scholarly journals General practice in the Nordic countries

2016 ◽  
Vol 4 (1) ◽  
pp. 56-67 ◽  
Author(s):  
Kim Rose Olsen ◽  
Anders Anell ◽  
Unto Häkkinen ◽  
Tor Iversen ◽  
Thorhildur Ólafsdóttir ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Private Practice ◽  
Financial Incentives ◽  
Health Care Systems ◽  
Nordic Countries ◽  
Future Research ◽  
The Future ◽  
Care Systems ◽  
Common Framework

Background: General practice systems in the Nordic countries share certain common features. The sector is based on the Nordic model of a tax-financed supply of services with a political objective of equal access for all. The countries also share the challenges of increased political expectations to deliver primary prevention and increased workload as patients from hospital care are discharged earlier. However, within this common framework, primary care is organized differently. This is particularly in relation to the private-public mix, remuneration systems and the use of financial and non-financial incentives. Objective: The objective of this paper is to compare the differences and similarities in primary care among the Nordic countries, to create a mapping of the future plans and reforms linked to remuneration and incentives schemes, and to discuss the pros and cons for these plans with reference to the literature. An additional objective is to identify gaps in the literature and future research opportunities. Results/Conclusions: Despite the many similarities within the Nordic health care systems, the primary care sectors function under highly different arrangements. Most important are the differences in the gate-keeping function, private versus salaried practices, possibilities for corporate ownership, skill-mix and the organisational structure. Current reforms and political agendas appear to focus on the side effects of the individual countries’ specific systems. For example, countries with salaried systems with geographical responsibility are introducing incentives for private practice and more choices for patients. Countries with systems largely based on private practice are introducing more monitoring and public regulation to control budgets. We also see that new governments tends to bring different views on the future organisation of primary care, which provide considerable political tension but few actual changes. Interestingly, Sweden appears to be the most innovative in relation to introducing new incentive schemes, perhaps because decisions are made at a more decentralised level.Published: April 2016.

Accounting for the Rising Caesarean Section Rate in Canada: What Are the Roles of Changing Needs, Practices, and Incentives?

2021 ◽  
Author(s):  
Michael Baker ◽  
Maripier Isabelle ◽  
Mark Stabile ◽  
Sara Allin
Keyword(s):  
Caesarean Section ◽  
Financial Incentives ◽  
Health Care Systems ◽  
Caesarean Section Rate ◽  
The United States ◽  
World Health ◽  
Strong Increase ◽  
Primary Determinant ◽  
Care Systems ◽  
Health Organization

In most high-income countries, including Canada, the share of births by Caesarean section (C‑section) has risen over the past decades to far exceed World Health Organization recommendations of the proportion justified on medical grounds (15 percent). Although unnecessary C-sections represent an important cost for health care systems, they are not associated with clear benefits for the mother and the child and can sometimes represent additional risks. Drawing on administrative records of nearly four million births in Canada, as well as macro data from the United States and Australia, we provide a comprehensive account of rising C-section rates. We explicitly consider the contributions of the main factors brought forward in the policy literature, including changing characteristics of mothers, births, and physicians as well as changing financial incentives for C-section deliveries. These factors account for at most one-half of the increase in C-section rates. The majority of the remaining increase in C-sections over the period 1994–2011 occurred in the early 2000s. We suggest that some event or shock in the early 2000s is likely the primary determinant of the recent strong increase in the C-section rate in Canada.

scholarly journals The incidence, prevalence, and management of plantar heel pain in Dutch general practice

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703217
Author(s):  
Nadine Rasenberg ◽  
Sita MA Bierma-Zeinstra ◽  
Patrick Bindels ◽  
Johan van der Lei ◽  
Marienke Van Middelkoop
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Medical Records ◽  
Search Algorithm ◽  
Heel Pain ◽  
Future Research ◽  
Healthcare Database ◽  
Plantar Heel Pain ◽  
Wait And See ◽  
Multiple Interventions

