scholarly journals COVID-19 – An Opportunity to Improve Access to Primary Care Through Organizational Innovations?

2021 ◽  
Author(s):  
Mylaine Breton ◽  
Emily Gard Marshall ◽  
Melanie Ann Smithman ◽  
Lauren R. Moritz ◽  
Richard Buote ◽  
...  
Keyword(s):  
Primary Care ◽  
Nova Scotia ◽  
Social Services ◽  
Primary Healthcare ◽  
Care Delivery ◽  
Diverse Range ◽  
Access To Primary Care ◽  
Unattached Patients ◽  
Organizational Innovations ◽  
Improve Access

Abstract Background COVID-19 catalyzed a rapid and substantial reorganization of primary care, accelerating the spread of existing strategies and fostering a proliferation of innovations. Access to primary care is an essential component of a health care system, particularly during a pandemic. We describe organizational innovations aiming to improve access to primary care and related contextual changes, during the first year of the COVID-19 pandemic in two Canadian provinces, Quebec and Nova Scotia.MethodsWe conducted a multiple case studies, based on 63 semi-structured interviews (n=33 in Quebec, n=30 in Nova Scotia) conducted between October 2020 and May 2021 and a review of related internal documents from both jurisdictions. We recruited a diverse range of provincial and regional stakeholders (e.g., policymakers, decision-makers, family physicians, nurses) involved in reorganizing primary care during COVID-19 using purposeful sampling (e.g., based on role, region). Interviews were transcribed verbatim and thematic analysis was conducted in NVivo12. Emerging results were discussed by team members to identify salient themes and organized into logic models.Results We identified and analyzed six organizational innovations. Four of these - centralized public online booking systems, centralized access centers for unattached patients, and interim primary care clinics for unattached patients and community connector to health and social services for older adults – pre-dated COVID-19 but were accelerated by the pandemic context. The remaining two innovations were created to specifically address pandemic-related needs: COVID-19 hotlines and COVID dedicated primary healthcare clinics. Innovation spread and proliferation was influenced by several factors such as a strengthened sense of community amongst providers, decreased patient demand at the beginning of the first wave, renewed policy and provider interest in population-wide access (versus attachment of patients only), suspended performance targets (e.g., continuity ≥80%) in Quebec, in modality of care delivery, modified fee codes, and greater regional flexibility to implement tailored innovations.Conclusion COVID-19 accelerated the uptake and creation of organizational innovations to potentially improve access to primary healthcare, removing, at least temporarily, certain longstanding barriers. Many stakeholders believed this reorganization would have positive impacts on access to primary care after COVID-19. Further studies should analyze the effectiveness and sustainability of innovations adapted, developed, and implemented during the COVID-19 pandemic.

scholarly journals O direito à saúde na atenção básica no MERCOSUL: a fraternidade como possibilidade de garantia de direitos sociais / The Right to Primary Healthcare in MERCOSUL: the Fraternity as a Possibility of Social Rights Guarantee

2019 ◽  
Vol 6 (2) ◽  
pp. 33-43
Author(s):  
Sandra Regina Martini ◽  
Maria Isabel Barros Bellini
Keyword(s):  
Primary Care ◽  
Primary Healthcare ◽  
International Organization ◽  
Social Rights ◽  
Economic Policies ◽  
Time Limits ◽  
Access To Primary Care ◽  
The Right ◽  
Dividing Line

ABSTRACTThis article discusses health as a fundamental and universal right therefore not limited to border demarcation, races and / or any other indicator . The analysis Locus is MERCOSUL- international organization between Brazil, Argentina , Paraguay and Uruguay established in 1991 to facilitate the integration of economic policies between these countries, it is associated with Chile and Bolivia. Discusses the importance of resizing the limits of law in today's society , for which the "frontier" is at the same time limits and possibilities between these to promote access to primary care as a bridge to the execution of other social rights thus breaking with traditional dimensions of the border or transfrontier idea where the right ended at the dividing line between one country and another.RESUMENEste artigo aborda a saúde como direito fundamental e universal portanto não limitado a demarcação de fronteiras, raças e/ou qualquer outro indicador. O Lócus de análise é o MERCOSUL -organização internacional entre Brasil, Argentina, Paraguai e Uruguai criada em 1991 para facilitar a integração de políticas econômicas entre estes países, tem como associados o Chile e Bolívia. Discute a importância de redimensionar os limites do direito na sociedade atual, para a qual a “fronteira” representa, ao mesmo tempo limites e possibilidades entre estas o de promover o acesso à atenção básica como uma ponte para a efetivação de outros direitos sociais rompendo assim com as dimensões tradicionais da ideia de fronteira ou transfronteira onde o direito terminava na linha divisória entre um país e outro. Tem como pressupostos teóricos o Direito Vivo e a Metateoria do Direito Fraterno e  aposta no pressuposto da fraternidade como uma possibilidade de agregação e superação das divisões postas pelas fronteiras.

