scholarly journals Treating patients with opioid overdose at a primary care emergency outpatient clinic: a cost-minimization analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Jon Hjellum Vibeto ◽  
Odd Martin Vallersnes ◽  
Andrea Dobloug ◽  
Mette Brekke ◽  
Dag Jacobsen ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Outpatient Clinic ◽  
Cost Minimization ◽  
Hospital Setting ◽  
Hospital Treatment ◽  
Opioid Overdose ◽  
Key Informants ◽  
Personnel Costs ◽  
Substances Of Abuse

Abstract Background Treating patients with acute poisoning by substances of abuse in a primary care emergency clinic has previously been shown to be a safe strategy. We conducted an economic evaluation of this strategy compared to hospital treatment, which is the usual strategy. Methods Assuming equal health outcomes, we conducted a cost-minimization analysis. We constructed a representative opioid overdose patient based on a cohort of 359 patients treated for opioid overdose at the Oslo Accident and Emergency Outpatient Clinic (OAEOC) from 1.10.2011 to 30.9.2012. Using a health care system perspective, we estimated the expected resources used on the representative patient in primary care based on data from the observed OAEOC cohort and on information from key informants at the OAEOC. A likely course of treatment of the same patient in a hospital setting was established from information from key informants on provider procedures at Drammen Hospital, as were estimates of hospital use of resources. We calculated expected costs for both settings. Given that the treatments usually last for less than one day, we used undiscounted cost values. Results The estimated per patient cost in primary care was 121 EUR (2018 EUR 1.00 = NOK 9.5962), comprising 97 EUR on personnel costs and 24 EUR on treatment costs. In the hospital setting, the corresponding cost was 612 EUR, comprising 186 EUR on personnel costs, 183 EUR on treatment costs, and 243 EUR associated with intensive care unit admission. The point estimate of the cost difference per patient was 491 EUR, with a low-difference scenario estimated at 264 EUR and a high-difference scenario at 771 EUR. Conclusions Compared to hospital treatment, treating patients with opioid overdose in a primary care setting costs substantially less. Our findings are probably generalizable to poisoning with other substances of abuse. Implementing elements of the OAEOC procedure in primary care emergency clinics and in hospital emergency departments could improve the use of health care resources.

scholarly journals Strengthening primary health care through primary care and public health collaboration: the influence of intrapersonal and interpersonal factors

2018 ◽  
Vol 19 (04) ◽  
pp. 378-391 ◽  
Author(s):  
Ruta K. Valaitis ◽  
Linda O’Mara ◽  
Sabrina T. Wong ◽  
Marjorie MacDonald ◽  
Nancy Murray ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Influencing Factors ◽  
Effective Communication ◽  
Key Informants ◽  
Primary Health ◽  
Interpersonal Factors ◽  
Beliefs And Attitudes

AimThe aim of this paper is to examine Canadian key informants’ perceptions of intrapersonal (within an individual) and interpersonal (among individuals) factors that influence successful primary care and public health collaboration.BackgroundPrimary health care systems can be strengthened by building stronger collaborations between primary care and public health. Although there is literature that explores interpersonal factors that can influence successful inter-organizational collaborations, a few of them have specifically explored primary care and public health collaboration. Furthermore, no papers were found that considered factors at the intrapersonal level. This paper aims to explore these gaps in a Canadian context.MethodsThis interpretative descriptive study involved key informants (service providers, managers, directors, and policy makers) who participated in one h telephone interviews to explore their perceptions of influences on successful primary care and public health collaboration. Transcripts were analyzed using NVivo 9.FindingsA total of 74 participants [from the provinces of British Columbia (n=20); Ontario (n=19); Nova Scotia (n=21), and representatives from other provinces or national organizations (n=14)] participated. Five interpersonal factors were found that influenced public health and primary care collaborations including: (1) trusting and inclusive relationships; (2) shared values, beliefs and attitudes; (3) role clarity; (4) effective communication; and (5) decision processes. There were two influencing factors found at the intrapersonal level: (1) personal qualities, skills and knowledge; and (2) personal values, beliefs, and attitudes. A few differences were found across the three core provinces involved. There were several complex interactions identified among all inter and intra personal influencing factors: One key factor – effective communication – interacted with all of them. Results support and extend our understanding of what influences successful primary care and public health collaboration at these levels and are important considerations in building and sustaining primary care and public health collaborations.

scholarly journals Out-of-hours primary care in 26 European countries: an overview of organizational models

2020 ◽  
Vol 37 (6) ◽  
pp. 744-750 ◽  
Author(s):  
Luca Steeman ◽  
Maike Uijen ◽  
Erik Plat ◽  
Linda Huibers ◽  
Marleen Smits ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
National Level ◽  
Fine Tuning ◽  
The European Union ◽  
Organizational Models ◽  
Out Of Hours ◽  
Key Informants ◽  
The Past ◽  
Future Plans

Abstract Background Various models exist to organize out-of-hours primary care (OOH-PC). We aimed to provide an up-to-date overview of prevailing organizational models in the European Union (EU), implemented changes over the last decade and future plans. This baseline overview may provide information for countries considering remodelling their OOH-PC system. Methods A cross-sectional web-based questionnaire among 93 key informants from EU countries, Norway and Switzerland. Key informants with expertise in the field of primary health care were invited to participate. Themes in the questionnaire were the existing organizational models for OOH-PC, model characteristics, major organizational changes implemented in the past decade and future plans. Results All 26 included countries had different coexisting OOH-PC models, varying from 3 to 10 models per country. ‘GP cooperative was the dominant model in most countries followed by primary care centre and rota group’. There was a large variation in characteristics between the models, but also within the models, caused by differences between countries and regions. Almost all countries had implemented changes over the past 10 years, mostly concerning the implementation of telephone triage and a change of organizational model by means of upscaling and centralization of OOH-PC. Planned changes varied from fine-tuning the prevailing OOH-PC system to radical nationwide organizational transitions in OOH-PC. Conclusions Different organizational models for OOH-PC exist on international and national level. Compared with a decade ago, more primary care-oriented organizational models are now dominant. There is a trend towards upscaling and centralization; it should be evaluated whether this improves the quality of health care.

