The Indigenous primary health care and policy research network: Guiding innovation within primary health care with Indigenous peoples in Alberta

In 2015, the Truth and Reconciliation Commission of Canada released its Final Report with 94 Calls to Action, several of which called upon the health care sector to reform based on the principles of reconciliation. In the province of Alberta, Canada, numerous initiatives have arisen to address the health legacy Calls to Action, yet there is no formal mechanism to connect them all. As such, these initiatives have resulted in limited improvements overall. Recognizing the need for clear leadership, responsibility, and dedicated funding, stakeholders from across Alberta were convened in the Spring of 2019 for two full-day roundtable meetings to provide direction for a proposed Canadian Institutes of Health Research Network Environment for Indigenous Health Research that focused on primary health care and policy research. The findings from these roundtable meetings were synthesized and integrated into the foundational principles of the Indigenous Primary Health Care and Policy Research (IPHCPR) Network. The IPHCPR Network has envisioned a renewed and transformed primary health care system to achieve Indigenous health equity, aligned with principles and health legacy Calls to Action advocated by the Truth and Reconciliation Commission of Canada.     

Total partnership for primary health care provision: a proposed model--Part II

This is the second part in a paper which studied the dynamics of primary health care provision. This paper examines external factors related to the management of General Practices. The study revealed that there are major problems at GP/FHSA interfaces involving poor communications, needs evaluation and understanding, and the lack of teamwork. The paper argues that attempts by FHSAs in terms of initiatives are so far failing and have not effectively been able to build strong partnerships between the parties concerned. The paper concludes by proposing a Model of Total Partnership for effective primary health care provision. The model suggests that structures need to be modified in a horizontal way, focusing on patients and building a collaborative way between FHSAs and GPs in a seamless fashion. The model is based on Total Quality Management (TQM) principles and is represented by the building of a customer-supplier chain, the spirit of continuous improvement and synergy through teamwork with the ultimate goal of Total Patient Satisfaction.     

Total partnership for primary health care provision: a proposed model: Part I

Presents the first of a two part paper, based on a study which examined the dynamics of primary health care provision. The study examined 49 general practices in the Kirklees area, UK, through a detailed questionnaire mode. The response was 67 per cent covering the views of 106 doctors. To capture further input for the study, an in-depth seminar with nine doctors from a range of practices was conducted. Examines internal factors for managing general practices and the levels of competence in addressing financial, strategic, quality issues and whether general practices get involved in any external activities for new learning and benchmarking. Comprehensively covers common areas of concern and areas where expertise may be inadequate or lacking.     

The physician-hospice partnership: expanding opportunities to improve end-of-life care

People living with a life-limiting illness require expert medical care to control often debilitating symptoms. Beyond physical care issues, people at the end of life also need emotional and spiritual support for themselves and their loved ones. Hospices offer a range of services via an interdisciplinary team to meet the specialized needs of people at the end of life. This article will explore the physician-hospice partnership and the benefits to patients, family caregivers, and physicians when hospice care is accessed early in the dying process. Benefits of interdisciplinary, patient/family-directed care will be discussed. The range of palliative services being offered by many hospices will also be presented as a mechanism to increase access to end-of-life services for patients and family caregivers.     

提高农村基层卫生服务绩效管理水平——中国农村卫生发展项目40县绩效改革设计与效果

世行贷款/英国赠款中国农村卫生发展项目(简称"卫十一项目")于2008年开始在我国8个省40个项目县引入绩效管理的思想,开展以绩效计划、绩效沟通、绩效考核、绩效改进为主要内容的循环管理,以绩效持续改进为目标,建立基于卫生服务绩效的激励机制。经过5年的试点,40个项目县中建成了若干个具有示范意义的绩效管理先进县,在改善卫生服务质量、提高基层医疗卫生机构管理者和员工的积极性、提高卫生服务效率等方面,取得了较好的效果,积累了一定的经验。绩效考核始终以质量为核心;经济激励与非经济激励措施有机结合;全员参与以保证绩效改善的可持续性;系统化的绩效管理思想应得到充分运用,以有效提升农村基层卫生服务绩效管理水平。     

Primary health care contribution to improve health outcomes in Bogota-Colombia: a longitudinal ecological analysis

ABSTRACT: BACKGROUND: Colombia has a highly segmented and fragmented national health system that contributes to inequitable health outcomes. In 2004 the district government of Bogota initiated a Primary Health Care (PHC) strategy to improve health care access and population health status. This study aims to analyse the contribution of the PHC strategy to the improvement of health outcomes controlling for socioeconomic variables. METHODS: A longitudinal ecological analysis using data from secondary sources was carried out. The analysis used data from 2003 and 2007 (one year before and 3 years after the PHC implementation). A Primary Health Care Index (PHCI) of coverage intensity was constructed. According to the PHCI, localities were classified into two groups: high and low coverage. A multivariate analysis using a Poisson regression model for each year separately and a Panel Poisson regression model to assess changes between the groups over the years was developed. Dependent variables were infant mortality rate, under-5 mortality rate, infant mortality rate due to acute diarrheal disease and pneumonia, prevalence of acute malnutrition, vaccination coverage for diphtheria, pertussis, tetanus (DPT) and prevalence of exclusive breastfeeding. The independent variable was the PHCI. Control variables were sewerage coverage, health system insurance coverage and quality of life index. RESULTS: The high PHCI localities as compared with the low PHCI localities showed significant risk reductions of under-5 mortality (13.8%) and infant mortality due to pneumonia (37.5%) between 2003 and 2007. The probability of being vaccinated for DPT also showed a significant increase of 4.9%. The risk of infant mortality and of acute malnutrition in children under-5 years was lesser in the high coverage group than in the low one; however relative changes were not statistically significant. CONCLUSIONS: Despite the adverse contextual conditions and the limitations imposed by the Colombian health system itself, Bogota's initiative of a PHC strategy has successfully contributed to the improvement of some health outcomes.     

