scholarly journals The role of Primary Health Networks in cardiovascular disease prevention: A qualitative interview study

2021 ◽  
Author(s):  
Samuel Cornell ◽  
Kristen Pickles ◽  
Paul Crosland ◽  
Carl de Wet ◽  
Lyndal Trevena ◽  
...  
Keyword(s):  
General Practice ◽  
Financial Incentives ◽  
Health Networks ◽  
Needs Assessments ◽  
Commonwealth Government ◽  
Improvement Programs ◽  
Prevention Activities ◽  
Competing Priorities ◽  
Quality Improvement Programs

Background: Since the inception of Primary Health Networks (PHNs) in Australia, it has been unclear what their role is regarding implementing chronic disease prevention activities in general practice. This study aimed to qualitatively explore the views of PHN staff on the role of PHNs in promoting prevention, with a focus on cardiovascular disease (CVD) prevention.Methods: Content analysis of PHN Needs Assessments was conducted to inform interview questions. 29 semi-structured interviews were conducted with 32 PHN staff, between June and December 2020, in varied roles across 18 PHNs in all Australian states and territories. Transcribed audio-recordings were thematically coded, using the Framework Analysis method to ensure rigour.Results: We identified three main themes about the role of PHNs in promoting, supporting, and improving CVD prevention. 1) Informal prevention: All respondents agreed the role of PHNs in prevention was indirect and, for the most part, outside the formal remit of PHN Key Performance Indicators (KPIs.) Nevertheless, prevention activities were conducted in partnership with external stakeholders, professional development and quality improvement programs, and PHN-funded data extraction and analysis software for general practice. 2) Constrained by financial incentives: Most interviewees felt the role of PHNs in prevention was contingent on the financial drivers provided by the Commonwealth government, such as Medicare funding and national quality improvement programs. 3) Shaped through competing priorities: The role of PHNs in prevention is a function of competing priorities. There was strong agreement amongst participants that the myriad competing priorities from government and local needs assessments impeded prevention activities.Conclusions: PHNs are well positioned to foster prevention activities in general practice and local communities. However, we found that PHNs role in prevention activities were informal, constrained by financial incentives, and shaped through competing priorities. Prevention can be improved through a more explicit prevention focus at Commonwealth government level. To optimise the role of PHNs therefore requires prioritising prevention, aligning it with KPIs, and supporting stakeholders like general practice.

scholarly journals The Challenges of Physicians' Participation in Hospital Accreditation Programs: A Qualitative Study in Iran

2021 ◽  
Author(s):  
Hosein Ebrahimipou ◽  
Elahe Houshmand ◽  
Mehdi Varmaghani ◽  
Javad Javan-Noughabi ◽  
Seyyed Morteza Mojtabaeian
Keyword(s):  
Quality Improvement ◽  
Quality Management ◽  
Evaluation System ◽  
Medical Community ◽  
Snowball Sampling ◽  
Hospital Accreditation ◽  
High Workload ◽  
Improvement Programs ◽  
Quality Improvement Programs

Abstract Background. Due to the increasing pressure on hospitals to improve the quality of patient care, the need for physicians to participate in quality improvement Programs, especially hospital accreditation, has become more important. The present study was conducted to describe challenges of physicians' participation in accreditation programs in Iran using a qualitative approach.Methods. We conducted interviews with 11 managers, 9 physicians, 8 officials and experts in the field of quality management selected through purposive snowball sampling. The initial in-depth unstructured interviews were reviewed and transformed into semi-structured ones. The data obtained were analyzed in ATLAS.ti using the conceptual framework method.Results. 3 main concepts (cultural, organizational, behavioral) and 12 sub-concepts (Motivation, patient demand, mutual trust and evaluation system, high workload, understanding the role of quality management unit, unrealistic accreditation, nature of accreditation, empowerment of physicians in the field of quality, effective communication, resource constraint, ambiguity in the role of uncertainty about participation), And 57 items emerged from the analysis of the data.Conclusion. The implementation of this program can be improved through Culture building, proper accreditation training and quality improvement activities in the medical community helped to implements.

scholarly journals How did a Quality Premium financial incentive influence antibiotic prescribing in primary care? Views of Clinical Commissioning Group and general practice professionals

2020 ◽  
Vol 75 (9) ◽  
pp. 2681-2688 ◽  
Author(s):  
Aleksandra J Borek ◽  
Sibyl Anthierens ◽  
Rosalie Allison ◽  
Cliodna A M McNulty ◽  
Donna M Lecky ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Financial Incentives ◽  
Financial Incentive ◽  
Antibiotic Prescribing ◽  
Telephone Interviews ◽  
Local Resources ◽  
Additional Funding ◽  
General Practices ◽  
Competing Priorities

