scholarly journals Implementation of a transformative learning collaborative training for family doctor teams and managers: a description of participant process and perception

2020 ◽  
Author(s):  
Peiya Cao ◽  
Yanli Huang ◽  
Huiqiang Luo ◽  
Danping Liu
Keyword(s):  
Primary Care ◽  
Transformative Learning ◽  
Care Delivery ◽  
Family Doctor ◽  
Scale Up ◽  
Rapid Change ◽  
Primary Care System ◽  
Learning Collaborative ◽  
Family Doctors ◽  
Care System

Abstract Background: The Health Commission of Wuhou reformed its primary care system by implementing a Transformative Learning Collaborative (TLC): a structure that supports shared learning and rapid change among a group of providers or organisations. This paper examines the adaptation of a district TLC to implement, disseminate, and scale up the principles of a District Model for family doctor teams and managers of Community Health Centres (CHCs) in China. We describe TLC as a means of informing training content and evaluated the implementation through participant feedback. Methods: A district TLC was implemented to disseminate a District Model, which included six quality improvement principles and was developed to reform the primary care delivery process. Family doctor teams (n=26, 52 family doctor individuals) and managers (n=13) from thirteen CHCs in a Chinese district participated in the TLC organisation. The TLC process was described, and survey data served to assess the activities and resource usefulness. The perceived implementation enablers and inhibitors were also descriptively analysed. Results: The purpose, content, and process of TLC were described. The implementation included four steps: structure establishment, participants identification, activities implementation, and setting up a feedback system. The survey findings captured family doctors’ and managers’ feedback with regard to preference, needs, concerns, and problems in implementing TLC training. In general, most family doctors and managers indicated that TLC was necessary. All the successfully implemented Plan-Do-Study-Action cycles (77.6%) were applied to the model. Family doctors and managers agreed that coaches, a programme director, and data analysts were useful resources. The top three enablers for successful TLC implementation were managers’ support (93.9%); improvements in self-ability and team-based ability and impacts on participants’ career goals (89.8%), and support from family doctor teams (87.8%). Conclusions: This study offered a guided process for running TLC in the primary care system of China and provided valuable feedback from family doctors and managers regarding TLC training. Challenges were also found for future research and consideration. Our findings suggest that manager support is necessary for collaboration in family doctor teams and that participants play an important role by evaluating learning sessions and providing recommendations for future learning.

scholarly journals Integrating nurse practitioners into primary care: policy considerations from a Canadian province

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Stacey Black ◽  
Raad Fadaak ◽  
Myles Leslie
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Care Delivery ◽  
Primary Care System ◽  
Structured Interviews ◽  
Primary Care Delivery ◽  
Key Stakeholders ◽  
The Status ◽  
Practice Opportunities ◽  
Care System

Abstract Background The integration of nurse practitioners (NPs) into primary care health teams has been an object of interest for policy makers seeking to achieve the goals of improving care, increasing access, and lowering cost. The province of Alberta in Canada recently introduced a policy aimed at integrating NPs into existing primary care delivery structures. This qualitative research sought to understand how that policy – the NP Support Program (NPSP) – was viewed by key stakeholders and to draw out policy lessons. Methods Fifteen semi-structured interviews with NPs and other stakeholders in Alberta’s primary care system were conducted, recorded, transcribed and analyzed using the interpretive description method. Results Stakeholders predominantly felt the NPSP would not change the status quo of limited practice opportunities and the resulting underutilization of primary care NPs in the province. Participants attributed low levels of NP integration into the primary care system to: 1) financial viability issues that directly impacted NPs, physicians, and primary care networks (PCNs); 2) policy issues related to the NPSP’s reliance on PCNs as employers, and a requirement that NPs panel patients; and 3) governance issues in which NPs are not afforded sufficient authority over their role or how the key concept of ‘care team’ is defined and operationalized. Conclusions In general, stakeholders did not see the NPSP as a long-term solution for increasing NP integration into the province’s primary care system. Policy adjustments that enable NPs to access funding not only from within but also outside PCNs, and modifications to allow greater NP input into how their role is utilized would likely improve the NPSP’s ability to reach its goals.

scholarly journals Impact of integrated healthcare: Taiwan’s Family Doctor Plan

2019 ◽  
Vol 34 (Supplement_2) ◽  
pp. ii56-ii66 ◽  
Author(s):  
Li-Lin Liang
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Integrated Care ◽  
Contextual Factors ◽  
Family Doctor ◽  
Emergency Department Visits ◽  
System Level ◽  
Primary Care System ◽  
Design Elements ◽  
Care System

Abstract Integration of health services has been pursued worldwide. Diversity in integration approaches and in the contexts in which integrated programmes operate, however, hinders comparative analysis of care integration in both high-income countries (HICs) and low- and middle-income countries (LMICs). This study evaluates an HIC programme implemented in a delivery system resembling those of LMICs, especially its weak primary care system. The programme, Taiwan’s Family Doctor Plan (FDP), targets high-cost and chronic patients, incorporating key elements of integrated care, viz., case management, multidisciplinary teams and care pathways. This study estimates the effects of shifting from usual to integrated care and locates contextual factors that may distort programme implementation. To estimate programme effects, difference-in-differences analysis is applied to a balanced panel comprising >160 000 patients over 2009–13. Because physician participation is voluntary, a propensity score matching method is used to match providers. The research findings reveal that introduction of the FDP has not reoriented the model of care from fragmented towards integrated health services. It reduces continuity of care and has no effect on co-ordination of care. Regarding quality of care, the FDP is shown to have no effect on avoidable admissions and increases drug injections and emergency department visits. Several contextual factors may serve as barriers that impede elements of FDP from generating desirable outcomes. These include absence of registration and gatekeeping systems; limited capacities of clinics; and preponderance of fee-for-service remuneration. These findings suggest that HIC design elements may not be directly transferrable to settings with weak primary care systems, as is typical of LMIC healthcare. Changes at the system level, such as establishing regular sources of care, may be necessary before elements of integrated care are introduced to a weaker primary care system.

