Availability Of Primary Care Services Research Articles

Understanding and addressing changing administrative workload in primary care in Canada: protocol for a mixed-method study

IntroductionMany Canadians struggle to access the primary care they need while at the same time primary care providers report record levels of stress and overwork. There is an urgent need...

An Analysis of Primary Care Physician Accessibility and Medical Resource Distribution in Eastern Quebec: Utilizing an Enhanced Two-Step Floating Catchment Area (E2SFCA) Methodology

Objective: The aim of this study is to evaluate the accessibility of primary care physicians (PCPs) in Eastern Quebec by employing an enhanced two-step floating catchment area (E2SFCA) methodology. This approach will facilitate the identification of patterns in primary care accessibility that may not be readily apparent through the use of regional availability measures. Methods: To evaluate the accessibility of primary care physicians (PCPs), an enhanced two-step floating catchment area methodology was utilized. This approach considers both the population supply of PCPs at the dissemination area level and the travel time between PCPs and dissemination areas. Additionally, a continuous distance decay function (β) was employed. Results: The enhanced two-step floating catchment area (E2SFCA) methodology is effective in identifying possibly underserved areas that could have otherwise appeared to have sufficient access when evaluated using traditional provider-to-population ratios. The availability of primary care services is contingent upon the presence of adequate road infrastructure. Populations residing in areas with limited access to main road networks may experience compromised access to primary care. This issue disproportionately affects vulnerable individuals who lack private transportation options. Conclusions: The application of the enhanced two-step floating catchment area methodology can facilitate the identification of areas experiencing a shortage of primary care physicians. This information can be used to inform the development of regional medical workforce programs, such as "plans régionaux d’effectifs médicaux", and to support the establishment of rural residency initiatives.

Patient experience with primary health care during the COVID-19 pandemic in Bulgaria

Abstract Background The COVID-19 pandemic has had a profound impact on the primary healthcare experience of patients. Restricted access, delays in routine services, postponed checkups owing to safety concerns led to disruptions in care, missed diagnoses, and delays in treatment. This study investigates primary care service obstacles faced by patients during the COVID-19 pandemic in Bulgaria. Methods A national cross-sectional survey was conducted between November and December 2021 by a poll agency using an online self-administered questionnaire with 800 respondents. Binomial logistic regression was used to examine the association between sociodemographic variables and issues related to the availability of primary care services. Results Around 32% (95% CI 28-35%; p < 0.001) of the respondents reported obstacles related to the primary care, and 25% (95% CI 22-38%; p < 0.001) postponed a visit to the general practitioner due to accessibility and availability issues or fear of infection. The most prevalent obstacle cited by patients was a refusal of a referral for specialized care (26%), followed by a refusal of an out-of-hours or weekend consultation in case of urgent need (25%). Home visits and routine examinations were also denied to patients, albeit less frequently. The multivariable analyses found associations between gender, health status, education, and impediments by obtaining primary care services. The odds of facing obstacles rose as self-rated health deteriorated (OR = 6.0, p < 0.001). The likelihood of experiencing availability issues increased with educational level (OR = 6.2, p < 0.001). Women were 1.6 times more likely (p = 0.009) to report difficulties with primary care. Conclusions The COVID-19 pandemic has created significant barriers for many patients to access primary healthcare services. In addition, it has highlighted the need for a primary healthcare system that is resilient and capable of maintaining its essential functions during public health emergencies. Key messages • Primary health care has a crucial role in supporting patients during public health emergencies. • The health system needs resilient primary health care that can adapt to swiftly changing conditions.

Patients’ Perceptions Regarding the Availability of Primary Care Services in Romania - A Pilot Survey Among Users of Primary Care Services in Braşov County

In Romania, users’ perceptions about availability of services in primary care have not been explored since 2009, when a national report was produced, and little is therefore known about the subject. The study aims to identify perceptions of primary healthcare service users regarding the availability of services in primary care. This research is a pen-and-paper self-administered survey applied to an opportunity sample of people, addressing family doctor’s practices, from 17 selected settlements of Brasov county. Overall, the analysis of population’s perceptions on the primary care system in Brasov County shows a high degree of satisfaction among the patients despite a narrow spectrum of services offered by family doctors.

The relationship between gender, parenthood and practice intentions among family medicine residents: cross-sectional analysis of national Canadian survey data

