scholarly journals Drug company payments to General Practices in England: Cross-sectional and social network analysis

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261077
Author(s):  
Eszter Saghy ◽  
Shai Mulinari ◽  
Piotr Ozieranski
Keyword(s):  
Pharmaceutical Industry ◽  
Drug Company ◽  
Marketing Strategies ◽  
Conflicts Of Interests ◽  
Cross Sectional ◽  
Practice Characteristics ◽  
Important Target ◽  
General Practices ◽  
Financial Dependency

Although there has been extensive research on pharmaceutical industry payments to healthcare professionals, healthcare organisations with key roles in health systems have received little attention. We seek to contribute to addressing this gap in research by examining drug company payments to General Practices in England in 2015. We combine a publicly available payments database managed by the pharmaceutical industry with datasets covering key practice characteristics. We find that practices were an important target of company payments, receiving £2,726,018, equivalent to 6.5% of the value of payments to all healthcare organisations in England. Payments to practices were highly concentrated and specific companies were also highly dominant. The top 10 donors and the top 10 recipients amassed 87.9% and 13.6% of the value of payments, respectively. Practices with more patients, a greater proportion of elderly patients, and those in more affluent areas received significantly more payments on average. However, the patterns of payments were similar across England’s regions. We also found that company networks–established by making payments to the same practices–were largely dominated by a single company, which was also by far the biggest donor. Greater policy attention is required to the risk of financial dependency and conflicts of interests that might arise from payments to practices and to organisational conflicts of interests more broadly. Our research also demonstrates that the comprehensiveness and quality of payment data disclosed via industry self-regulatory arrangements needs improvement. More interconnectivity between payment data and other datasets is needed to capture company marketing strategies systematically.

scholarly journals Importance of accessibility and opening hours to overall patient experience of general practice: analysis of repeated cross-sectional data from a national patient survey

2018 ◽  
Vol 68 (672) ◽  
pp. e469-e477 ◽  
Author(s):  
Thomas E Cowling ◽  
Azeem Majeed ◽  
Matthew J Harris
Keyword(s):  
General Practice ◽  
Patient Experience ◽  
Patient Survey ◽  
Cross Sectional ◽  
National Patient ◽  
General Practices ◽  
The Uk ◽  
Multilevel Linear Regression ◽  
Practice Patient

BackgroundThe UK government aims to improve the accessibility of general practices in England, particularly by extending opening hours in the evenings and at weekends. It is unclear how important these factors are to patients’ overall experiences of general practice.AimTo examine associations between overall experience of general practice and patient experience of making appointments and satisfaction with opening hours.Design and settingAnalysis of repeated cross-sectional data from the General Practice Patient Surveys conducted from 2011–2012 until 2013–2014. These covered 8289 general practice surgeries in England.MethodData from a national survey conducted three times over consecutive years were analysed. The outcome measure was overall experience, rated on a five-level interval scale. Associations were estimated as standardised regression coefficients, adjusted for responder characteristics and clustering within practices using multilevel linear regression.ResultsIn total, there were 2 912 535 responders from all practices in England (n = 8289). Experience of making appointments (β 0.24, 95% confidence interval [CI] = 0.24 to 0.25) and satisfaction with opening hours (β 0.15, 95% CI = 0.15 to 0.16) were modestly associated with overall experience. Overall experience was most strongly associated with GP interpersonal quality of care (β 0.34, 95% CI = 0.34 to 0.35) and receptionist helpfulness was positively associated with overall experience (β 0.16, 95% CI = 0.16 to 0.17). Other patient experience measures had minimal associations (β≤0.06). Models explained ≥90% of variation in overall experience between practices.ConclusionPatient experience of making appointments and satisfaction with opening hours were only modestly associated with overall experience. Policymakers in England should not assume that recent policies to improve access will result in large improvements in patients’ overall experience of general practice.

scholarly journals Quality of Care for Patients With Type 2 Diabetes in Primary Care in Norway Is Improving: Results of cross-sectional surveys of 33 general practices in 1995 and 2005

