Can hospital services work in primary care settings?

In this post, the author analyzes how recent changes in primary care in the National Health Services could face the purpose of moving some services from hospital to primary care settings.

The author bases her discussion on a report published by RAND corporation (“Outpatient Services and Primary Care”) that identifies five main areas to be considered when moving services from hospital to primary care:

1. Transfer: The substitution of services delivered by specialists for services delivered by primary care clinicians.
2. Relocation: Shifting the venue of specialist care from hospitals to primary care settings.
3. Liaison: Joint working between specialists and primary care clinicians to provide care to individual patients.
4. Professional behaviour change: Changing the way GPs refer patients to specialists.
5. Patient behaviour change: Helping patients make informed decisions about their care.

There is not a unique way of moving these services; many studies suggest that patients’ satisfaction usually grows when services are ...

Understanding pressures in general practice

“General practice is in crisis”; that is how this King’s Fund report start its analysis, pointing to funding and workforce as two of the main problems in general practice situation. Increasing needs and complexity, trends of moving patients from hospital to communities and rising expectations in population act as factors that increase pressures in general practice.

This report identifies some immediate priorities and some future challenges in order to protect general practice and to make it can face future needs.

Immediate priorities would be: (I) providing practical support to practices, (II) accelerating the uptake of technologies that can help practice deal with growing pressures more effectively, (III) encouraging reshaping of workforce in primary care, (IV) reducing bureaucratic burdens, (V) placing primary care at the heart of sustainability and transformation plans, (VI) supporting patients to use health services appropriately.
Long-term challenges pointed by this report are: (I) solving deficiencies in ...

Reshaping the workforce to deliver the care patients need

Workforce structure is one of the most difficult things to modulate in health systems. Current transition to new models of care could be a good opportunity to make workforce structure match actual needs of systems and populations. In this report, published by the Nuffield Trust, it is analyzed how organizations could reshape their current workforce and what the benefits would be:

There is a need to evolve from an illness-based system to a patient-centred system.
Workforce should meet future needs by incorporating professionals with a vision aligned with future models of care.
There are opportunities to develop the current workforce at all grades: from redeploying support staff, extending the skills of registered professionals and training advanced practitioners.
There is good evidence that support workers can provide good-quality, patient-focused care as well as reduce the workload of more highly qualified staff. Investment here could provide a cost-effective and rapid solution to ...

Developing care for a changing population: Learning from GP-led organisations

The way a health system is organized may influence the care this system provides. In this Nuffield Trust report some GP-led experiences are described, analyzing what are the internal characteristics and external context that have affected GP-led progress.

The intra-organizational characteristics listed are: (I) strong links between clinical leaders and GP member practices, (II) sophisticated strategic and operational management support, (III) use of multiple forms of peer-led improvement, (IV) organizations are both entrepeneurial and pragmatic, (V) linked data between the organization’s own services and other providers.

In what concerns to external context, the three characteristics listed are: (I) a receptive context for change, (II) capability to transfer some of the commissioner role to providers through capitated budgets, (III) slow pace and short-term nature of decision-making.

The slow pace and short-term nature of decision-making in clinical commissioning groups may drive emerging organisations to focus on service developments outside of their ...

Integrating Addiction Services into General Medicine

Importance:
National epidemiologic information from recently collected data on the new DSM-5 classification of alcohol use disorder (AUD) using a reliable, valid, and uniform data source is needed.

Objective:
To present nationally representative findings on the prevalence, correlates, psychiatric comorbidity, associated disability, and treatment of DSM-5 AUD diagnoses overall and according to severity level (mild, moderate, or severe).

Design, Setting, and Participants:
We conducted face-to-face interviews with a representative US noninstitutionalized civilian adult (≥18 years) sample (N = 36?309) as the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions III (NESARC-III). Data were collected from April 2012 through June 2013 and analyzed in October 2014.

Main Outcomes and Measures:
Twelve-month and lifetime prevalences of AUD.

Results:
Twelve-month and lifetime prevalences of AUD were 13.9% and 29.1%, respectively. Prevalence was generally highest for men (17.6% and 36.0%, respectively), white (14.0% and 32.6%, respectively) and ...