General Practice in Canada

1972 ◽  
Vol 2 (2) ◽  
pp. 229-237 ◽  
Author(s):  
I. R. McWhinney
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practitioner ◽  
Family Physician ◽  
Hospital Care ◽  
Rapid Change ◽  
Teaching Hospitals ◽  
Physician Services ◽  
District Hospitals ◽  
Tier System

Medical practice in Canada is in a stage of rapid change. All provinces now have government insurance schemes which pay for hospital care and physician services. Health care is being reorganized in several provinces. The pattern evolving is a three–tier system, with health centers for primary care, district hospitals for inpatient care, and regional hospitals—usually teaching hospitals—for highly specialized services. A regional administrative structure is being developed. Although many variations exist the general practitioner (family physician) is still the major source of primary care. Current trends indicate that in the future the family physician will continue to be the usual source of primary and continuing health care. General practitioners in Canada normally have hospital admission privileges. Although the role of the general practitioner in hospital is changing, there is no indication that the general practitioner will cease to play a part in hospital care. Nurses are beginning to play a more important role in primary health care. Most Canadian medical schools now have departments or divisions of family medicine. The College of Family Physicians has played a major part in establishing postgraduate training for family practice.

scholarly journals Workshop: Health workforce meets HSR: Tackling regional inequalities in health service provision

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Services ◽  
Health Workforce ◽  
Health Care Professionals ◽  
Rural Areas ◽  
Hospital Care ◽  
Health Service Provision ◽  
Care Practices ◽  
Do So

Abstract Background Many countries across Europe are facing considerable challenges in providing accessible and high quality care regardless of where people live. A major element is the difficulty that countries face to attract and retain health care professionals to work in remote and rural areas. This applies to primary care services as well as to hospital care, and to the care provided by physicians and other health professionals, including nurses. A widely shared question is therefore how to safeguard access to health care in rural areas and to solve recruitment and retention problems in such regions, both of medical and nursing staff. The workshop will build on last year’s joint workshop of the Sections on HSR and HWR that ended with questions related to how to organize accessible and equitable health services including the workforces required to do so. Objectives This workshop will provide a snapshot of studies from across the European region, with a particular focus on differences between rural and urban health care practices and the types of solutions being used to reduce regional disparities in provision of care. This often refers to retention and recruitment strategies, but the session will also address other types of solutions in the organization of care that can help ensure accessible care, including in vulnerable regions and settings. Tackling this challenge will therefore require a joint approach, tapping into experience from health workforce research as well as wider health services research, bringing together research into the organization and management of healthcare and into the health human resources providing this care, operated from different angles and being informed by different research traditions and data sources. Based on statements, we will discuss the topic of how to organize accessible and equitable health services including the workforces required to do so after the presentations. Key messages Workforce policies should focus on retaining primary care workforce in rural areas and integrated policies should attract new primary care practices. Both in primary care and hospital care new solutions are being sought which should help resolve regional differences in access to care and attractiveness for the health workforce.

Regional shortages in a small country: how to provide the right care in the right place?

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
J Hansen ◽  
R Batenburg ◽  
E Vis ◽  
L Van der Velden
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Professionals ◽  
Hospital Care ◽  
Ageing Population ◽  
Regional Collaboration ◽  
Care Workers ◽  
Vested Interests ◽  
More Care ◽  
The Right

Abstract Background The Netherlands, though being a relatively small and densely populated country, is faced with a similar challenge as other countries in terms of regional differences in access to care and attractiveness for care workers to build their careers. Both in primary care and hospital care new solutions are being sought which should help resolve these growing difficulties. Methods We conducted a literature review, survey and registry analysis, and held interviews with key stakeholders. Results Substantial differences exist between regions in the supply of both primary care and hospital care doctors. Particular and less populated regions appear to be hit in multiple ways, both with an extra ageing population requiring more care as well as by limited attractiveness for both primary care and hospital care workers. Solutions being used so far are mostly initiated by individual health care settings, such as strategic personnel management, redistribution of tasks and campaigns to increase the inflow of staff. Increasingly, solutions are also being explored at regional level, including a growing emphasis on regional collaboration, both in providing the right care in the right place as well as in terms of joint recruitment strategies. Still, such approaches only have a limited effect as a result of which new approaches are needed. Conclusions Strategies to improve the attractiveness of particular regions are now often fragmented, both between types of professions and sectors and different regions. In addition, innovative and new solutions appear to be hampered by vested interests of stakeholders. If new solutions are to be developed it is key that stakeholders are willing to compromise, be it when it comes to the autonomy of health care professionals and their associations and to the financial commitments required from government and insurer side.

