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Primary Care Transformation

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https://www.readbyqxmd.com/read/29621992/analytical-typology-of-multiprofessional-primary-care-models
#1
Damien Contandriopoulos, Mélanie Perroux, Aurore Cockenpot, Arnaud Duhoux, Emmanuelle Jean
BACKGROUND: There is only limited evidence to support care redefinition and role optimization processes needed for scaling up of a stronger primary care capacity. METHODS: Data collection was based on a keyword search in MEDLINE, EMBASE and CINAHL databases. Three thousand, two hundred and twenty-nine documents were identified, 1851 met our inclusion criteria, 71 were retained for full-text assessment and 52 included in the final selection. The analysis process was done in four steps...
April 5, 2018: BMC Family Practice
https://www.readbyqxmd.com/read/29617375/gender-transformative-bandebereho-couples-intervention-to-promote-male-engagement-in-reproductive-and-maternal-health-and-violence-prevention-in-rwanda-findings-from-a-randomized-controlled-trial
#2
Kate Doyle, Ruti G Levtov, Gary Barker, Gautam G Bastian, Jeffrey B Bingenheimer, Shamsi Kazimbaya, Anicet Nzabonimpa, Julie Pulerwitz, Felix Sayinzoga, Vandana Sharma, Dominick Shattuck
BACKGROUND: Rigorous evidence of the effectiveness of male engagement interventions, particularly on how these interventions impact relationship power dynamics and women's decision-making, remains limited. This study assessed the impact of the Bandebereho gender-transformative couples' intervention on impact on multiple behavioral and health-related outcomes influenced by gender norms and power relations. METHODS: We conducted a multi-site randomised controlled trial in four Rwandan districts with expectant/current fathers and their partners, who were randomised to the intervention (n = 575 couples) or control group (n = 624 couples)...
2018: PloS One
https://www.readbyqxmd.com/read/29616906/diagnostic-pathway-of-oral-cavity-cancer-in-an-integrated-health-care-system
#3
Kevin H Wang, Brian H Song, Jason E Gilde, Jeanne A Darbinian, Miranda L Ritterman Weintraub, Tara J Wu, Eleanor L Yang, James W Salazar, Deepak Gurushanthaiah
CONTEXT: Survival for patients with oral cavity squamous cell carcinoma (OCSCC) has remained relatively stagnant despite advances in treatment. Few studies have examined why advanced-stage disease is diagnosed in 40% of patients with OCSCC nationally. OBJECTIVE: To characterize the diagnostic pathway of OCSCC in an integrated health care system. DESIGN: Retrospective study of patients with OCSCC (2007-2010). MAIN OUTCOME MEASURES: Referral patterns and demographic, clinical, and tumor characteristics associated with time to diagnosis (diagnostic interval)...
March 30, 2018: Permanente Journal
https://www.readbyqxmd.com/read/29607245/future-of-health-findings-from-a-survey-of-stakeholders-on-the-future-of-health-and-healthcare-in-england
#4
Jennie Corbett, Camilla d'Angelo, Lorenzo Gangitano, Jon Freeman
This article presents findings from a survey conducted by RAND Europe at the request of the National Institute for Health Research (NIHR) to gather and synthesise stakeholder views on the future of health and healthcare in England in 20 to 30 years' time. The aim of the research was to generate an evidenced-based picture of the future health and healthcare needs, and how it might differ from today, in order to inform strategic discussions about the future priorities of the NIHR and the health and social care research communities more broadly...
April 2018: Rand Health Quarterly
https://www.readbyqxmd.com/read/29606892/management-of-abnormal-uterine-bleeding-focus-on-ambulatory-hysteroscopy
#5
REVIEW
Shilpa Kolhe
The rapid evolution in ambulatory hysteroscopy (AH) has transformed the approach to diagnose and manage abnormal uterine bleeding (AUB). The medical management in primary care remains the mainstay for initial treatment of this common presentation; however, many women are referred to secondary care for further evaluation. To confirm the diagnosis of suspected intrauterine pathology, the traditional diagnostic tool of day case hysteroscopy and dilatation and curettage in a hospital setting under general anesthesia is now no longer required...