BackgroundFamily medicine (FM) residents choose among a range of options as they enter practice, including practice model, clinical domains, settings, and populations. The choices they make have implications for primary care workforce planning and may differ between FM residents who are parents and those who are not, as well as between male and female FM residents. We investigate whether parenthood shapes intentions among FM residents entering practice and whether the effect of parenthood differs between male and female FM residents.MethodsWe conducted cross-sectional analysis of national survey data collected from FM residents in Canadian residency programs by the College of Family Physicians of Canada between 2014 and 2017. The survey captures information on intentions for comprehensive or focused practice, practice model, clinical domains, practice setting, and populations. We used chi-square tests and multivariable logistic regression to investigate the relationships between parenthood, gender, and practice intentions, adjusting for other physician personal characteristics.ResultsAlmost a quarter of FM residents were parents or became parents during residency. Intentions for the provision comprehensive care were higher among parents, and intentions for clinically focused practice were lower. Differences in intentions for practice models, domains, and settings/population were primarily by gender, though in several cases the effects of parenthood differed between female and male FM residents. Even during residency, the effects of parenthood differ between male and female residents: while three quarters of male parents finish residency in two years, fewer than half of female parents do.ConclusionsBoth parenthood and gender independently shape practice intentions, but the effect of parenthood differs for male and female FM residents. Supporting FM residents who are parents may positively impact the quality and availability of primary care services, especially since parents are more likely to report intentions to provide comprehensive care soon after entering practice.

In British Columbia, The Supply Of Primary Care Physicians Grew, But Their Rate Of Clinical Activity Declined.

Reports of a primary care shortage are ubiquitous in Canada and the United States. We used a population-based, retrospective cohort study to examine the extent to which the feminization and aging of the primary care physician workforce and secular trends may contribute to changes in the availability of primary care services. We used billing data for all primary care physicians in British Columbia for the period 2005-12. We used multivariate linear mixed-effects models to study physician remuneration and activity levels. We found limited change in per physician remuneration over the study period. However, numbers of patient contacts and practice sizes (numbers of unique patients) declined by 14percent and 10percent, respectively. Although the feminization of the workforce-and, to a lesser extent, its aging-contributed to this decline, the primary driver appears to be a broad trend toward reduced clinical activity over time. To the extent that similar trends are occurring in the United States, the implications of our study for the availability of primary care services beyond Canada are potentially significant.

Higher mortality rates amongst emergency patients admitted to hospital at weekends reflect a lower probability of admission.

ObjectivePatients admitted as emergencies to hospitals at the weekend have higher death rates than patients admitted on weekdays. This may be because the restricted service availability at weekends leads to selection of patients with greater average severity of illness. We examined volumes and rates of hospital admissions and deaths across the week for patients presenting to emergency services through two routes: (a) hospital Accident and Emergency departments, which are open throughout the week; and (b) services in the community, for which availability is more restricted at weekends.MethodRetrospective observational study of all 140 non-specialist acute hospital Trusts in England analyzing 12,670,788 Accident and Emergency attendances and 4,656,586 emergency admissions (940,859 direct admissions from primary care and 3,715,727 admissions through Accident and Emergency) between April 2013 and February 2014.Emergency attendances and admissions to hospital and deaths in any hospital within 30 days of attendance or admission were compared for weekdays and weekends.ResultsSimilar numbers of patients attended Accident and Emergency on weekends and weekdays. There were similar numbers of deaths amongst patients attending Accident and Emergency on weekend days compared with weekdays (378.0 vs. 388.3). Attending Accident and Emergency at the weekend was not associated with a significantly higher probability of death (risk-adjusted OR: 1.010).Proportionately fewer patients who attended Accident and Emergency at weekend were admitted to hospital (27.5% vs. 30.0%) and it is only amongst the subset of patients attending Accident and Emergency who were selected for admission to hospital that the probability of dying was significantly higher at the weekend (risk-adjusted OR: 1.054).The average volume of direct admissions from services in the community was 61% lower on weekend days compared to weekdays (1317 vs. 3404). There were fewer deaths following direct admission on weekend days than weekdays (35.9 vs. 80.8). The mortality rate was significantly higher at weekends amongst direct admissions (risk-adjusted OR: 1.212) due to the proportionately greater reduction in admissions relative to deaths.ConclusionsThere are fewer deaths following hospital admission at weekends. Higher mortality rates at weekends are found only amongst the subset of patients who are admitted. The reduced availability of primary care services and the higher Accident and Emergency admission threshold at weekends mean fewer and sicker patients are admitted at weekends than during the week. Extending services in hospitals and in the community at weekends may increase the number of emergency admissions and therefore lower mortality, but may not reduce the absolute number of deaths.

Process and Outcomes of Patient-Centered Medical Care With Alaska Native People at Southcentral Foundation

This study describes key elements of the transition to a patient-centered medical home (PCMH) model at Southcentral Foundation (SCF), a tribally owned and managed primary care system, and evaluates changes in emergency care use for any reason, for asthma, and for unintentional injuries, during and after the transition. We conducted a time series analyses of emergency care use from medical record data. We also conducted 45 individual, in-depth interviews with PCMH patients (customer-owners), primary care clinicians, health system employees, and tribal leaders. Emergency care use for all causes was increasing before the PCMH implementation, dropped during and immediately after the implementation, and subsequently leveled off. Emergency care use for adult asthma dropped before, during, and immediately after implementation, subsequently leveling off approximately 5 years after implementation. Emergency care use for unintentional injuries, a comparison variable, showed an increasing trend before and during implementation and decreasing trends after implementation. Interview participants observed improved access to primary care services after the transition to the PCMH tempered by increased staff fatigue. Additional themes of PCMH transformation included the building of relationships for coordinated, team-based care, and the important role of leadership in PCMH implementation. All reported measures of emergency care use show a decreasing trend after the PCMH implementation. Before the implementation, overall use and use for unintentional injuries had been increasing. The combined quantitative and qualitative results are consistent with decreased emergency care use resulting from a decreased need for emergency care services due to increased availability of primary care services and same-day appointments.