scholarly journals Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year (the PUPPY Study): Protocol for a Longitudinal Mixed Methods Study (Preprint)

2021 ◽  
Author(s):  
Emily Gard Marshall ◽  
Mylaine Breton ◽  
Benoit Cossette ◽  
Jennifer Isenor ◽  
Maria Mathews ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Nova Scotia ◽  
Research Ethics ◽  
Health Research ◽  
Health Sciences ◽  
Mixed Methods Study ◽  
Care Practice ◽  
Research Ethics Board ◽  
Unattached Patients

BACKGROUND The COVID-19 pandemic has significantly disrupted primary care in Canada, with many walk-in clinics and family practices initially closing or being perceived as inaccessible; pharmacies remaining open with restrictions on patient interactions; rapid uptake of virtual care; and reduced referrals for lab tests, diagnostics, and specialist care. OBJECTIVE The PUPPY Study (Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year) seeks to understand the impact of the COVID-19 pandemic across the quadruple aims of primary care, with particular focus on the effects on patients without attachment to a regular provider and those with chronic health conditions. METHODS The PUPPY study builds on an existing research program exploring patients’ access and attachment to a primary care practice, pivoted to adapt to the emerging COVID-19 context. We intend to undertake a longitudinal mixed methods study to understand critical gaps in primary care access and coordination, as well as compare prepandemic and postpandemic data across 3 Canadian provinces (Quebec, Ontario, and Nova Scotia). Multiple data sources will be used such as a policy review; qualitative interviews with primary care policymakers, providers (ie, family physicians, nurse practitioners, and pharmacists), and patients (N=120); and medication prescriptions and health care billing data. RESULTS This study has received funding by the Canadian Institutes of Health Research COVID-19 Rapid Funding Opportunity Grant. Ethical approval to conduct this study was granted in Ontario (Queens Health Sciences & Affiliated Teaching Hospitals Research Ethics Board, file 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol 40335) in November 2020, Québec (Centre intégré universitaire de santé et de services sociaux de l'Estrie, project 2020-3446) in December 2020, and Nova Scotia (Nova Scotia Health Research Ethics Board, file 1024979) in August 2020. CONCLUSIONS To our knowledge, this is the first study of its kind to explore the effects of the COVID-19 pandemic on primary care systems, with particular focus on the issues of patient’s attachment and access to primary care. Through a multistakeholder, cross-jurisdictional approach, the findings of the PUPPY study will inform the strengthening of primary care during and beyond the COVID-19 pandemic, as well as have implications for future policy and practice. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/29984

scholarly journals Do mail-shots improve access to primary care for young men with depression?

2007 ◽  
Vol 21 (1) ◽  
Author(s):  
Paul Walters ◽  
MRC Fellow ◽  
James Fisher ◽  
André Tylee
Keyword(s):  
Primary Care ◽  
Young Men ◽  
Access To Primary Care ◽  
Improve Access

scholarly journals Access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya

2020 ◽  
Author(s):  
Peter O. Otieno ◽  
Elvis Omondi Achach Wambiya ◽  
Shukri M Mohamed ◽  
Martin Kavao Mutua ◽  
Peter M Kibe ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Healthcare ◽  
Associated Factors ◽  
Healthcare Services ◽  
Urban Slums ◽  
Public Facility ◽  
Health Coverage ◽  
Ordinal Logistic Regression Analysis ◽  
Access To Primary Care ◽  
Female Headed Households

