February 16, 2012
This TED Talk with Brian Goldman address the some of the issues surrounding the medical culture of denying errors. “Every doctor makes mistakes. ‘But,’ says physician Brian Goldman, ‘medicine’s culture of denial (and shame) keeps doctors from ever talking about those mistakes, or using them to learn and improve.’ Telling stories from his own long practice, he calls on doctors to start talking about being wrong.”
Posted in Multimedia, READ Portal | Tagged with Primary health care, Safety | No Comments
December 9, 2011
“Only 48% of Canadians feel involved and are actively participating in their health care – which affects how they feel about their health. In a report released today, How Engaged are Canadians in their Primary Care? Results from the 2010 Commonwealth Fund International Health Policy Survey, the Health Council of Canada takes a look at why less than half of Canadians are taking a more active role in maintaining their health.
The report shows that engaged patients are happier with their care and more likely to participate in disease prevention, screenings and health promoting activities. The biggest barrier to patient engagement is time, and those patients who had experiences with long waits or who felt they didn’t have enough time with their doctor did not feel as engaged in their care.
Among 10 other countries who take part in the survey, Canada falls in the middle when it pertains to patient engagement. The countries ranking highest – New Zealand, Australia and Switzerland – are the same countries in a past Commonwealth survey (2010) who earned high ratings from citizens on access, affordability, timeliness and coordination of care.”
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Posted in READ Portal, Reports & Papers | Tagged with Canada, Primary health care | No Comments
December 8, 2011
“ABSTRACT: Recent reforms in Australia, England, and the Netherlands have sought to enhance the quality and accessibility of primary care. Quality improvement strategies include postgraduate training programs for family physicians, accreditation of general practitioner (GP) practices, and efforts to modify professional behaviors—for example, through clinical guideline development. Strategies for improving access include national performance targets, greater use of practice nurses, assured after-hours care, and medical advice telephone lines. All three countries have established midlevel primary care organizations both to coordinate primary care health services and to serve other functions, such as purchasing and population health planning. Better coordination of primary health care services is also the objective driving the use of patient enrollment in a single general practice. Payment reform is also a key element of English and Australian reforms, with both countries having introduced payment for quality initiatives. Dutch payment reform has stressed financial incentives for better management of chronic disease.
With well-developed primary care systems that have track records of strong performance, Australia, England, and the Netherlands offer some potentially useful lessons to the United States as it implements health care reforms. This brief outlines how primary care is provided in those three countries, it evaluates data on a range of primary care system performance indicators, and it examines the three countries’ major strategies for strengthening primary care:
- Promoting coordination of care;
- Reforming primary care payment;
- Improving quality and access.
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Posted in READ Portal, Reports & Papers | Tagged with Benchmarking, Health care reform, Primary health care, Quality control, Quality improvement | No Comments
November 9, 2011
“Context: During the 1980s and 1990s, innovations in the organization, funding, and delivery of primary health care in Canada were at the periphery of the system rather than at its core. In the early 2000s, a new policy environment emerged.
Methods: This policy analysis examines primary health care reform efforts in Canada during the last decade, drawing on descriptive information from published and gray literature and from a series of semistructured interviews with informed observers of primary health care in Canada.
Findings: Primary health care in Canada has entered a period of potentially transformative change. Key initiatives include support for interprofessional primary health care teams, group practices and networks, patient enrollment with a primary care provider, financial incentives and blended-payment schemes, development of primary health care governance mechanisms, expansion of the primary health care provider pool, implementation of electronic medical records, and quality improvement training and support.
Conclusions: Canada’s experience suggests that primary health care transformation can be achieved voluntarily in a pluralistic system of private health care delivery, given strong government and professional leadership working in concert.”
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Posted in Journal Articles, READ Portal | Tagged with Canada, Health care reform, Primary health care | No Comments
September 22, 2011
“Major discrepancies exist between patient preferences and the medical care they receive for many common conditions. Shared decision making (SDM) is a process where a patient and clinician faced with more than one medically acceptable treatment option jointly decide which option is best based on current evidence and the patient’s needs, pref- erences and values. Many believe shared decision making can help bridge the gap between the care patients want and the care they receive. At the same time, SDM may help con- strain heath care spending by avoiding treatments that patients don’t want. However, barriers exist to wider use of shared decision making, including lack of reimbursement for physicians to adopt SDM under the existing fee-for-service payment system that rewards higher service volume; insufficient information on how best to train clinicians to weigh evidence and discuss treatment options for preference-sensitive conditions with patients; and clinician concerns about malpractice liability. Moreover, challenges to engaging some patients in shared decision making range from low health literacy to fears they will be denied needed care. Adding to these challenges is a climate of political hyperbole that stifles discussion about shared decision making, particularly when applied to difficult end- of-life-care decisions.”
