Primary Health Care Organizations Research Articles

Managers do it their way: How managers act in a decentralised healthcare services provider organisation - a mixed methods study.

Purpose: Decentralisation is considered a way to get managers more committed and more prone to respond to local needs. This study analyses how managers perceive a decentralised management model within a large public healthcare delivery organisation in Sweden. Design/methodology/approach: A programme theory evaluation was performed applying direct content analysis to in-depth interviews with healthcare managers. Balance score card data were used in a blinded comparative content analysis to explore relations between performance and how the delegated authority was perceived and used by the managers. Findings: Managers' perceptions of the decentralised management model supported its intentions to enable the front-line to make decisions to better meet customer needs and flexibly adapt to local conditions. The managers appreciated and used their delegated authority. Central policies and control on human resources and investments were accepted as those are to the benefit of the whole organisation. Leadership development and organisation-wide improvement programmes were of support. Units showing high organisational performance had proactive managers, although differences in manager perceptions across units were small. Originality: This, one of the first of its kind, study of a decentralisation in service delivery organisation shows a congruence between the rationale of a management model, the managers' perceptions of the authority and accountability as well as management practises. These observations stemming from a large public primary and community healthcare organisation has not, to our knowledge, been reported and provide research-informed guidance on decentralisation as one strategy for resolving challenges in healthcare service delivery organisations.

Examining area-level variation in service organisation and delivery across the breadth of primary healthcare. Usefulness of measures constructed from routine data.

Australia has a universal healthcare system, yet organisation and delivery of primary healthcare (PHC) services varies across local areas. Understanding the nature and extent of this variation is essential to improve quality of care and health equity, but this has been hampered by a lack of suitable measures across the breadth of effective PHC systems. Using a suite of measures constructed at the area-level, this study explored their application in assessing area-level variation in PHC organisation and delivery. Routinely collected data from New South Wales, Australia were used to construct 13 small area-level measures of PHC service organisation and delivery that best approximated access (availability, affordability, accommodation) comprehensiveness and coordination. Regression analyses and pairwise Pearson's correlations were used to examine variation by area, and by remoteness and area disadvantage. PHC service delivery varied geographically at the small-area level-within cities and more remote locations. Areas in major cities were more accessible (all measures), while in remote areas, services were more comprehensive and coordinated. In disadvantaged areas of major cities, there were fewer GPs (most disadvantaged quintile 0.9[SD 0.1] vs least 1.0[SD 0.2]), services were more affordable (97.4%[1.6] bulk-billed vs 75.7[11.3]), a greater proportion were after-hours (10.3%[3.0] vs 6.2[2.9]) and for chronic disease care (28%[3.4] vs 17.6[8.0]) but fewer for preventive care (50.7%[3.8] had cervical screening vs 62.5[4.9]). Patterns were similar in regional locations, other than disadvantaged areas had less after-hours care (1.3%[0.7] vs 6.1%[3.9]). Measures were positively correlated, except GP supply and affordability in major cities (-0.41, p < .01). Application of constructed measures revealed inequity in PHC service delivery amenable to policy intervention. Initiatives should consider the maldistribution of GPs not only by remoteness but also by area disadvantage. Avenues for improvement in disadvantaged areas include preventative care across all regions and after-hours care in regional locations.

Complex wound care by a nurse practitioner in primary care: a quality improvement evaluation on healing rates, costs and patient satisfaction.

Complex wounds are a major burden for healthcare professionals. Patients with complex wounds are often referred to hospitals or wound expertise centres. Complex wound care could be organised in primary care, but very little published evidence for this is available. In this study, members of a primary healthcare organisation were interviewed to ascertain how the wound care was organised. Patient characteristics and data regarding wound care, healing rates and costs were collected from medical records. Patients filled in a questionnaire concerning accessibility, communication, medical counselling and the overall experience of their treatment. This study followed 25 patients with a total of 42 wounds. Some 82% of the wounds were healed within a mean treatment duration of 9.7 weeks. Mean treatment costs were calculated at €155 (£130) for healed patients. Patients were generally very satisfied with their treatment, illustrated by an overall 8.7 out of 10 scoring on an amended survey based on the Consumer Quality Index. Treating complex wounds in primary care seemed adequate, with high patient satisfaction and tolerable costs.

