scholarly journals Primary Care Reform in Montenegro

2013 ◽  
Vol 52 (4) ◽  
pp. 247-254 ◽  
Author(s):  
Ljiljana Cvejanov Kezunović ◽  
Mara Drecun ◽  
Igor Švab
Keyword(s):  
Primary Care ◽  
Health Care ◽  
European Union ◽  
Waiting Times ◽  
Educational Interventions ◽  
Quality Of Services ◽  
Independent State ◽  
Primary Care Reform ◽  
Initial Results

Abstract Background: Montenegro is a newly independent state. As with many countries of that region, the country was faced with the need to reform its health care system. The overall aims of the reform were to improve the quality of services. This paper describes the process of implementation of the reform and its first achievements in patient satisfaction and quality of services since it has been introduced. Methods: The ministry of health introduced a series of steps that included changes to legislation, financing and manpower structure. Investments in primary care have been made and informatics support was developed. Educational interventions at the undergraduate and postgraduate levels were also introduced. Results: The initial results show that the changes have improved the quality of care provided: the composition of professionals in primary care has improved; preventive activities have remained high. Primary care is more accessible and organization of services is better, which can be seen in reduced waiting times for consultation in primary care and improved satisfaction with health care. Conclusions: The initial results show some progress since the reform was put into place. New measures aimed at raising the level of health care to reach European Union standards are still to be introduced.

scholarly journals Patient Suffering in Chronic Digestive Diseases: Will Primary Care-Specialist Collaboration With Effective Interactive Communication and Integrative Medicine in the Plan of Care Improve Quality of Life?

2020 ◽  
Vol 7 (6) ◽  
pp. 989-993
Author(s):  
Andrew Thomas ◽  
Annie Thomas
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
The United States ◽  
Care Providers ◽  
Physician Visits ◽  
Digestive Diseases ◽  
Care Specialist

Acute and chronic digestive diseases are causing increased burden to patients and are increasing the United States health care spending. The purpose of this case report was to present how nonconfirmatory and conflicting diagnoses led to increased burden and suffering for a patient thus affecting quality of life. There were many physician visits and multiple tests performed on the patient. However, the primary care physician and specialists could not reach a confirmatory diagnosis. The treatment plans did not offer relief of symptoms, and the patient continues to experience digestive symptoms, enduring this burden for over 2 years. The central theme of this paper is to inform health care providers the importance of utilizing evidence-based primary care specialist collaboration models for better digestive disease outcomes. Consistent with patient’s experience, the authors propose to pilot/adopt the integrative health care approaches that are proven effective for treating digestive diseases.

scholarly journals The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Dimuthu Rathnayake ◽  
Mike Clarke
Keyword(s):  
Primary Care ◽  
Health Systems ◽  
Elective Surgery ◽  
Waiting Times ◽  
Surgical Care ◽  
High Income ◽  
Surgical Patients ◽  
Timely Access ◽  
Referral Systems

Abstract Background Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455. Results The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics. Conclusions The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.

scholarly journals Factors related to perceived continuity of care in hospitalized cardiac patients

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Safstrom ◽  
T.J Jaarsma ◽  
L.N Nordgren ◽  
M.L Liljeroos ◽  
A.S Stomberg
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Health Care ◽  
Continuity Of Care ◽  
Perceived Control ◽  
Care Utilization ◽  
Funding Source ◽  
Patient Reported

Abstract Background Since healthcare systems are increasingly complex and often fragmented, continuity of care after hospitalization is a priority to increase patient safety and satisfaction. Aim Describe factors related to continuity of care in patients hospitalized due to cardiac conditions. Methods This cross-sectional multicenter study enrolled patients 6 weeks after hospitalization due to cardiac conditions. A total of 993 patients were included (mean age 72.2 (SD 10.4), males 66%) with AMI (35%), AF (25%), angina (21%) and HF (17.3%). Patients completed the Patient Continuity of Care Questionnaire, a questionnaire based on the definition that continuity of care is “the extent to which a series of health care services is experienced as connected and coherent and is consistent with a patient's health needs and personal circumstances”. The total score of the questionnaire ranges from 6 to 30, higher score indicating higher continuity and a score <24 indicating insufficient continuity. Cronbach's alpha on the total PCCQ was 0.94. Correlations between PCCQ and quality of life, depression, anxiety, perceived control and health care utilization were estimated using spearman rang correlation. Results Insufficient continuity of care ranged between 47% to 59% in the different diagnosis groups, which the highest continuity in the AMI group and lowest in patients with atrial fibrillation. In patients hospitalized due to AMI (n=355, mean age 71 (± 11), 70% men), continuity of care was related to higher perceived control, higher quality of life, a good financial situation, being a man, no symptoms of anxiety or depression (ᚹ range 0.17–0.26 p≤0.002). A low score on the PCCQ were associated with follow-up visit to a nurse in primary care after hospitalization (ᚹ −0.12 p=0.033). In patients hospitalized due to angina (n=210, mean age 73 (± 9), 74% men), continuity of care was related to higher perceived control, higher quality of life and no depressive symptoms (ᚹ range between 0.20 and 0.26 p=0.005). In patients with AF, (n=255, mean age 71 (± 10.), 58% men), continuity of care was related to having had contact by telephone with a nurse-led AF clinic, higher perceived control, higher quality of life and not being depressed (ᚹ range between 0.14–0.25 p=0.03). In patients with HF, (n=173, mean age 77 (±8) 59% men), continuity was related to male ender, younger age, follow-up in a nurse-led HF clinic and not being anxious (ᚹ range between 0.16 and 0.22 p=0.004–0.047). Low total score on PCCQ correlated to having had telephone contact with nurse in primary care (ᚹ −0.24 p=0.002). Conclusion Almost half of all patient reported insufficient continuity of care. Perceived control, quality of life, and symptoms of depression were related to higher continuity of care in all diagnose groups except heart failure. Further, there was a correlation between continuity and follow-up visits or contact by telephone with nurse-led clinics in all diagnose groups except angina. Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Medical Research Council of Southeast Sweden, Centre for Clinical Research Sörmland

