scholarly journals The evidence gap on gendered impacts of performance-based financing among family physicians for chronic disease care: a systematic review reanalysis in contexts of single-payer universal coverage

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Neeru Gupta ◽  
Holly M. Ayles
Keyword(s):  
Systematic Review ◽  
Chronic Disease ◽  
Gender Equity ◽  
Primary Care Physicians ◽  
Grey Literature ◽  
Unintended Consequences ◽  
Sex And Gender ◽  
Chronic Disease Care ◽  
Single Payer ◽  
Gender Based

Abstract Background Although pay-for-performance (P4P) among primary care physicians for enhanced chronic disease management is increasingly common, the evidence base is fragmented in terms of socially equitable impacts in achieving the quadruple aim for healthcare improvement: better population health, reduced healthcare costs, and enhanced patient and provider experiences. This study aimed to assess the literature from a systematic review on how P4P for diabetes services impacts on gender equity in patient outcomes and the physician workforce. Methods A gender-based analysis was performed of studies retrieved through a systematic search of 10 abstract and citation databases plus grey literature sources for P4P impact assessments in multiple languages over the period January 2000 to April 2018, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The study was restricted to single-payer national health systems to minimize the risk of physicians sorting out of health organizations with a strong performance pay component. Two reviewers scored and synthesized the integration of sex and gender in assessing patient- and provider-oriented outcomes as well as the quality of the evidence. Findings Of the 2218 identified records, 39 studies covering eight P4P interventions in seven countries were included for analysis. Most (79%) of the studies reported having considered sex/gender in the design, but only 28% presented sex-disaggregated patient data in the results of the P4P assessment models, and none (0%) assessed the interaction of patients’ sex with the policy intervention. Few (15%) of the studies controlled for the provider’s sex, and none (0%) discussed impacts of P4P on the work life of providers from a gender perspective (e.g., pay equity). Conclusions There is a dearth of evidence on gender-based outcomes of publicly funded incentivizing physician payment schemes for chronic disease care. As the popularity of P4P to achieve health system goals continues to grow, so does the risk of unintended consequences. There is a critical need for research integrating gender concerns to help inform performance-based health workforce financing policy options in the era of the Sustainable Development Goals.

scholarly journals Systematic review protocol examining the effects of introducing pay-for-performance for primary care physicians on diabetes outcomes in single-payer healthcare systems (Preprint)

2018 ◽  
Author(s):  
Neeru Gupta
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Diabetes Care ◽  
Primary Care Physicians ◽  
Pay For Performance ◽  
Unintended Consequences ◽  
Research Database ◽  
Diabetes Outcomes ◽  
Single Payer ◽  
Wide Range

BACKGROUND Although pay-for-performance (P4P) for diabetes care is increasingly common across health organizations, evidence of its effectiveness in improving population health and service delivery is deficient. This information gap is attributable in part to the heterogeneity of healthcare financing, covered medical conditions, care settings, and provider remuneration arrangements within and across countries. OBJECTIVE This paper outlines a protocol for a systematic review examining the effects of introducing P4P for physicians in primary care and community settings to support guideline-based diabetes care. Our aim is to reduce the heterogeneity of evidence presented that has deterred conclusiveness of previous reviews by narrowing the focus to disease-specific P4P schemes in single-payer healthcare insurance systems. This approach enables us to minimize the risk of unintended consequences of P4P such as physicians’ gaming the payment system. METHODS Our review systematically searches, appraises, and synthesizes the literature concentrating on whether P4P for primary care physicians leads to better diabetes outcomes in single-payer health systems. We search 10 electronic databases and manually scan the reference lists of review articles and other global health literature. We include primary studies evaluating the effects of introducing P4P for diabetes care among primary care physicians in countries of universal health coverage. Outcomes of interest include patient morbidity, avoidable hospitalization, premature death, and healthcare costs. RESULTS We have received funding from Diabetes Canada and the New Brunswick Health Research Foundation to conduct policy-actionable diabetes health services research. Database searches were conducted and full-texts screened by two reviewers in 2017. We aim to submit the review for publication in 2018. CONCLUSIONS We are narratively synthesizing the data. Because of the wide range of outcomes considered, we do not expect to perform a meta-analysis. Since database searches were completed prior to the publication of this protocol, it is ineligible for registration with PROSPERO.

scholarly journals Perceptions of risk in pregnancy with chronic disease: A systematic review and thematic synthesis

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0254956
Author(s):  
Elizabeth R. Ralston ◽  
Priscilla Smith ◽  
Joseph Chilcot ◽  
Sergio A. Silverio ◽  
Kate Bramham
Keyword(s):  
Systematic Review ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Perceived Risk ◽  
Risk Perceptions ◽  
Grey Literature ◽  
Pregnancy Risk ◽  
Thematic Synthesis ◽  
Increased Risk ◽  
In Pregnancy

