An Idea Worth Sustaining: Evaluation of the sustainability potential of Choosing Wisely across Ontario Community Hospitals and Family Health Teams

2020 ◽  
Author(s):  
Monika Kastner ◽  
Julie Makarski ◽  
Kate Mossman ◽  
Kegan Harris ◽  
Leigh Hayden ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Action Plan ◽  
Family Health ◽  
Healthcare Services ◽  
Choosing Wisely ◽  
Community Hospitals ◽  
Priority Areas ◽  
Care Family ◽  
Sustainability Challenges

Abstract BackgroundEvidence shows that 30% of healthcare services are unnecessary and unlikely to benefit patients and may even be harmful. Choosing Wisely (CW) is a physician-initiated, international campaign (with campaigns in at least 20 countries) aimed at addressing unnecessary medical care through the provision of evidence-based resources and clinical guidance. Our objectives were to evaluate the sustainability potential of CW across four Ontario community hospitals and affiliated family health teams (FHT). MethodsWe recruited CW implementation teams across Ontario hospitals and their affiliated primary care family health teams (FHTs) to participate in a mixed-methods study to identify and respond to their CW implementation and sustainability challenges. The study involved the administration of a validated sustainability Survey at baseline, 6- and 12-months follow-up, and participation in two focus groups (at baseline and 6 months) to discuss identified successes and opportunities for improvement, and to respond to implementation and sustainability challenges through a team exercise involving the co-creation and implementation of an action plan to directly address them.ResultsFifteen CW implementation teams across five Ontario community hospitals and affiliated FHTs participated in the study. Three CW de-adoption priority areas were investigated by teams: de-prescribing of proton pump inhibitors (PPIs), and reducing Pre-Op testing and BUN/Urea lab testing. All 15 teams achieved a baseline sustainability team score that was well above the threshold of what is considered a potentially sustainable innovation (i.e., >55%). We observed steady improvements in sustainability scores over three time points across all primary care teams, which is a strong indication that CW is sustainable in these settings. Regardless of site or priority area, facilitators that were common across all teams were fit with existing processes and workflows, leadership support, and optimized team communication. Common challenges were: lack of awareness and buy-in, lack of leadership engagement or a champion, and lack of fit with existing workflow and culture. All teams identified at least one challenge (during the baseline focus groups) for which they co-designed and implemented a plan to address them aimed at maximizing the sustainability potential of their CW priority areas. ConclusionsEvaluating the sustainability potential of an innovation such as Choosing Wisely is critical to ensuring that they have the best potential for impact. Our work highlights that implementation teams can be empowered to influence their implementation efforts, and to realize positive outcomes for their healthcare services and patients.

scholarly journals Conceptions of the professionals about their attributions in the Expanded Nucleus of Family Health

Psico-USF ◽  
2019 ◽  
Vol 24 (4) ◽  
pp. 661-671
Author(s):  
Meyrielle Belotti ◽  
Alexandra Iglesias ◽  
Luziane Zacché Avellar
Keyword(s):  
Primary Care ◽  
Qualitative Research ◽  
Content Analysis ◽  
Data Collection ◽  
Focus Groups ◽  
Health Professionals ◽  
Family Health ◽  
Work Processes ◽  
The Family ◽  
Specialized Care

Abstract The article aims to analyze the conceptions conferred by the health professionals that compose the Expanded Nuclei of Family Health (NASF) on their work assignments. This is a qualitative research, in which was used, for the data collection, eight focus groups, with a total of 43 participants. The data were submitted to content analysis. The results outlined the following categories: integrating NASF work with the Family Health Teams (ESF); developing specialized care; promoting intersectionality; contributing to the promotion of teamwork in Primary Care (AB) and strengthening AB. The study indicates the importance of a better understanding of the functions of the NASF, so that it does not restrict the opportunity to perform specialized care in AB. It is pointed out, the need for adjustments in the work processes of the ESF, in order to enable the shared work in the AB.

scholarly journals Communities as ‘renewable energy’ for healthcare services? a multimethods study into the form, scale and role of voluntary support for community hospitals in England

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030243
Author(s):  
Angela Ellis Paine ◽  
Daiga Kamerāde ◽  
John Mohan ◽  
Deborah Davidson
Keyword(s):  
Focus Groups ◽  
Patient Experience ◽  
Community Hospital ◽  
Well Being ◽  
Healthcare Services ◽  
Multidisciplinary Teams ◽  
Community Hospitals ◽  
Community Stakeholders ◽  
Charity Commission

