scholarly journals An expert-based mapping of healthcare system strategies to support rational drug prescribing in primary care across 13 European countries

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Alexandru M. Rotar ◽  
Michael J. van den Berg ◽  
Niek S. Klazinga
Keyword(s):  
Primary Care ◽  
Research Question ◽  
European Countries ◽  
Control Mechanisms ◽  
Drug Prescribing ◽  
Expert Opinions ◽  
Rational Prescribing ◽  
Rational Drug ◽  
Reported Data ◽  
The Impact

Abstract Background Irrational prescribing has received increasing attention among policy-makers to improve drug safety and effectiveness while avoiding economic waste. The policies intended to rationalise prescribing have been grouped by WHO under a taxonomy, classifying them into two types of strategies – (1) targeted approaches (micro level) and (2) system-oriented approaches (macro level). The extent to which countries implement strategies and the existing types is currently unknown. This paper explores the following research question via expert opinions: to what extent have European countries implemented strategies to support rational prescribing (targeted and system oriented) and what are the types implemented? Methods We assessed the available information on policies intended to promote rational prescribing. We used the WHO taxonomy to explore our research question as the basis for a standardised questionnaire. The data were collected between August 2018 and April 2019. The questionnaire consisted of questions that solicited the opinion of experts on the implementation of prescribing control mechanisms in primary care in their respective countries. Experts were identified through the literature and relevant networks. The questionnaire was sent to 17 identified country experts from 17 different countries; 15 responded and 13 were used in our analysis. Answers were validated through follow-up correspondence, interviews and presentation at an OECD meeting. Results Expert-reported data shows that all 13 countries included in our study have several mechanisms in place for enhancing rational prescribing in primary care. All approaches were reported to have been implemented in at least two countries. We identified two groups of countries, namely a small group of countries (n = 3) with fewer mechanisms in place and a larger group of countries (n = 10) with a large number of strategies with accompanying instruments at both the micro and macro levels. Conclusions The data reported by the experts suggests that all 13 countries included in our study have several mechanisms in place for enhancing rational prescribing in primary care on both the micro and macro levels. With respect to the extent of mechanisms being in place, two groups of countries were identified. This initial mapping of strategies forms a basis for more in-depth research to be able to assess the impact of bundles of strategies on system and targeted level on rational drug prescribing in primary care in Europe.

scholarly journals Estimation of the Amount of Disposed Antibiotics

2019 ◽  
Vol 11 (6) ◽  
pp. 1800 ◽  
Author(s):  
Gabriela Cioca ◽  
Florentina-Daniela Munteanu
Keyword(s):  
Antimicrobial Resistance ◽  
Solid Waste ◽  
Present Article ◽  
European Countries ◽  
Beta Lactams ◽  
Reported Data ◽  
The Impact

The impact of the antibiotics in the environment is not well understood yet. Moreover, the total amount of antibiotics that are ending up in the environment as solid waste is not known and cannot be rigorously determined as many variables are influencing the determination of their concentration. The present article is focused on the estimation of the amount of non-prescribed antibiotics that are used in different European countries. Particular attention is paid to the class of beta-lactams, as they are responsible for a considerate share of the antimicrobial resistance. The primary purpose was the estimation of the quantity of non-prescribed antibiotics that might reach the environment as solid waste. For the present study, we used the ECDC and EUROSTAT reported data.

scholarly journals Patients’ and clinicians’ perspectives on the primary care consultations for acute respiratory infections during the first wave of the COVID-19 pandemic: an eight-country qualitative study in Europe

BJGP Open ◽  
2022 ◽  
pp. BJGPO.2021.0172
Author(s):  
Marta Wanat ◽  
Melanie Eugenie Hoste ◽  
Nina Helene Gobat ◽  
Marilena Anastasaki ◽  
Femke Böhmer ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Respiratory Infections ◽  
Care Delivery ◽  
European Countries ◽  
Structured Interviews ◽  
Delivery Of Care ◽  
Primary Care Delivery ◽  
The Impact ◽  
Remote Consultations

BackgroundThe impact of the COVID-19 pandemic on patients’ and clinicians’ perceptions of healthcare-seeking behaviour and delivery of care is unclear. The pandemic accelerated the use of remote care and understanding its benefits and drawbacks may inform its implementation during this and future healthcare emergencies.AimTo explore patients’ and primary care professionals’ (PCPs) experiences of primary care delivery in the first wave of the pandemic.Design & settingQualitative study using semi-structured interviews in primary care in eight European countriesResultsWe conducted 146 interviews with 80 PCPs and 66 patients consulting for respiratory tract infection (RTI) symptoms, in eight European countries (England, Ireland, Belgium, the Netherlands, Greece, Poland, Sweden and Germany). Data was collected between April and July 2020 and analysed using thematic analysis. We found that patients accepted telemedicine when PCPs spent time to understand and address their concerns, but a minority preferred in-person consultations. PCPs felt that remote consultations created emotional distance between themselves and patients, and they reported having to manage diverse COVID-19-related medical and social concerns.ConclusionRemote consultations for RTI symptoms may be acceptable long-term if both groups are happy to use this format but it is important that PCPs take time to address patients’ concerns and provide safety-netting advice.

