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"PRIMARY HEALTH CARE"
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Revitalizing health for all : case studies of the struggle for comprehensive primary health care
\"The concept of Comprehensive Primary Health Care focuses on health system efforts to improve equity in health care access, community empowerment, participation of marginalized groups, and actions on the social determinants of health. Despite its existence since the late 1970s very few studies have been able to highlight the outcomes of this concept, until now. Revitalizing Health for All examines thirteen cases of efforts to implement CPHC reforms from around the globe including Australia, Brazil, Democratic Republic of Congo, Iran, South Africa, and more. The findings presented in this volume originate from an international action-research set of studies that utilized triads of senior and junior researchers and knowledge users from each country's public health system. Primary health care reform is an important policy discourse both at the national level in these countries and in the global conversations, and this volume reveals the similarities among CPHC projects in diverse national contexts. These similarities provide a rich evidence base from which future CPHC reform initiatives can draw, regardless of their country.\"-- Provided by publisher.
Book
Shifts in office and virtual primary care during the early COVID-19 pandemic in Ontario, Canada
Globally, primary care changed dramatically as a result of the coronavirus disease 2019 (COVID-19) pandemic. We aimed to understand the degree to which office and virtual primary care changed, and for which patients and physicians, during the initial months of the pandemic in Ontario, Canada.
This population-based study compared comprehensive, linked primary care physician billing data from Jan. 1 to July 28, 2020, with the same period in 2019. We identified Ontario residents with at least 1 office or virtual (telephone or video) visit during the study period. We compared trends in total physician visits, office visits and virtual visits before COVID-19 with trends after pandemic-related public health measures changed the delivery of care, according to various patient and physician characteristics. We used interrupted time series analysis to compare trends in the early and later halves of the COVID-19 period.
Compared with 2019, total primary care visits between March and July 2020 decreased by 28.0%, from 7.66 to 5.51 per 1000 people/day. The smallest declines were among patients with the highest expected health care use (8.3%), those who could not be attributed to a primary care physician (10.2%), and older adults (19.1%). In contrast, total visits in rural areas increased by 6.4%. Office visits declined by 79.1% and virtual care increased 56-fold, comprising 71.1% of primary care physician visits. The lowest uptake of virtual care was among children (57.6%), rural residents (60.6%) and physicians with panels of ≥ 2500 patients (66.0%).
Primary care in Ontario saw large shifts from office to virtual care over the first 4 months of the COVID-19 pandemic. Total visits declined least among those with higher health care needs. The determinants and consequences of these major shifts in care require further study.
Journal Article
Depression in primary care : evidence and practice
\"Although depression is a major cause of illness and disability, the quality of care offered is often poor. Research evidence demonstrating how the quality of primary care can be improved is dispersed in different academic journals and written in technical jargon. Depression in Primary Care: Evidence and Practice summarizes this research in a clear and useable format. This collection of high quality reviews of research evidence takes the form of a series of clinical and economic evaluations. Each provides a clear summary of the best evidence from trials and an accessible 'how to do it' guide, written by international experts. Global approaches towards the organization and delivery of primary care for depression are presented, from the UK, North America, Europe and the developing world. An important source of practical guidance about how to implement quality improvement programs in clinical practice, this book will assist practitioners, researchers and policy makers alike. - Combines clear evidence summaries with a simple and practical guide about how to implement quality improvement programmes in practice - Prepared by international experts and of interest and relevance in all countries and healthcare settings - Addresses a major healthcare priority identified by the World Health Organization, US Agency for Healthcare Research and UK National Institute for Clinical Excellence\"--Provided by publisher.
Book
The effects of integrated care: a systematic review of UK and international evidence
Background
Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context.
Methods
The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence.
Results
One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users.
Conclusions
Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand.
Trial registration
Prospero registration number:
42016037725
.