scholarly journals Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management [intersec-CM]: study protocol for a randomised controlled trial

2019 ◽  
Author(s):  
Angela Nikelski ◽  
Armin Keller ◽  
Fanny Schumacher-Schönert ◽  
Terese Dehl ◽  
Jessica Laufer ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cognitive Impairment ◽  
Hospital Admission ◽  
Collaborative Care ◽  
Hospital Care ◽  
Care Management ◽  
Unmet Needs ◽  
Controlled Trial ◽  
Somatic Illness

Abstract BackgroundSectorization of health care systems causes inefficient treatment, especially for elderly people with cognitive impairments. The transition from hospital care to primary care is insufficiently coordinated, and communication between health care providers is often lacking. Consequences include a further deterioration of health, higher rates of hospital readmission, and institutionalization. Models of collaborative care have shown their efficacy in primary care by improving patient-related outcomes. The main goal of this trial is to test the effectiveness of a collaborative care model for people with cognitive impairment (PCI) and current hospital treatment due to a somatic illness to improve the continuity of treatment and care across the transition between the in-hospital and adjoining primary care sectors.Methods The trial is a longitudinal multisite randomized controlled trial with two arms (“care as usual” and “intersectoral care management”). Inclusion criteria at the time of hospital admission due to a somatic illness: age 70+, cognitive impairment (Mini Mental State Examination, MMSE ≤ 26), live at home, provide written informed consent. Each participant will have a baseline assessment at the hospital and two follow-up assessments at home (three and twelve months after discharge). The estimated sample size is n=398 participants together with (where available) their respective informal caregivers.In the intersectoral care management group, specialized care managers will develop, implement and monitor individualized treatment and care based on comprehensive assessments of the patients and informal caregivers for unmet needs at the hospital and in their homes. Primary outcomes are (1) activities of daily living, (2) readmission to the hospital, and (3) institutionalization. Secondary outcomes include (a) frailty, (b) delirium, (c) quality of life, (d) cognitive status, (e) behavioral and psychological symptoms of dementia, (f) utilization of services, and (g) informal caregiver burden.DiscussionIn the event of proving efficacy, this trial delivers proof of concept for implementation into routine care. Cost-effectiveness analyses as well as an independent process evaluation increase the likelihood of meeting this goal. The trial allows in-depth analysis of mediating and moderating effects for different health outcomes at the interface between hospital care and primary care. Highlighting treatment and care, the study will provide insights into unmet needs at the time of hospital admission, the opportunities and barriers to meeting those needs during the hospital stay and after discharge.Trial registration ClinicalTrials.gov Identifier: NCT03359408

From Cottage to Community Hospitals: Watlington Cottage Hospital and its Regional Context, 1874–2000

2012 ◽  
pp. 33-49 ◽  
Author(s):  
John Hall
Keyword(s):  
General Practitioner ◽  
Case Studies ◽  
Hospital Care ◽  
Teaching Hospitals ◽  
Community Hospitals ◽  
Regional Context ◽  
Regional Setting ◽  
Regional Basis ◽  
The Impact

The appearance in England from the 1850s of 'cottage hospitals' in considerable numbers constituted a new and distinctive form of hospital provision. The historiography of hospital care has emphasised the role of the large teaching hospitals, to the neglect of the smaller and general practitioner hospitals. This article inverts that attention, by examining their history and shift in function to 'community hospitals' within their regional setting in the period up to 2000. As the planning of hospitals on a regional basis began from the 1920s, the impact of NHS organisational and planning mechanisms on smaller hospitals is explored through case studies at two levels. The strategy for community hospitals of the Oxford NHS Region—one of the first Regions to formulate such a strategy—and the impact of that strategy on one hospital, Watlington Cottage Hospital, is critically examined through its existence from 1874 to 2000.

Triage bei Kopfschmerz in der Hausarztpraxis: Wann einweisen?