The Perspective of Older Men With Depression on Suicide and Its Prevention in Primary Care

Crisis ◽  
2018 ◽  
Vol 39 (5) ◽  
pp. 397-405 ◽  
Author(s):  
Steven Vannoy ◽  
Mijung Park ◽  
Meredith R. Maroney ◽  
Jürgen Unützer ◽  
Ester Carolina Apesoa-Varano ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Socioeconomic Status ◽  
Thematic Analysis ◽  
Older Men ◽  
Primary Care Providers ◽  
Depression Treatment ◽  
Care Providers ◽  
Low Socioeconomic ◽  
Self Image ◽  
The Impact

Abstract. Background: Suicide rates in older men are higher than in the general population, yet their utilization of mental health services is lower. Aims: This study aimed to describe: (a) what primary care providers (PCPs) can do to prevent late-life suicide, and (b) older men's attitudes toward discussing suicide with a PCP. Method: Thematic analysis of interviews focused on depression and suicide with 77 depressed, low-socioeconomic status, older men of Mexican origin, or US-born non-Hispanic whites recruited from primary care. Results: Several themes inhibiting suicide emerged: it is a problematic solution, due to religious prohibition, conflicts with self-image, the impact on others; and, lack of means/capacity. Three approaches to preventing suicide emerged: talking with them about depression, talking about the impact of their suicide on others, and encouraging them to be active. The vast majority, 98%, were open to such conversations. An unexpected theme spontaneously arose: "What prevents men from acting on suicidal thoughts?" Conclusion: Suicide is rarely discussed in primary care encounters in the context of depression treatment. Our study suggests that older men are likely to be open to discussing suicide with their PCP. We have identified several pragmatic approaches to assist clinicians in reducing older men's distress and preventing suicide.

The Impact of Primary Care Resident Physician Training on Patient Weight Loss at 12 Months

Obesity ◽  
2012 ◽  
Author(s):  
Melanie R. Jay ◽  
Colleen C. Gillespie ◽  
Sheira L. Schlair ◽  
Stella M. Savarimuthu ◽  
Scott E. Sherman ◽  
...  
Keyword(s):  
Primary Care ◽  
Weight Loss ◽  
Resident Physician ◽  
Physician Training ◽  
Primary Care Resident ◽  
Patient Weight ◽  
The Impact

A Comparison of the Impact of the 2017 ACC/AHA Hypertension Guidelines on Primary Care Populations With and Without Diabetes

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 172-OR
Author(s):  
JOANN M. SPERL-HILLEN ◽  
JEFFREY P. ANDERSON ◽  
JAY R. DESAI ◽  
KAREN L. MARGOLIS ◽  
A. LAUREN CRAIN ◽  
...  
Keyword(s):  
Primary Care ◽  
Hypertension Guidelines ◽  
The Impact

The Fiscal Effects of Economic Immigration on Subnational Government Finance in Poland

e-Finanse ◽  
2019 ◽  
Vol 15 (1) ◽  
pp. 45-58
Author(s):  
Marzanna Poniatowicz ◽  
Agnieszka Piekutowska
Keyword(s):  
Social Policy ◽  
Income Tax ◽  
Research Question ◽  
Personal Income Tax ◽  
Government Finance ◽  
Subnational Government ◽  
Migration Research ◽  
The Impact ◽  
High Share

AbstractThe aim of the paper is to analyse the effects of economic immigration on subnational government finance (SNG) in Poland. The goal to achieve is to answer the following research question: what are the fiscal effects of immigration on SNG budget revenues and expenditures. To answer this question, logarithmic models were developed. The analysis refers to the years 2007-2016. In this respect, data from Statistics Poland - referring to budget revenues and expenditures of communes, cities of district status, districts and voivodeships - were used. As far as immigration statistics are concerned, data from the Ministry of Family, Labour and Social Policy were used. The results indicate an increase in both revenues and expenditures of SNG as a result of immigration. Such results can be explained inter alia by the nature of migration - research were focused on economic immigration. Results confirm that the level of employment of foreigners is one of the determinants shaping the fiscal effect of immigration. Moreover, the impact of economic immigration on SNG budget revenues and expenditures depends on the structure of this budget. This explains the differentiated results of the analysis of the impact of immigration on SNG in different countries. The positive correlation between immigration and SNG revenues in Poland can be associated with a high share of subnational governments in personal income tax revenues as this tax is one of the main categories of SNG revenues. Furthermore, results show that the impact of immigration on local government budgets in Poland is modest. This confirms the conclusions drawn by other authors (e.g. Auerbach and Oreopoulos), that in the long term, immigration cannot be considered as a potential instrument for resolving fiscal imbalances.

The impact of participant pathways on the effectiveness of a community-based physical activity intervention grounded in motivational interviewing

2020 ◽  
Author(s):  
Matthew Wade ◽  
Nicola Brown ◽  
James Steele ◽  
Steven Mann ◽  
Bernadette Dancy ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Motivational Interviewing ◽  
Social Action ◽  
Multilevel Models ◽  
Physical Activity Intervention ◽  
Mental Wellbeing ◽  
Community Based ◽  
The Impact ◽  
Time Point

Background: Brief advice is recommended to increase physical activity (PA) within primary care. This study assessed change in PA levels and mental wellbeing after a motivational interviewing (MI) community-based PA intervention and the impact of signposting [SP] and Social Action [SA] (i.e. weekly group support) pathways. Methods: Participants (n=2084) took part in a community-based, primary care PA programme using MI techniques. Self-reported PA and mental wellbeing data were collected at baseline (following an initial 30-minute MI appointment), 12-weeks, six-months, and 12-months. Participants were assigned based upon the surgery they attended to the SP or SA pathway. Multilevel models were used to derive point estimates and 95%CIs for outcomes at each time point and change scores. Results: Participants increased PA and mental wellbeing at each follow-up time point through both participant pathways and with little difference between pathways. Retention was similar between pathways at 12-weeks, but the SP pathway retained more participants at six-months and 12-months. Conclusions: Both pathways produced similar improvements in PA and mental wellbeing, suggesting the effectiveness of MI based PA interventions. However, due to lower resources required yet similar effects, SP pathways are recommended over SA to support PA in primary care settings.

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