Abstract Background Changes in demographics with an older population, the illness panorama with increasing prevalence of non-communicable diseases, and the shift from hospital care to home-based care ...place demand on primary health care, which requires multiprofessional collaboration and team-based organization of work. The COVID-19 pandemic affected health care in various ways, such as heightened infection control measures, changing work practices, and increased workload. Objectives This study aimed to investigate the association between primary care practices’ organization, and quality and safety changes during the COVID-19 pandemic. Design Data were collected from 38 countries in a large online survey, the PRICOV-19 study. For this paper, the participating practices were categorized as “Only GPs”, comprising practices with solely general practitioners (GPs) and/or GP trainees, without any other health care professionals ( n = 1,544), and “Multiprofessional,” comprising practices with at least one GP or GP trainee and one or more other health professionals ( n = 3,936). Results Both categories of practices improved in infection control routines when compared before and during the COVID-19 pandemic. A larger proportion of the multiprofessional practices changed their routines to protect vulnerable patients. Telephone triage was used in more “Multiprofessional” practices, whereas “Only GPs” were more likely to perform video consultations as an alternative to physical visits. Both types of practices reported that the time to review new guidelines and scientific literature decreased during the pandemic. However, both had more meetings to discuss directives than before the pandemic. Conclusions Multiprofessional teams were keener to introduce changes to the care organization to protect vulnerable patients. However, practices with only GPs were found to be more aligned with video consultations, perhaps reflecting the close patient-doctor relationship. In contrast, telephone triage was used more in multiprofessional teams.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The COVID-19 pandemic substantially magnified the inequity gaps among vulnerable populations. Both public health (PH) and primary health care (PHC) have been crucial in addressing the challenges ...posed by the pandemic, especially in the area of vulnerable populations. However, little is known about the intersection between PH and PHC as a strategy to mitigate the inequity gap. This study aims to assess the collaboration between PHC and PH with a focus on addressing the health needs of vulnerable populations during the COVID-19 pandemic across jurisdictions. We analyzed and compared data from jurisdictional reports of COVID-19 pandemic responses in PHC and PH in Belgium, Canada (Ontario), Germany, Italy, Japan, the Netherlands, Norway, and Spain from 2020 to 2021. Four themes emerge from the analysis: (1) the majority of the countries implemented outreach strategies targeting vulnerable groups as a means to ensure continued access to PHC; (2) digital assessment in PHC was found to be present across all the countries; (3) PHC was insufficiently represented at the decision-making level; (4) there is a lack of clear communication channels between PH and PHC in all the countries. This study identified opportunities for collaboration between PHC and PH to reduce inequity gaps and to improve population health, focusing on vulnerable populations. The COVID-19 response in these eight countries has demonstrated the importance of an integrated PHC system. Consequently, the development of effective strategies for responding to and planning for pandemics should take into account the social determinants of health in order to mitigate the unequal impact of COVID-19. Careful, intentional coordination between PH and PHC should be established in normal times as a basis for effective response during future public health emergencies. The pandemic has provided significant insights on how to strengthen health systems and provide universal access to healthcare by fostering stronger connections between PH and PHC.
Introduction
Medical deserts are a growing phenomenon across many European countries. They are usually defined as (i) rural areas, (ii) underserved areas or (iii) by applying a measure of ...distance/time to a facility or a combination of the three characteristics. The objective was to define medical deserts in Spain as well as map their driving factors and approaches to mitigate them.
Methods
A mixed methods approach was applied following the project “A Roadmap out of medical deserts into supportive health workforce initiatives and policies” work plan. It included the following elements: (i) a scoping literature review; (ii) a questionnaire survey; (iii) national stakeholders' workshop; (iv) a descriptive case study on medical deserts in Spain.
Results
Medical deserts in Spain exist in the form of mostly rural areas with limited access to health care. The main challenge in their identification and monitoring is local data availability. Diversity of both factors contributing to medical deserts and solutions applied to eliminate or mitigate them can be identified in Spain. They can be related to demand for or supply of health care services. More national data, analyses and/or initiatives seem to be focused on the health care supply dimension.
Conclusions
Addressing medical deserts in Spain requires a comprehensive and multidimensional approach. Effective policies are needed to address both the medical staff education and planning system, working conditions, as well as more intersectoral approach to the population health management.
Highlights
Existence of medical deserts have been a growing concern among many European countries.
In Spain they are mostly identified as rural, often isolated and/or depopulated areas.
Health care demand and supply characteristics define and influence medical deserts.