Abstract Background The Quality Premium (QP) was introduced for Clinical Commissioning Groups (CCGs) in England to optimize antibiotic prescribing, but it remains unclear how it was implemented. Objectives To understand responses to the QP and how it was perceived to influence antibiotic prescribing. Methods Semi-structured telephone interviews were conducted with 22 CCG and 19 general practice professionals. Interviews were analysed thematically. Results The findings were organized into four categories. (i) Communication: this was perceived as unstructured and infrequent, and CCG professionals were unsure whether they received QP funding. (ii) Implementation: this was influenced by available local resources and competing priorities, with multifaceted and tailored strategies seen as most helpful for engaging general practices. Many antimicrobial stewardship (AMS) strategies were implemented independently from the QP, motivated by quality improvement. (iii) Mechanisms: the QP raised the priority of AMS nationally and locally, and provided prescribing targets to aim for and benchmark against, but money was not seen as reinvested into AMS. (iv) Impact and sustainability: the QP was perceived as successful, but targets were considered challenging for a minority of CCGs and practices due to contextual factors (e.g. deprivation, understaffing). CCG professionals were concerned with potential discontinuation of the QP and prescribing rates levelling off. Conclusions CCG and practice professionals expressed positive views of the QP and associated prescribing targets and feedback. The QP helped influence change mainly by raising the priority of AMS and defining change targets rather than providing additional funding. To maximize impact, behavioural mechanisms of financial incentives should be considered pre-implementation.

scholarly journals Financial Incentives, Quality Improvement Programs, and the Adoption of Clinical Information Technology

Medical Care ◽  
2009 ◽  
Vol 47 (4) ◽  
pp. 411-417 ◽  
Author(s):  
James C. Robinson ◽  
Lawrence P. Casalino ◽  
Robin R. Gillies ◽  
Diane R. Rittenhouse ◽  
Stephen S. Shortell ◽  
...  
Keyword(s):  
Information Technology ◽  
Quality Improvement ◽  
Financial Incentives ◽  
Clinical Information ◽  
Clinical Information Technology ◽  
Improvement Programs ◽  
Quality Improvement Programs

The Relation Between Financial Incentives, Motivation, and Performance

2017 ◽  
Vol 16 (2) ◽  
pp. 61-76 ◽  
Author(s):  
Anaïs Thibault Landry ◽  
Marylène Gagné ◽  
Jacques Forest ◽  
Sylvie Guerrero ◽  
Michel Séguin ◽  
...  
Keyword(s):  
Financial Incentives ◽  
Work Performance ◽  
Autonomous Motivation ◽  
Compensation Plans ◽  
Work Settings ◽  
Path Analyses ◽  
Three Samples ◽  
And Performance ◽  
Performance Results

Abstract. To this day, researchers are debating the adequacy of using financial incentives to bolster performance in work settings. Our goal was to contribute to current understanding by considering the moderating role of distributive justice in the relation between financial incentives, motivation, and performance. Based on self-determination theory, we hypothesized that when bonuses are fairly distributed, using financial incentives makes employees feel more competent and autonomous, which in turn fosters greater autonomous motivation and lower controlled motivation, and better work performance. Results from path analyses in three samples supported our hypotheses, suggesting that the effect of financial incentives is contextual, and that compensation plans using financial incentives and bonuses can be effective when properly managed.

Addressing Communication Breakdowns during Emergency Care Transitions of Older Adults: Evaluation of a Standardized Inter-Facility Health Care Communication Form

2021 ◽  
pp. 1-11
Author(s):  
Patrick McLane ◽  
Kaitlyn Tate ◽  
R. Colin Reid ◽  
Brian H. Rowe ◽  
Carole Estabrooks ◽  
...  
Keyword(s):  
Older Persons ◽  
Chart Review ◽  
Care Transitions ◽  
Unintended Consequences ◽  
Term Care ◽  
Usual Practice ◽  
Improvement Programs ◽  
Quality Improvement Programs ◽  
Communication Breakdowns

Abstract Transitions for older persons from long-term care (LTC) to the emergency department (ED) and back, can result in adverse events. Effective communication among care settings is required to ensure continuity of care. We implemented a standardized form for improving consistency of documentation during LTC to ED transitions of residents 65 years of age or older, via emergency medical services (EMS), and back. Data on form use and form completion were collected through chart review. Practitioners’ perspectives were collected using surveys. The form was used in 90/244 (37%) LTC to ED transitions, with large variation in data element completion. EMS and ED reported improved identification of resident information. LTC personnel preferred usual practice to the new form and twice reported prioritizing form completion before calling 911. To minimize risk of harmful unintended consequences, communication forms should be implemented as part of broader quality improvement programs, rather than as stand-alone interventions.

Choice and privatisation in Swedish primary care

2010 ◽  
Vol 6 (4) ◽  
pp. 549-569 ◽  
Author(s):  
Anders Anell
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Financial Incentives ◽  
Degrees Of Freedom ◽  
New Wave ◽  
Improve Performance ◽  
Financial Responsibility ◽  
New Models ◽  
Financial Characteristics

AbstractIn 2007, a new wave of local reforms involving choice for the population and privatisation of providers was initiated in Swedish primary care. Important objectives behind reforms were to strengthen the role of primary care and to improve performance in terms of access and responsiveness. The purpose of this article was to compare the characteristics of the new models and to discuss changes in financial incentives for providers and challenges regarding governance from the part of county councils. A majority of the models being introduced across the 21 county councils can best be described as innovative combinations between a comprehensive responsibility for providers and significant degrees of freedom regarding choice for the population. Key financial characteristics of fixed payment and comprehensive financial responsibility for providers may create financial incentives to under-provide care. Informed choices by the population, in combination with reasonably low barriers for providers to enter the primary care market, should theoretically counterbalance such incentives. To facilitate such competition is indeed a challenge, not only because of difficulties in implementing informed choices but also because the new models favour large and/or horizontally integrated providers. To prevent monopolistic behaviour, county councils may have to accept more competition as well as more governance over clinical practice than initially intended.

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