Diabetes Care ◽  
2008 ◽  
Vol 32 (1) ◽  
pp. 81-83 ◽  
Author(s):  
J. G. Cooper ◽  
T. Claudi ◽  
A. K. Jenum ◽  
G. Thue ◽  
M. F. Hausken ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Quality Of Care ◽  
Cross Sectional ◽  
General Practices

From Bad Pharma to Good Pharma: Aligning Market Forces with Good and Trustworthy Practices through Accreditation, Certification, and Rating

2013 ◽  
Vol 41 (3) ◽  
pp. 601-610 ◽  
Author(s):  
Jennifer E. Miller
Keyword(s):  
Pharmaceutical Industry ◽  
Best Practices ◽  
Credit Rating ◽  
Revolving Door ◽  
Rating System ◽  
Pharmaceutical Companies ◽  
Market Forces ◽  
Conflicts Of Interests ◽  
Rating Agencies

Could an accreditation, certification, or rating mechanism help the pharmaceutical industry improve both its bioethical performance and its public reputation? Other industries have used such systems to assess, improve, distinguish, and demonstrate the quality of their services, processes, and products. These systems have also helped increase transparency, accountability, stakeholder confidence, and awareness of industry best practices. This article explains how market forces can be harnessed to recognize and promote better bioethical performance by pharmaceutical companies when there are good systems to accredit, certify, or rate. It concludes with a review of relevant failures of credit-rating agencies — such as conflicts of interests and revolving-door practices — to illuminate some of the pitfalls of developing a bioethics accreditation, certification, or rating system for pharmaceutical companies.

scholarly journals Associations between general practice characteristics with use of urgent referrals for suspected cancer and endoscopies: a cross-sectional ecological study

2018 ◽  
Vol 36 (5) ◽  
pp. 573-580 ◽  
Author(s):  
Silvia C Mendonca ◽  
Gary A Abel ◽  
Carolynn Gildea ◽  
Sean McPhail ◽  
Michael D Peake ◽  
...  
Keyword(s):  
General Practice ◽  
Practice Variation ◽  
Cross Sectional ◽  
Referral Rates ◽  
Targeted Interventions ◽  
Practice Level ◽  
Urgent Referral ◽  
Practice Characteristics ◽  
General Practices ◽  
Health Need

Abstract Background Large variation in measures of diagnostic activity has been described previously between English general practices, but related predictors remain understudied. Objective To examine associations between general practice population and characteristics, with the use of urgent referrals for suspected cancer, and use of endoscopy. Methods Cross-sectional observational study of English general practices. We examined practice-level use (/1000 patients/year) of urgent referrals for suspected cancer, gastroscopy, flexible sigmoidoscopy and colonoscopy. We used mixed-effects Poisson regression to examine associations with the sociodemographic profile of practice populations and other practice attributes, including the average age, sex and country of qualification of practice doctors. Results The sociodemographic characteristics of registered patients explained much of the between-practice variance in use of urgent referrals (32%) and endoscopic investigations (18–25%), all being higher in practices with older and more socioeconomically deprived patients. Practice-level attributes explained a substantial amount of between-practice variance in urgent referral (19%) but little of the variance in endoscopy (3%-4%). Adjusted urgent referral rates were higher in training practices and those with younger GPs. Practices with mean doctor ages of 41 and 57 years (at the 10th/90th centiles of the national distribution) would have urgent referral rates of 24.1 and 19.1/1000 registered patients, P < 0.001. Conclusion Most between-practice variation in use of urgent referrals and endoscopies seems to reflect health need. Some practice characteristics, such as the mean age of GPs, are associated with appreciable variation in use of urgent referrals, though these associations do not seem strong enough to justify targeted interventions.

scholarly journals Are formalised implementation activities associated with aspects of quality of care in general practice? A cross-sectional study

BJGP Open ◽  
2017 ◽  
Vol 1 (2) ◽  
pp. bjgpopen17X100737 ◽  
Author(s):  
Jette V Le ◽  
Jesper Lykkegaard ◽  
Line B Pedersen ◽  
Helle Riisgaard ◽  
Jørgen Nexøe ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Quality Of Care ◽  
Implementation Strategies ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Mixed Effect ◽  
Knowledge Implementation ◽  
General Practices