Journal Article
The importance of patient-centered care and co-creation of care for satisfaction with care and physical and social well-being of patients with multi-morbidity in the primary care setting
Background
Patients with multi-morbidity have complex care needs that often make healthcare delivery difficult and costly to manage. Current healthcare delivery is not tailored to the needs of patients with multi-morbidity, although multi-morbidity poses a heavy burden on patients and is related to adverse outcomes. Patient-centered care and co-creation of care are expected to improve outcomes, but the relationships among patient-centered care, co-creation of care, physical well-being, social well-being, and satisfaction with care among patients with multi-morbidity are not known.
Methods
In 2017, a cross-sectional survey was conducted among 216 (of 394 eligible participants; 55% response rate) patients with multi-morbidity from eight primary care practices in Noord-Brabant, the Netherlands. Correlation and regression analyses were performed to identify relationships among patient-centered care, co-creation of care, physical well-being, social well-being, and satisfaction with care.
Results
The mean age of the patients was 74.46 ± 10.64 (range, 47–94) years. Less than half (40.8%) of the patients were male, 43.3% were single, and 39.3% were less educated. Patient-centered care and co-creation of care were correlated significantly with patients’ physical well-being, social well-being, and satisfaction with care (all
p
≤ 0.001). Patient-centered care was associated with social well-being (
B
= 0.387,
p
≤ 0.001), physical well-being (
B
= 0.368,
p
≤ 0.001) and satisfaction with care (
B
= 0.425,
p
≤ 0.001). Co-creation of care was associated with social well-being (
B
= 0.112,
p
= 0.006) and satisfaction with care (
B
= 0.119,
p
= 0.007).
Conclusions
Patient-centered care and co-creation of care were associated positively with satisfaction with care and the physical and social well-being of patients with multi-morbidity in the primary care setting. Making care more tailored to the needs of patients with multi-morbidity by paying attention to patient-centered care and co-creation of care may contribute to better outcomes.
Journal Article
The public health care system and primary care services in Saudi Arabia: a system in transition
Background: Saudi Arabia has invested heavily in its health care system by establishing health care infrastructures to improve health of the nation. However, it remains to be seen whether it is efficient and effective in providing health care services needed. Primary health care, which is the basis of universal health coverage, needs to be assessed on its performance, challenges and future opportunities to serve the Saudi Arabian population. Aims: This review aimed to identify challenges within the Saudi Arabian health care system with a focus on primary health care services, and to analyse the interrelated factors in order to suggest remedial reforms to further strengthen and improve the health care system. Methods: A narrative review of previous studies and governmental reports was undertaken to extract, analyse, synthesize and report the findings. Results: The review found a number of key areas for improvement in the primary health care system. These areas include: the scope, structure, infrastructure, financing, increased demand, increased costs and workforce capacity. Other critical challenges include inequitable access to health services, quality and safety of services, the growing burden of chronic diseases, lack of an effective information system, management and leadership issues, and gaps in the referral system. Conclusion: The Saudi Arabian health care system needs comprehensive reform with a focus on primary health care.
Journal Article
Ten Ways Artificial Intelligence Will Transform Primary Care
Artificial intelligence (AI) is poised as a transformational force in healthcare. This paper presents a current environmental scan, through the eyes of primary care physicians, of the top ten ways AI will impact primary care and its key stakeholders. We discuss ten distinct problem spaces and the most promising AI innovations in each, estimating potential market sizes and the Quadruple Aims that are most likely to be affected. Primary care is where the power, opportunity, and future of AI are most likely to be realized in the broadest and most ambitious scale. We propose how these AI-powered innovations must augment, not subvert, the patient–physician relationship for physicians and patients to accept them. AI implemented poorly risks pushing humanity to the margins; done wisely, AI can free up physicians’ cognitive and emotional space for patients, and shift the focus away from transactional tasks to personalized care. The challenge will be for humans to have the wisdom and willingness to discern AI’s optimal role in twenty-first century healthcare, and to determine when it strengthens and when it undermines human healing. Ongoing research will determine the impact of AI technologies in achieving better care, better health, lower costs, and improved well-being of the workforce.
Journal Article