BackgroundPlantar heel pain (PHP) is a common cause of foot complaints, but information on the occurrence in primary care is scarce.AimThe objective of this study was to determine the incidence and prevalence of PHP and to gain insight in types of treatments provided to patients with PHP in primary care.MethodA cohort study was conducted in a healthcare database containing the electronic general practice medical records of approximately 1.9 million patients throughout the Netherlands. A search algorithm was defined and used to identify cases of PHP in the years 2013–2016. Descriptive statistics were used to obtain the incidence and prevalence of PHP. Data on the management of PHP was extracted in a random sample of 1000 patients.ResultsThe overall incidence of PHP was 3.81 (95% confidence [CI] = 3.75 to 3.87) per 1000 patient years and the overall prevalence of PHP was 0.4374% (95% CI = 0.4369 to 0.4378). Incidence of PHP peaked in the last quarter of every calendar year. The GP applied a wait-and-see policy at the first consultation for PHP in 18.0% of patients. The most commonly applied interventions included prescription for NSAID (19.9%), referral to a paramedical podiatric specialist (19.7%), and advice to wear insoles (16.4%): 34.0% of patients received multiple interventions (range 2–11) and 30.9% had multiple consultations for PHP (range 2–8).ConclusionPHP appears to be common in primary care. Despite a lack of evidence for most treatments, multiple interventions are applied. This urges the need for future research on effectiveness of treatments.

Institutionalization and Professionalization

2016 ◽  
Author(s):  
Trish Reay ◽  
Elizabeth Goodrick ◽  
Bob Hinings
Keyword(s):  
Health Care ◽  
Organizational Change ◽  
Health Care Systems ◽  
Future Research ◽  
Power Dynamics ◽  
Care Systems

Health care systems are both highly institutionalized and highly professionalized. We suggest that both characteristics should be considered to understand the underlying power dynamics and how organizational change can occur. Although these characteristics have mostly been considered separately, we identify three ways they are being brought together and show how each reveals different underlying power dynamics that in turn suggest different explanations of organizational change. To conclude, we set out three avenues for future research that will continue to advance our knowledge of change in health care.

scholarly journals Nurse Leaders’ Reflections and Difficulties Fighting the NCP Epidemic： A Qualitative Study

2021 ◽  
Author(s):  
Jing Wang ◽  
Lihua Tang ◽  
Huanyuan Da ◽  
Huan Lu ◽  
Xinping Shi ◽  
...  
Keyword(s):  
Interpersonal Relationships ◽  
Health Care Systems ◽  
Nurse Leaders ◽  
Fear Learning ◽  
Survival Strategies ◽  
Internal Conflicts ◽  
The Future ◽  
Care Systems ◽  
Novel Coronavirus ◽  
Outstanding Leadership

Abstract Objective. To understand the difficulties and survival strategies in nursing during NCP outbreak, and to reflect and summarize the experience. Background. Since December 2019, the highly infectious novel coronavirus pneumonia overwhelmed health care systems and medical workers who had to provide care in situations involving high personal risk and stress, some becoming infected and dying. Nurse leaders had to develop new strategies for nursing care. Methods. Using the phenomenological research method in qualitative research, 8 head nurses who participated in NCP treatment were interviewed in-depth, and then Colaizzi 7-step analysis method was used to summarize.Results. Working under great pressure, nursing leaders led the team through a period of crisis: shock and fear, learning in chaos, supporting nurses, and rewarding nurses. Conclusion. As important intervention performers in the crisis, nurse leaders need to have their own outstanding leadership to effectively manage internal conflicts and interpersonal relationships, strengthen teamwork training and establish supportive system so as to better deal with the management of similar public health events in the future. Relevance to clinical practice. Findings will assist nurse leaders to prepare themselves in the outbreak. It is hoped that the results of this study will contribute to disaster management in similar infectious outbreaks in the future.