Background Women with chronic disease are at increased risk of adverse pregnancy outcomes. Pregnancies which pose higher risk, often require increased medical supervision and intervention. How women perceive their pregnancy risk and its impact on health behaviour is poorly understood. The aim of this systematic review of qualitative literature is to evaluate risk perceptions of pregnancy in women with chronic disease. Methods Eleven electronic databases including grey literature were systematically searched for qualitative studies published in English which reported on pregnancy, risk perception and chronic disease. Full texts were reviewed by two researchers, independently. Quality was assessed using the Critical Appraisal Skills Programme Qualitative checklist and data were synthesised using a thematic synthesis approach. The analysis used all text under the findings or results section from each included paper as data. The protocol was registered with PROSPERO. Results Eight studies were included in the review. Three themes with sub-themes were constructed from the analysis including: Information Synthesis (Sub-themes: Risk to Self and Risk to Baby), Psychosocial Factors (Sub-themes: Emotional Response, Self-efficacy, Healthcare Relationship), and Impact on Behaviour (Sub-themes: Perceived Risk and Objective Risk). Themes fitted within an overarching concept of Balancing Act. The themes together inter-relate to understand how women with chronic disease perceive their risk in pregnancy. Conclusions Women’s pregnancy-related behaviour and engagement with healthcare services appear to be influenced by their perception of pregnancy risk. Women with chronic disease have risk perceptions which are highly individualised. Assessment and communication of women’s pregnancy risk should consider their own understanding and perception of risk. Different chronic diseases introduce diverse pregnancy risks and further research is needed to understand women’s risk perceptions in specific chronic diseases.

scholarly journals Impact of Practice Facilitation in Primary Care on Chronic Disease Care Processes and Outcomes: a Systematic Review

2018 ◽  
Vol 33 (11) ◽  
pp. 1968-1977 ◽  
Author(s):  
Andrew Wang ◽  
Teresa Pollack ◽  
Lauren A. Kadziel ◽  
Samuel M. Ross ◽  
Megan McHugh ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Chronic Disease ◽  
Practice Facilitation ◽  
Chronic Disease Care ◽  
Care Processes

A Systematic Review of the Impact of Healthcare Reforms on Access to Emergency Department and Elective Surgery Services

2017 ◽  
Vol 48 (1) ◽  
pp. 81-105 ◽  
Author(s):  
Sandeep Reddy ◽  
Peter Jones ◽  
Harsha Shanthanna ◽  
Raechel Damarell ◽  
John Wakerman
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Emergency Department ◽  
United Kingdom ◽  
Elective Surgery ◽  
Grey Literature ◽  
Unintended Consequences ◽  
Health Care Reforms ◽  
The United Kingdom ◽  
The Impact

This systematic review sought to identify whether health care reforms led to improvement in the emergency department (ED) length of stay (LOS) and elective surgery (ES) access in Australia, Canada, New Zealand, and the United Kingdom. The review was registered in the PROSPERO database (CRD42015016343), and nine databases were searched for peer-reviewed, English-language reports published between 1994 and 2014. We also searched relevant “grey” literature and websites. Included studies were checked for cited and citing papers. Primary studies corresponding to national and provincial ED and ES reforms in the four countries were considered. Only studies from Australia and the United Kingdom were eventually included, as no studies from the other two countries met the inclusion criteria. The reviewers involved in the study extracted the data independently using standardized forms. Studies were assessed for quality, and a narrative synthesis approach was taken to analyze the extracted data. The introduction of health care reforms in the form of time-based ED and ES targets led to improvement in ED LOS and ES access. However, the introduction of targets resulted in unintended consequences, such as increased pressure on clinicians and, in certain instances, manipulation of performance data.

scholarly journals Sex- and Gender-Based Analysis in Cannabis Treatment Outcomes: A Systematic Review

2020 ◽  
Vol 17 (3) ◽  
pp. 872 ◽  
Author(s):  
Andreea C. Brabete ◽  
Lorraine Greaves ◽  
Natalie Hemsing ◽  
Julie Stinson
Keyword(s):  
Systematic Review ◽  
Future Research ◽  
Sex And Gender ◽  
Pharmacological Interventions ◽  
Full Paper ◽  
Eligibility Criteria ◽  
Related Factors ◽  
Patterns Of Use ◽  
Gender Based ◽  
And Gender

