisted of 163 health professionals, of both genders, who worked in the basic care of the Municipality of Juazeiro do Norte, Ceará. Access to first contact was evaluated by the Primary Care Assessment Tool (PCATool). The 6.60 mark was used as the cut-off point for the evaluated attribute. Results: access to first contact reached a score of 3.3, denoting a low degree of orientation for Primary Health Care. Nurses were the ones who evaluated the attribute more negatively (p=3.2). Conclusions: access to first contact obtained a low score, pointing to the fragility of the Family Health Strategy as a gateway to the Brazilian Unified Health System (Sistema Único de Saúde).

scholarly journals Influenza Vaccination in Coronavirus Times: Intention to Be Vaccinated by Primary Care Professionals in Central Catalonia (VAGCOVID)

2021 ◽  
Author(s):  
Raquel Muñoz-Miralles ◽  
Anna Bonet-Esteve ◽  
Anna Rufas Cebollero ◽  
Xavier Pelegrin Cruz ◽  
Josep Vidal Alaball
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Influenza Vaccination ◽  
Vaccination Coverage ◽  
Health Professionals ◽  
Online Survey ◽  
Health Workers ◽  
Cross Sectional ◽  
History Of ◽  
Primary Care Professionals

Abstract BackgroundInfluenza vaccination is the main measure of prevention against the epidemic flu, which annually produces a significant increase in the pressure on healthcare systems, in addition to influencing the absenteeism of health workers. Although it is recommended that health professionals be vaccinated, their vaccination coverage is low. The lack of knowledge about the evolution of influenza in the context of the SARS-CoV-2 coronavirus pandemic led to the continued recommendation of influenza vaccination to people at risk and to professionals. The aim of the study is to determine the intention to vaccinate against seasonal flu of health professionals in the 2020-21 campaign in the context of the SARS-CoV-2 pandemic, and to analyse the factors that influence it.MethodsCross-sectional study through a structured online survey aimed at Primary Care professionals in the region of central Catalonia.ResultsA total of 610 participants responded to the survey, 65.7% of whom intended to be vaccinated against the flu in this campaign and 11.1% did not yet know or did not answer. The intention to be vaccinated against flu is associated with the professional category, the years of professional practice, the fact of making face-to-face guards, and the perception of the risk of suffering from flu. It is also related to a history of influenza vaccination in the previous year and to having been vaccinated on another occasion. The profile of professionals who intend to be vaccinated against flu includes professionals with a history of vaccination, who were on duty and perceived that their staff were at risk of becoming ill with flu.ConclusionsDuring the SARS-CoV-2 pandemic, many professionals show a clear intention to get vaccinated against the flu, but there are still some who doubt it. In order to improve influenza vaccination coverage among health professionals, it is necessary to design strategies aimed at professionals who are hesitant or reluctant to vaccination.

scholarly journals Patient motives for contacting out-of-hours care in Denmark: a cross-sectional study

2019 ◽  
Author(s):  
Linda Huibers ◽  
Anders H Carlsen ◽  
Grete Moth ◽  
Helle C Christensen ◽  
Ingunn S Riddervold ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Medical Services ◽  
Healthcare Service ◽  
Service Providers ◽  
Patient Characteristics ◽  
Medical Services ◽  
Cross Sectional ◽  
Out Of Hours ◽  
Emergency Medical ◽  
Acute Healthcare

Abstract Background Patients in need of acute healthcare do not always contact the most suitable healthcare service provider. Contacting out-of-hours primary care for an urgent problem may delay care, whereas contacting emergency medical services for a non-urgent problem could ultimately affect patient safety. More insight into patient motives for contacting a specific healthcare provider may help optimise patient flows. This study aims to explore patient motives for contacting out-of-hours primary care and the emergency medical services in Denmark. Methods We conducted a cross-sectional observational study by sending a questionnaires to patients contacting out-of-hours primary care and emergency medical services, both of which can be directly contacted by patients, in two of five Danish regions in 2015. As we aimed to focus on the first access point, the emergency department was not included. The questionnaire included items on patient characteristics, health problem and 26 pre-defined motives. Descriptive analyses of patient characteristics and motives were conducted, stratified by the two healthcare service providers. Factors associated with contacting each of the two service providers were explored in a modified Poisson regression analysis, and adjusted risk ratios were calculated. Results Three key motives for contacting the two service providers were identified: ‘unpleasant symptoms’, ‘perceived need for prompt action’ and ‘perceived most suitable healthcare provider’. Other important motives were ‘need arose outside office hours’ and ‘wanted to talk to a physician’ (out-of-hours primary care) and ‘expected need for ambulance’ and ‘worried’ (emergency medical services). Higher probability of contacting the emergency medical services versus out-of-hours primary care was seen for most motives relating to own assessment and expectations, previous experience and knowledge, and own needs and wishes. Lower probability was seen for most motives relating to perceived barriers and benefits. Conclusions Patient motives for contacting the two healthcare service providers were partly overlapping. The study contributes with new knowledge on the complex decision-making process of patients in need of acute healthcare. This knowledge could help optimise existing healthcare services, such as patient safety and the service level, without increasing healthcare costs.

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