scholarly journals AB009. How should doctors be paid?—a systematic review of the impacts of provider payment methods for primary care physicians on patient healthcare utilisation

2021 ◽  
Vol 5 ◽  
pp. AB009-AB009
Author(s):  
Margaret Kay Ho ◽  
Elaine Tian
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Healthcare Utilisation ◽  
Payment Methods ◽  
Provider Payment

WikiRecs primary care: developing rapid recommendations for primary care through effective collaboration between systematic review and guideline teams

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697085
Author(s):  
Trudy Bekkering ◽  
Bert Aertgeerts ◽  
Ton Kuijpers ◽  
Mieke Vermandere ◽  
Jako Burgers ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Clinical Practice ◽  
Primary Care Physicians ◽  
Urinary Stones ◽  
Care Practice ◽  
Supporting Evidence ◽  
Supervised Exercise ◽  
Review Team ◽  
New Evidence

BackgroundThe WikiRecs evidence summaries and recommendations for clinical practice are developed using trustworthy methods. The process is triggered by studies that may potentially change practice, aiming at implementing new evidence into practice fast.AimTo share our first experiences developing WikiRecs for primary care and to reflect on the possibilities and pitfalls of this method.MethodIn March 2017, we started developing WikiRecs for primary health care to speed up the process of making potentially practice-changing evidence in clinical practice. Based on a well-structured question a systematic review team summarises the evidence using the GRADE approach. Subsequently, an international panel of primary care physicians, methodological experts and patients formulates recommendations for clinical practice. The patient representatives are involved as full guideline panel members. The final recommendations and supporting evidence are disseminated using various platforms, including MAGICapp and scientific journals.ResultsWe are developing WikiRecs on two topics: alpha-blockers for urinary stones and supervised exercise therapy for intermittent claudication. We did not face major problems but will reflect on issues we had to solve so far. We anticipate having the first WikiRecs for primary care available at the end of 2017.ConclusionThe WikiRecs process is a promising method — that is still evolving — to rapidly synthesise and bring new evidence into primary care practice, while adhering to high quality standards.

scholarly journals Socioeconomic inequalities in primary-care and specialist physician visits: a systematic review

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sara Lena Lueckmann ◽  
Jens Hoebel ◽  
Julia Roick ◽  
Jenny Markert ◽  
Jacob Spallek ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Web Of Science ◽  
Adult Population ◽  
Socioeconomic Inequalities ◽  
Eligibility Criteria ◽  
Physician Visits ◽  
General Adult Population ◽  
Registration Number

Abstract Background Utilization of primary-care and specialist physicians seems to be associated differently with socioeconomic status (SES). This review aims to summarize and compare the evidence on socioeconomic inequalities in consulting primary-care or specialist physicians in the general adult population in high-income countries. Methods We carried out a systematic search across the most relevant databases (Web of Science, Medline) and included all studies, published since 2004, reporting associations between SES and utilization of primary-care and/or specialist physicians. In total, 57 studies fulfilled the eligibility criteria. Results Many studies found socioeconomic inequalities in physician utilization, but inequalities were more pronounced in visiting specialists than primary-care physicians. The results of the studies varied strongly according to the operationalization of utilization, namely whether a physician was visited (probability) or how often a physician was visited (frequency). For probabilities of visiting primary-care physicians predominantly no association with SES was found, but frequencies of visits were higher in the most disadvantaged. The most disadvantaged often had lower probabilities of visiting specialists, but in many studies no link was found between the number of visits and SES. Conclusion This systematic review emphasizes that inequalities to the detriment of the most deprived is primarily a problem in the probability of visiting specialist physicians. Healthcare policy should focus first off on effective access to specialist physicians in order to tackle inequalities in healthcare. PROSPERO registration number CRD42019123222.

scholarly journals A systematic review of behavioural weight-loss interventions involving primary-care physicians in overweight and obese primary-care patients (1999–2011)

2012 ◽  
Vol 16 (11) ◽  
pp. 2083-2099 ◽  
Author(s):  
Sze Lin Yoong ◽  
Mariko Carey ◽  
Rob Sanson-Fisher ◽  
Alice Grady
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Weight Loss ◽  
High Intensity ◽  
Primary Care Physicians ◽  
Population Characteristics ◽  
Significant Weight Loss ◽  
Primary Care Patients ◽  
Clinically Significant ◽  
Weight Loss Interventions