Abstract Background: Access to primary healthcare is crucial for the delivery of Kenya’s universal health coverage policy. However, disparities in healthcare have proved to be the biggest challenge for implementing primary care in poor-urban resource settings. In this study, we assessed the level of access to primary healthcare services and associated factors in urban slums in Nairobi-Kenya. Methods: The data were drawn from the Lown scholars’ study of 300 randomly selected households in Viwandani slums (Nairobi, Kenya), between June and July 2018. Access to primary care was measured using Penchansky and Thomas’ model. Access index was constructed using principal component analysis and recorded into tertiles with categories labeled as poor, moderate, and highest. Generalized ordinal logistic regression analysis was used to determine the factors associated with access to primary care. The adjusted odds ratios (AOR) and 95 percent confidence intervals were used to interpret the strength of associations. Results: The odds of being in the highest access tertile versus the combined categories of lowest and moderate access tertile were 3.5 times higher for males than female-headed households (AOR 3.05 [95% CI 1.47-6.37]; p<.05). Households with an average quarterly out-of-pocket healthcare expenditure of ≥$30 had significantly lower odds of being in the highest versus combined categories of lowest and moderate access tertile compared to those spending ≤ $5.(AOR 0.36 [95% CI 0.18-0.74]; p<.05). Households that sought primary care from private facilities had significantly higher odds of being in the highest versus combined categories of lowest and moderate access tertiles compared to the public facilities (AOR 6.64 [95% CI 3.67-12.01]; p<.001). Conclusion: In Nairobi slums in Kenya, living in a female-headed household, seeking care from a public facility, and paying out of pocket for healthcare are significantly associated with low access to primary care. Therefore, the design of the UHC program in this setting should prioritize quality improvement in public health facilities and focus on policies that encourage economic empowerment of female-headed households to improve access to primary healthcare

scholarly journals Influencers on deprescribing practice of primary healthcare providers in Nova Scotia: An examination using behavior change frameworks

2020 ◽  
Vol 4 ◽  
pp. 239920262092250
Author(s):  
Natalie Kennie-Kaulbach ◽  
Rachel Cormier ◽  
Olga Kits ◽  
Emily Reeve ◽  
Anne Marie Whelan ◽  
...  
Keyword(s):  
Primary Care ◽  
Nova Scotia ◽  
Behavior Change ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Primary Care Providers ◽  
System Level ◽  
Care Providers ◽  
Behavior Change Wheel ◽  
Primary Healthcare Providers

Background: Deprescribing is a complex process requiring consideration of behavior change theory to improve implementation and uptake. Aim: The aim of this study was to describe the knowledge, attitudes, beliefs, and behaviors that influence deprescribing for primary healthcare providers (family physicians, nurse practitioners (NPs), and pharmacists) within Nova Scotia using the Theoretical Domains Framework version 2 (TDF(v2)) and the Behavior Change Wheel. Methods: Interviews and focus groups were completed with primary care providers (physicians, NPs, and pharmacists) in Nova Scotia, Canada. Coding was completed using the TDF(v2) to identify the key influencers. Subdomain themes were also identified for the main TDF(v2) domains and results were then linked to the Behavior Change Wheel—Capability, Opportunity, and Motivation components. Results: Participants identified key influencers for deprescribing including areas related to Opportunity, within TDF(v2) domain Social Influences, such as patients and other healthcare providers, as well as Physical barriers (TDF(v2) domain Environmental Context and Resources), such as lack of time and reimbursement. Conclusion: Our results suggest that a systematic approach to deprescribing in primary care should be supported by opportunities for patient and healthcare provider collaborations, as well as practice and system level enhancements to support sustainability of deprescribing practices.

scholarly journals Using CBPR to Decrease Health Disparities in a Suburban Latino Neighborhood

2017 ◽  
Vol 15 (3) ◽  
pp. 121-129 ◽  
Author(s):  
Maren J. Coffman ◽  
Brisa Urquieta de Hernandez ◽  
Heather A. Smith ◽  
Andrew McWilliams ◽  
Yhenneko J. Taylor ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
High Risk ◽  
Social Services ◽  
Care Provider ◽  
Primary Care Provider ◽  
Access To Health Care ◽  
Care Delivery ◽  
Research Network ◽  
Community Based

