Increasing workload in National Health Service (NHS) primary care in the United Kingdom (UK) is placing a dwindling workforce under unsustainable pressure. Significant expansion of the General Practitioner (GP) workforce is unlikely, making it essential that other options are considered to ensure provision of safe and effective care. One possible answer is the integration of clinical pharmacists in GP practices.Pharmacists require significantly shorter training than GPs, and their numbers are currently increasing. When integrated in GP practices, pharmacists may have impact in three key areas: prescribing safety, health outcomes, and access. Trained to identify and solve medication related problems, they can also assist in chronic disease management and auditing for performance measured aspects of primary care, potentially reducing GP workload and therefore improving patients' access to GP appointments.Although some questions remain about how pharmacists can be most effectively integrated in general practices, existing evidence suggests likely benefit both for patients and the NHS.Positive outcomes of a recent pilot scheme placing pharmacists in UK NHS general practices have resulted in further investment in this programme. With greater numbers anticipated, there is an important opportunity for further research to assess the impact on primary care safety, quality and access.3
BackgroundThe structural factors of primary care potentially influence its performance and quality. This study investigated the association between structural factors, including available primary care resources and health outcomes, by using diabetes-related ambulatory care sensitive conditions hospitalizations under the Universal Coverage Scheme in Thailand.MethodsA 2-year panel study used secondary data compiled at the district level. Administrative claim data from 838 districts during the 2014–2015 fiscal years from the National Health Security Office were used to analyze overall diabetes mellitus (DM) hospitalizations and its three subgroups: hospitalizations for uncontrolled diabetes, short-term complications, and long-term complications. Primary care structural data were obtained from the Ministry of Public Health. Generalized estimating equations were used to estimate the influence of structural factors on the age-standardized DM hospitalization ratio.ResultsA higher overall DM and uncontrolled diabetes hospitalization ratio was related to an increasing concentration of outpatient utilization (using the Herfindahl–Hirschman Index) (overall DM; beta [standard error, SE]=0.003 [0.001], 95% CI 0.000, 0.006) and decreasing physician density and bed supply (overall DM; beta [SE]=−1.350 [0.674], 95% CI −2.671, −0.028), beta [SE]=−0.023 [0.011], 95% CI −0.045, −0.001, respectively). Hospitalizations for short-term complications increased with a decrease in health care facility density, whereas hospitalizations for long-term complications increased as that density increased. Rurality was strongly associated with higher hospitalization ratios for all DM hospitalizations except short-term complications.ConclusionsThis study identified structural factors associated with health outcomes, many of which can be changed through reorganization at the district level.
The purpose of this cross-sectional, national online survey was to assess the magnitude of mental health problems and to identify job task and organizational factors associated with mental health outcomes during the COVID-19 pandemic among healthcare workers in Thailand. The data were collected during the first wave of the COVID-19 pandemic (May 1-15, 2020). Study participants were 417 healthcare workers in public health care facilities of all 12 health regions in Thailand. Demographic data, job task and organizational factors, and mental health outcomes were collected. The mental health outcome was assessed by the Thai version of the Depression, Anxiety, and Stress Scale - 21 Items (DASS-21). Multivariate logistic regression was performed to identify factors associated with mental health outcomes. The results found that most participants were women (77.7%). The largest proportion of participants were nurses (40.5%), followed by public health officers (20.9%). The average age of participants was 41.82 years (SD=10.06). We identified 21.1%, 22.5%, and 15.3% of all respondents had mild to extremely severe depression, anxiety and stress, respectively. Caring for inpatients with COVID-19 was associated with anxiety (aOR=3.41; 95% CI= 1.34, 8.68) and stress (aOR =2.96; 95% CI= 1.11, 7.95). Lack of readiness among management to reduce infection risk, inadequate PPE, working with the fear of being infected and transmitting infection when returning home, and having patients who did not strictly adhere to guidelines were identified as risk factors for all mental health outcomes, after adjustment for confounding. Organizational approaches, such as effective management can help reduce infection of both patients and healthcare providers. These strategies may also protect the mental health of health care workers in a “new, emerging phase” or a future wave of COVID-19 cases.
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