BackgroundThere is a substantial variation in how different general practices manage knowledge implementation, including the degree to which activities are collectively and formally organised. Yet, it is unclear how these differences in implementation activities affect quality of care.AimTo investigate if there are associations between specific formalised knowledge implementation activities and quality of care in general practices, exemplified by the use of spirometry testing.Design & settingA nationwide cross-sectional study combining survey and register data in Denmark.MethodAn electronic questionnaire was distributed to GPs, and data on spirometry testing among first-time users of medication against obstructive lung diseases were obtained from national registers. Associations were investigated using multilevel mixed-effect logit models.ResultsGPs from 1114 practices (58%) responded, and 33 788 patients were linked to a responding practice. In partnership practices, the frequency of interdisciplinary and GP meetings affected the quality of care. Interdisciplinary and GP meetings held on a weekly basis were significantly associated with a higher level of quality of care and this was measured by the odds ratio (OR) of patients having spirometry. The development of practice protocols and standard recordings in the electronic medical record (EMR) for a range of disease areas compared with few or no areas at all also impacted the quality of care level provided. The effect of formalised implementation activities was not as evident in single-handed practices as in partnerships.ConclusionThis study provides valuable knowledge for GPs who aim to organise their practice in a way that supports implementation and quality improvement most effectively. Also, results may be useful for managers of implementation strategies and quality improvement initiatives when planning future activities.

scholarly journals Capitated versus fee-for-service reimbursement and quality of care for chronic disease: a US cross-sectional analysis

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Sri Lekha Tummalapalli ◽  
Michelle M. Estrella ◽  
Deanna P. Jannat-Khah ◽  
Salomeh Keyhani ◽  
Said Ibrahim
Keyword(s):  
Quality Of Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Cross Sectional ◽  
Practice Characteristics ◽  
Sectional Analysis ◽  
Payment Models ◽  
Statin Use

Abstract Background Upcoming alternative payment models Primary Care First (PCF) and Kidney Care Choices (KCC) incorporate capitated payments for chronic disease management. Prior research on the effect of capitated payments on chronic disease management has shown mixed results. We assessed the patient, physician, and practice characteristics of practices with capitation as the majority of revenue, and evaluated the association of capitated reimbursement with quality of chronic disease care. Methods We performed a cross-sectional analysis of visits in the United States’ National Ambulatory Medical Care Survey (NAMCS) for patients with hypertension, diabetes, or chronic kidney disease (CKD). Our predictor was practice reimbursement type, classified as 1) majority capitation, 2) majority FFS, or 3) other reimbursement mix. Outcomes were quality indicators of hypertension control, diabetes control, angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) use, and statin use. Results About 9% of visits were to practices with majority capitation revenue. Capitated practices, compared with FFS and other practices, had lower visit frequency (3.7 vs. 5.2 vs. 5.2, p = 0.006), were more likely to be located in the West Census Region (55% vs. 18% vs. 17%, p < 0.001), less likely to be solo practice (21% vs. 37% vs. 35%, p = 0.005), more likely to be owned by an insurance company, health plan or HMO (24% vs. 13% vs. 13%, p = 0.033), and more likely to have private insurance (43% vs. 25% vs. 19%, p = 0.004) and managed care payments (69% vs. 23% vs. 26%, p < 0.001) as the majority of revenue. The prevalence of controlled hypertension, controlled diabetes, ACEi/ARB use, and statin use was suboptimal across practice reimbursement types. Capitated reimbursement was not associated with differences in hypertension, diabetes, or CKD quality indicators, in multivariable models adjusting for patient, physician, and practice characteristics. Conclusions Practices with majority capitation revenue differed substantially from FFS and other practices in patient, physician, and practice characteristics, but were not associated with consistent quality differences. Our findings establish baseline estimates of chronic disease quality of care performance by practice reimbursement composition, informing chronic disease care delivery within upcoming payment models.