A new approach for psychological consultation: the psychologist at the chemist's.

BackgroundThe prevalence of mental illness and psychological suffering is greater than the availability of primary care services in Europe and, in particular, in Italy. The main barriers that hinder the access to these services are economic, the lack of proximity of services and some prejudices that may promote stigma and shame.A new mental health service, named “Psychologist in the Neighbourhood” was created to intercept unexpressed needs for psychological assistance. The service allows everyone to ask for free psychological consultation, consisting of no more than four meetings with a psychologist, in certain chemists’ shops around the city of Milan. This article aims to present the service specific features of this initiative and the results of a pilot study.MethodsInformation gathered on all users included socio-demographic data, the reasons why they approached this specific service, how they learnt about it, the main presented problem and, for a random sub-group, the level of psychological well-being (as measured by the PGWBI). Socio-demographic data were compared with previously collected information about general users of psychological services. The outcome of the intervention was assessed by the clinicians.ResultsDuring the two-year project a total of 1,775 people accessed the service. Compared to traditional users of psychological services, the participants in this service were characterized by a higher presence of females, unemployed and retired people. The main factors encouraging access were proximity and the fact that the service was free of charge. Many of the users were redirected to more specific services, while for about a third of the sample the consultation cycle was sufficient to resolve the presented problem.ConclusionsThe interest and participation of the population was high and this initiative intercepted an unexpressed requirement for psychological support. Free access and home proximity, were the main reasons for accessing this specific service. Subjects were mostly re-directed to appropriate services, while about a third of the sample addressed and resolved their problem with the psychologist in the chemist’s shop.These encouraging results suggest the benefits of bringing psychological consultations closer to citizens, particularly to those who cannot afford it, reducing socio-economic inequalities.

Still Piecing It Together: Women's Primary Care

The 20-year anniversary of Women’s Health Issues is an opportune time to consider whether the past two decades have seen substantial progress in improving primary care for American women. At least as early as 1992, when Clancy and Massion (1992) described women’s health care as ‘‘a patchwork quilt with gaps,’’ health services researchers and health care providers have been aware of the unique challenges to providing coordinated, comprehensive, high-quality primary care services to women. One of the major issues is how to integrate and coordinate routine reproductive health services with other components of women’s primary care in a seamless delivery system. This is not a trivial question, because reproductive caredincluding, for example, contraceptive services, pregnancy-related care, infertility services, gynecological care, and gender-specific cancer screeningdis needed by all women at some point in their lives. Despite the fact that women are the majority of health care consumers, this issue has not beenwidely recognized by those promoting ideal conceptions of ‘‘primary care’’ or the newer concept of a ‘‘patient-centered medical home.’’ Have we made any progress at all? Historical patterns of care delivery based on the specialty areas of physicians, as well as on the ways in which health services are funded or reimbursed, have resulted in fragmented primary care for women. Most women have directly experienced fragmentation. Any womanwho has visited her family physician for a regular checkup and then had tomake a separate visit (with another copay) for a routine Pap smear understands that her convenience and needs are not foremost in the design of basic health services. Anywomanwhose obstetrician-gynecologist has told her that she has to go elsewhere for a cholesterol test knows that a reproductive health specialist does not provide comprehensive care. Any womanwho reports symptoms of postpartum depression or consequences of intimate partner violence to her

School-Based Health Centers

To examine students' knowledge, barriers to access, and use of services at two school-based health centers. In-person survey. Two urban public schools in Baltimore, Md. One hundred forty-nine middle school and 131 high school African-American students. The response rate was 84%. Knowledge about center operations and services, reported barriers to access to the center, and reported use of the center. Knowledge about center operations and services was generally high. However, knowledge was low with respect to the need for an appointment for non-emergency visits (40% correct) and the availability of dental service referrals (51% correct). One fifth of students incorrectly reported their enrollment status. Boys were more likely to report that they knew about the availability of sports physical examinations (odds ratio, 3.7), and girls were more likely to report that they knew about reproductive services (odds ratio, 3.0). The most frequently identified barriers to access were difficulty in obtaining a teacher's permission to leave class (55%), requiring parental permission for enrollment (31%), and concern about confidentiality (26%). Barriers to access were reported more frequently by students in the middle school than by students in the high school. Seven eighths of enrolled students reported that they had used the center in the past year, but only a third would use it if they woke up on a Monday with a bad cough and needed to see a physician or nurse. Despite increasing the availability of primary care services by locating health centers in schools, some barriers to access remain. School-based health centers could more actively promote awareness of their operation and services among students and their parents.