The development of a restorative Managed Clinical Network within the defence primary healthcare organisation.

The United Kingdom Armed Forces introduced a Managed Clinical Network to transform care provision for military patients referred with complex restorative treatment needs. This article discusses the processes that underpinned this transformation of service, from assessment of populations needs to implementation of clinical delivery.

Influence of Interpersonal Processes on the Performance of Primary Health Care Organizations

Processes in the health sector include diagnostics, treatment, rehabilitation, prevention, education of patients, and all other interactions between qualified medical personnel and patients. Interpersonal processes pertain to the psychosocial aspect of said activities and include variables that describe communication, continuity, patient awareness, and the degree of patient involvement and influence the performance of health institutions in primary health care (PHC). The dimensions of importance for researching the influence of indicators of interpersonal processes on the performance of PHC organizations were identified, taking into account the underlying theory and specifics and characteristics of PHC. This paper studies the influence that patient-centeredness, as a dominant dimension that encompasses interpersonal processes, has on effectiveness, i.e., outcomes presented through health-related quality of life (HRQOL). Data on the factors of importance for this research subject were collected in the Republic of Serbia, while data analysis was carried out using partial least squares structural equation modeling (PLS-SEM). The research results show a complex relationship between indicators of interpersonal processes, highlight the importance of this group of processes for increasing the effectiveness of PHC organizations, and demonstrate the influence of interpersonal processes on the performance of PHC organizations.

Рынок медицинских услуг: тренд - COVID-19

The article considers the trends in the development of the medical services market in the Krasnodar Territory in the conditions of the spread of coronavirus infection, analyzes their impact on the activities of primary medical organizations, presents the development directions of the medical services market in the region in the conditions of the spread of COVID-19.&#x0D; Based on the results of the sociological study, trends in the development of the medical services market in the region in the context of the spread of coronavirus infection were identified: the introduction of new methods for diagnosing coronavirus infection (CT, tests), repurposing, hiring (reducing) medical personnel, refurbishing (refurbishing) a medical organization, treating patients with COVID-19, changing the financial situation of primary medical organizations, expanding the list of medical services. The directions of development of the market of medical services of the region in conditions of COVID-19 distribution are proposed.&#x0D; The purpose of the study is to determine the direction of development of the medical services market in the Krasnodar Territory in the conditions of the spread of COVID-19.&#x0D; The achievement of the goal of the study predetermined the setting and consistent solution of the following interrelated tasks:&#x0D;  according to the results of a sociological study, highlight trends in the development of the medical services market in the Krasnodar Territory in the conditions of the spread of coronavirus infection;&#x0D;  analyze the impact of trends on primary health care organizations in the region;&#x0D;  to offer directions for the development of the medical services market of the Krasnodar Territory in the conditions of the spread of coronavirus infection.&#x0D; When compiling a review of literary sources on the topic of the study, the method of content analysis was applied. Analytical results of the assessment of trends in the development of the medical services market in the Krasnodar Territory in the context of the spread of COVID-19 were obtained using statistical and sociological methods of research - a survey and questionnaire of representatives of medical organizations of the primary level of the region.&#x0D; The results obtained during the study will be useful in the development of strategic documents and initiatives for the development of the medical services market in the Krasnodar Territory in the conditions of COVID-19 distribution.

The experience, results, and possible perspectives of organizing the optimally accessible primary medical care for the rural population of Zaporizhzhia region

