Abstract:BackgroundSeven chronic disease prevention and management programs were implemented across Quebec with funding support from a provincial-private industry funding initiative. Given the complexity of implementing integrated primary care chronic disease management programs, a knowledge transfer meeting was held to share experiences across programs and synthesize common challenges and success factors for implementation.MethodsThe knowledge translation meeting was held in February 2014 in Montreal, Canada. Seventy-… Show more
“…Alongside the regular care of enrolled patients, doctors who participate in DMPs receive mandatory training courses. Moreover, medical practices that offer treatment within the framework of DMPs must fulfil set quality requirements; this can lead to changes in the practice’s workflow [ 10 , 11 ]. Depending upon the program, structured training courses are also offered to patients in support of their treatment and/or for the purposes of prevention.…”
Section: Introductionmentioning
confidence: 99%
“…The DMP objectives cannot be achieved without the substantial participation of general practitioners as primary care providers with access to a broad, unselected patient base [ 10 , 11 , 22 ]. In this respect, general practitioners play a key role in the recruitment of patients, ensuring compliance and coordination of the treatment process [ 7 , 22 ].…”
Summary
Background
Disease management programs (DMPs) were set up in Germany in 2003 to improve outpatient care of chronically ill patients. The present study looks at the attitudes and experiences of general practitioners (GPs) in relation to DMPs, how they rate them almost 20 years after their introduction and where they see a need for improvement.
Methods
A total of 1504 GPs in the Federal States of Rhineland Palatinate, Saarland and Hesse were surveyed between December 2019 and March 2020 using a written questionnaire.
Results
In total, 58% of respondents rate DMPs positively and regard them as making a useful contribution to primary care. The guarantee of regular, structured patient care and greater compliance are regarded as particularly positive aspects. It was also established that diagnostic and therapeutic knowledge was expanded through participation in DMPs. 57% essentially follow the DMP recommendations for (drug) treatment. Despite positive experiences of DMPs in patient care, the GPs surveyed mention various challenges (documentation requirements, frequent changes to the programmes, inflexibility). Univariant linear regression analysis revealed factors influencing the satisfaction with DMPs, such as improvement of compliance and clearly defined procedures in medical care.
Conclusion
Most of the GPs surveyed consider the combination of continuous patient care and evidence-based diagnosis and treatment to be a great advantage. To better adapt DMPs to the conditions of primary care, it makes sense to simplify the documentation requirements, to regulate cooperation with other healthcare levels more clearly and to give GPs more decision-making flexibility. Increased inclusion of GP experience in the process of developing and refining DMPs can be helpful.
“…Alongside the regular care of enrolled patients, doctors who participate in DMPs receive mandatory training courses. Moreover, medical practices that offer treatment within the framework of DMPs must fulfil set quality requirements; this can lead to changes in the practice’s workflow [ 10 , 11 ]. Depending upon the program, structured training courses are also offered to patients in support of their treatment and/or for the purposes of prevention.…”
Section: Introductionmentioning
confidence: 99%
“…The DMP objectives cannot be achieved without the substantial participation of general practitioners as primary care providers with access to a broad, unselected patient base [ 10 , 11 , 22 ]. In this respect, general practitioners play a key role in the recruitment of patients, ensuring compliance and coordination of the treatment process [ 7 , 22 ].…”
Summary
Background
Disease management programs (DMPs) were set up in Germany in 2003 to improve outpatient care of chronically ill patients. The present study looks at the attitudes and experiences of general practitioners (GPs) in relation to DMPs, how they rate them almost 20 years after their introduction and where they see a need for improvement.
Methods
A total of 1504 GPs in the Federal States of Rhineland Palatinate, Saarland and Hesse were surveyed between December 2019 and March 2020 using a written questionnaire.
Results
In total, 58% of respondents rate DMPs positively and regard them as making a useful contribution to primary care. The guarantee of regular, structured patient care and greater compliance are regarded as particularly positive aspects. It was also established that diagnostic and therapeutic knowledge was expanded through participation in DMPs. 57% essentially follow the DMP recommendations for (drug) treatment. Despite positive experiences of DMPs in patient care, the GPs surveyed mention various challenges (documentation requirements, frequent changes to the programmes, inflexibility). Univariant linear regression analysis revealed factors influencing the satisfaction with DMPs, such as improvement of compliance and clearly defined procedures in medical care.