Organizational Leadership and Health Care Reform

2016 ◽  
pp. 1043-1063
Author(s):  
T. Ray Ruffin ◽  
Joyce Marie Hawkins ◽  
D. Israel Lee
Keyword(s):  
Health Care ◽  
Organizational Leadership ◽  
Health Care Systems ◽  
Future Research ◽  
Health Care Reforms ◽  
Use Of Technology ◽  
Hitech Act ◽  
Care Systems ◽  
Future Research Directions ◽  
And Function

Policies, health, and government regulations affect various Health Care organizations and their members. One such policy, the Health Information Technology for Economic and Clinical Health (HITECH) Act, attempts to improve the performance of health care systems through the use of technology, such as Electronic Health Records (Bluementhal, 2010). The most critical task of leadership is to establish a mindset at the top of the organization and function to infuse a culture of excellence throughout the organization (Bentkover, 2012). Health organizations can only progress if their members share a set of values and are single-mindedly committed to achieving openly defined objectives (Bentkover, 2012). This chapter investigates organizational leadership in relation to health care reforms to include trends in health care leadership, Stratified Systems Theory (SST), Systems Thinking, and regulators perspectives. The chapter will consist of the following sections: background; issues controversies, and problems; solutions and recommendation; future research directions; and conclusion.

scholarly journals Introducing teledermoscopy of possible skin cancers in general practice in Southern Denmark

2020 ◽  
Vol 37 (4) ◽  
pp. 513-518
Author(s):  
Tine Vestergaard ◽  
Sumangali C Prasad ◽  
Annette Schuster ◽  
Rasa Laurinaviciene ◽  
Anette Bygum ◽  
...  
Keyword(s):  
General Practice ◽  
Diagnostic Accuracy ◽  
Health Care Systems ◽  
Final Diagnosis ◽  
Skin Lesions ◽  
University Hospital ◽  
Predictive Values ◽  
Face To Face ◽  
Skin Cancers ◽  
Care Systems

Abstract Background The increasing incidence of skin cancers poses a burden to health care systems. General practitioners (GPs) play an important role in triaging these diseases and referring relevant patients to specialists. It is challenging to distinguish benign from malignant skin lesions, and GPs may benefit from diagnostic support from teledermoscopy (TD). Objectives To assess whether the introduction of TD in general practice was feasible and might reduce the number of unnecessary referrals to specialists and to assess the diagnostic accuracy and confidence of participating GPs. Methods Fifty general practices in Southern Denmark participated. Adult patients presenting to their GP with suspected skin cancer could be included. Images including dermoscopy were taken by the GP and sent for evaluation by specialized dermatologists at a university hospital. Patients were simultaneously referred for a face-to-face evaluation at the university hospital. Diagnoses proposed by the GPs and by TD were compared to the final diagnoses obtained by histopathology or, if not available, face-to-face evaluation. Results Five hundred and nineteen patients with 600 suspected skin cancers were included. The final diagnosis was benign in 72.3%. The photo quality was good or fair in 90.5%. GPs reported uncertainty about their diagnoses in 41.5% of cases. The GPs’ positive predictive values for any malignancy and for malignant melanoma were 49.5% and 26.3%, respectively. On evaluation by TD, 31.5% of lesions did not need further in-person assessment. Conclusion Useful images of suspicious skin lesions were obtained from general practice, and GPs could benefit from TD to improve their diagnostic accuracy and confidence.

scholarly journals Back to the Future: Principles on Resuming Outpatient Services in the COVID-19 Era

2020 ◽  
Vol 163 (4) ◽  
pp. 705-706 ◽  
Author(s):  
Taher S. Valika ◽  
Kathleen R. Billings
Keyword(s):  
Health Care ◽  
Outpatient Care ◽  
Health Care Systems ◽  
Lessons Learned ◽  
Outpatient Services ◽  
Drastic Reduction ◽  
The Public ◽  
Outpatient Visits ◽  
The Future ◽  
Care Systems

The rapidly changing health care climate related to coronavirus disease 2019 (COVID-19) has resulted in numerous changes to health care systems and in practices that protect both the public and the workers who serve in hospitals around the country. As a result, these past few months have seen a drastic reduction in outpatient visits. With phased reopening and appropriate guidance, health care systems are attempting to return to normal. The experiences and lessons learned are described, and we provide guiding principles to allow for a safe and effective return to outpatient care.

