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Journal of Ambulatory Care Management

Margaret Flinter, Clarissa Hsu, DeAnn Cromp, MaryJoan D Ladden, Edward H Wagner
The years since the passage of the Affordable Care Act have seen substantial changes in the organization and delivery of primary care. These changes have emphasized greater team involvement in care and expansion of the roles of each team member including registered nurses (RNs). This study examined the roles of RNs in 30 exemplary primary care practices. We identified the emergence of new roles and activities for RNs characterized by greater involvement in face-to-face patient care and care management, their own daily schedule of patient visits and contacts, and considerable autonomy in the care of their patients...
March 20, 2017: Journal of Ambulatory Care Management
Langs de Arantes Ferreira de Mello, Teresa Tonini, Alexandre Sousa da Silva, Steven Dutt-Ross, Luciane de Souza Velasque
To assess the quality of the primary health care network, the Ministry of Health created the Program for Improving Access and Quality in Primary Care (PMAQ), a national evaluation of family health teams. Thus, this study aims to present the geolocation of PMAQ 2012 quality indicators in the city of Rio de Janeiro. The PMAQ data show that, in the city of Rio de Janeiro, 65% of the teams achieved the performances "good" or "excellent," 34.7% "regular," and 0.3% "unsatisfactory." The results show a clear PMAQ polarization between teams units classified as optimal and regular in program areas 5 and 3, respectively...
April 2017: Journal of Ambulatory Care Management
Márcia Cristina Rodrigues Fausto, Aylene Bousquat, Juliana Gagno Lima, Ligia Giovanella, Patty Fidelis de Almeida, Maria Helena Magalhães de Mendonça, Helena Seidl, Andréa Tenório Correia da Silva
The objective of this study was to examine the experience of primary care center (PCC) users in Brazil, classified according to the quality of its structure, in relation to the aspects of accessibility, continuity, and acceptability. The source of information was the National Program to Improve Access and Quality of Primary Care in 2013-2014. A total of 109 919 interviewees in 24 055 PCCs comprised the sample. Results show that the structure of a PCC was associated with better indicators of accessibility (oral health and medicines) and continuity of care (patient navigation in the health system)...
April 2017: Journal of Ambulatory Care Management
Antônio Thomaz Gonzaga Matta-Machado, Ângela Maria L Dayrell de Lima, Daisy Maria Xavier de Abreu, Lucas Lobato Araújo, Délcio Fonseca Sobrinho, Érica Lopes Silva Araújo, Gabriel Henrique Silva Teixeira, Alaneir de Fátima Dos Santos
The use of information and communication technology (ICT) is on the increase in the health systems, representing a means of improving the quality of health care. This study analyzed the ICT incorporation in primary care in Brazil and identified the different aspects that may be associated with better quality in the care provided, in relation to certain aspects of women's care. We noted an unevenness regarding ICT incorporation in Brazil. However, the findings indicate an association between ICT and certain aspects of the quality provided in women's health care, which reinforces the need for further studies on this type of evaluation...
April 2017: Journal of Ambulatory Care Management
Matheus Neves, Jessye Melgarejo do Amaral Giordani, Alcindo Antônio Ferla, Fernando Neves Hugo
This cross-sectional study aimed to evaluate the association between sociodemographic characteristics, health care indicators, work process characteristics, and the performance of preventive dental procedures by oral health care teams (OHCTs) assessed during the first phase of the PMAQ in Brazil. A census of 10 334 primary OHCTs was conducted. The outcome included topical application of fluoride, application of sealants, detection of oral lesions, and monitoring of suspected or confirmed cases of oral cancer...
April 2017: Journal of Ambulatory Care Management
Thiago Augusto Hernandes Rocha, Núbia Cristina da Silva, Erika Bárbara Abreu Fonseca Thomaz, Rejane Christine de Sousa Queiroz, Marta Rovery de Souza, Adriana Lein, João Victor Muniz Rocha, Viviane Alvares, Dante Grapiuna de Almeida, Allan Claudius Queiroz Barbosa, Elaine Thumé, Catherine Staton, João Ricardo Nickenig Vissoci, Luiz Augusto Facchini
Cervical cancer is a common neoplasm that is responsible for nearly 230 000 deaths annually in Brazil. Despite this burden, cervical cancer is considered preventable with appropriate care. We conducted a longitudinal ecological study from 2002 to 2012 to examine the relationship between the delivery of preventive primary care and cervical cancer mortality rates in Brazil. Brazilian states and the federal district were the unit of analysis (N = 27). Results suggest that primary health care has contributed to reducing cervical cancer mortality rates in Brazil; however, the full potential of preventive care has yet to be realized...
April 2017: Journal of Ambulatory Care Management
Elaine Tomasi, Maria Aurora Dropa Chrestani Cesar, Rosália Garcia Neves, Paulo Ricardo Correa Schmidt, Elaine Thumé, Denise Silva da Silveira, Fernando Carlos Vinholes Siqueira, Bruno Pereira Nunes, Anaclaudia Gastal Fassa, Mirelle de Oliveira Saes, Suele Manjourany Silva Duro, Pamela Moraes Volz, Luiz Augusto Facchini
This article describes the primary health care offered to 8118 service users with diabetes in Brazil based on data from the PMAQ (Program to Improve Primary Care Access and Quality) first survey. Structure, access, service organization and management, and clinical care quality were analyzed. Prevalence of self-reported receipt of appropriate treatment was 14.3% (95% confidence interval [CI]: 13.4-15.2). Following adjustment, it was 26% higher (prevalence ratio [PR] = 1.26; 95% CI: 1.04-1.54) when primary health care centers had all the structure items investigated, it was 13% higher (PR = 1...