2019 ◽  
Vol 144 (10) ◽  
pp. 651-658
Author(s):  
Solveig Carmienke ◽  
Dagny Holle-Lee
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practitioner ◽  
Hospital Care ◽  
Secondary Headache ◽  
Red Flags ◽  
Secondary Headaches ◽  
Specialist Treatment ◽  
Yellow Flags ◽  
Headache Patients

AbstractHeadache is one of patients’ most common reasons to consult their general practitioner and covers about 2 – 5 % of the consultations in primary care. Often, the general practitioner is the first to be contacted by patients with headache. Mostly, headaches are primary and only 2 % of the patients have secondary headaches. The distinction between primary and secondary headache is the most important step in the management of patients with headache in primary care. Therefore, this article shows important elements of anamnesis and examination of headache patients in primary care. Furthermore, this article focuses on identification of red flags and yellow flags in the consultation of patients with headache and suggests recommendations for referral to emergency department, hospital care or specialist treatment.

The Practice of Pathology in Africa

2013 ◽  
Vol 137 (6) ◽  
pp. 752-755 ◽  
Author(s):  
Ronald Otto Christian Kaschula
Keyword(s):  
Health Care ◽  
Care Delivery ◽  
Laboratory Medicine ◽  
Traditional Healers ◽  
Teaching Hospitals ◽  
Health Care Clinics ◽  
Life Styles ◽  
Tier System ◽  
To Come

In attempting to advance the health of women and children in Africa, practitioners should be cognizant of the history of health care delivery in the continent and the nature of the existing systems. Although autopsies began in Africa several millennia ago, traditional healers have held sway for many centuries and continue to do so for most of Africa's people. The role of laboratory medicine in advancing modern health care has been impeded by its ever-increasing high cost, lack of confidence in the system, lack of adequately trained personnel, and inadequate provision of facilities and training opportunities. This is partly caused by the continent having the highest proportion of young children in the world, an exceptionally heavy disease burden, and a low proportion of tax payers. For laboratory medicine to have its intended effect in making accurate diagnoses, national, minimal standards for certification and practice should be formulated. There should be periodic inspections, rewards for excellence, and opportunities for professional development. It is recommended that laboratory medicine be practiced in a 4-tier system, with the highest in teaching hospitals, and the lowest in primary health care clinics. For the practice of anatomic pathology to advance, an effective referral system and an equitable minimal and maximal workload for each pathologist are needed. The changing dynamics of urbanization, with massive unemployment rates, unhealthy life styles, and the continued role of traditional healers calls for gifted leaders to come to the fore and facilitate internal and external cooperation with diverse health care agencies.

scholarly journals Primary health care engagement among marginalized people who use drugs in Ottawa, Canada

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Jessy Donelle ◽  
Ahmed Bayoumi ◽  
Lisa Boucher ◽  
Alana Martin ◽  
Dave Pineau ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Family Physician ◽  
People Who Use Drugs ◽  
Outpatient Visits ◽  
Primary Health ◽  
Co Morbidity ◽  
Health Care Engagement

IntroductionEngagement in primary health care may be lower among marginalized people who use drugs (PWUD) compared to the general population, despite having greater mental and physical healthcare needs as evidenced by higher co-morbidity, and more frequent use of emergency department care. Objectives and ApproachWe investigated which socio-structural factors were related to primary care engagement among PWUD using rich survey data from the Participatory Research in Ottawa: Understanding Drugs cohort study; these data were deterministically linked to several robust provincial-level health administrative databases held at the Institute for Clinical Evaluative Sciences. We defined primary care engagement over the 2 years prior to survey completion (March-December 2013) as: not engaged (<3 outpatient visits to the same family physician) versus engaged in care (3+ outpatient visits to the same family physician). Multi-variable logistic regression was used to identify factors associated with primary health care engagement. ResultsAmong 663 participants, characteristics include: mean age of 41.4 years, 75.6% male, 66.7% in the lowest two income quintiles, and 51.1% with 6+ co-morbidities. 372 (56%) were engaged in primary care, with a mean of 15.97 visits per year (SD=20.18). Engagement was significantly associated with the following factors: receiving drug benefits from either the Ontario Disability Support Program (adjusted odds ratio [AOR] 4.48; 95% confidence interval [95%CI] 2.64 to 7.60) or Ontario Works (AOR 3.41; 95%CI 1.96 to 5.91), having ever taken methadone (AOR 3.05; 95%CI 1.92 to 4.87), mental health co-morbidity (AOR 2.93; 95%CI 1.97 to 4.36), engaging in sex work in the last 12 months (AOR 2.05; 95%CI 1.01 to 4.13), and having stable housing (AOR 1.98; 95%CI 1.30 to 3.01). Conclusion/ImplicationsNearly half of PWUD are not engaged in primary care, representing missed opportunities to improve health. Engagement in primary care may reflect both an increased need for health care, such as mental health disability, and increased access to primary care through other health and social services, such as housing support.

