scholarly journals Identifying multimorbidity clusters with the highest primary care use: 15 years of evidence from a multi-ethnic metropolitan population

2021 ◽  
pp. BJGP.2021.0325
Author(s):  
Marina Soley-Bori ◽  
Alessandra Bisquera ◽  
Mark Ashworth ◽  
Yanzhong Wang ◽  
Stevo Durbaba ◽  
...  
Keyword(s):  
Primary Care ◽  
Ethnic Group ◽  
Substance Dependence ◽  
Panel Study ◽  
Urban Setting ◽  
Asian Ethnicity ◽  
Care Services ◽  
Healthcare Needs ◽  
Rate Of Increase ◽  
Over Time

Background: People with multimorbidity have complex healthcare needs. Some co-occurring diseases interact with each other to a larger extent than others and may impact differently on primary care use. Aim: To assess the association between multimorbidity clusters and primary care consultations over time. Design and setting: A retrospective longitudinal (panel) study design was used. Data comprised electronic primary care health records of 826,166 patients registered at GP practices in an ethnically diverse, urban setting in London between 2005 and 2020. Method: Primary care consultation rates were modelled using Generalised Estimating Equations. Key controls included the total number of LTCs, five multimorbidity clusters, and their interaction effects, ethnicity, and polypharmacy (proxy of disease severity). Models were also calibrated by consultation type and ethnic group. Results: Individuals with multimorbidity use two to three times more primary care services than those without multimorbidity (IRR=2.3, 95% CI:2.29-2.32). Patients in the alcohol dependency, substance dependence, and HIV cluster have the highest rate of increase in primary care consultations as additional LTCs accumulate, followed by the mental health cluster (anxiety and depression). Differences by ethnic group are observed, with the largest impact in the chronic liver disease and viral hepatitis cluster for individuals of Black or Asian ethnicity. Conclusion: This paper identifies multimorbidity clusters with the highest primary care demand over time as additional LTCs develop, differentiating by consultation type and ethnicity. Targeting clinical practice to prevent multimorbidity progression for these groups may lessen future pressures on primary care demand by improving health outcomes.

scholarly journals Primary care nurses in a local Belgian setting: Responding to healthcare needs of people with disabilities

2017 ◽  
Vol 7 (7) ◽  
pp. 44
Author(s):  
Hannelore Storms ◽  
Neree Claes
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Nursing Care ◽  
Healthcare Professionals ◽  
Informal Caregivers ◽  
Care Services ◽  
Healthcare Needs ◽  
Swallowing Problems ◽  
Primary Care Nurses ◽  
The Impact

Background: Given the worldwide evolution to deinstitutionalize care for people with a disability (PD), the importance of having care services, for instance as offered by primary care nurses (PCN), to deliver necessary care to PD can only be emphasized. European data (from 2014) show a relatively high percentage of PD in Belgium (16.2%) using home care services provided by primary health care providers (PCN, general practitioners…). Moreover, satisfaction levels regarding these services are among the highest in Europe. The objective of this research was to gain insight into the needs of PD regarding nursing care, based on PCN’s experiences.Methods: Between September and December 2015, a questionnaire – drawn up by a multidisciplinary team (4 general practitioners and 20 PCN) – was distributed electronically to 1547 PCN working in primary care in the Belgian region Limburg. Open-ended questions of this questionnaire were analyzed using techniques developed for qualitative data analysis. PCN were asked to report about (1) mental and behavioural problems, (2) medication policy, (3) swallowing problems, (4) monitoring of nutritional status and (5) any other needs arising in the care for PD.Results: Comments of 588 PCN were generated (response rate of 38%). Besides the (routine) tasks of PCN, the impact of PD’s and informal caregivers’ behaviour on PCN’s working environment were mentioned, particularly regarding medication policy, swallowing problems and nutrional status monitoring. PCN’s collaboration with PD and their informal caregivers is often reported about in relation to respectively PD’s limited ability to communicate or to understand PCN and informal caregivers behaving in a counteracting way, not following through PCN’s advice. Additionally, PCN report about consulting and activating other healthcare professionals in the interest of PD’s. Overall, PCN mentioned tasks in all facets of PD’s lives: from the expected nursing care and far beyond.Conclusions: Besides providing nursing care, PCN are also helping with different tasks related to daily living. This “beyond standard” - care enhances the likelihood of PD to keep on living in their homes for a longer period of time. PCN seem to play a crucial role in activating other healthcare professionals to meet the healthcare needs of PD. More extensive research should be carried out to gain insight in healthcare needs of PD and the challenges PCN come across in their care for this population. Findings can be used to align pre-qualification training and education of (future) PCN with the (unmet) needs of PD.