scholarly journals Estimating the Costs of Implementing Comprehensive Primary Care: A Narrative Review

2019 ◽  
Vol 6 ◽  
pp. 233339281984248
Author(s):  
Grant R. Martsolf ◽  
Ryan Kandrack ◽  
Mark W. Friedberg ◽  
Brian Briscombe ◽  
Peter S. Hussey ◽  
...  
Keyword(s):  
Primary Care ◽  
Narrative Review ◽  
Fee For Service ◽  
Primary Care System ◽  
High Functioning ◽  
Illness Burden ◽  
Care Practices ◽  
Primary Care Practices ◽  
Limited Generalizability ◽  
Care System

The performance of the any health-care system relies on a high-functioning primary care system. Increasing primary care practices’ adoption of “comprehensive primary care” capabilities might yield meaningful improvements in the quality and efficiency of primary care. However, many comprehensive primary care capabilities, such as care management and coordination, are not compensated via traditional fee-for-service payment. To calculate new payments for these capabilities, policymakers would need estimates of the costs that practices incur when adopting, maintaining, and using the capabilities. We performed a narrative review of the existing literature on the costs of adopting and implementing comprehensive primary care capabilities. These studies have found that practices incur significant costs when adopting and implementing comprehensive primary care capabilities. However, the studies had significant limitations that prevent extensive use of their estimates for payment policy. Particularly, the strongest studies focused on a small numbers of practices in specific geographic areas and the concepts and methods used to assess costs varied greatly across the studies. Furthermore, none of the studies in our review attempted to estimate differences in costs across practices with patients at varying levels of complexity and illness burden which is important for risk-adjusting payments to practices. Therefore, due to the heterogeneous designs and limited generalizability of published studies highlight the need for additional research, especially if payers wish to link their financial support for comprehensive primary care capabilities to the costs of these capabilities for primary care practices.

scholarly journals New Zealand among global social media initiative leaders for primary care advocacy

2016 ◽  
Vol 8 (2) ◽  
pp. 94 ◽  
Author(s):  
Kyle Hoedebecke ◽  
Joseph Scott-Jones ◽  
Luís Pinho-Costa
Keyword(s):  
Primary Care ◽  
Social Media ◽  
New Zealand ◽  
Family Medicine ◽  
Family Doctor ◽  
Primary Care Providers ◽  
Care Providers ◽  
Family Doctors ◽  
Medicine Community ◽  
World Organisation

Abstract The international ‘#1WordforFamilyMedicine’ initiative explores the identity of General Practitioners (GPs) and Family Physicians (FPs) by allowing the international Family Medicine community to collaborate on advocating for the discipline via social media. The New Zealand version attracted 83 responses on social media. Thematic analysis was performed on the responses and a ‘word cloud’ image was created based on an image identifying the country around the world - that of the silver fern. The ‘#1WorldforFamilyMedicine’ project was promoted by WONCA (World Organisation of Family Doctors) globally to help celebrate World Family Doctor Day on 19 May 2015. To date, over 80 images have been created in 60 different countries on six continents. The images represent GPs’ love for their profession and the community they serve. We hope that this initiative will help inspire current and future Family Medicine and Primary Care providers.

Do We Need More Pediatricians? Effect of Group Practice

PEDIATRICS ◽  
1973 ◽  
Vol 51 (4) ◽  
pp. 754-755
Author(s):  
Harvey Klevit
Keyword(s):  
Primary Care ◽  
Health Plan ◽  
Statistical Data ◽  
Group Practice ◽  
Primary Care System ◽  
Manpower Shortage ◽  
Care System

We appreciate being cited as a model efficient primary care system by D. Haggerty1 in his commentary which questions the existence of a pediatric manpower shortage. Readers might be interested in some of our statistical data. Our group of 20 pediatricians (18 when corrected for research and administrative activities), has provided primary services to a known Kaiser Health Plan (Oregon Region) population of 55,000 children under age 17 in 1972. We have been able to function at a ratio of one pediatrician per 2,800 to 3,200 patients since 1965, when we began "keeping score."

The Education of Pediatricians for Primary Care: The Score After Two Score Years

PEDIATRICS ◽  
1995 ◽  
Vol 95 (2) ◽  
pp. 270-272
Author(s):  
Evan Charney
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care System ◽  
Medical Profession ◽  
Primary Care System ◽  
Educational Structure ◽  
Task Forces ◽  
Do So ◽  
Care System

In a 1973 monograph on the education of physicians for primary care, Joel Alpert and I wrote, "There are two interrelated and serious problems in our present educational structure—not enough physicians enter primary care and those who do so are not adequately prepared for the job."1 Twenty years and many task forces and exhortatory editorials later, much the same could be said. But that conclusion would not be entirely fair: changes have indeed occurred in the subsequent two score years. There is now clear consensus that a strong primary care system should be the linchpin of our nation's health care system, with 50 to 60% of physicians as generalists, 2,3 and the medical profession has at least professed to agree with that strategy.4

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