ObjectiveTo examine the forms, scale and role of community and voluntary support for community hospitals in England.DesignA multimethods study. Quantitative analysis of Charity Commission data on levels of volunteering and voluntary income for charities supporting community hospitals. Nine qualitative case studies of community hospitals and their surrounding communities, including interviews and focus groups.SettingCommunity hospitals in England and their surrounding communities.ParticipantsCharity Commission data for 245 community hospital Leagues of Friends. Interviews with staff (89), patients (60), carers (28), volunteers (35), community representatives (20), managers and commissioners (9). Focus groups with multidisciplinary teams (8 groups across nine sites, involving 43 respondents), volunteers (6 groups, 33 respondents) and community stakeholders (8 groups, 54 respondents).ResultsCommunities support community hospitals through: human resources (average=24 volunteers a year per hospital); financial resources (median voluntary income = £15 632); practical resources through services and activities provided by voluntary and community groups; and intellectual resources (eg, consultation and coproduction). Communities provide valuable supplementary resources to the National Health Service, enhancing community hospital services, patient experience, staff morale and volunteer well-being. Such resources, however, vary in level and form from hospital to hospital and over time: voluntary income is on the decline, as is membership of League of Friends, and it can be hard to recruit regular, active volunteers.ConclusionsCommunities can be a significant resource for healthcare services, in ways which can enhance patient experience and service quality. Harnessing that resource, however, is not straight forward and there is a perception that it might be becoming more difficult questioning the extent to which it can be considered sustainable or ‘renewable’.

scholarly journals Understanding how patients establish strategies for living with asthma: a qualitative study in UK primary care as part of IMP2ART

2020 ◽  
Vol 70 (694) ◽  
pp. e303-e311 ◽  
Author(s):  
Luke Daines ◽  
Susan Morrow ◽  
Sharon Wiener-Ogilvie ◽  
Caroline Scott ◽  
Liz Steed ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Cognitive Skills ◽  
Action Plan ◽  
Management Strategies ◽  
Asthma Patient ◽  
Self Management ◽  
Children With Asthma ◽  
Prompt Action

BackgroundIn the context of a variable condition such as asthma, patient recognition of deteriorating control and knowing what prompt action to take is crucial. Yet, implementation of recommended self-management strategies remains poor.AimTo explore how patients with asthma and parents/carers of children with asthma develop and establish recommended self-management strategies for living with asthma, and how clinicians can best support the process.Design and settingA qualitative study in UK primary care.MethodPatients with asthma and parents/carers of children with asthma from 10 general practices were purposively sampled (using age, sex, and duration of asthma) to participate in focus groups or interviews between May 2016 and August 2016. Participants’ experiences of health care, management of asthma, and views on supported self-management were explored. Interviews and focus group sessions were audio-recorded and transcribed verbatim. Iterative thematic analysis was conducted, guided by the research questions and drawing on habit theory in discussion with a multidisciplinary research team.ResultsA total of 49 participants (45 patients; 4 parents/carers) took part in 32 interviews and five focus groups. Of these, 11 reported using an action plan. Patients learnt how to self-manage over time, building knowledge from personal experience and other sources, such as the internet. Some regular actions, for example, taking medication, became habitual. Dealing with new or unexpected scenarios required reflective abilities, which may be supported by a tailored action plan.ConclusionPatients reported learning intuitively how to self-manage. Some regular actions became habitual; dealing with the unexpected required more reflective cognitive skills. In order to support implementation of optimal asthma self- management, clinicians should consider both these aspects of self-management and support, and educate patients proactively.

scholarly journals OVERVIEW OF THE UNIQUE HEALTH SYSTEM (SUS):

2021 ◽  
Vol 1 (06) ◽  
Author(s):  
Suellen Cristina Ribeiro Akamine
Keyword(s):  
Primary Care ◽  
Health System ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Care Service ◽  
Family Health ◽  
Health Problems ◽  
Unified Health System ◽  
Family Health Strategy ◽  
Care Family

The Unified Health System has a network of teaching and research institutions such as universities, institutes and schools of public health that interact with state and municipal secretariats, the ministry of health, agencies and foundations. Primary Care is the main gateway to the SUS, starting with welcoming, listening and offering solutions to most health problems of the population, minimizing damage and suffering, aiming at the effectiveness of care, ensuring its completeness. SUS offers users the Hospital Care service of medium and high complexity. The objective of this study was to emphasize the importance of organizing the Unified Health System, highlighting Primary Care, Family Health Strategy and NASF, aiming at preventing health problems for the population. The results observed through bibliographic studies were the importance of adopting prevention strategies to minimize or avoid the individual's illness. It was concluded that the organization of the health system from Primary Care to Hospital Care is extremely important, emphasizing the need to seek preventive strategies adopted by the teams to prevent diseases, minimizing the need for hospital admissions, and providing quality of life to population.