Nowadays, the assessment of the activity of the domestic healthcare system is an important and actual issue, especially against the background the active reformation of this industry. One of the important elements of the assessment is studying the availability of primary healthcare to the rural population. The aim of this work is to study the territorial accessibility of primary healthcare, the adequacy and effectiveness of the principles of forming a network of primary care facilities in the rural areas of Zaporizhzhia region that enables to address issues and optimize the location of primary care facilities in the rural areas. Materials and methods. The materials of the research were the data of the official statistical reports for the past 20 years, which characterize the state of health and the degree of medical care accessibility to the rural population. During the research, the technique of complex social and hygienic research was applied, with the use of historical, sociological, sanitary and statistical methods, organizational experiment and others. Results. The article presents the main results of studying the current state of primary healthcare organization for the rural population of Zaporіzhzhia region against the background of active reforming processes. According to the research results, the main elements forming the system of accessibility are territorial, medical, social and economic. The main factors of impact on territorial accessibility are identified. These are: the nature of the settlement of rural residents (density, compactness, service-area radius, the proportion of the rural population, the distance between villages, the distance from a household to a healthcare facility); quality of roads; transport connections between settlements and healthcare facilities; availability of communication means. Conclusions. As a result of the research, the following conclusions were drawn. Such factors as population density, compactness of its location, service-area radius, distance between villages, distance from a household to a healthcare facility, condition and quality of roads, transport connections between settlements and healthcare facilities are important during forming or improving the network of healthcare facilities in rural areas. These factors must be considered for the rational placement of primary care facilities in rural areas.

Implementation Science for Managers and Healthcare Organizations Responding to Emergencies

The purpose of the article is to illustrate how implementation science concepts and methods can be applied by researchers and implementers to understand and assist emergency management in a large primary and community healthcare organization. The article refers to a single-case implementation action evaluation of an emergency management system in a healthcare organization. It describes the methods used in this study and findings to explain how a joint healthcare and university research team were able to use the science and methods both to help implementation and contribute to science. We report two sets of findings. First, findings about implementation of emergency management to illustrate how the investigation adapted implementation science and concepts to achieve the objectives evaluation. We discovered that implementation science provides useful concepts to understand contextual factors and adds to knowledge about organizational change and emergency management in the uncertain and evolving situation we encountered. The second set of findings are the strengths and limitations of both implementation science and the action evaluation methods we used to achieve the dual objectives of practical help with implementation and to contribute to science. The article uses the first implementation action evaluation study of the response of large public primary and community healthcare organization to a pandemic to illustrate how implementation science can be applied. This type of study was able to improve implementation of the response as well as contribute to scientific knowledge about emergency healthcare management and organization.

Implementation of Integrated Primary Care for Patients with Diabetes and Hypertension: A Case from Slovenia.

Introduction:Research on models of integrated health care for hypertension and diabetes is one of the priority issues in the world. There is a lack of knowledge about how integrated care is implemented in practice. Our study assessed its implementation in six areas: identification of patients, treatment, health education, self-management support, structured collaboration and organisation of care.Methods:This was a mixed methods study based on a triangulation method using quantitative and qualitative data. It took place in different types of primary health care organisations, in one urban and two rural regions of Slovenia. The main instrument for data collection was the Integrated Care Package (ICP) Grid, assessed through four methods: 1) a document analysis (of a current health policy and available protocols; 2) observation of the infrastructure of health centres, organisation of work, patient flow, interaction of patients with health professionals; 3) interview with key informants and 4) review of medical documentation of selected patients.Results:The implementation of the integrated care in Slovenia was assessed with the overall ICP score of 3.7 points (out of 5 possible points). The element Identification was almost fully implemented, while the element Self-management support was weakly implemented.Discussion:The implementation of the integrated care of patients with diabetes and/or hypertension in Slovenian primary health care organisations achieved high levels of implementation. However, some week points were identified.Conclusion:Integrated care of the chronic patients in Slovenia is already provided at high levels, but the area of self-management support could be improved.

Evidence-based practice in primary healthcare from the managerial point of view \u2013 a national survey

BackgroundThe vast availability of and demand for evidence in modern primary healthcare force clinical decisions to be made based on condensed evidence in the form of policies and guidelines. Primary healthcare managers play a key role in implementing these governing documents. Thus, the aim of this article is to investigate the use and availability of evidence-based practice resources from the perspective of first-line primary healthcare managers.MethodsThe study is based on a national survey of primary healthcare managers, consisting of 186 respondents, recruited nationally from Sweden. The data was analysed using empirically constructed concepts and validated using factor analysis. A chi-square test was utilized to determine the statistical significance of comparisons. Associations between variables were calculated using Spearman’s correlation coefficients. All tests were two-sided, and the significance level was set to 0.05.ResultsA majority (97 %) of managers stated that guidelines and policy documents impacted primary healthcare; 84 % of managers observed a direct effect on daily practices. Most of the managers (70 %) stated that some adaptation was needed when new evidence was introduced. The managers emphasized the importance of keeping themselves updated and open to new information about work routines (96 %).ConclusionsThe study illustrates a nearly unanimous response about the influence of clinical evidence on daily practice. The emphasis on the importance of all staff members keeping their professional knowledge up to date is viewed as a direct result of this effect on daily practice. An information-dense organization such as a primary healthcare organization would have much to gain from increased cooperation with regional information resources such as clinical libraries.