The Compendium of Pharmaceuticals and Specialties: A Critical Analysis

1983 ◽  
Vol 13 (1) ◽  
pp. 107-118 ◽  
Author(s):  
R. Warren Bell ◽  
John W. Osterman
Keyword(s):  
Pharmaceutical Industry ◽  
Drug Company ◽  
Critical Analysis ◽  
Drug Information ◽  
Marketing Strategies ◽  
Current Drug ◽  
Governmental Organizations ◽  
The Creation

The Compendium of Pharmaceuticals and Specialties (CPS) is the most widely used source of drug information in Canada, and is heavily financed by the pharmaceutical industry. A close examination of its contents comparing a computer-drawn, randomized sample of monographs from its “White Pages” to standard pharmacological reference works demonstrates certain of its characteristics: it uncritically includes many inadequate preparations; it overstates the benefits and understates the adverse qualities of many preparations; and it contains little or no information on relative indications, efficacy, or price. These characteristics serve to promote the marketing goals of the drug manufacturers and severely limit the volume's usefulness as an objective source of drug information. The role of the CPS and similar publications in the overall context of current drug company marketing strategies is discussed. Finally, suggestions for improvements are made involving the elimination of direct manufacturer financing, and the creation of an objective, independent, nonprofit publishing agency supported by professional and governmental organizations.

scholarly journals Progress of GP clusters 2 years after their introduction in Scotland: findings from the Scottish School of Primary Care national GP survey

BJGP Open ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. bjgpopen20X101112
Author(s):  
Stewart Mercer ◽  
John Gillies ◽  
Bridie Fitzpatrick
Keyword(s):  
Factor Analysis ◽  
Quality Improvement ◽  
Quality Of Care ◽  
Early Stage ◽  
Great Majority ◽  
Intelligence Analysis ◽  
Activity Data ◽  
Cross Sectional ◽  
Practice Characteristics

BackgroundThe concept of GP clusters is derived from 'quality circles' in general practice in Europe and Canada. GP clusters commenced across Scotland in 2016 to improve the quality of care of local populations.AimTo determine GPs' views on clusters, and the robustness of bespoke questions about them.Design & settingA cross-sectional national survey of work satisfaction of GPs in Scotland took place, which was conducted in July 2018–October 2018.MethodAn analysis of bespoke questions on GP clusters was undertaken. The questions were completed by quality leads (QLs) and all other GPs in a nationally representative sample of GPs.ResultsIn total, 2456 responses were received from 4371 GPs (56.4%). QLs reported that clusters were meeting regularly, and were friendly and well organised but not always productive. Support for cluster activity (data, health intelligence, analysis, quality improvement methods, advice, leadership, and evaluation) was suboptimal. Factor analysis identified two separate constructs (cluster meetings [CMs] and cluster support [CS]), which were minimally influenced (<2%) by GP and practice characteristics. Non-QLs (75% of all GPs) were generally satisfied with the two-way communication with the cluster QLs, but the great majority (>70%) reported no positive changes in various aspects of quality improvement. Factor analysis of these items indicated two constructs (cluster knowledge and engagement [CKE] and cluster quality improvement [CQI]), which were minimally affected by GP and practice characteristics.ConclusionGP clusters are ‘up and running’ in Scotland but are at an early stage in terms of perceived impact and appear to be in need of more support in order to improve quality of care. The bespoke questions developed on clusters have robust construct validity, suitable for future surveys.