AbstractObjectiveThe present review aimed to examine the effectiveness of behavioural weight-loss interventions involving primary-care physicians in producing weight loss in overweight and obese primary-care patients.DesignA systematic review was conducted by searching online databases (MEDLINE, EMBASE, Cochrane, PsycINFO and SCOPUS) from January 1999 to December 2011. All abstracts were screened and coded for eligibility. The Cochrane Effective Practice and Organisation of Care Group quality criteria were used to assess the methodological adequacy of included studies. Information related to study design, population characteristics and intervention details was extracted.SettingPrimary care.SubjectsOverweight or obese (defined as having a BMI ≥ 25·0 kg/m2) primary-care patients.ResultsSixteen different studies were included. Of these, six assessed primary-care physicians’ delivery of weight-loss counselling; nine assessed weight-loss counselling delivered by non-physician personnel with monitoring by primary-care physicians; and one assessed a multi-component intervention. Overall, high-intensity weight-loss counselling by primary-care physicians resulted in moderate but not clinically significant weight loss. High-intensity weight-loss counselling delivered by non-physicians, meal replacements delivered in conjunction with dietitian counselling and referral to commercial weight-loss centre programmes accompanied by regular monitoring by a primary-care physician were effective in producing clinically significant weight loss. Dietitian-delivered care appeared effective in producing weight loss regardless of level of intervention intensity.ConclusionsOverall, there were few studies on this topic and the methodological rigour of some included studies was poor. Additional studies assessing the effectiveness and acceptability of potential interventions are needed to confirm these findings.

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 Primary care physicians’ decision-making processes in the context of multimorbidity: protocol of a systematic review and thematic synthesis of qualitative research

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e023832 ◽  
Author(s):  
David Silvério Rodrigues ◽  
Paulo Faria Sousa ◽  
Nuno Basílio ◽  
Ana Antunes ◽  
Maria da Luz Antunes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Making ◽  
Qualitative Research ◽  
Primary Care Physicians ◽  
Medical Decision ◽  
Published Data ◽  
Qualitative Evidence Synthesis ◽  
Thematic Synthesis ◽  
Qualitative Evidence

IntroductionGood patient outcomes correlate with the physicians’ capacity for good clinical judgement. Multimorbidity is common and it increases uncertainty and complexity in the clinical encounter. However, healthcare systems and medical education are centred on individual diseases. In consequence, recognition of the patient as the centre of the decision-making process becomes even more difficult. Research in clinical reasoning and medical decision in a real-world context is needed. The aim of the present review is to identify and synthesise available qualitative evidence on primary care physicians’ perspectives, views or experiences on decision-making with patients with multimorbidity.Methods and analysisThis will be a systematic review of qualitative research where PubMed, CINAHL, PsycINFO, Embase and Web of Science will be searched, supplemented with manual searches of reference lists of included studies. Qualitative studies published in Portuguese, Spanish and English language will be included, with no date limit. Studies will be eligible when they evaluate family physicians’ perspectives, opinions or perceptions on decision-making for patients with multimorbidity in primary care. The methodological quality of studies selected for retrieval will be assessed by two independent reviewers before inclusion in the review using the Critical Appraisal Skills Programme (CASP) tool. Thematic synthesis will be used to identify key categories and themes from the qualitative data. The Confidence in the Evidence from Reviews of Qualitative research approach will be used to assess how much confidence to place in findings from the qualitative evidence synthesis.Ethics and disseminationThis review will use published data. No ethical issues are foreseen. The findings will be disseminated to the medical community via journal publication and conference presentation(s).PROSPERO registration numberID 91978.

Interventions to Improve Adherence to Preventive Care in Inflammatory Bowel Disease: A Systematic Review

2021 ◽  
Author(s):  
Natalie Yu ◽  
Chamara Basnayake ◽  
William Connell ◽  
Nik Sheng Ding ◽  
Emily Wright ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Inflammatory Bowel Disease ◽  
Preventive Care ◽  
Primary Care Physicians ◽  
Controlled Trial ◽  
Preventive Health ◽  
Randomized Controlled ◽  
Health Measures ◽  
Inflammatory Bowel

Abstract Background Preventive health measures reduce treatment and disease-related complications including infections, osteoporosis, and malignancies in patients with inflammatory bowel disease (IBD). Although guidelines and quality measures for IBD care highlight the importance of preventive care, their uptake remains variable. This systematic review evaluates interventions aimed at improving the rates of provision and uptake of preventive health measures, including vaccinations, bone density assessment, skin cancer screening, cervical cancer screening, and smoking cessation counseling. Methods We searched PubMed, MEDLINE, EMBASE, and CENTRAL for full text articles published until March 2021. Studies were included if they evaluated interventions to improve the provision or uptake of 1 or more preventive health measures in adult IBD patients and if they reported pre- and postintervention outcomes. Results In all, 4655 studies were screened, and a total of 17 studies were included, including 1 randomized controlled trial, 1 cluster-controlled trial, and 15 prospective interventional studies. A variety of interventions were effective in improving the rates of adherence to preventive health measures. The most common interventions targeted gastroenterologists, including education, electronic medical records tools, and audit feedback. Other interventions targeted patients, such as education, questionnaires, and offering vaccine administration at clinic visits. Few interventions involved IBD nurses or primary care physicians. Conclusions A range of interventions—targeted at gastroenterologists, patients, or both—were effective in improving the provision and uptake of preventive care. Future studies should involve randomized controlled trials evaluating multifaceted interventions that target barriers to adherence and involve IBD nurses and primary care physicians.

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