Intellectual Capital Report in the Healthcare Sector

2017 ◽  
pp. 272-285
Author(s):  
Giovanni Bronzetti ◽  
Maria Assunta Baldini ◽  
Graziella Sicoli
Keyword(s):  
Health Care ◽  
Intellectual Capital ◽  
Exploratory Study ◽  
Health Care Organizations ◽  
Healthcare Sector ◽  
Quality Of Services ◽  
Structure Knowledge

In the healthcare sector the growing interest in intellectual capital begins with the understanding that the ability to maintain and develop knowledge within it is one of a major reason for the success of the structure. Knowledge presents in health care organizations is a valuable asset, essential to ensure a good quality of services, which has been not only enhanced but also continuously developed. In this sense, analyzing the intellectual capital in healthcare means put at the centre of attention knowledge, the processes that make it possible. This exploratory study aims to investigate the importance of intellectual capital in the healthcare sector, thorough the examination and interpretation of Intellectual Capital Report in a specific realty: the hospital in Udine, which systematically by few years prepares this report.

scholarly journals Assessing the quality of maternal health care in Indigenous primary care services

2010 ◽  
Vol 192 (10) ◽  
pp. 597-598 ◽  
Author(s):  
Alice R Rumbold ◽  
Ross S Bailie ◽  
Damin Si ◽  
Michelle C Dowden ◽  
Catherine M Kennedy ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Maternal Health ◽  
Maternal Health Care ◽  
Care Services ◽  
Primary Care Services

scholarly journals Patient-centred method to evaluate the spatial accessibility of primary health care in a case study in Shanghai

2020 ◽  
Vol 26 (4) ◽  
pp. 344
Author(s):  
Xuechen Xiong ◽  
Li Luo
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Waiting Times ◽  
Care Facility ◽  
Wait Time ◽  
Spatial Accessibility ◽  
Quantitative Methodology ◽  
Time Cost ◽  
Primary Health

Quantitative methodology investigating medical resource accessibility does not incorporate patients’ feelings about the adequacy and fairness of primary health care (PHC). In this study we quantified the spatial accessibility of PHC from the patient perspective. The main obstacles regarding access to PHC services are: (1) distance from the medical facility; and (2) waiting times after reaching the facility. The total time cost to access PHC is calculated as the sum of the time cost to access the PHC facility and the time cost waiting to receive health care; the total time cost was used in this study to reflect the potential spatial accessibility (i.e. probable entry into the healthcare system) of PHC. In Shanghai, it took residents approximately 13min to reach the nearest primary care facility, with an approximate 23min wait time after arriving at the facility. Thus, the spatial accessibility of PHC in Shanghai is approximately 36min. The method of assessing the spatial accessibility of PHC from the perspective of patients is more explanatory and easier to interpret. In the case of Shanghai, the regional accessibility of PHC is much better than its regional availability. Relevant managers should focus on increasing the resource supply capacity of existing facilities providing primary care in the suburbs of Shanghai.

scholarly journals Development and validation of the Vietnamese Primary Care Assessment Tool – provider version

2019 ◽  
Vol 20 ◽  
Author(s):  
Nguyen Thi Hoa ◽  
Anselme Derese ◽  
Jeffrey F. Markuns ◽  
Nguyen Minha Tam ◽  
Wim Peersman
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Internal Consistency ◽  
Assessment Tool ◽  
Care Quality ◽  
Quality Of Primary Care ◽  
Care Assessment ◽  
The Impact ◽  
Primary Care Assessment Tool

