Reforming primary care: innovation or destruction?

Weel, Chris van; Carelli, Francesco; Gerada, Clare

doi:10.3399/bjgp12x616463

Cited by 8 publications

(7 citation statements)

References 18 publications

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“…[ 12 ] Periodic reviewing of EMRs, with or without the support of nephrologists, could be a component of support models. [ 28 ] Introduction of a pay-for-performance system for CKD management has shown favourable results in the UK. [ 17 ] Quality improvement strategies should focus on better recognition, systematic monitoring of disease progression including albuminuria, and blood pressure targets.…”

Section: Discussionmentioning

confidence: 99%

Quality of chronic kidney disease management in primary care: a retrospective study

Gelder

Haan

Grauw

et al. 2016

Scandinavian Journal of Primary Health Care

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BackgroundEarly detection and appropriate management of chronic kidney disease (CKD) in primary care are essential to reduce morbidity and mortality.AimTo assess the quality of care (QoC) of CKD in primary healthcare in relation to patient and practice characteristics in order to tailor improvement strategies.Design and settingRetrospective study using data between 2008 and 2011 from 47 general practices (207 469 patients of whom 162 562 were adults).MethodCKD management of patients under the care of their general practitioner (GP) was qualified using indicators derived from the Dutch interdisciplinary CKD guideline for primary care and nephrology and included (1) monitoring of renal function, albuminuria, blood pressure, and glucose, (2) monitoring of metabolic parameters, and alongside the guideline: (3) recognition of CKD. The outcome indicator was (4) achieving blood pressure targets. Multilevel logistic regression analysis was applied to identify associated patient and practice characteristics.ResultsKidney function or albuminuria data were available for 59 728 adult patients; 9288 patients had CKD, of whom 8794 were under GP care. Monitoring of disease progression was complete in 42% of CKD patients, monitoring of metabolic parameters in 2%, and blood pressure target was reached in 43.1%. GPs documented CKD in 31.4% of CKD patients. High QoC was strongly associated with diabetes, and to a lesser extent with hypertension and male sex.ConclusionRoom for improvement was found in all aspects of CKD management. As QoC was higher in patients who received structured diabetes care, future CKD care may profit from more structured primary care management, e.g. according to the chronic care model. Key pointsQuality of care for chronic kidney disease patients in primary care can be improved.In comparison with guideline advice, adequate monitoring of disease progression was observed in 42%, of metabolic parameters in 2%, correct recognition of impaired renal function in 31%, and reaching blood pressure targets in 43% of chronic kidney disease patients.Quality of care was higher in patients with diabetes.Chronic kidney disease management may be improved by developing strategies similar to diabetes care.

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Section: Discussionmentioning

confidence: 99%

Quality of chronic kidney disease management in primary care: a retrospective study

Gelder

Haan

Grauw

et al. 2016

Scandinavian Journal of Primary Health Care

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“…Conversely, generalist care produces greater value at the population level by achieving a similar quality of care at lower cost 3 4. Therefore, an effective, efficient partnership between the two levels of care would seem important5 and has long been the focus of attention for primary care reforms 3 6 7. Such reforms are especially needed in enhancing healthcare delivery, where referrals to specialist care face increasing pressure due to growing demands and provider shortages 8 9.…”

Section: Introductionmentioning

confidence: 99%

Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review

et al. 2019

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IntroductionElectronic consultation (eConsult)—provider-to-provider electronic asynchronous exchanges of patient health information at a distance—is emerging as a potential tool to improve the interface between primary care providers and specialists. Despite growing evidence that eConsult has clinical benefits, it is not widely adopted. We investigated factors influencing the adoption and implementation of eConsult services.MethodsWe applied established methods to guide the review, and the recently published Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews to report our findings. We searched five electronic databases and the grey literature for relevant studies. Two reviewers independently screened titles and full texts to identify studies that reported barriers to and/or facilitators of eConsult (asynchronous (store-and-forward) use of telemedicine to exchange patient health information between two providers (primary and secondary) at a distance using secure infrastructure). We extracted data on study characteristics and key barriers and facilitators were analysed thematically and classified using the Quadruple Aim framework taxonomy. No date or language restrictions were applied.ResultsAmong the 2579 publications retrieved, 130 studies met eligibility for the review. We identified and summarised key barriers to and facilitators of eConsult adoption and implementation across four domains: provider, patient, healthcare system and cost. Key barriers were increased workload for providers, privacy concerns and insufficient reimbursement for providers. Main facilitators were remote residence location, timely responses from specialists, utilisation of referral coordinators, addressing medicolegal concerns and incentives for providers to use eConsult.ConclusionThere are multiple barriers to and facilitators of eConsult adoption across the domains of Quadruple Aim framework. Our findings will inform the development of practice tools to support the wider adoption and scalability of eConsult implementation.

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“…Primary care is described as a sector highly influenced by political decisions and defined by its imperative role in the overall health care system [1, 2]. Policymakers in many countries are involved in system reforms that aim to strengthen the primary care sector [3]. The Nordic countries are no exception.…”

Section: Introductionmentioning

confidence: 99%

Tending to innovate in Swedish primary health care: a qualitative study

Avby

Kjellström

Bäck

2019

BMC Health Serv Res

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BackgroundPolicymakers in many countries are involved in system reforms that aim to strengthen the primary care sector. Sweden is no exception. Evidence suggests that targeted financial micro-incentives can stimulate change in certain areas of care, but they do not result in more radical change, such as innovation. The study was performed in relation to the introduction of a national health care reform, and conducted in Jönköping County Council, as the region’s handling of health care reforms has attracted significant national and international interest. This study employed success case method to explore what enables primary care innovations.MethodsFive Primary Health Care Centres (PHCCs) were purposively selected to ensure inclusion of a variety of aspects, such as size, location, ownership and regional success criteria. 48 in-depth interviews with managers and staff at the recruited PHCCs were analysed using content analyses. The COREQ checklist for qualitative studies was used to assure quality standards.ResultsThis study identified three types of innovations, which break with previous ways of organizing work at these PHCCs: (1) service innovation; (2) process innovation; and (3) organizational innovation. A learning-oriented culture and climate, comprising entrepreneurial leadership, cross-boundary collaboration, visible and understandable performance measurements and ability to adapt to external pressure were shown to be advantageous for innovativeness.ConclusionsThis qualitative study highlights critical features in practice that support primary care innovation. Managers need to consistently transform and integrate a policy “push” with professionals’ understanding and values to better support primary care innovation. Ultimately, the key to innovation is the professionals’ engagement in the work, that is, their willingness, capability and opportunity to innovate.Electronic supplementary materialThe online version of this article (10.1186/s12913-019-3874-y) contains supplementary material, which is available to authorized users.

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Reforming primary care: innovation or destruction?

Cited by 8 publications

References 18 publications

Quality of chronic kidney disease management in primary care: a retrospective study

Quality of chronic kidney disease management in primary care: a retrospective study

Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review

Tending to innovate in Swedish primary health care: a qualitative study

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