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Posted in READ Portal, Reports & Papers | Tagged with Patient satisfaction, Patient-centered care, Primary health care | No Comments
June 17, 2011
“Most Americans get their health care in small physician practices. Yet, small practice settings are often unable to provide the same range of services or participate in quality improvement initiatives as large practices because they lack the staff, information technology, and office systems. One promising strategy is to share clinical support services and information systems with other practices. New findings from the 2009 Commonwealth Fund International Health Policy Survey of Primary Care Physicians suggest smaller practices that share resources are more likely than those without shared resources to have advanced electronic medical records and health information technology, routinely track and manage patient information, have after-hours care arrangements, and engage in quality monitoring and benchmarking. This issue brief highlights strategies that can increase resources among small- and medium-sized practices and efforts supported by states, the private sector, and the Affordable Care Act that encourage the expansion of shared-resource models.”
Posted in Journal Articles, READ Portal | Tagged with Integrated care, Primary health care | No Comments
May 24, 2011
“Many of the estimated thirty-two million Americans expected to gain coverage under the Affordable Care Act are likely to have high levels of unmet need because of various chronic illnesses and to live in areas that are already underserved. In New Mexico an innovative new model of health care education and delivery known as Project ECHO (Extension for Community Healthcare Outcomes) provides high-quality primary and specialty care to a comparable population. Using state-of-the-art telehealth technology and case-based learning, Project ECHO enables specialists at the University of New Mexico Health Sciences Center to partner with primary care clinicians in underserved areas to deliver complex specialty care to patients with hepatitis C, asthma, diabetes, HIV/AIDS, pediatric obesity, chronic pain, substance use disorders, rheumatoid arthritis, cardiovascular conditions, and mental illness. As of March 2011, 298 Project ECHO teams across New Mexico have collaborated on more than 10,000 specialty care consultations for hepatitis C and other chronic diseases.”
Posted in Journal Articles, READ Portal | Tagged with Access to care, Chronic disease, Disease management, Primary health care | No Comments
March 16, 2011
A Discharge Summary (DS) is an important tool to communicate the post-discharge framework of care between hospital physicians and primary care as well as patients and their families. This paper assesses the quality of information in Electronic Discharge Summaries (EDSs) with respect to adequacy and specificity for optimal post-discharge care of the patient. The assessments were done by randomly selecting 40 EDSs of the patients discharged from two secondary care hospitals affiliated with Waitemata District health board, Auckland and using a questionnaire with an expert panel composed of two medical specialists and a clinical coder. The data was analysed using descriptive statistics and thematic analysis. Irrelevant data in laboratory results, and insufficient management and follow up information to patients and primary care physicians are identified as the most common quality issues. We conclude by outlining an ongoing programme of work to support improvement of the quality issues using Information Technology (IT), with a focus on improving the patient advice section of the EDS with decision support to EDS authors and embedding of readability support in the EDS documents themselves.
Posted in Journal Articles, READ Portal | Tagged with Efficiency, Primary health care, Safety, Statistics & numerical data, Technology | No Comments
November 9, 2010
This article aims to describe the development of measurable indicators on the basis of characteristics (called dimensions and features) of primary care systems identified in the literature. This set of indicators and its underlying structure of dimensions and features will be referred to as the Primary Care Monitoring System (in short: PC Monitor). The PC Monitor is meant to produce comparable information of the variation of primary care systems across Europe. The study is part of the EC funded project Primary Health Care Activity Monitor for Europe (PHAMEU), that aims to describe and compare primary care systems in 31 European countries [18].
Posted in Journal Articles, READ Portal | Tagged with Access to care, Benchmarking, Efficiency, Policy, Primary health care, Quality assessment, Statistics & numerical data | No Comments
October 13, 2010
This publication presents experiences of how health systems in Member States of the WHO European Region respond to the challenge of meeting the health and developmental needs of young people. The main aim is to facilitate experience-sharing and stimulate actions in countries.
Posted in READ Portal, Reports & Papers | Tagged with Adolescent health services, Policy, Primary health care | No Comments