2018: International Journal of Women's Health
https://www.readbyqxmd.com/read/29590431/an-overview-of-future-eu-health-systems-an-insight-into-governance-primary-care-data-collection-and-citizens-participation
#6
Gianluca Quaglio, Josep Figueras, Domenico Mantoan, Amr Dawood, Theodoros Karapiperis, Caroline Costongs, Enrique Bernal-Delgado
Background: Health systems in the European Union (EU) are being questioned over their effectiveness and sustainability. In pursuing both goals, they have to conciliate coexisting, not always aligned, realities. Methods: This paper originated from a workshop entitled 'Health systems for the future' held at the European Parliament. Experts and decision makers were asked to discuss measures that may increase the effectiveness and sustainability of health systems, namely: (i) increasing citizens' participation; (ii) the importance of primary care in providing integrated services; (iii) improving the governance and (iv) fostering better data collection and information channels to support the decision making process...
March 26, 2018: Journal of Public Health
https://www.readbyqxmd.com/read/29578853/michigan-pharmacists-transforming-care-and-quality-developing-a-statewide-collaborative-of-physician-organizations-and-pharmacists-to-improve-quality-of-care-and-reduce-costs
#7
Hae Mi Choe, Alexandra Tungol Lin, Kathleen Kobernik, Marc Cohen, Laurie Wesolowicz, Nabeel Qureshi, Tom Leyden, David A Share, Rozanne Darland, David A Spahlinger
BACKGROUND: Inappropriate drug use, increasing complexity of drug regimens, continued pressure to control costs, and focus on shared accountability for clinical measures drive the need to leverage the medication expertise of pharmacists in direct patient care. A statewide strategy based on the collaboration of pharmacists and physicians regarding patient care was developed to improve disease state management and medication-related outcomes. PROGRAM DESCRIPTION: Blue Cross Blue Shield of Michigan (BCBSM) partnered with Michigan Medicine to develop and implement a statewide provider-payer program called Michigan Pharmacists Transforming Care and Quality (MPTCQ), which integrates pharmacists within physician practices throughout the state of Michigan...
April 2018: Journal of Managed Care & Specialty Pharmacy
https://www.readbyqxmd.com/read/29559000/too-afraid-to-go-fears-of-dignity-violations-as-reasons-for-non-use-of-maternal-health-services-in-south-sudan
#8
Sumit Kane, Matilda Rial, Maryse Kok, Anthony Matere, Marjolein Dieleman, Jacqueline E W Broerse
BACKGROUND: South Sudan has one of the worst health and maternal health situations in the world. Across South Sudan, while maternal health services at the primary care level are not well developed, even where they exist, many women do not use them. Developing location specific understanding of what hinders women from using services is key to developing and implementing locally appropriate public health interventions. METHODS: A qualitative study was conducted to gain insight into what hinders women from using maternal health services...
March 20, 2018: Reproductive Health
https://www.readbyqxmd.com/read/29553080/china-s-achievements-and-challenges-in-improving-health-insurance-coverage
#9
Cuirong Zhao, Chao Wang, Chengwu Shen, Qian Wang
China has undertaken waves of healthcare reforms to keep pace with its rapid economic growth. By 2011, universal health insurance coverage was successfully achieved through the creation of a basic social medical insurance system. Growing economic power, extensive government subsidies, and strategies for program implementation are critical to that achievement. However, the breadth and depth of coverage varies considerably across insurance schemes and localities. The disjointed insurance scheme led to inequality in coverage, accessibility, and affordability of medical services, lopsided allocation of health resources, and increasing medical expenditures, and these remain crucial challenges for healthcare insurance coverage...
2018: Drug Discoveries & Therapeutics
https://www.readbyqxmd.com/read/29535239/barriers-and-facilitators-to-expanding-roles-of-medical-assistants-in-patient-centered-medical-homes-pcmhs
#10
Jeanne M Ferrante, Eric K Shaw, Jennifer E Bayly, Jenna Howard, M Nell Quest, Elizabeth C Clark, Connie Pascal
BACKGROUND: Many primary care practices participating in patient-centered medical home (PCMH) transformation initiatives are expanding the work roles of their medical assistants (MAs). Little is known about attitudes of MAs or barriers and facilitators to these role changes. METHODS: Secondary data analysis of qualitative cross-case comparison study of 15 New Jersey primary care practices participating in a PCMH project during 2012 to 2013. Observation field notes and in-depth and key informant interviews (with physicians, office managers, staff and care coordinators) were iteratively analyzed using grounded theory...