Primary Health Care and Hospital Management During COVID-19: Lessons from Lombardy.

The pandemic due to SARS-CoV-2 tested the resilience of health systems worldwide. The outcome of the pandemic is impacted by health management choices made over the course of the disaster, which in turn are strongly dependent on the underlying healthcare system – as mirrored by the fact that regional pandemic experiences differ considerably: In Italy (a country most impacted by the COVID-19 outbreak), infection and mortality rates vary vastly between regions, with Lombardy – a comparatively well-equipped region with regard to hospitals and centers of scientific excellence – being amongst the worst-affected areas. Within this article, we focus on the challenges within primary health care and hospital organization, cooperation between primary and specialist care, and access to health care services: In Lombardy, neglected primary health care with a comparatively low availability of general practitioners (GPs) per inhabitant, the initial prioritization of hospitals during the pandemic while neglecting primary health care in terms of personal protective equipment (PPE), the lack of testing resources, and a failure to achieve coordinated support contributed to a quick overburdening of hospitals, where the dissolution of traditional departments into “macro-areas” may favor nosocomial infections during an ongoing pandemic. Neither specialized medicine nor privatization, but rather flexible public healthcare services working in consistent cooperation with GPs, show better efficiency in containing viral spread and managing patients. Strengthening the primary health care sector with regard to human and technical resources and supporting the coordination between the different levels of health care providers help to avoid overcrowded hospitals, while protecting patients and health care workers during large-scale health emergencies. Overall, further in-depth analysis of structural determinants is needed in order to develop more-resilient and integrative health care systems.

USING OF THE «GOAL TREE» MODEL TO ENSURE THE COMPETITIVENESS OF PRIMARY HEALTHCARE ORGANIZATIONS

USING OF THE &laquo;GOAL TREE&raquo; MODEL TO ENSURE THE COMPETITIVENESS OF PRIMARY HEALTHCARE ORGANIZATIONS Anna Davydovich Candidate of Science, Economy, Associate Professor, Associate Professor of Management and technologies in tourism and r

Intuition and rationality in intrapreneurship and innovation outputs: The case of health professionals in primary health care

The aim of this article is to explore the role of cognitive styles and intrapreneurship in health professionals’ innovation outputs, as well the mediated effect of intrapreneurship between cognitive styles and innovation output. This study used the survey method of data collection, through a self-administered questionnaire. Partial least square structural equation modelling method was used to analyse the result of the sample of 209 professionals of primary health care providers in Northern Portugal. Our findings reveal that cognitive style plays a significant role in intrapreneurship and innovation outputs, which are mediated by intrapreneurship. In particular, health care professionals with the rational cognitive style are likely to be more of a intrapreneur and innovative as compared to those with a intuitive cognitive style. Promoting intrapreneurship is crucial for successful innovation outputs. This study reveals that an understanding of the cognitive style of the health care professionals can help managers allocate appropriate individuals to different healthcare tasks. Our primary contribution to theory has been to highlight the importance of cognitive styles in intrapreneurship and innovation within the context of primary health care organizations.