A NOVEL TOOL FOR THE EARLY IDENTIFICATION OF FRAILTY IN ELDERLY PEOPLE: THE APPLICATION IN PRIMARY CARE SETTINGS

2019 ◽  
pp. 1-6
Author(s):  
M. Maggio ◽  
M. Barbolini ◽  
Y. Longobucco ◽  
L. Barbieri ◽  
C. Benedetti ◽  
...  
Keyword(s):  
Primary Care ◽  
Construct Validity ◽  
Predictive Value ◽  
Community Health Centers ◽  
Health Care Systems ◽  
Cross Sectional Study ◽  
Criterion Validity ◽  
Cross Sectional ◽  
Care Systems ◽  
The One

Objectives: Frailty is a pre-disability condition in older persons providing a challenge to Health-Care Systems. Systematic reviews highlight the absence of a gold-standard for its identification. However, an approach based on initial screening by the General Practitioner (GP) seems particularly useful. On these premises, a 9-item Sunfrail Checklist (SC), was developed by a multidisciplinary group, in the context of European Sunfrail Project, and tested in the Community. Objectives: – to measure the concordance between the judgments of frailty (criterion-validity): the one formulated by the GP, using the SC, and the one subsequently expressed by a Comprehensive Geriatric Assessment Team (CGA-Team); – to determine the construct-validity through the correspondence between some checklist items related to the 3 domains (physical, cognitive and social) and the three tools used by the CGA-Team; – to measure the instrument’s performance in terms of positive predictive value (PPV) and negative predictive value (NPV). Design: Cross-sectional study, with a final sample-size of 95 subjects. Setting: Two Community-Health Centers of Parma, Italy. Participants: Subjects aged 75 years old or more, with no disability and living in the community. Measurements: We compared the screening capacity of the GP using the SC to that one of CGA-Team based on three tests: 4-meter Gait-Speed, Mini-Mental State Examination and Loneliness Scale. Results: 95 subjects (51 women), with a mean age of 81±4 years were enrolled. According to GPs 34 subjects were frail; the CGA-Team expressed a frailty judgment on 26 subjects. The criterion-validity presented a Cohen’s k of 0.353. Construct-validity was also low, with a maximum contingency-coefficient of 0.19. The analysis showed a PPV of 58.1% and a NPV equal to 84.6%. Conclusions: Our data showed a low agreement between the judgements of GP performed by SC and CGA-Team. However, the good NPV suggests the applicability of SC for screening activities in primary-care.

Do GPs use motivational interviewing skills in routine consultations with patients living with mental-physical multimorbidity? An observational study of primary care in Scotland

2018 ◽  
pp. 174239531881596
Author(s):  
Kylie J McKenzie ◽  
David Pierce ◽  
Stewart W Mercer ◽  
Jane M Gunn
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Observational Study ◽  
Motivational Interviewing ◽  
Secondary Analysis ◽  
Future Research ◽  
Global Rating ◽  
Coding System ◽  
Interviewing Skills ◽  
Multimorbid Patients

Objectives To examine whether motivational interviewing is used by GPs in consultations with patients living with mental-physical multimorbidity. Methods Secondary analysis of selected videos from an existing database of routine general practice consultations with adult patients in Glasgow, Scotland. Consultations involving patients with mental-physical multimorbidity were selected and coded using the Motivational Interviewing Treatment Integrity (MITI) coding system. Results Sixty consultations were coded involving 32 GPs across 16 practices. Mean consultation length was 9.9 min. On average GPs asked 1.7 questions per minute and offered 1.2 pieces of information per minute. Using the MITI, five GPs met beginner proficiency for the relational global qualities of partnership and empathy; however, none of the GPs met beginner proficiency for the technical global rating of efforts made to encourage patients to discuss behaviour change. Simple reflections were observed in 67% of consultations and complex reflections in 28% of consultations. Confrontation, a technique inconsistent with motivational interviewing, was observed in 18% of consultations. Discussion MI was not evident in these consultations with patients living with mental-physical multimorbidity. This study provides information about the baseline motivational interviewing-consistent skills of GPs working with multimorbid patients and may be helpful in informing motivational interviewing training efforts and future research.

Sign in / Sign up

Export Citation Format

Share Document