March 2018: Journal of the American Board of Family Medicine: JABFM
https://www.readbyqxmd.com/read/29531108/moving-from-problem-oriented-to-goal-directed-health-records
#11
Zsolt J Nagykaldi, Huibert Tange, Jan De Maeseneer
Electronic health records (EHRs) have been in place for decades; however, most existing systems were designed in the prevailing disease- and payment-focused care paradigm that often loses sight of the goals, needs, and values of patients and clinicians. The goal-directed health care model was proposed more than 20 years ago, but no design principles have been developed for corresponding electronic record systems. Newly designed EHRs are needed to facilitate health care that is anchored by patient life and health goals...
March 2018: Annals of Family Medicine
https://www.readbyqxmd.com/read/29525916/transformation-of-a-pediatric-primary-care-waiting-room-creating-a-bridge-to-community-resources
#12
Adrienne W Henize, Andrew F Beck, Melissa D Klein, John Morehous, Robert S Kahn
Introduction Children and families living in poverty frequently encounter social risks that significantly affect their health and well-being. Physicians' near universal access to at-risk children and their parents presents opportunities to address social risks, but time constraints frequently interfere. We sought to redesign our waiting room to create a clinic-to-community bridge and evaluate the impact of that redesign on family-centered outcomes. Methods We conducted a pre-post study of a waiting room redesign at a large, academic pediatric primary care center...
March 10, 2018: Maternal and Child Health Journal
https://www.readbyqxmd.com/read/29522688/transformation-of-medical-education-through-decentralised-training-platforms-a-scoping-review
#13
Motlatso Mlambo, Abigail Dreyer, Rainy Dube, Nontsikelelo Mapukata, Ian Couper, Richard Cooke
INTRODUCTION: Medical education in South Africa is facing a major paradigm shift. The urgency to increase the number of suitable, qualified and socially accountable health sciences graduates has brought to the fore the need to identify alternative training platforms and learning environments, often in rural areas. Subsequently, the focus has now shifted towards strengthening primary health care and community based health services. This scoping review presents a synopsis of the existing literature on decentralized training platform (DTP) strategies for medical education internationally, outlining existing models within it and its impact...
March 2018: Rural and Remote Health
https://www.readbyqxmd.com/read/29514605/predictive-value-of-spot-versus-24-hour-measures-of-proteinuria-for-death-end-stage-kidney-disease-or-chronic-kidney-disease-progression
#14
Tracey Ying, Philip Clayton, Chetana Naresh, Steven Chadban
BACKGROUND: Proteinuria is well recognised as a marker of chronic kidney disease (CKD), as a risk factor for progression of CKD among those with known CKD, and as a risk factor for cardiovascular events and death among both the general and CKD populations. Which measure of proteinuria is most predictive of renal events remains uncertain. METHODS: We conducted a prospective study with 144 proteinuric CKD and kidney transplant recipients attending an outpatient clinic of a tertiary care hospital in Australia...
March 7, 2018: BMC Nephrology
https://www.readbyqxmd.com/read/29514547/managing-professional-knowledge-boundaries-during-echo-telementoring-consultations-in-two-veterans-affairs-specialty-care-liver-clinics-a-theme-oriented-discourse-analysis
#15
Christopher J Koenig, Matthew Wenger, Glenn D Graham, Steven Asch, Catherine Rongey
Introduction Consultations are the traditional method of communication between generalist and specialist providers managing patients with specialty care needs. Traditional written consultations have limitations, including inadequate clinical information and inappropriate, or unclear consultation questions. Teleconsultations minimize these limitations through real-time communication between generalist and specialist providers to actively manage professional knowledge boundaries about specialty care problems...