scholarly journals Reducing health care costs by rationalizing staffing in primary care settings

2004 ◽  
Vol 10 (3) ◽  
pp. 382-388
Author(s):  
S. Mawajdeh ◽  
S. A. Khoury ◽  
M. Qtaishat ◽  
R. Yoder
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Services ◽  
Cost Effective ◽  
Personnel Costs ◽  
Care Services ◽  
Care Facilities ◽  
Staffing Patterns ◽  
Nationally Representative ◽  
Effective Use

Jordan spends around 9% of its GDP on health care services, a high figure compared with similar developing countries. This study assessed staffing patterns in relation to Ministry of Health expenditures in a nationally representative sample of 97 primary care facilities. The economic costs of primary care facilities amounted to Jordanian dinar [JD] 42.3 million. Personnel costs consumed 53.8% of recurrent costs and in monetary terms the amount of down time [time not being used effectively] amounted to JD 9.7 million [about US$ 13.7 million]. The Ministry should consider changing the functioning of its primary care facilities to obtain a more cost-effective use of staff time

Pediatrician's Role in Primary Health Care

PEDIATRICS ◽  
1983 ◽  
Vol 71 (3) ◽  
pp. 441-442
Author(s):  
JAMES E. STRAIN
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Pediatric Care ◽  
Coordination Of Care ◽  
Care Model ◽  
Primary Health ◽  
Primary Care Model

The article by Starfield1 highlights important aspects of primary pediatric care. She points to some of the deficiencies of the pediatric primary care model as they relate to accessibility, comprehensiveness of care and coordination of care. She then poses several provocative questions about the pediatrician's role in the delivery of primary health care to children. Pediatrics, internal medicine, and family practice have traditionally been considered primary care specialties. The truth of the matter is that general pediatrics is a mix of primary and secondary care and in some cases tertiary care. It is the mundane and the esoteric, the assessment of growth and development and the treatment of acute and chronic diseases, the management of psychosocial and biomedical disorders and the care provided in the ambulatory as well as the hospital setting that make pediatrics interesting and exciting.

scholarly journals Data envelopment analysis applications in primary health care: a systematic review

2019 ◽  
Author(s):  
Izabela Zakowska ◽  
Maciek Godycki-Cwirko
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Data Envelopment Analysis ◽  
Data Envelopment ◽  
Personnel Costs ◽  
Use Of Data ◽  
Primary Health ◽  
Economic Analyses ◽  
Analysis Models

Abstract Background Strategic management of primary health care centres is necessary for creating an efficient global health care system that delivers good care. Objectives To perform a systematic literature review of the use of data envelopment analysis in estimating the relative technical efficiency of primary health care centres, and to identify the inputs, outputs and models used. Methods PubMed, MEDLINE Complete, Embase and Web of Science were searched for papers published before the 25 March 2019. Results Of a total of 4231 search results, 54 studies met the inclusion criteria. The identified inputs included personnel costs, gross expenditures, referrals and days of hospitalization, as well as prescriptions and investigations. Outputs included consultations or visits, registered patients, procedures, treatments and services, prescriptions and investigations. A variety of data envelopment analysis models used was identified, with no standard approach. Conclusions Data envelopment analysis extends the scope of tools used to analyse primary care functioning. It can support health economic analyses when assessing primary care efficiency. The main issues are setting outputs and inputs and selecting a model best suited for the range of products and services in the primary health care sector. This article serves as a step forward in the standardization of data envelopment analysis, but further research is needed.

scholarly journals What are the impacts when primary care providers diminish stigma for patients with opioid use disorder in British Columbia?

2020 ◽  
Author(s):  
◽  
Mary MacLellan
Keyword(s):  
Primary Care ◽  
Health Care ◽  
British Columbia ◽  
Literature Review ◽  
Access To Health Care ◽  
Primary Care Providers ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Care Providers ◽  
Opioid Use

Stigma is a complex phenomenon with a myriad of detrimental health and social impacts that are not fully studied or understood. Persistent stigma exists towards individuals who have opioid use disorder (OUD) in British Columbia. OUD is a chronic, relapsing, clinical condition that has been identified as one of the most challenging substance use disorders. For those affected, they must also endure the consequences of stigma that promote barriers to health care, health and social inequalities, diminished quality of life as well as increased morbidity and mortality. The current unremitting opioid overdose crisis in British Columbia further emphasizes the importance of eradicating stigma towards individuals who use opioids and/or suffer from OUD, as untreated OUD is fueling this multifaceted public health emergency. For these reasons, an integrative literature review has been conducted to identify how primary care providers in British Columbia can address the intersecting stigmas for individuals suffering OUD. The results are discussed within the context of primary health care in British Columbia. Whittemore and Knafl’s approach to the integrative literature review was utilized in this study to review eleven pertinent articles. The findings suggest that stigma occurs on varying levels for individuals with OUD that serve to reinforce each other and manifest as discrimination, mistrust, social distancing, minimized advocacy, unequal access to health care and suboptimal health care. Further, the findings indicated that the role of primary care providers may be instrumental in eradicating stigma in a timely manner. Recommendations for primary care providers to dismantle the stigma associated with OUD are discussed, and specific strategies for the primary care setting are presented.

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