Perceived Facilitators and Barriers to Implementation of a Decision Support Tool for Adolescent Depression and Suicidality Screening: A Qualitative Study (Preprint)

2020 ◽  
Author(s):  
Ana Radovic ◽  
Nathan Anderson ◽  
Megan Hamm ◽  
Brandie George-Milford ◽  
Carrie Fascetti ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Decision Support Tool ◽  
Depression Screening ◽  
Self Disclosure ◽  
Support Tool ◽  
Adolescent Parent ◽  
Barriers To Implementation

BACKGROUND Screening Wizard (SW) is a technology-based decision support tool aimed at guiding primary care providers (PCPs) to respond to depression and suicidality screens in adolescents. Separate screens assess adolescents’ and parents’ reports on mental health symptoms, treatment preferences, and potential treatment barriers. A detailed summary is provided to PCPs, also identifying adolescent-parent discrepancies. The goal of SW is to enhance decision making to increase utilization of evidence-based treatments. OBJECTIVE We describe a multi-stakeholder qualitative study with adolescents, parents, and providers to understand potential barriers to implementation of SW. METHODS We interviewed 11 parents and 11 adolescents, and conducted 2 focus groups with 17 healthcare providers (PCPs, nurses, therapists, staff) across 2 pediatric practices. Participants described previous experiences with screening for depression and were shown a mock-up of SW and asked for feedback. Interviews and focus groups were transcribed verbatim, and codebooks inductively developed based on content. Transcripts were double-coded, and disagreements adjudicated to full agreement. Completed coding was used to produce thematic analyses of interviews and focus groups. RESULTS We identified five main themes across the interviews and focus groups: (1) parents, adolescents, and pediatric PCPs agree that depression screening should occur in pediatric primary care; (2) there is concern that accurate self-disclosure does not always occur during depression screening; (3) Screening Wizard is viewed as a tool that could facilitate depression screening, and which might encourage more honesty in screening responses; (4) parents, adolescents and providers do not want Screening Wizard to replace mental health discussions with providers; and (5) providers want to maintain autonomy in treatment decisions. CONCLUSIONS We identified that providers, parents, and adolescents all have concerns with current screening practices, mainly regarding inaccurate self-disclosure. They recognized value in SW as a computerized tool that may elicit more honest responses and identify adolescent-parent discrepancies. Surprisingly, providers did not want the SW report to include treatment recommendations, and all groups did not want the SW report to replace conversations with the PCP about depression. While SW was originally developed as a treatment decision algorithm, this qualitative study has led us to remove this component, and instead focus on aspects identified as most useful by all groups. We hope that this initial qualitative work will improve future implementation of SW.

Athlete health and safety at large sport events: the development of consensus-driven guidelines

2020 ◽  
pp. bjsports-2020-102771
Author(s):  
Margo Mountjoy ◽  
Jane Moran ◽  
Hosny Ahmed ◽  
Stephane Bermon ◽  
Xavier Bigard ◽  
...  
Keyword(s):  
Knowledge Translation ◽  
Action Plan ◽  
Health And Safety ◽  
Healthcare Services ◽  
International Federation ◽  
Medical Services ◽  
Local Context ◽  
Sporting Events ◽  
Medical Risk ◽  
Sport Events

All sport events have inherent injury and illness risks for participants. Healthcare services for sport events should be planned and delivered to mitigate these risks which is the ethical responsibility of all sport event organisers. The objective of this paper was to develop consensus-driven guidelines describing the basic standards of services necessary to protect athlete health and safety during large sporting events. By using the Knowledge Translation Scheme Framework, a gap in International Federation healthcare programming for sport events was identified. Event healthcare content areas were determined through a narrative review of the scientific literature. Content experts were systematically identified. Following a literature search, an iterative consensus process was undertaken. The outcome document was written by the knowledge translation expert writing group, with the assistance of a focus group consisting of a cohort of International Federation Medical Chairpersons. Athletes were recruited to review and provide comment. The Healthcare Guidelines for International Federation Events document was developed including content-related to (i) pre-event planning (eg, sport medical risk assessment, public health requirements, environmental considerations), (ii) event safety (eg, venue medical services, emergency action plan, emergency transport, safety and security) and (iii) additional considerations (eg, event health research, spectator medical services). We developed a generic standardised template guide to facilitate the planning and delivery of medical services at international sport events. The organisers of medical services should adapt, evaluate and modify this guide to meet the sport-specific local context.