January 1, 2018: Journal of Telemedicine and Telecare
https://www.readbyqxmd.com/read/29510010/-the-actual-approaches-to-reformation-of-medical-organizations-providing-out-patient-care-to-population
#16
A I Vialkov, G P Skvirskaia, I M Son, A Sh Senenko, I A Kupeieva, V B Rosanov, S A Leonov, F K Bilalov, A V Gajeva, V A Evdakov, N A Kravtchenko
The article presents analysis of the system of organization of primary medical sanitary care in the Russian Federation, its strong and weak aspects are emphasized. The main indices of out-patient care of population and their dynamics are considered. The necessity of system development is substantiated with the purpose of supporting accessibility and quality of medical care in out-patient conditions. The concept of development of organizational functional model of primary medical sanitary care in actual conditions is presented...
July 2017: Problemy Sot︠s︡ialʹnoĭ Gigieny, Zdravookhranenii︠a︡ i Istorii Medit︠s︡iny
https://www.readbyqxmd.com/read/29507699/grade-progression-in-urothelial-carcinoma-can-occur-with-high-or-low-mutational-homology-a-first-step-toward-tumor-specific-care-in-initial-low-grade-bladder-cancer
#17
Ralf Kittler, Christine Shiang, Ryan Hutchinson, Rahul K Kollipara, Payal Kapur, Francis Franto, Yair Lotan
Purpose: Low-grade (LG) urothelial carcinomas of the bladder (UCB) are common malignancies that are costly to surveil and rarely progress to life threatening, high-grade (HG) malignancies. It is unknown if the progression of LG to HG is a result of second primary tumors or transformation of existing LG tumors. We examined tumor genetics in patients with grade progression in urothelial carcinoma and compared to patients with no progression. Results: Five patients were identified with progression...
February 6, 2018: Oncotarget
https://www.readbyqxmd.com/read/29505371/oregon-s-emphasis-on-equity-shows-signs-of-early-success-for-black-and-american-indian-medicaid-enrollees
#18
K John McConnell, Christina J Charlesworth, Thomas H A Meath, Rani M George, Hyunjee Kim
In 2012 Oregon transformed its Medicaid program, providing coverage through sixteen coordinated care organizations (CCOs). The state identified the elimination of health disparities as a priority for the CCOs, implementing a multipronged approach that included strategic planning, community health workers, and Regional Health Equity Coalitions. We used claims-based measures of utilization, access, and quality to assess baseline disparities and test for changes over time. Prior to the CCO intervention there were significant white-black and white-American Indian/Alaska Native disparities in utilization measures and white-black disparities in quality measures...
March 2018: Health Affairs
https://www.readbyqxmd.com/read/29502089/factors-affecting-decisions-to-extend-access-to-primary-care-results-of-a-qualitative-evaluation-of-general-practitioners-views
#19
Sally Fowler Davis, Hilary Piercy, Sarah Pearson, Ben Thomas, Shona Kelly
OBJECTIVES: To report general practitioners' (GPs') views and experiences of an Enhanced Primary Care programme (EPCP) funded as part of the Prime Minister's Challenge Fund (second wave) for England which aimed to extend patient access to primary care. SETTING: Primary care in Sheffield, England. PARTICIPANTS: Semi-structured interviews with a purposive sample of GPs working in 24 practices across the city. RESULTS: Four core themes were derived: GPs' receptivity to the aims of the EPCP, their capacity to support integrated care teams, their capacity to manage urgent care and the value of some new community-based schemes to enhance locality-based primary care...
March 3, 2018: BMJ Open
https://www.readbyqxmd.com/read/29499843/impact-of-multidisciplinary-standardization-of-care-for-gastroschisis-treatment-outcomes-and-cost
#20
Candace Haddock, Al Ghalgya Al Maawali, Joseph Ting, Julie Bedford, Kourosh Afshar, Erik D Skarsgard
BACKGROUND/PURPOSE: Elimination of unnecessary practice variation through standardization creates opportunities for improved outcomes and cost-effectiveness. A quality improvement (QI) initiative at our institution used evidence and consensus to standardize management of gastroschisis (GS) from birth to discharge. METHODS: An interdisciplinary team utilized best practice evidence and expert opinion to standardize GS care. Following stakeholder engagement and education, care standardization was implemented in September 2014...
February 7, 2018: Journal of Pediatric Surgery
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