Conclusion
Most of the GPs surveyed consider the combination of continuous patient care and evidence-based diagnosis and treatment to be a great advantage. To better adapt DMPs to the conditions of primary care, it makes sense to simplify the documentation requirements, to regulate cooperation with other healthcare levels more clearly and to give GPs more decision-making flexibility. Increased inclusion of GP experience in the process of developing and refining DMPs can be helpful.
“…Physicians could be included in the groups involved in guideline drafting to make them accessible to all and as close as possible to the real practice conditions. All the main concerned parties (clinicians, researchers, knowledge users, and institutions) should be brought together to identify common challenges and success factors for the implementation of a new program [ 49 ].…”
Background
Urinary tract infections (UTIs) are among the most common infections that require antibiotic therapy. In December 2015, new guidelines for UTI management were published in France with the aim of reducing antibiotic misuse and the risk of antimicrobial resistance.
Objectives
To analyze changes in antibiotic prescribing behavior for acute uncomplicated UTI in women in France from 2014 to 2019.
Methods
Retrospective study using data extracted from the medico-administrative database ‘OpenMedic’ that is linked to the French National Health Data System and collects data on the reimbursement of prescribed drugs. The analyses focused on the number of boxes of antibiotics delivered by community pharmacies, the molecule class, and the prescriber’s specialty.
Results
Overall, antibiotic dispensing by community pharmacies increased by 2% between 2014 and 2019, but with differences in function of the antibiotic class. The use of antibiotics recommended as first-line and second-line treatment increased (+ 41% for fosfomycin and + 7430% for pivmecillinam). Conversely, the dispensing of lomefloxacin and norfloxacin decreased by 80%, and that of ciprofloxacin by 26%. Some antibiotics were mostly prescribed by general practitioners (lomefloxacin, pivmecillinam) and others by secondary care physicians (ofloxacin). Dispensing increased for antibiotics prescribed by secondary care physicians (+ 13% between 2014 and 2019) and decreased for antibiotics prescribed by GPs (− 2% for the same period).
Conclusion
These data suggest that the new recommendations are followed, as indicated by the increased prescription of fosfomycin and pivmecillinam and decreased prescription of fluoroquinolones. However, the efficient transmission and implementation of new recommendations by practitioners requires time, means and dedicated tools.
“…[40] Research projects, such as this study, which incorporate stakeholders in the development of these needed interventions, is one approach to ensure the collegial support of various HCPs within the institution to drive these programs. [40,41] With the support of various stakeholders within institutions the sustainability and effectiveness of promoting behavioural change is likely to be enhanced.…”
Objective: To determine, from the diverse perspective of vested members of the health care team, novel exercise intervention strategies to implement within the cancer care institution in order to overcome barriers to exercise participation and promotion for women with breast cancer (BC). Methods: Design: Qualitative descriptive study. Setting: Cancer care institution. Participants: Health care professionals (HCPs) who work with women with BC. Intervention: A focus group was used to answer the research question. A moderator guided the focus group using a semi-structured script. Measurements: The focus group was recorded and transcribed. The transcript was coded independently using topic and analytical coding. Results: Three main issues came forth during analysis. These included a lack of (1) exercise programming and equipment available within the cancer care institution (2) communication with rehabilitation professionals, and (3) effective exercise education strategies available for patients with BC. Specific strategies were suggested to overcome each issue. Limitations: As purposeful sampling was used for recruitment, it is possible that participants agreed to be in this study because they had positive views on the need to incorporate exercise more effectively into practice. Conclusions: To our knowledge this is the first study to include a multidisciplinary team to come to a consensus on a knowledge translation exercise strategy. Findings show that future exercise interventions should implement active interventions within the cancer institution, include rehabilitation professionals as part of the health care team, and use technology to educate patients.
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