scholarly journals Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ka Chun Chong ◽  
Hong Fung ◽  
Carrie Ho Kwan Yam ◽  
Patsy Yuen Kwan Chau ◽  
Tsz Yu Chow ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Public Sector ◽  
System Dynamics ◽  
The Elderly ◽  
Healthcare Services ◽  
Dynamics Simulation ◽  
Public And Private ◽  
The Public ◽  
The Impact

Abstract Background The elderly healthcare voucher (EHCV) scheme is expected to lead to an increase in the number of elderly people selecting private primary healthcare services and reduce reliance on the public sector in Hong Kong. However, studies thus far have reported that this scheme has not received satisfactory responses. In this study, we examined changes in the ratio of visits between public and private doctors in primary care (to measure reliance on the public sector) for different strategic scenarios in the EHCV scheme. Methods Based on comments from an expert panel, a system dynamics model was formulated to simulate the impact of various enhanced strategies in the scheme: increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for the model calibration were collected from various sources. Results The simulation results show that the current EHCV scheme is unable to reduce the utilization of public healthcare services, as well as the ratio of visits between public and private primary care among the local aging population. When comparing three different tested scenarios, even if the increase in the annual voucher amount could be maintained at the current pace or the age eligibility can be lowered to include those aged 60 years, the impact on shifts from public-to-private utilization were insignificant. The public-to-private ratio could only be marginally reduced from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in a significant drop of 0.50 in the public-to-private ratio during the early implementation phase. However, the effect could not be maintained for an extended period. Conclusions Our findings will assist officials in improving the design of the EHCV scheme, within the wider context of promoting primary care among the elderly. We suggest that an additional chronic disease-oriented voucher can serve as an alternative strategy. The scheme must be redesigned to address more specific objectives or provide a separate voucher that promotes under-utilized healthcare services (e.g., preventive care), instead of services designed for unspecified reasons, which may lead to concerns regarding exploitation.

scholarly journals Analysis of Annual Costs of Mobile Clinics in the Southern United States

2020 ◽  
Vol 11 ◽  
pp. 215013272098062
Author(s):  
Sharon Attipoe-Dorcoo ◽  
Rigoberto Delgado ◽  
Dejian Lai ◽  
Aditi Gupta ◽  
Stephen Linder
Keyword(s):  
Primary Care ◽  
Healthcare Services ◽  
Medicare Beneficiaries ◽  
Mobile Clinic ◽  
Efficient Manner ◽  
Healthcare Facilities ◽  
Capital Costs ◽  
At Risk Populations ◽  
Mobile Clinics ◽  
The Cost

Introduction Mobile clinics provide an efficient manner for delivering healthcare services to at-risk populations, and there is a need to understand their economics. This study analyzes the costs of operating selected mobile clinic programs representing service categories in dental, dental/preventive, preventive care, primary care/preventive, and mammography/primary care/preventive. Methods The methodology included a self-reported survey of 96 mobile clinic programs operating in Texas, North Carolina, Georgia, and Florida; these states did not expand Medicaid and have a large proportion of uninsured individuals. Data were collected over an 8-month period from November 2016 to July 2017. The cost analyses were conducted in 2018, and were analyzed from the provider perspective. The average annual estimated costs; as well the costs per patient in each mobile clinic program within different service delivery types were assessed. Costs reported in the study survey were classified into recurrent direct costs and capital costs. Results Results indicate that mean operating costs range from about $300 000 to $2.5 million with costs increasing from mammography/primary care/preventive delivery to dental/preventive. The majority of mobile clinics provided dental care followed by dental/preventive. The cost per patient visit for all mobile clinic service types ranged from $65 to $529, and appears to be considerably less than those reported in the literature for fixed clinic services. Conclusion The overall costs of all delivery types in mobile clinics were lower than the costs of providing care to Medicare beneficiaries in federally funded health centers, making mobile clinics a sound economic complement to stationary healthcare facilities.

scholarly journals A qualitative exploration of patients’ experiences, needs and expectations regarding online access to their primary care record

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044221
Author(s):  
Brian McMillan ◽  
Gail Davidge ◽  
Lindsey Brown ◽  
Moira Lyons ◽  
Helen Atherton ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Negative Consequences ◽  
Face To Face ◽  
Primary Care Record ◽  
Online Access ◽  
Additional Support ◽  
The Uk ◽  
Records Access ◽  
Qualitative Exploration

ObjectivesPrimary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need.DesignFocus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach.SettingFocus groups and interviews were conducted in community settings in the UK.ParticipantsFifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else.ResultsParticipants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated.ConclusionsDiscussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.

Sign in / Sign up

Export Citation Format

Share Document