April 2017: Journal of Ambulatory Care Management
James Macinko, Matthew J Harris, Marcia Gomes Rocha
Despite some remarkable achievements, there are several challenges facing Brazil's Family Health Strategy (FHS), including expanding access to primary care and improving its quality. These concerns motivated the development of the National Program for Improving Primary Care Access and Quality (PMAQ). Although voluntary, the program now includes nearly 39 000 FHS teams in the country and has led to a near doubling of the federal investment in primary care in its first 2 rounds. In this article, we introduce the PMAQ and advance several recommendations to ensure that it continues to improve primary care access and quality in Brazil...
April 2017: Journal of Ambulatory Care Management
James Macinko, Matthew J Harris, Marcia Gomes Rocha
No abstract text is available yet for this article.
April 2017: Journal of Ambulatory Care Management
Rushika Fernandopulle
No abstract text is available yet for this article.
April 2017: Journal of Ambulatory Care Management
Kevin Quinn
This commentary analyzes the patient-centered medical home (PCMH) model within a framework of the 8 basic payment methods in health care. PCMHs are firmly within the fee-for-service tradition. Changes to the process and structure of the Resource Based Relative Value Scale, which underlies almost all physician fee schedules, could make PCMHs more financially viable. Of the alternative payment methods being considered, shared savings models are unlikely to transform medical practice whereas capitation models place unrealistic expectations on providers to accept epidemiological risk...
April 2017: Journal of Ambulatory Care Management
Billy Millwee
No abstract text is available yet for this article.
April 2017: Journal of Ambulatory Care Management
Foster Gesten
No abstract text is available yet for this article.
April 2017: Journal of Ambulatory Care Management
Kevin Fiscella
No abstract text is available yet for this article.
April 2017: Journal of Ambulatory Care Management
John Wasson
The patient-centered medical home (PCMH) costs a lot to build and maintain. Deficiencies have become apparent: it has provided few of its advertised benefits and is becoming a troubled asset. A troubled asset relief program for the PCHM is needed (PCMH-TARP). This report presents a PCMH-TARP that places patients' interests first. The PCMH-TARP addresses regulatory barriers and greatly simplifies the complexity of the PCMH blueprint. A disruptively renovated PCMH will stand on a foundation of measures that matter to patients...
April 2017: Journal of Ambulatory Care Management
(no author information available yet)
No abstract text is available yet for this article.
April 2017: Journal of Ambulatory Care Management
Brad Wright, Andrew J Potter, Amal N Trivedi
Using Medicare claims data from 2007 to 2010, we sought to determine whether dual eligibles 65 years and older who utilize federally qualified health centers (FQHCs) have lower rates of ambulatory care-sensitive hospitalizations and emergency department visits compared with nonusers. We found that FQHC use is associated with increased ambulatory care-sensitive hospitalization rates for whites and other races, but a decrease among blacks. Depending on race, FQHC use is associated with an increase of 24 to 43 ambulatory care-sensitive emergency department visits per thousand persons annually...
April 2017: Journal of Ambulatory Care Management
Ursula Koch, Asaf Bitton, Bruce E Landon, Russell S Phillips
Adoption of new primary care models has been slow in academic teaching practices. We describe a common framework that academic learning collaboratives are using to transform primary care practice based on our analysis of 6 collaboratives nationally. We show that the work of the collaboratives could be divided into 3 phases and provide detail on the phases of work and a road map for those who seek to emulate this work. We found that learning collaboratives foster transformation, even in complex academic practices, but need specific support adapted to their unique challenges...
April 2017: Journal of Ambulatory Care Management
Lusine Poghosyan, Allison A Norful, Grant R Martsolf
Developing team-based care models and expanding nurse practitioner (NP) workforce in primary care are recommended by policy makers to meet demand. Little is known how to promote interprofessional teamwork. Using a mixed-methods design, we analyzed qualitative interview and quantitative survey data from primary care NPs to explore practice characteristics important for teamwork. The Interprofessional Teamwork for Health and Social Care Framework guided the study. We identified NP-physician and NP-administration relationships; organizational support and governance; time and space for teamwork; and regulations and economic impact as important...
January 2017: Journal of Ambulatory Care Management
Leiyu Shi, De-Chih Lee, Geraldine Pierre Haile, Hailun Liang, Michelle Chung, Alek Sripipatana
This study examined access to care and satisfaction among health center patients with chronic conditions. Data for this study were obtained from the 2009 Health Center Patient Survey. Dependent variables of interest included 5 measures of access to and satisfaction with care, whereas the main independent variable was number of chronic conditions. Results of bivariate analysis and multiple logistic regressions showed that patients with chronic conditions had significantly higher odds of reporting access barriers than those without chronic conditions...
January 2017: Journal of Ambulatory Care Management
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