Strengthening primary care through patient registration: a review of 10 countries

Background Effective primary care requires continuity in the patient-provider relationship so that the primary care provider can act as the central coordinator of services. For this reason, some high-income countries have insisted on patient registration with a primary care team as part of different reform efforts. This paper develops a framework for analysing the characteristics of patient registration across countries; applies this framework to a selection of high-income countries that have introduced registration; and identifies challenges related to registration and ongoing reform efforts. Methods Based on a literature review, 10 countries - Canada, Denmark, England, France, Germany, Israel, Norway, Sweden Switzerland, and the Netherlands - were selected for analysis. Information was collected using a standardized questionnaire completed by national researchers who reviewed relevant literature and policy documents to report on the establishment and evolution of the policy, the requirements for providers and patients, the benefits for patients, providers and payers, and its connection to primary care reform. Results Patient registration establishes a triangular accountability relationship between patients, providers and payers that many reform advocates claim is the key to achieving better continuity and coordination of care. Results will provide information about the introduction of patient registration in the included countries; the characteristics of patient registration agreements; quantitative indicators, such as the proportion of patients registered, the proportion of primary care providers registering patients, and the average list size of providers. Recent reform experiences and ongoing challenges will also be reviewed. Conclusions This study will allow us to assess patient registration in terms of its key characteristics and outcomes. A preliminary evaluation of the policy's strengths and weaknesses based on key reform criteria is also presented.

A RURAL-BASED MEDICAL AND SOCIOLOGICAL STUDY ON THE RESULTS OF THE PRIMARY CARE REFORM

The aim: To study the results of a medical and sociological research as to the attitude of rural population in amalgamated hromadas (AH), i.e. united territorial communities, of Sumy region to the results of primary care reform. Materials and methods: The form of research – a survey with closed questionnaire. The study was conducted on a specially designed three-tier quota sample, which was calculated allowing for the territorial and socio-demographic indicators. A total of 320 respondents residing in the specified rural communities (hromadas) were surveyed with quota sampling. The theoretical sampling error makes 3%. The questionnaires were processed by the laboratory staff with the help of the “OСA” program. Results: Among the surveyed in Nyzhniosyrovatska AH (amalgamated hromada), 23.5% of the population emphasized that their authorities neglected medical problems, while in Bezdrytska AH this indicator was 6.7%, as evidenced by the difference in the industry financing from own assets (274 thousand less than in Bezdrytska AH). The survey revealed that in the communities where the population knows their family doctors better and trusts them, the satisfaction with the quality of medical care and the attitude to prophylaxis (prevention) is much higher. Conclusions: A significant part of the population demonstrates a low level of awareness of the course of the reforms, their goals and objectives. The specified trends may indicate a lack of communication or distortion of information on the implementation of medical reform. It is an information support that is one of the key instruments for effective introduction of medical reform. At the local level, this function is assigned to a family doctor who becomes a determining factor not only for providing medical services to patients, but also for communication, keeping the population informed and prophylaxis.

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

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.

Student and Resident Involvement in Family Medicine for America’s Health

Background and Objectives: Trainees—medical students and residents—are an important constituency of family medicine. The Family Medicine for America’s Health (FMAHealth) Workforce Education and Development (WED) Tactic Team attempted to engage trainees in FMAHealth objectives via a nationally accessible leadership development program. We discuss a how-to mechanism to develop similar models, while highlighting areas for improvement. Methods: The Student and Resident Collaborative recruited a diverse group of trainees to comprise five teams: student choice of family medicine, health policy and advocacy, burnout prevention, medical student education, and workforce diversity. An early-career physician mentored team leaders and a resident served as a liaison between the Collaborative and WED Team. Each team established its own goals and objectives. A total of 36 trainees were involved with the Collaborative for any given time. Results: Including trainees in a national initiative required special considerations, from recruitment to scheduling. Qualitative feedback indicated trainees valued the leadership development and networking opportunities. The experience could have been improved by clearly defining how trainees could impact the broader FMAHealth agenda. To date, the Collaborative has produced a total of 17 conference presentations and four manuscripts. Conclusions: Although trainees felt improvement in leadership skills, more robust trainee involvement in FMAHealth core teams would have made the leadership initiative stronger, while simultaneously improving sustainability among family medicine and primary care reform strategies. Nonetheless, the unique structure of the Collaborative facilitated involvement of diverse trainees, and some trainee involvement should be integrated into any future strategic planning.