THE ASSESSMENT OF THE RESEARCH POTENTIAL OF THE AMBULATORY-POLYCLINICAL INSTITUTIONS OF THE MOSCOW HEALTHCARE SYSTEM

Scientific research and their inclusion in the health care system is an important part of modern medical science. To study the readiness of primary care physicians as well as administration staff to introduce a research component into the national health care system, "The Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department" conducted an online survey of two groups of respondents - physicians of primary care settings (n = 593) and heads of outpatient clinics in Moscow (n = 168) in 2021. The results of the study show the insufficient involvement of primary care doctors in research activities in their working places: more than half do not consider scientific activities as a priority, motivating it by the lack of conditions, practical skills, age and health status as well as high level of employment, although they do not reject it in the future. Heads of Moscow primary health care settings demonstrate similar answers. According to their opinion, research activities are poorly represented in organizations of this type, and most likely the situation will not be changed in the near future; about half do not have sufficient information about the number of employees engaged in scientific work and are rarely familiar with their topics (often extensive, represented by various fields of medicine); about one third of managers reported participating in research projects of Moscow City Department of Health. The study made it possible to identify barriers that prevent the introduction of research components into the activities of Moscow primary health care organizations, which should be taken into account when making managerial decisions.

The GP-OH (General Practice – Organizational Health) Survey: Development and Validation of a Novel Instrument to Measure Organizational Health in General Practice

Primary care healthcare organizations are complex and multidimensional, and there has been much discussion about the potential dangers of focusing on outcomes as quality indicators in isolation without understanding the processes and system characteristics that drive them. Organizational health, as a concept, shifts the focus of measurement upstream and considers the elements needed for sustainable long-term success. This study has both designed and tested the first survey seeking to measure organizational health specifically within the context of primary care. A stepwise approach was taken to ensure that the validity and reliability of the survey was examined at multiple stages. Supplemental data for this article is available online at https://doi.org/10.1080/00185868.2021.1947164

Organization of primary health care in pandemics

Background: The world is experiencing one of the greatest public health emergencies in history with the global spread of COVID-19. Health systems, including Primary Health Care (PHC) services, are pillars of pandemic coping strategies. Objective: To systematic review of the literature that analyzes the effectiveness of PHC organization strategies in the context of epidemics. Methods: We performed a rapid systematic literature review on MEDLINE (via PubMed), EMBASE and LILACS (via VHL), in order to analyze empirical studies on the effectiveness of PHC organization strategies in the context of epidemics to improve access and reduce morbidity and mortality. There was no assessment of risk of bias, and the synthesis was narrative. PROSPERO CRD42020178310.Results: We selected seven articles, which studied the responses to different epidemic–s in different parts of the world. In terms of access, the studies suggest positive results with the adoption of adjustments of work processes of the teams and the structure of the services, combined with diversification of actions (including call center), adequate provision of inputs and personal protective equipment, adequate action plans and communication strategies, and effective integration with public health services and other levels of care. No study analyzed population morbidity and mortality. The included studies suggest also that community-oriented PHC is more effective in crisis scenarios, indicating the necessity of strengthening of the Family Health Strategy in the Brazilian context. Conclusion: PHC can be effective in coping with public health emergencies. Action plans should be built with broad participation by the actors involved in coping with the epidemic. Emphasis is placed on the importance of empowering the link between the healthcare service and its registered population.

A Comparative Case Study: Does the Organization of Primary Health Care in Brazil and Turkey Contribute to Reducing Disparities in Access to Care?

ABSTRACT Brazil and Turkey are among the few high-middle-income countries that explicitly chose to strengthen their primary health care (PHC) systems as the centerpiece of much broader health system reforms aiming to narrow inequities in access to care. This comparative case study reviews the organization of Brazil and Turkey’s PHC systems to derive lessons that can apply to other countries that may consider reforming the organization of PHC systems as a way to address health inequities. The analysis uses the Flagship Framework to investigate how the organization of PHC delivery in Brazil and Turkey can lead to measurable improvements in access to care. It compares (1) the degree of decentralization in PHC service delivery responsibilities, (2) the use of multi-professional PHC teams, and (3) patient impanelment strategies. The comparative analysis offers three important lessons. First, changes in the organization of PHC systems can contribute to observable improvements in the level and distribution of health outcomes, but organizational strategies do not guarantee eliminating disparities in access. Second, PHC systems can operate in health systems with varying degrees of decentralization, but the level of decentralization may influence implementation. Third, relying on multi-professional PHC teams that serve geographically empaneled populations can improve equitable access to care, but course corrections may be needed to address evolving health demands.

Scaling-up an Integrated Care for Patients with Non-communicable Diseases: An Analysis of Healthcare Barriers and Facilitators in Slovenia and Belgium.