Home health care may improve diabetic outcomes among non-English speaking patients in primary care practice: a pilot study

There are multiple challenges to proactive diabetic management in minority, non-English speaking populations. In this study, we seek to determine if enrollment in a home health care program would improve diabetic outcomes in this traditionally vulnerable population. Of the 64 non-English speaking diabetics evaluated in our clinic between 1/1/2002 and 12/30/2005, 26 (40.6%) patients who met the criteria for poor glycemic control (defined by HgbA1c > 8% on two separate occasions) were identified, but three were excluded because they did not participate in home health. Comparing diabetic outcomes 24 months post-home health intervention to 24 months prior, patients showed improvement in mean HbA1c, mean LDL, and mean systolic blood pressure. With home health intervention, there appears to be improved diabetic outcomes across all measured parameters.     

Insurance status and access to primary health care:disparate outcomes for potentially preventable hospitalization

This study examines associations between hospitalization for ambulatory care sensitive (ACS) conditions and insurance status for working age adults, and for people age 65 and older. ACS hospitalization is a recognized indicator of access to primary care. Using data from the 1997 U.S. Nationwide Inpatient Sample and the U.S. Census, we calculate population-based rates of ACS hospitalization. We also use the 1997 Medical Expenditure Panel Survey to calculate the prevalence of ACS conditions in the groups studied. Among working age adults, those receiving Medicaid and the uninsured had higher ACS hospitalization rates than insured individuals, even after adjusting for the prevalence of ACS conditions. Among Medicare beneficiaries, those who also received Medicaid benefits had higher ACS hospitalization rates than others, again after adjusting for the prevalence of ACS conditions; those with private insurance supplementing Medicare had lower ACS hospitalization rates.     

Will changes in primary care improve health outcomes? Modelling the impact of financial incentives introduced to improve quality of care in the UK

Objectives: To estimate the total health gain from improving the quality of care among patients with cardiovascular disease in line with the quality indicator targets in the new contract for general practitioners (GPs) in the UK.

Design: Statistical modelling, applying population impact measures to estimate cardiovascular health gains from achieving treatment targets in the GP contract, taking into account current levels of treatment and control.

Main outcome measures: Number of events prevented in the population over 5 years applied to a notional general practice population of 10 000.

Results: The greatest health gain in those aged 45–84 years would come from reaching cholesterol reduction targets. This could prevent 15 events in people with coronary heart disease, seven events in those with a history of stroke, and seven events in those with diabetes. Achieving blood pressure control targets in hypertensive patients without the above conditions could prevent 15 cardiovascular events, with further benefits from reducing blood pressure in patients with high blood pressure and coronary heart disease, stroke, or diabetes. Achieving other targets would have smaller impacts because high levels of care are already being achieved or because of the low prevalence of conditions or associated event risk.

Conclusion: It is possible to quantify the health gain to a practice population of achieving quality targets such as those set in the new GP contract. The amount of health gain is sensitive to current quality of care, prevalence of conditions, and risk factors, and to the size of change anticipated. Nevertheless, it appears that significant health gains could result from achieving the proposed quality targets.

     

Appropriate research for primary health care: an anthropologist's view

In Primary Health Care (PHC) projects, it has become customary to conduct all-purpose surveys early in the project. These are usually based on questionnaires administered to a relatively large sample of the population and elicit information on demography, living conditions, health status, sanitary facilities and socio-economic attributes of the population, in addition to providing baseline data on the indicators of program success. It is recommended that a distinction be made between different types of data collection efforts and that consideration be given to the timing of such surveys so as not to raise community expectations. Early in the project a survey of demographic characteristics and health indicators may be appropriate. However, major surveys of living conditions and health problems are better delayed until the program is in operation and such surveys can be used as mechanisms for community participation, motivation and education. The limitations on the use of questionnaires is discussed. Because anthropological methods are more suited to the skills of health promoters and yield valuable behavioral data, it is suggested that anthropologists encourage the use of these alternatives to questionnaires. The use of participant-observation, life stories, interviews, mapping and essays are discussed in the context of PHC programs.     

Recommendations to improve preconception health and health care: strategies for implementation

Promoting preconception health and health care is widely accepted as a useful prevention strategy to lessen adverse maternal and infant health outcomes. There remains, however, a lack of national standards of practice or a comprehensive agenda to ensure that all women of childbearing age receive appropriate services that will enable them to achieve optimal health before any pregnancy. To address this need, the Centers for Disease Control and Prevention (CDC) launched the Preconception Health and Health Care Initiative, which aims to improve the health of women before pregnancy. In 2005, the CDC sponsored the first National Summit on Preconception Care, bringing together over 400 participants to share their expertise and information about various activities currently underway. In conjunction with the National Summit, a Select Panel on Preconception Care, a group of experts and representatives of 35 national organizations and 22 CDC programs, was convened. Based on the literature, presentations made at the National Summit, and deliberations during the Select Panel meeting, the recommendations to improve Preconception Health and Health Care--United States were developed. In order to move the recommendations from paper to practice, the Select Panel was convened to develop strategies to implement the recommendations across three areas: clinical practice, consumer roles, and public health practice. Future plans include developing a research agenda, supporting existing and new research activities, and developing policy and financing initiatives that will advance the practice of preconception health and health care. In addition, a Second National Summit is being planned. This paper describes current and future activities to implement the recommendations.