Do family physicians need more payment for working better? Financial incentives in primary care

IntroductionFinancial incentives are widely used in health services to improve the quality of care or to reach some specific targets. Pay for performance systems were also introduced in the primary health care systems of many European countries.ObjectiveOur study aims to describe and compare recent existing primary care indicators and related financing in European countries.MethodsLiterature search was performed and questionnaires were sent to primary care experts of different countries within the European General Practice Research Network.ResultsTen countries have published primary care quality indicators (QI) associated with financial incentives. The number of QI varies from 1 to 134 and can modify the finances of physicians with up to 25% of their total income.ConclusionsThe implementations of these schemes should be critically evaluated with continuous monitoring at national or regional level; comparison is required between targets and their achievements, health gains and use of resources as well.     

Fall Prevention Research and Practice: A Total Worker Safety Approach

Slips, trips, and falls (STF) represent a serious hazard to workers and occupants in many industries, homes, and communities. Often, the cause of a STF incident is multifactorial, encompassing human, environmental, and task risk factors. A STF-related disability can greatly diminish the occupational capability and quality of life of individuals in both the workplace and the home. Countering STF hazards and risks both on and off the job and on all aspects of control measures is a “total worker safety” matter, a challenging yet tangible undertaking. As the federal organization responsible for conducting research for the prevention of work-related injuries in the United States, the National Institute for Occupational Safety and Health (NIOSH) has been conducting research on STF controls for some decades. Many NIOSH research outcomes have been utilized for STF prevention in workplaces, with potential for prevention in homes as well. This paper summarizes the concept of total worker safety for STF control, NIOSH priority research goals, major activities, and accomplishments, and some emerging issues on STF. The strategic planning process for the NIOSH research goals and some identified research focuses are applicable to the development and implementation of global STF research goals.     

TO THE EDITOR

No abstract available for this article.     

Comparative Cost Analysis of Clinical Reminder for HIV Testing at the Veterans Affairs Healthcare System

ObjectiveTo estimate the cost and health outcomes associated with a new HIV testing strategy that utilizes routine-based clinical reminders.MethodsWe conducted an economic analysis of 1) traditional pretest/post-test counseling; 2) counseling and a new clinical reminders system; and 3) only clinical reminder in the veterans’ health care system. A payer-perspective decision model was conducted to calculate the 1-year budget impact of three HIV testing strategies. Parameter values were obtained from the literature, including patients’ probability of accepting test, and costs associated with HIV testing procedures. Deidentified patient data, including total population screened and number of new HIV cases, were collected from one clinic in Los Angeles, California, from August 2004 to December 2011. Annual total costs and costs per new case were calculated on the basis of parameter values and patient data. Sensitivity analyses were conducted to evaluate the robustness of the critical variable on costs.ResultsThe total cost of the clinical reminder system with pretest counseling was $81,726 over 1 year compared with $109,208 for traditional HIV testing. Under a clinical reminder system with no pretest counseling, the number of HIV tests performed and the number of new diagnoses increased for that year. In addition, cost per new diagnoses was the lowest.ConclusionsThe clinical reminder system can reduce the cost per cases identified and promote better performance of HIV testing compared with traditional HIV testing. The fundamental decision model can be used for hospital facilities outside the Veteran Affairs adopting a similar program for improving the HIV testing rate.     

面向中小型医院的移动医疗信息系统构建

阐述制约移动医疗信息系统在中小型医院发展的因素,总结在中小型医院建设移动医疗信息系统的策略,分析安卓系统作为医疗信息系统开发平台的优点,在此基础上设计一个适合中小型医院的移动医疗信息系统的模型,详细介绍系统设计原则、结构、为客户端提供服务的方式等方面。     

Knowledge and awareness of adverse drug reactions and pharmacovigilance practices among healthcare professionals in Al-Madinah Al-Munawwarah,Kingdom of Saudi Arabia

Adverse Drug Reactions (ADRs) are scantly reported with poor contribution by healthcare professionals worldwide and in particular in developing countries. The aim of this study was to assess the knowledge and awareness of adverse drug reactions (ADRs) reporting and pharmacovigilance system among healthcare professionals in Al-Madinah Al-Munawwarah hospitals, Kingdom of Saudi Arabia. A questionnaire was designed addressing; awareness of ADRs, knowledge of pharmacovigilance system, availability of ADRs reporting system, patient counseling about ADRs and documentation of ADRs. The questionnaire was distributed to randomly selected healthcare professionals (n = 585) such as physicians, pharmacists, nurses and pharmacists’ technicians of hospitals. Completed questionnaires were collected and data were analyzed. Data were expressed in number as well as percentage. Of the 585 questionnaires circulated, a total of 384 healthcare professionals responded. Healthcare professional categories involved in the study were 148 physicians, 37 pharmacists, 158 nurses and 41 pharmacist technicians. The percent of the respondents who accepted to enroll in the study was 65.64%. Most of the respondents were unable to correctly define the pharmacovigilance term, but they were aware of ADRs. The awareness among healthcare professionals of the national pharmacovigilance system was 39.6%. Pharmacists had a good knowledge of pharmacovigilance and ADRs terminology and showed a more positive attitude to report ADRs. A greater number of the healthcare professionals were aware of ADRs reporting, but practically it is not implemented in hospitals. Most hospitals had follow-up documentation systems, but did not include ADRs reporting. There was no distinct pharmacovigilance system in place. Our study has demonstrated a lack of knowledge and awareness of pharmacovigilance and ADRs reporting among healthcare professionals in hospitals. The poor knowledge of ADRs reporting emphasized the urgent need to implement the appropriate strategies to improve the awareness of pharmacovigilance practices and ADRs reporting in Al-Madinah Al-Munawwarah hospitals.     

Accounting for personal and professional choices for pandemic influenza vaccination amongst English healthcare workers

BackgroundHealthcare workers (HCWs) are encouraged to get vaccinated during influenza pandemics to reduce their own, and patients’, risk of infection, and to encourage their patients to get immunised. Despite extensive research on HCWs’ receipt of vaccination, little is known about how HCWs articulate pandemic influenza vaccination advice to patients.AimsTo explore HCWs’ uptake of the A/H1N1 vaccine during the pandemic of 2009–2010, their recommendations to patients at the time, and their anticipated choices around influenza vaccination under different pandemic scenarios.MethodWe conducted semi-structured interviews and focus groups with eight vaccinated and seventeen non-vaccinated HCWs from primary care practices in England. The data was analysed using thematic analysis.ResultsThe HCWs constructed their receipt of vaccination as a personal choice informed by personal health history and perceptions of vaccine safety, while they viewed patients’ vaccination as choices made following informed consent and medical guidelines. Some HCWs received the A/H1N1 vaccine under the influence of their local practice organizational norms and values. While non-vaccinated HCWs regarded patients’ vaccination as patients’ choice, some vaccinated HCWs saw it also as a public health issue. The non-vaccinated HCWs emphasised that they would not allow their personal choices to influence the advice they gave to patients, whereas some vaccinated HCWs believed that by getting vaccinated themselves they could provide a reassuring example to patients, particularly those who have concerns about influenza vaccination. All HCWs indicated they would accept vaccination under the severe pandemic scenario. However, most non-vaccinated HCWs expressed reticence to vaccinate under the mild pandemic scenario.ConclusionsProviding evidence-based arguments about the safety of new vaccines and the priority of public health over personal choice, and creating strong social norms for influenza vaccination as part of the organizational culture, should increase uptake of influenza vaccination among primary care HCWs and their patients.