IntroductionAlthough the concept of integrated care for non-communicable diseases was introduced at the primary level to move from disease-centered to patient-centered care, it has only been partially implemented in European countries. The aim of this study was to identify and compare identified facilitators and barriers to scale-up this concept between Slovenia and Belgium.MethodsThis was a qualitative study. Fifteen focus groups and fifty-one semi-structured interviews were conducted with stakeholders at the micro, meso and macro levels. In addition, data from two previously published studies were used for the analysis. Data collection and analysis was initially conducted at country level. Finally, the data was evaluated by a cross-country team to assess similarities and differences between countries.ResultsFour topics were identified in the study: patient-centered care, teamwork, coordination of care and task delegation. Despite the different contexts, true teamwork and patient-centered care are limited in both countries by hierarchies and a very heavily skewed medical approach. The organization of primary healthcare in Slovenia probably facilitates the coordination of care, which is not the case in Belgium. The financing and organization of primary practices in Belgium was identified as a barrier to the implementation of task delegation between health professionals.ConclusionsThis study allowed formulating some important concepts for future healthcare for non-communicable diseases at the level of primary healthcare. The results could provide useful insights for other countries with similar health systems.

The National Health Insurance System of Indonesia and primary care physicians' job satisfaction: a prospective qualitative study.

The implementation of the National Health Insurance System (NHIS) in Indonesia has been changing the primary care physician (PCP) work condition and their job satisfaction. This research aimed to explore the reasons behind PCPs' satisfaction and dissatisfaction with job satisfaction's aspect under the NHIS reform. We conducted an exploratory qualitative study within two areas in Central Java, Indonesia, using semi-structured in-depth interviews with 34 PCPs and 19 triangulation sources. We conducted both inductive and deductive analyses by the NVivo 11. Most PCPs felt dissatisfied with the following aspects of the NHIS: referral system, NHIS health services standard, NHIS programmes, performance evaluation and pay-for-performance, relationship with patient and workloads. PCPs felt constrained with the referral regulation and non-specialist diagnoses, which led to dissatisfaction with performance evaluation and the pay-for-performance implementation. Furthermore, an increase in workload and conflict with patients resulted from patients' misunderstanding the NHIS health service procedures. However, PCPs felt satisfied with the chronic disease management programme and patients' appreciation. This study presents the reasons behind PCPs' satisfaction and dissatisfaction with job satisfaction's aspect under the NHIS reform. There is a need for additional discussion among all stakeholders (Ministry of Health, Social Security Agency for Health/SSAH, primary health care and physician's professional organizations about the non-specialist diagnoses list, performance evaluation and pay-for-performance). The government and SSAH need to improve the communication and socialization of the NHIS procedures/regulations.

Opioid medicines management in primary care settings: A scoping review of quantitative studies of pharmacist activities.

To undertake a scoping review of pharmacist activities in opioid medicines management in primary care settings, including those developed or led by pharmacists, or in which pharmacists were members of broader multidisciplinary teams, and to collate the activities, models of care and settings, and reported outcomes. The bibliographic databases MEDLINE, EMBASE, International Pharmaceutical Abstracts, CINAHL, SCOPUS and Web of Science were searched. Studies with quantitative evaluation and published in English were eligible. Participants were patients with any pain category or an opioid use disorder, and healthcare providers. Studies originating in hospitals or involving supply functions were not included. Screening of literature and data charting of results were undertaken by two researchers. The 51 studies included in the scoping review occurred in primary care settings collated into four categories: general practice or primary care clinics, healthcare organisations, community pharmacies and outreach services. Studies were primarily of opioid use in chronic, noncancer pain. Other indications were opioid use disorder, cancer and dental pain. Pharmacist activities targeted risk mitigation, patient and provider education and broader, strategic approaches. Patient-related outcomes included reduced opioid load, improved functionality and symptom management, enhanced access to services and medication-assisted treatments, and engagement in risk-mitigation strategies. Behaviour change of providers was demonstrated. The review has identified the significant contribution that pharmacists working in primary care settings can make to minimise harm from opioids. Strategies implemented in isolation have the potential to further reduce adverse clinical outcomes with greater collaboration and coordination, such as opioid stewardship.