Mitigating medical deserts in Spain requires a comprehensive and multisectoral approach.
IntroductionEvidence shows that gender has a substantial impact on health behaviours, access to and use of health systems and health system responses. This study aims to assess gender bias in ...patients subjected to low-value practices in the primary care setting and to develop recommendations for reducing adverse events that women experience for this reason.Methods and analysisA Delphi study will be performed to reach a consensus on the ‘Do Not Do’ recommendations with a possible gender bias. A retrospective cohort study in a random selection of medical records will then be carried out to identify the frequency of adverse events that occur when the selected ‘Do Not Do’ recommendations are ignored. Qualitative research techniques (consensus conference and nominal group) will be carried out to develop recommendations to address any gender bias detected, considering barriers and facilitators in clinical practice.Ethics and disseminationThe study was approved by the ethics committee of San Juan de Alicante Hospital (San Juan de Alicante, Spain) Reference N. 21/061. We will disseminate the research findings via peer-reviewed articles, presentations at national and international scientific forums and webinars.Trial registration numberThe study was registered at ClinicalTrials.gov (NCT05233852) on 10 February 2022.
CONTEXT: The COVID-19 pandemic highlights the importance of strong public health (PH) and primary health care (PHC) systems to respond nimbly and effectively during times of crisis. Both play a ...crucial role in triage and prevention, management, vaccination, and communication. PH and PHC systems, however, often act in parallel streams, but rarely together. OBJECTIVE: This study aims to describe PH and PHC collaboration during the COVID-19 pandemic in eight high-income countries. METHODS: In-depth case study reports were generated for each country or jurisdiction. Reports searched both peer-review publications and grey literature on five dimensions identified by the World Health Organization regarding COVID-19 management. Reports included country-specific health system descriptions, PH and PHC actions during the pandemic, and an evaluation of strengths and weaknesses. Expert validation was conducted by internal country stakeholders prior to cross-jurisdiction analyses. ANALYSIS: Thematic content analysis was conducted on all reports to develop a coding framework. Codes were identified that were relevant to the research questions. The study team discussed and reconciled discrepancies in themes until consensus was reached. RESULTS: Data was collected from eight high-income countries (Belgium, Canada, Germany, Italy, Japan, the Netherlands, Norway, and Spain) from March 2020 to July 2021. Four key themes were identified along with respective strengths/weaknesses. 1) Health information systems: this played a critical role for disease containment and management when designed for efficient data management and cross-sectoral data-sharing. 2) Communication: In countries where PHC was engaged early on, PH messages were amplified; in other countries, a lack of cohesion in communication resulted in poor or delayed community-level responses. 3) Human resource capacity: Health human resources were overwhelmed, with many staff redeployed and undertrained. 4) Professional training: Health professionals who received dual training in PH and PHC acted as strong community champions and may be a bridge for future pandemics. CONCLUSION: Health system needs shifted dramatically throughout the COVID-19 pandemic. Our findings highlight four key lessons regarding PH and PHC collaboration from eight high-income countries. Future pandemic preparedness should focus on health information systems and data management, PH communication, health human resources, and education and training.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
Los médicos de familia atendemos una gran variedad de pacientes, con un amplio rango de complejidad, en poco tiempo y con pocos medios diagnósticos. Esta situación hace más vulnerables a los ...profesionales de atención primaria a los errores diagnósticos (EEDD). Por ello, un adecuado proceso de razonamiento clínico es la herramienta más potente con la que contamos para orientar con seguridad el proceso asistencial de los pacientes. El hecho de considerar estos errores como oportunidades perdidas de un diagnóstico correcto, que pueden producir daño al paciente, nos lleva como profesionales a revisar cómo mejorar dicho proceso. La revisión incluye, entre otros aspectos, identificar sesgos cognitivos, analizar las formas de organización del trabajo en los equipos de atención primaria y situaciones del contexto asistencial que pueden contribuir a dichos errores. En este artículo describimos los EEDD y sus factores causales más frecuentes en atención primaria, el impacto que tienen los fallos de los procesos cognitivos, las situaciones de sobrediagnóstico y las cascadas diagnósticas y terapéuticas asociadas a estos. Finalmente, proponemos un conjunto de herramientas para mejorar la toma de decisiones en el proceso diagnóstico en atención primaria.
