Primary care networks: an opportunity to improve community wound care

2020 ◽  
Vol 25 (3) ◽  
pp. S20-S25
Author(s):  
Liam Benison
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Health Services ◽  
Health System ◽  
Community Health ◽  
Patient Outcomes ◽  
Wound Care ◽  
Community Health Services ◽  
Predominant Role ◽  
Poor Outcomes

Primary care networks (PCNs) were introduced in England in 2019 to bring about closer collaboration between general practice and community health services. The ambition is that greater collaboration between services will achieve better patient outcomes and reduce costs through more effective sharing of staff and resources. Wound care might be considered an ideal focus for PCNs, since general practice and community health services not only have a predominant role in the management of wounds, but variable and suboptimal practice continues and poor outcomes persist. This article investigates some ways in which PCNs might enable health-system changes that could improve the provision of wound care.

Health System

2020 ◽  
pp. 9-19
Author(s):  
Julie Sin
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Services ◽  
Health System ◽  
Community Health Services ◽  
Population Approach ◽  
Group Type ◽  
Health Authorities ◽  
System P ◽  
Over Time

This chapter covers the visible and ‘behind-the-scenes’ components of health system structures. There is a range of visible structures such as GP practices, hospitals, community health services, and mental health services. They are more visible to the population at large because of their direct association with delivering care and their everyday presence in the community. Behind that layer is a layer to plan and secure health services for populations (commissioning). There have been various formats for doing this over time, for example health authorities, primary care trusts and clinical commissioning group type configurations. This layer aims to distribute available resources across services to reach those in need in an equitable way. The development of this layer, why it or its equivalent is needed, and who commissions what in general, is discussed. The constancy of the population approach, whatever the health service structures of the day, is observed.

scholarly journals Gaining knowledge of Ontario’s community mental health and addictions system: linking community-based health services data with administrative health data in Toronto, Ontario, Canada

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Paul Kurdyak ◽  
Abigail Amartey ◽  
Julie Yang ◽  
Daniel Liadsky ◽  
Rachel Solomon ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Service ◽  
Health Services ◽  
Community Health ◽  
Community Health Services ◽  
Health Data ◽  
Local Health ◽  
Community Based ◽  
Administrative Health Data

IntroductionIn most developed countries, a significant amount of mental health and addictions care occurs in community settings. Data reflecting populations served by community-based mental health and addictions providers and the types of services provided are not available, resulting in an incomplete reflection of the entire mental health and addictions system within existing administrative data. Objectives and ApproachThe Community Business Intelligence (CBI) initiative is a data collection project that captures information on adults receiving community-based mental health, addictions, and support services in Toronto Central Local Health Integration Network (LHIN), located in Ontario, Canada. Leveraging administrative health data and data linkage capacity at the Institute for Clinical Evaluative Sciences (ICES), along with engagement of external stakeholders knowledgeable of CBI and the community health sector, we linked the 2015/16 CBI dataset to administrative health data. Demographic characteristics, health-service utilization, primary care attachment, and 30-day emergency department (ED) revisits were calculated for individuals accessing community health services. ResultsThere was an 80.8% linkage rate, of which 36.9% linked deterministically via health card number, while 43.9% linked probabilistically. After study exclusions, 37,688 individuals in the CBI dataset used community health services between April 2015 and March 2016. Compared to Toronto Central LHIN, a greater proportion in the CBI dataset were female, older than 65 years of age, and living in a low income neighbourhood. Furthermore, 95.5%of individuals had at least one outpatient physician visit, 51.3%had at least one ED visit, and 21.7%had at least one hospitalization in the past year. Few individuals in the CBI dataset were without primary care attachment (4.5%); however, a larger proportion had a 30-day ED revisit, particularly those receiving community addictions services (19%). Conclusion/ImplicationsThe availability of community health services data in the CBI dataset and its successful linkage to the administrative health data held at ICES identified health service intersections and outcomes that were previously unknown. This linkage project demonstrates a successful framework for sector-wide performance measurement to address a critical infrastructure gap.

Integration of General Practitioners with Hospitals and Community Health Services: A Qualitative Examination

1998 ◽  
Vol 4 (4) ◽  
pp. 68
Author(s):  
Yelena Fridgant ◽  
Gawaine P. Powell Davies ◽  
Brian I. O'Toole ◽  
Luc Betbeder-Matibet ◽  
Mark F. Harris
Keyword(s):  
General Practice ◽  
Health System ◽  
Community Health ◽  
General Practitioners ◽  
Service Providers ◽  
Health Workers ◽  
Hospital Staff ◽  
Community Health Services ◽  
Health Staff ◽  
Barriers To Integration

A series of focus groups was conducted with general practitioners (GPs), community health workers, hospital staff and consumers to examine the issue of integration of general practice within the wider Australian health system. Groups were held in various urban and rural locations to provide coverage of urban and rural conditions. The groups had representation from managerial as well as service provider staff and included GPs, hospital discharge planners, and emergency department staff, and from community health staff, nurses, physiotherapists, mental health workers, occupational therapists, and educators. Agreement was widespread that enhanced integration would confer benefits to patients, GPs, other health professionals, and to the health system generally. However, the health system was seen to be limited in its ability to integrate services. General practice, as small business working within the public health system, had different procedures and methods of remuneration than other health system components. Barriers to integration included structural, procedural and organisational factors, and included communication difficulties, variability in the roles and expectations of various service providers, and resource allocation and methods of funding. It is necessary to examine the barriers to integration more closely within the context of each type of service, to investigate effective ways of overcoming these barriers, and to describe and quantify the benefits that might arise from increased integration.

scholarly journals Why Community Health Systems Have Not Flourished in High Income Countries: What the Australian Experience Tells Us

2021 ◽  
Author(s):  
Fran Baum ◽  
Toby Freeman
Keyword(s):  
Health Promotion ◽  
Health Services ◽  
Health System ◽  
Community Health ◽  
Health Systems ◽  
The United States ◽  
Community Health Services ◽  
High Income ◽  
Community Health Systems ◽  
Effective Community

Background: Despite the value of community health systems, they have not flourished in high income countries and there are no system-wide examples in high income countries where community health is regarded as the mainstream model. Those that do exist in Australia, Canada, the United States and the United Kingdom provide examples of comprehensive primary healthcare (PHC) but are marginal to bio-medical primary medical care. The aim of this paper is to examine the factors that account for the absence of strong community health systems in high income countries, using Australia as an example. Methods: Data are drawn from two Australian PHC studies led by the authors. One examined seven case studies of community health services over a five-year period which saw considerable health system change. The second examined regional PHC organisations. We conducted new analysis using the ‘three I’s’ framework (interests, institutions, ideas) to examine why community health systems have not flourished in high-income countries. Results: The elements of the community health services that provide insights on how they could become the basis of an effective community health system are: a focus on equity and accessibility, effective community participation/control; multidisciplinary teamwork; and strategies from care to health promotion. Key barriers identified were: when general practitioners (GPs) were seen to lead rather than be part of a team; funding models that encourage curative services rather than disease prevention and health promotion; and professional and medical dominance so that community voices are drowned out. Conclusion: Our study of the community health system in Australia indicates that instituting such a system in high income countries will require systematic ideological, political and institutional change to shift the overarching government policy environment, and health sector policies and practices towards a social model of health which allows community control, and multidisciplinary service provision.

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