Community psychiatric nurses in primary care: consumer survey

1988 ◽  
Vol 12 (11) ◽  
pp. 483-485 ◽  
Author(s):  
Femi Oyebode ◽  
Elaine Gadd ◽  
David Berry ◽  
Mary Lynes ◽  
Patricia Lashley
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practitioner ◽  
Primary Prevention ◽  
Psychiatric Patients ◽  
Psychiatric Nurses ◽  
Consumer Survey ◽  
Psychiatric Institutions ◽  
Community Psychiatric ◽  
Chronic Psychiatric Patients

There has been a dramatic increase in the numbers of community psychiatic nurses (CPNs) in the last decade; in the period 1980–1985 the number grew from 1667 to 2758, an overall increase of 65%. Traditionally, CPNs were based within psychiatric institutions. However, in the period 1980–1985 there was growth from 8% to 16.2% in the population of CPNs based in health care centres or General Practitioner (GP) surgeries. Some of the functions of CPNs is also changing, developing away from involvement with chronic psychiatric patients towards patients with minor disorders. CPNs have also argued that work in the community and in GP surgeries is synonymous with primary prevention.

scholarly journals Supporting elderly people with cognitive impairment during and after hospital stays with Intersectoral Care Management [intersec-CM]: study protocol for a randomised controlled trial

2019 ◽  
Author(s):  
Angela Nikelski ◽  
Armin Keller ◽  
Fanny Schumacher-Schönert ◽  
Terese Dehl ◽  
Jessica Laufer ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Cognitive Impairment ◽  
Hospital Admission ◽  
Collaborative Care ◽  
Hospital Care ◽  
Care Management ◽  
Unmet Needs ◽  
Controlled Trial ◽  
Somatic Illness

Abstract Background Sectorization of health care systems causes inefficient treatment, especially for elderly people with cognitive impairments. The transition from hospital care to primary care is insufficiently coordinated, and communication between health care providers is often lacking. Consequences include a further deterioration of health, higher rates of hospital readmission, and institutionalization. Models of collaborative care have shown their efficacy in primary care by improving patient-related outcomes. The main goal of this trial is to test the effectiveness of a collaborative care model for people with cognitive impairment (PCI) and current hospital treatment due to a somatic illness to improve the continuity of treatment and care across the transition between the in-hospital and adjoining primary care sectors. Methods The trial is a longitudinal multisite randomized controlled trial with two arms (“care as usual” and “intersectoral care management”). Inclusion criteria at the time of hospital admission due to a somatic illness: age 70+, cognitive impairment (Mini Mental State Examination, MMSE ≤ 26), live at home, provide written informed consent. Each participant will have a baseline assessment at the hospital and two follow-up assessments at home (three and twelve months after discharge). The estimated sample size is n=398 participants together with (where available) their respective informal caregivers. In the intersectoral care management group, specialized care managers will develop, implement and monitor individualized treatment and care based on comprehensive assessments of the patients and informal caregivers for unmet needs at the hospital and in their homes. Primary outcomes are (1) activities of daily living, (2) readmission to the hospital, and (3) institutionalization. Secondary outcomes include (a) frailty, (b) delirium, (c) quality of life, (d) cognitive status, (e) behavioral and psychological symptoms of dementia, (f) utilization of services, and (g) informal caregiver burden. Discussion In the event of proving efficacy, this trial delivers proof of concept for implementation into routine care. Cost-effectiveness analyses as well as an independent process evaluation increase the likelihood of meeting this goal. The trial allows in-depth analysis of mediating and moderating effects for different health outcomes at the interface between hospital care and primary care. Highlighting treatment and care, the study will provide insights into unmet needs at the time of hospital admission, the opportunities and barriers to meeting those needs during the hospital stay and after discharge.

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