Abstract Aim: To adapt the provider version of the Primary Care Assessment Tool (PCAT) for Vietnam and determine its internal consistency and validity. Background: There is a growing need to measure and explore the impact of various characteristics of health care systems on the quality of primary care. It would provide the best evidence for policy makers if these evaluations come from both the demand and supply sides of the health care sector. Comparatively more researchers have studied primary care quality from the consumer perspective than from the provider’s perspective. This study aims at the latter. Method: Our study translated and adapted the PCAT provider version (PCAT PE) into a Vietnamese version, after which a cross-sectional survey was conducted to examine the feasibility, internal consistency and validity of the Vietnamese PCAT provider version (VN PCAT PE). All general doctors working at 152 commune health centres in Thua Thien Hue province had been selected to participate in the survey. Findings: The VN PCAT PE is an instrument for evaluation of primary care in Vietnam with 116 items comprising six scales representing four core primary care domains, and three additional scales representing three derivative domains. From the translation and cultural adaptation stage, two items were combined, two items were removed and one item was added. Six other items were excluded due to problems in item-total correlations. All items have a low non-response or ‘don’t know/don’t remember’ response rate, and there were no floor or ceiling effects. All scales had a Cronbach’s alpha above 0.80, except for the Coordination scale, which still was above the minimum level of 0.70. Conclusion: The VN PCAT PE demonstrates adequate internal consistency and validity to be used as an effective tool for measuring the quality of primary care in Vietnam from the provider perspective.

scholarly journals Tinkering at the margins: evaluating the pace and direction of primary care reform in Ontario, Canada

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Monica Aggarwal ◽  
A. Paul Williams
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Providers ◽  
Quantitative Methods ◽  
Audit And Feedback ◽  
Political Agenda ◽  
Care Providers ◽  
System Transformation ◽  
Primary Care Reform ◽  
Care Assessment

Abstract Background Primary care reform has been on the political agenda in Canada and many industrialized countries for several decades; it is widely seen as the foundation for broader health system transformation. Federal investments in primary care, including major cash transfers to provinces and territories as part of a 10-year health care funding agreement in 2004, triggered waves of primary care reform across Canada. Nevertheless, Commonwealth Fund surveys show, Canada continues to lag behind other industrialized nations with respect to timely access to care, electronic medical record use and audit and feedback for quality improvement in primary care. This paper evaluates the pace and direction of primary care reform as well as the extent of resulting change in the organization and delivery of primary care in Ontario, Canada’s most populous province. Methods Qualitative and quantitative methods were used for this study. A literature review was conducted to analyze the core dimensions of primary care reform, the history of reform in Ontario, and the extent to which different dimensions are integrated into Ontario’s models. Quantitative data on the number of family physicians/general practitioners and patients enrolled in these models was examined over a 10-year period to determine the degree of change that has taken place in the organization and delivery of primary care in Ontario. Results There are 11 core reform dimensions that individually and collectively shift from conventional primary care toward the more expansive vision of primary health care. Assessment of Ontario’s models against these core dimensions demonstrate that there has been little substantive change in the organization and delivery of primary care over 10 years in Ontario. Conclusions Primary care reform is a multi-dimensional construct with different reform models bundling core dimensions in different ways. This understanding is important to move beyond the rhetoric of “reform” and to critically assess the pace and direction of change in primary care in Ontario and in other jurisdictions. The conceptual framework developed in this paper can assist decision-makers, academics and health care providers in all jurisdictions in evaluating the pace of change in the primary care sector, as well as other sectors.

scholarly journals Medical Audit of the Quality of Diabetes Care

2011 ◽  
Vol 3 (1) ◽  
pp. 42-50 ◽  
Author(s):  
Abdulbari Bener ◽  
Mariam Abdulmalik ◽  
Mohammed Al-Kazaz ◽  
Abdul-Ghani Mohammed ◽  
Rahima Sanya ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Diabetes Care ◽  
Diabetic Patients ◽  
Primary Health ◽  
Primary Care Patients ◽  
Primary Health Care Centers ◽  
Health Care Centers

Objective: To assess the quality of diabetes care provided to patients attending primary care settings and hospitals in the State of Qatar. Design: Observational cohort study. Setting: The survey was carried out in primary health care centers and hospitals. Subjects and Methods: The study was conducted from January 2010 to August 2010 among diabetic patients attending primary health care centers and hospitals. Among the patients participating, 575 were from hospitals and 1103 from primary health care centers. Face-to-face interviews were conducted using a structured questionnaire including sociodemographic, clinical, and satisfaction score of the patients. Results: The mean age of the primary care diabetic patients was 46.1 ± 15.1 years and 44.5 ± 14.8 years for hospital patients ( P = .03). There was a significant difference observed in terms of age group, gender, marital status, occupation, and consanguinity of the diabetic patients in both medical settings ( P < .001). Overweight was less prevalent in primary care patients than in hospital diabetes mellitus patients (40.4% vs 46.4%). A significant variation was observed in the mean values of blood glucose (−0.76), HbA1C (−0.78), LDL (−0.01), albumin (−0.37), bilirubin (−0.76), and triglyceride (−0.01) in primary care patients compared to the mean values of the preceding year. Overall, complications were lower in primary care diabetic patients, and patients attending primary care were more satisfied with the diabetes care. Conclusion: The present study revealed that in general, primary health care provided a better quality of care to diabetic patients compared to that of hospitals. Also, primary care patients had a better satisfaction score towards diabetes care.

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