Introduction: This project tested the feasibility of using a community-based participatory research (CBPR) approach to deliver health and social resources in two high-risk, suburban neighborhoods. Method: An established research network was used to engage stakeholders to design and deliver a neighborhood-based intervention targeting a Latino immigrant population. The intervention provided screenings for hypertension, diabetes, and depression; primary care provider visits; and information about navigating health care delivery systems and related community-based resources. Participants ( N = 216) were consented for participation and their subsequent use of health and social services were measured at baseline and 1 year post intervention. Results: At baseline, 5.1% of participants had health insurance, 16.7% had a primary care provider, and 38.4% had a chronic illness. SF-12 scores showed a majority of participants with low perceived health status (56%) and high risk for clinical depression (33%). Self-reported use of primary care services increased from 33.8% at baseline to 48% 1 year after the intervention, and 62% reported use of social services. Conclusion: Neighborhood-based interventions informed by a CBPR approach are effective in both identifying community members who lack access to health care–related services and connecting them into needed primary care and social services.

Sharing the Care to Improve Access to Primary Care

2012 ◽  
Vol 366 (21) ◽  
pp. 1955-1957 ◽  
Author(s):  
Amireh Ghorob ◽  
Thomas Bodenheimer
Keyword(s):  
Primary Care ◽  
Access To Primary Care ◽  
Improve Access

scholarly journals The geographic accessibility of pharmacies in Nova Scotia

2013 ◽  
Vol 146 (1) ◽  
pp. 39-46 ◽  
Author(s):  
Michael R. Law ◽  
Deborah Heard ◽  
Judith Fisher ◽  
Jay Douillard ◽  
Greg Muzika ◽  
...  
Keyword(s):  
Primary Care ◽  
Nova Scotia ◽  
Rural Areas ◽  
Urban Areas ◽  
Walking Distance ◽  
Community Pharmacies ◽  
Geographic Proximity ◽  
Geographic Access ◽  
Access To Primary Care ◽  
Urban And Rural Areas

Introduction: Geographic proximity is an important component of access to primary care and the pharmaceutical services of community pharmacies. Variations in access to primary care have been found between rural and urban areas in Canadian and international jurisdictions. We studied access to community pharmacies in the province of Nova Scotia. Methods: We used information on the locations of 297 community pharmacies operating in Nova Scotia in June 2011. Population estimates at the census block level and network analysis were used to study the number of Nova Scotia residents living within 800 m (walking) and 2 km and 5 km (driving) distances of a pharmacy. We then simulated the impact of pharmacy closures on geographic access in urban and rural areas. Results: We found that 40.3% of Nova Scotia residents lived within walking distance of a pharmacy; 62.6% and 78.8% lived within 2 km and 5 km, respectively. Differences between urban and rural areas were pronounced: 99.2% of urban residents lived within 5 km of a pharmacy compared with 53.3% of rural residents. Simulated pharmacy closures had a greater impact on geographic access to community pharmacies in rural areas than urban areas. Conclusion: The majority of Nova Scotia residents lived within walking or short driving distance of at least 1 community pharmacy. While overall geographic access appears to be lower than in the province of Ontario, the difference appears to be largely driven by the higher proportion of rural dwellers in Nova Scotia. Further studies should examine how geographic proximity to pharmacies influences patients’ access to traditional and specialized pharmacy services, as well as health outcomes and adherence to therapy. Can Pharm J 2013;146:39-46.

scholarly journals Integrative literature review: access to primary healthcare services

2018 ◽  
Vol 71 (3) ◽  
pp. 1178-1188 ◽  
Author(s):  
Maura Cristiane e Silva Figueira ◽  
Wellington Pereira da Silva ◽  
Eliete Maria Silva
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Primary Healthcare ◽  
Healthcare Services ◽  
Health Plans ◽  
Access To Health Services ◽  
Primary Health ◽  
Study Selection ◽  
Access To Health ◽  
Access To Primary Care

ABSTRACT Objective: Analyze the scientific production that describes the type of access to primary healthcare services and identify specific populations that have differentiated access to health services. Method: An integrative review. For study selection, the following databases were used: PubMed, Scopus, Bireme, and Cinahl. The sample included 22 national and international articles. Results: The results describe the access of specific populations to health services, the access to primary care through health plans and proposed improvements to the access to primary care. Conclusion: The access to services is a challenge in many countries and some strategies and policies are implemented to solve and improve primary health care.

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