2015 Geneva Declaration on Person-Centered Primary Health Care

2015 ◽  
Vol 5 (2) ◽  
pp. 51-52
Author(s):  
International College of Person Centered Medicine
Keyword(s):  
Primary Care ◽  
Healthcare Needs ◽  
Primary Health ◽  
Healthcare Experiences ◽  
Health Related ◽  
Source Of Care ◽  
Time And Being ◽  
The Individual ◽  
Relationship Of ◽  
Over Time

 Person-centered healthcare aims to provide healthcare experiences and services that attain the health-related goals of the individual being served. Person-centeredness is an attitude, philosophy and approach that truly puts the person in the center of the healthcare system. Person-centeredness starts with a relationship with a healthcare professional that becomes the person’s usual source of care. From this relationship grows trust. From trust grows the ability to engage, educate, and empower people in their healthcare. This relationship of trust is based on continuity of care over time and being present for the person’s healthcare needs. This continuous, comprehensive, and caring approach of primary care is the formula in which the person becomes empowered and engaged in their health.

scholarly journals Inequalities in the distribution of the general practice workforce in England: a practice-level longitudinal analysis

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0066
Author(s):  
Claire Nussbaum ◽  
Efthalia Massou ◽  
Rebecca Fisher ◽  
Marcello Morciano ◽  
Rachel Harmer ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Financial Incentives ◽  
Direct Patient Care ◽  
Care Services ◽  
Primary Care Services ◽  
Recent Trends ◽  
Unadjusted Analysis ◽  
Over Time ◽  
Deprived Areas

BackgroundIn England, demand for primary care services is increasing and GP shortages are widespread. Recently introduced primary care networks (PCNs) aim to expand the use of additional practice-based roles such as physician associates (PAs), pharmacists, paramedics, and others through financial incentives for recruitment of these roles. Inequalities in general practice, including additional roles, have not been examined in recent years, which is a meaningful gap in the literature. Previous research has found that workforce inequalities are associated with health outcome inequalities.AimTo examine recent trends in general practice workforce inequalities.Design & settingA longitudinal study using quarterly General Practice Workforce datasets from 2015–2020 in England.MethodThe slope indices of inequality (SIIs) for GPs, nurses, total direct patient care (DPC) staff, PAs, pharmacists, and paramedics per 10 000 patients were calculated quarterly, and plotted over time, with and without adjustment for patient need.ResultsFewer GPs, total DPC staff, and paramedics per 10 000 patients were employed in more deprived areas. Conversely, more PAs and pharmacists per 10 000 patients were employed in more deprived areas. With the exception of total DPC staff, these observed inequalities widened over time. The unadjusted analysis showed more nurses per 10 000 patients employed in more deprived areas. These values were not significant after adjustment but approached a more equal or pro-poor distribution over time.ConclusionSignificant workforce inequalities exist and are even increasing for several key general practice roles, with workforce shortages disproportionately affecting more deprived areas. Policy solutions are urgently needed to ensure an equitably distributed workforce and reduce health inequities.

scholarly journals Impact of Long Working Hours and Shift Work on Perceived Unmet Dental Need: A Panel Study

2021 ◽  
Vol 18 (6) ◽  
pp. 2939
Author(s):  
Hye-Eun Lee ◽  
Nam-Hee Kim ◽  
Tae-Won Jang ◽  
Ichiro Kawachi
Keyword(s):  
Shift Work ◽  
Dental Care ◽  
Fixed Effects ◽  
Panel Study ◽  
Working Hours ◽  
Care Needs ◽  
Long Working Hours ◽  
Care Services ◽  
Dental Care Needs ◽  
Dental Needs

This study investigates whether workers with long working hours as well as shift workers perceive higher unmet dental care needs, and whether there is a gender difference in the associations. We used the Korea Health Panel (2009, 2011–2014) involving 20,451 person-wave observations from 5567 individuals. Perceived unmet dental care needs was defined when the participants reported that they perceived a need for dental treatment or check-up but had failed to receive dental care services during the past year. Fixed effects logit models were applied to examine how changes in weekly working hours or shift work status were linked to changes in perceived unmet dental needs within each individual. Among participants, 15.9–24.7% reported perceived unmet dental needs and the most common reason was time scarcity. We found that long working hours (>52 h/week) was significantly associated with perceived unmet dental needs due to time scarcity in both men (OR = 1.42, 95% CI 1.13–1.78) and women (OR = 1.35, 95% CI 1.03–1.79) compared workers working 40–52 h per week. Shift work was also a significant risk factor, but only in women (OR = 1.57, 95% CI 1.06–2.32). These findings provide evidence for labor policies to reduce working hours in order to improve access to dental care services.

Sign in / Sign up

Export Citation Format

Share Document