There is evidence that sex- and gender-related factors are involved in cannabis patterns of use, health effects and biological mechanisms. Women and men report different cannabis use disorder (CUD) symptoms, with women reporting worse withdrawal symptoms than men. The objective of this systematic review was to examine the effectiveness of cannabis pharmacological interventions for women and men and the uptake of sex- and gender-based analysis in the included studies. Two reviewers performed the full-paper screening, and data was extracted by one researcher. The search yielded 6098 unique records—of which, 68 were full-paper screened. Four articles met the eligibility criteria for inclusion. From the randomized clinical studies of pharmacological interventions, few studies report sex-disaggregated outcomes for women and men. Despite emergent evidence showing the influence of sex and gender factors in cannabis research, sex-disaggregated outcomes in pharmacological interventions is lacking. Sex- and gender-based analysis is incipient in the included articles. Future research should explore more comprehensive inclusion of sex- and gender-related aspects in pharmacological treatments for CUD.

scholarly journals Systematic Review of Sex and Gender Effects in Traumatic Brain Injury: Equity in Clinical and Functional Outcomes

2021 ◽  
Vol 12 ◽  
Author(s):  
Tatyana Mollayeva ◽  
Shirin Mollayeva ◽  
Nicole Pacheco ◽  
Angela Colantonio
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Gender Equity ◽  
Functional Outcomes ◽  
Social Equity ◽  
Gender Effects ◽  
Sex And Gender ◽  
Male And Female ◽  
And Gender

Background: Although traumatic brain injury (TBI) is a leading cause of death and disability in male and female patients worldwide, little is known about the effect of sex and gender on TBI outcomes.Objectives: This systematic review summarizes the evidence on the effect of sex and gender on core TBI outcomes.Methods: All English-language studies from six literature databases that addressed core outcomes in adults with TBI and included sex or gender, TBI severity, and age in their analyses were considered eligible. Two reviewers extracted data, and two reviewers assessed study quality using tools recommended by the National Institutes of Health. The results were sorted according to time post-injury, injury severity, gender equity ranking of the study's country of origin, and outcomes studied. The results from the included studies were grouped based on the approach taken in reporting their respective findings.Results and Limitations: Of 172 articles assessed, 58 studies were selected, comprising 1, 265, 955 participants with TBI (67% male across all studies) of all injury severities. All studies were conducted in countries with a very high or high human development index, while the Gender Inequality Index (GII) varied. While the heterogeneity across studies limited any meaningful conclusions with respect to the role of sex and gender, we did observe that as gender equality ranking improved, differences between male and female participants in outcomes would diminish. Inclusion of social equity parameters in the studies was limited.Conclusions and Implications: The non-uniform findings observed bring forth the need to develop and use a comprehensive and consistent methodology in the study of sex and gender post-TBI, incorporating social equity parameters to uncover the potential social underpinnings of gender effects on health and functional outcomes.Systematic Review Registration: CRD42018098697.

scholarly journals Tele-Nursing in Chronic Disease Care: A Systematic Review

2019 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Faezeh Ghoulami-Shilsari ◽  
Mohammad Esmaeilpour Bandboni
Keyword(s):  
Systematic Review ◽  
Chronic Disease ◽  
Chronic Disease Care

scholarly journals Integrated chronic disease care delivery at a primary care level in sub-Saharan Africa: A systematic review, best fit framework synthesis, and new conceptual model

2021 ◽  
Author(s):  
Simon R Harrison ◽  
Aileen M Jordan
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Chronic Disease ◽  
Conceptual Model ◽  
Conceptual Models ◽  
A Priori ◽  
Sub Saharan Africa ◽  
Chronic Disease Care ◽  
African Context ◽  
Sub Saharan

Background: Existing chronic care conceptual models were not designed for sub-Saharan Africa, where there is a growing burden of chronic disease. This review provides a qualitative synthesis and new conceptual model for primary care approaches to the integration of chronic communicable and non-communicable disease care in a sub-Saharan African context. Methods: A best fit framework synthesis comprising two systematic reviews, with information retrieved from PubMed, Embase, CINAHL plus, Global Health, and Global Index Medicus databases between 1st and 30th April 2020. Articles on chronic care conceptual models were included if they were developed for application in a primary care context and described a framework for long-term management of chronic disease care, and themes extracted to construct an a priori framework. A second systematic review included articles focussing on integrated HIV and diabetes care at a primary care level in sub-Saharan Africa, with thematic analysis carried out against the a priori framework. A new conceptual model was constructed from a priori themes and new themes. Risk of bias of included studies was assessed using CASP and MMAT. Results: Two conceptual models of chronic disease care, comprising 6 themes, were used to build the a priori framework. The systematic review of primary research identified 12 articles, with all 6 of the a priori framework themes, and 5 new themes identified. A new patient-centred conceptual model for integrated HIV and diabetes care was constructed, specific to a sub-Saharan African context. Discussion: Improving patient access to chronic disease care through implementing decentralised, integrated, affordable and efficient primary care services should be prioritised in sub-Saharan Africa. Services must be acceptable to patients, viewing them as partners, addressing their concerns, and seeking to safeguard confidentiality. Limitations of this study include potential publication bias, and impact of policy environment and economic factors in sub-Saharan Africa.

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