Family doctors see a wide range of patients, with a wide range of complexity, in a short time and with few diagnostic resources. This situation makes primary care professionals more vulnerable to diagnostic errors. For this reason, an adequate clinical reasoning process is the most powerful tool family doctors have to safely guide the patient care process. Considering these errors as missed opportunities for a correct diagnosis, which may cause harm to the patient, leads us as professionals to review how to improve this process. The review includes, among other aspects, identifying cognitive biases, analysing the ways in which work is organised in primary care teams, and situations in the care context that may contribute to such errors. In this article we describe the most frequent diagnostic errors and their causal factors in primary care, the impact of cognitive process failures, situations of overdiagnosis and the diagnostic and therapeutic cascades associated with them. Finally, we propose a set of tools to improve decision-making in the diagnostic process in primary care.
Conflicts of interest in the medical profession Altisent, Rogelio; Delgado-Marroquín, María-Teresa; Astier-Peña, María-Pilar
Atención primaria,
10/2019, Letnik:
51, Številka:
8
Journal Article
Recenzirano
Odprti dostop
In the last decades the world of medicine has become familiar with the disclosure of conflicts of interest (CDI). The requirement for authors to declare their CDIs concerning their publications is a ...common issue. Another topic for CDI is related to the medical decision making on prescription. Finally, professionals being in positions of responsibility in professional societies or associations and healthcare institutions are asked to show their disclosure of CDI. These debates show up the interest of democratic societies for justice and social ethics that demand fair play in making decisions that may affect third parties, particularly patients. In the present work, the concept and types of CDIs are analyzed, and authors make proposals for the management of CDI in the medical profession.
This narrative review manuscript aims to raise the difficulties and opportunities for patient safety in specialised healthcare training considering undergraduate, postgraduate, specialist and ...continuing education, even during the COVID-19 pandemic. It also suggests some proposals for carrying it out. It very briefly discusses this specific training and its current situation in primary care. Highlighting that patient safety is a need, an area of competence and a training opportunity for residents. It establishes the general framework of patient safety in primary care in the document "7 steps for Patient Safety in Primary Care", stating the need for a systemic approach. It highlights the elaboration and presentation of cases on clinical errors as the most frequent training strategy. The real-life clinical scenarios relate to difficult patients, critical incidents and bioethics issues in professional practice. These scenarios have as common characteristics, the fact to produce difficulties and suffering for all the actors involved. Several instruments for training in patient safety are also included. The medium-term goal is to consolidate clinical safety in specialised healthcare training. Finally, an analysis is made of the impact of the pandemic on patient safety training, particularly on specialised healthcare training and some proposals are recommended on how to carry out safe teaching in the times of the COVID-19 pandemic.
Primary care is an essential foundation for the global response to COVID-19 pandemic. It plays a significant role in the health care response: identifying and triaging potential COVID-19 cases, ...making an early diagnosis, helping vulnerable people cope with their anxiety about the virus, strengthening compliance with prevention and protection measures, and reducing the demand for hospital services. Primary care teams have continued to address citizens’ health problems during the pandemic, adapting to strict social control measures imposed by governments such as closing of borders, lockdowns and self-isolation of cases and contacts. We describe the COVID-19 response from primary care in Hong Kong and China, based on their recent pandemic experiences. We also present that of a European country, United Kingdom, less experienced in pandemic management, but with universal and highly developed primary care with great social recognition. Finally, we point out some crucial learning for future pandemic management, highlighting the crucial need to improve the relationship between primary care and public health to improve pandemics response.
La atención primaria es una parte esencial de los sistemas de salud para la respuesta global a la pandemia COVID-19. Desempeña un papel importante en la respuesta asistencial y en su control: identificando y clasificando los posibles casos de COVID-19, realizando un diagnóstico precoz, ayudando a las personas vulnerables a hacer frente a su ansiedad por el virus, reforzando el cumplimiento de las medidas de prevención y protección y reduciendo la demanda de servicios hospitalarios. Los equipos de atención primaria han continuado atendiendo los problemas de salud de los ciudadanos durante la pandemia, adaptándose a las estrictas medidas sociales de control impuestas por los gobiernos como el cierre de fronteras, el confinamiento de la sociedad, y el autoaislamiento de casos y contactos. En este artículo se describe la respuesta a la pandemia COVID-19 desde el nivel de atención primaria en Hong Kong y China, basada en sus experiencias de pandemias anteriores. También se describe la de Reino Unido, con menos experiencia en gestión de pandemias, pero con una atención primaria muy desarrollada, con una cobertura universal de la población y con gran reconocimiento social. Finalmente, se señalan algunos aprendizajes cruciales para la gestión de la pandemia en atención primaria de cara al futuro, entre ellas la importante necesidad de potenciar la relación entre atención primaria y salud pública.
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