Contents

Contents tagged: primary care

May 26, 2016 Europe Publication

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 ...

May 26, 2016 Europe Publication

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 ...

May 24, 2016 Europe Publication

Assessing health services delivery performance with hospitalizations for ambulatory care sensitive conditions

This document was published by the WHO Regional Office for Europe and explores means of measuring health system delivery performance. It sets out to review evidence related to ambulatory care sensitive condition hospitalizations (ACSHs) as a proxy indicator of health services delivery (HSD) performance. Based on ACSHs, this review identifies specific vantage points for HSD improvements. Explored concepts and evidence is further operationalized in a guide for country studies on ACSCs.

ACSCs are an example of acute, chronic, or vaccine-preventable conditions that can serve as markers for assessing HSD performance. Examples of ACSCs include chronic obstructive pulmonary disease (COPD), diabetes, asthma and angina, and can be described as those conditions where it is possible, to a large extent, to prevent acute exacerbations and reduce the need for hospitalizations through strong primary health care-based services delivery.

This work has set out to review the different approaches to measuring ACSCs set in ...

May 19, 2016 Europe Practice

Implementing an integrated cardiology programme in Eastern Lithuania to improve cardiovascular health

The initiative strengthened cardiovascular care in primary and secondary settings, providing new training and equipment to providers to establish infrastructure for improved cardiology care outside of specialist settings; a detailed situational analysis informed the initiative’s design and provided evidence supporting the intervention; strong leadership by senior management at Vilnius University Hospital provided technical expertise and generated stakeholder support, while backing from the Ministry of Health added legitimacy to activities; extensive engagement of providers from the beginning was necessary for overcoming an individualistic culture and building collaborative relationships; distribution of a standardized cardiology equipment package to participating locations established basic quality standards and helped enable providers to implement new training.

May 12, 2016 Global Publication

New primary care model yielding early results

Several ways of shaping primary care are being developed all around the world. Improving the role of nurses or giving general practitioners new competences are just a couple of ways of moving primary care towards a more comprehensive way of working.

In this post in the NHS Confederation Blog, some of the initiatives performed to change primary care are explained and some of the challenges that future primary care will face are listed.


One of the main points outstanded is the need of integrating care and workforce from different levels of health care. As it is said in this post “Patients will benefit from easy access to a single integrated, multidisciplinary team drawn from a wide range of health and social care professionals”

April 21, 2016 Global Publication

Integrated care – taking specialist medical care beyond the hospital walls

The Royal College of Physicians has published in 2016 a document titled “Integrated care -  taking specialist medical care beyond the hospital walls”.

In the first part of this document they are described some of the main topics about integrated care, how it is conceptualize and what it really implies for patients, professionals and for the whole system.

Afterwards, some study cases are shown as examples to go deeper into different dimensions of integrated care such as the need for sustainable models of integrated care, leadership, management and governance or self-management and care.

Finally, the document lists five key areas where physicians should focus in order to improve integrated care: (I) Ensure that the patient’s and carer’s perspective is the organising principle of service delivery across organisations, (II) Support population health and wellbeing outside the hospital walls, while offering specialist care within the hospital and being an advocate for ...

March 18, 2016 Americas Publication

Primary Care and Public Health Services Integration in Brazil’s Unified Health System

Objectives: We examined associations between transdisciplinary collaboration, evidence-based practice, and primary care and public health services integration in Brazil’s Family Health Strategy. We aimed to identify practices that facilitate service integration and evidence-based practice.

Methods: We collected cross-sectional data from community health workers, nurses, and physicians (n = 262). We used structural equation modeling to assess providers’ service integration and evidence-based practice engagement operationalized as latent factors. Predictors included endorsement of team meetings, access to and consultations with colleagues, familiarity with community, and previous research experience.

Results: Providers’ familiarity with community and team meetings positively influenced evidence-based practice engagement and service integration. More experienced providers reported more integration and engagement. Physicians reported less integration than did community health workers. Black providers reported less evidence-based practice engagement than did Pardo (mixed races) providers. After accounting for all variables, evidencebased practice engagement and service integration were moderately correlated.

Conclusions: Age and race ...

March 14, 2016 Europe Publication

Improving the Delivery of Adult Diabetes Care Through Integration: Sharing Experience and Learning

In October 2014 the charity Diabetes UK published a report titled "Improving the Delivery of Adult Diabetes Care Through Integration: Sharing Experience and Learning".  The report identifies five key enablers for integrated care and outlines specific local initiatives in the UK which deliver integrated care for patients with diabetes. For example, the Royal Wolverhampton Hospitals NHS Trust (which delivers community and hospital services in Wolverhampton) along with the local Clinical Commissioning Group and various GP practices have been involved in an integrated and patient-centred model of diabetes care for many years. The model is characterised by partnerships between primary and specialist care that aim to increase the proportion of services delivered through primary care. All key enablers for integrated care that were identified by the report are present in Wolverhampton. Examples of these include:  1. Integrated IT. The CareCentric patient portal has allowed GP practices and the trust to integrate ...

Jan. 9, 2016 Europe Publication

Acute hospitals and integrated care

In March 2015, the King’s Fund published a report regarding the progress made by five acute hospital providers in England towards developing more integrated models of care. According to the report, becoming more closely integrated with primary care has proved a considerable challenge for these hospitals. This is partly due to the lack of alternatives to building relationships on a practice-by-practice basis. As the report explains, GP provider groups or federations “are still at an early stage of development in many areas of the country, and where they do exist it is not always clear that they are sufficiently cohesive to represent local practices and have leverage over them”. 

However, the report identifies a number of factors which facilitate the coordination between hospitals and primary care. These include strong clinical leadership in general practice; employing people with a primary care background at a senior level within the acute provider ...