Perceived Overprotection and Its Association With Quality of Life in Dementia

GeroPsych ◽  
2019 ◽  
Vol 32 (3) ◽  
pp. 125-134
Author(s):  
Mechthild Niemann-Mirmehdi ◽  
Andreas Häusler ◽  
Paul Gellert ◽  
Johanna Nordheim
Keyword(s):  
Quality Of Life ◽  
Patient Autonomy ◽  
Positive Association ◽  
Well Being ◽  
Negative Association ◽  
Significant Positive Association ◽  
Cross Sectional ◽  
People With Dementia ◽  
Mental Well Being

Abstract. To date, few studies have focused on perceived overprotection from the perspective of people with dementia (PwD). In the present examination, the association of perceived overprotection in PwD is examined as an autonomy-restricting factor and thus negative for their mental well-being. Cross-sectional data from the prospective DYADEM study of 82 patient/partner dyads (mean age = 74.26) were used to investigate the association between overprotection, perceived stress, depression, and quality of life (QoL). The analyses show that an overprotective contact style with PwD has a significant positive association with stress and depression, and has a negative association with QoL. The results emphasize the importance of avoiding an overprotective care style and supporting patient autonomy.

HUBUNGAN KUALITAS KEHIDUPAN KERJA TERHADAP KINERJA PERAWAT PELAKSANA

2019 ◽  
Vol 9 (4) ◽  
pp. 413-420
Author(s):  
Amella Gusty ◽  
Dachriyanus Dachriyanus ◽  
Leni Merdawati
Keyword(s):  
District Hospital ◽  
Simple Random Sampling ◽  
Work Life ◽  
Quality Of Work Life ◽  
P Value ◽  
Work Context ◽  
Cross Sectional ◽  
Quality Of Work ◽  
The Relationship

Kinerja perawat merupakan hasil yang dicapai dalam melaksanakan asuhan keperawatan di rumah sakit. Terciptanya asuhan keperawatan yang optimal sangat diperlukan dukungan dari pihak rumah sakit salah satunya adalah menciptakan kualitas kehidupan kerja baik bagi perawat. Penelitian ini bertujuan untuk mengetahui hubungan antara kualitas kehidupan kerja terhadap kinerja perawat pelaksana di RSUD Teluk Kuantan. Jenis penelitian kuantitatif dengan pendekatan cross sectional. Jumlah sampel 120 responden yang diperoleh melalui proportionate simple random sampling. Hasil penelitian menunjukkan kualitas kehidupan kerja perawat RSUD Teluk Kuantan berada pada kategori sedang, kinerja perawat berada pada kategori kurang baik. Berdasarkan analisis kedua variabel teridentifikasi bahwa tidak ada hubungan antara kualitas kehidupan kerja dengan kinerja perawat pelaksana dengan  p value 0,817. Dimensi work context merupakan komponen yang memiliki hubungan dengan kinerja perawat pelaksana dengan p value 0,008, dimensi work life  tidak berhubungan secara signifikan dengan kinerja perawat. Kesimpulan penelitian diketahui tidak ada hubungan antara kualitas kehidupan kerja dengan kinerja perawat pelaksana. Ada hubungan dimensi work context dengan kinerja perawat pelaksana. Tidak ada hubungan dimensi work life dengan kinerja perawat.   Kata kunci: kualitas kehidupan kerja, kinerja, perawat pelaksana   THE RELATIONSHIP BETWEEN THE QUALITY OF WORK LIFE AND THE PERFORMANCE OF IMPLEMENTERS NURSES   ABSTRACT Nurse performance is the result achieved in implementing nursing care in a hospital. The creation of optimal nursing care is very much needed support from the hospital, one of which is to create a good quality of work life for nurses. This study aims to determine the relationship between the quality of work life and the performance of nurses at the Kuantan District Hospital. This type of quantitative research with cross sectional approach. The number of samples of 120 respondents obtained through proportionate simple random sampling. The results showed that the quality of work life of nurses at the Kuantan District Hospital was in the medium category, the nurses' performance was in the unfavorable category. Based on the analysis of the two variables, it was identified that there was no relationship between the quality of work life with the performance of implementing nurses with a p value of 0.817. The work context dimension is a component that has a relationship with the performance of nurses implementing with p value 0.008, the dimension of work life does not significantly correlate with nurse performance. The conclusion of the research is that there is no relationship between the quality of work life and the performance of the implementing nurses. There is a relationship between the dimensions of the work context and the performance of the nurses. There is no relationship between the dimensions of work life and nurse performance.   Keywords: quality of work life, performance, implementers nurse

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