| 1. |
- Björkelund, Cecilia, 1948, et al.
(författare)
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Impact of continuity on quality of primary care: from the perspective of citizens' preferences and multimobidity - position paper of the European Forum for Primary Care
- 2013
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Ingår i: Quality in Primary Care. - 1479-1072 .- 1479-1064. ; 21:3, s. 193-204
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Continuity of care is one of the cornerstones of primary care. Initially, the concept of continuity largely corresponded to one care provider and continuity between doctor and patient, but today, healthcare processes and organisations have grown and become more complex. A survey of patients with complex care needs found that in all of 11 countries studied care was often poorly coordinated. Multidimensional models of continuity have to be developed. AIM: To study existing evidence concerning significance of continuity in primary care with special consideration given to the preferences of citizens and to patients with complex care needs. METHODS: Contemporary literature was studied from the aspects of primary care, patients' point of view, multimorbidity and organisational models. Examples from country systems were collected. The topic and drafts were presented and discussed at two EFPC conference workshops. RESULTS: Evidence shows that both patients and caregivers identify and value continuity in the form of regular sources of care, and that provider continuity is related to lower total healthcare costs on a macro level. Continuity is a considerable component of quality in primary care. Methods to measure and compare between primary care centres, organisations and countries to stimulate improvements in continuity is lacking. The complexity of operationalising continuity in the context of multidisciplinary team-based primary care today and in the future remains a challenge. CONCLUSIONS: Continuity is, and will be, an important component of quality in primary care, especially from the perspective of citizens and growing multimorbidity. Methods to develop continuity should be promoted.
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| 2. |
- Maun, Andy
(författare)
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Approaches to ensure and improve quality at primary healthcare centres - a study of the effects of a structured patient-sorting system and a healthcare reform
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Primary healthcare in Sweden meets increased demands from an aging population concerning quality and accessibility while dealing with a growing shortage of general practitioners and imperfect efficiency. Initiatives in the delivery and governance of primary care services attempt to improve quality and performance, but frequently do not attain the targeted results. Aim: The thesis studies the effects of i) an initiative for improved health service delivery – the structured patient-sorting system (PSS) – and ii) a healthcare reform aiming to strengthen the patient’s role and to improve access and responsiveness through freedom of choice and establishment. Methods: A Swedish primary healthcare centre (PHCC) developed and implemented the PSS using improvement science methods. Changes in access rates and questionnaires on patients’ and staff members’ perceptions were analyzed quantitatively (Paper I). In a qualitative study (phenomenography) 11 staff members’ conceptions of the PSS were analyzed (Paper II). In another qualitative study (content analysis) the perceptions of 24 managers of publicly owned PHCCs about the changes through the healthcare reform in Region Västra Götaland were analyzed (Paper III). In an observational study the differences between privately and publicly owned PHCCs in Region Västra Götaland were quantitatively analyzed concerning the listed populations, the patient perceived quality, the prescription rates of antibiotics and benzodiazepines, and the rate of follow-up for certain chronic conditions (Paper IV). Results: The introduction of the PSS resulted in a 13% increase in the access rate on average, mainly through improved accessibility to physiotherapists and psychologists. More than 90% of the surveyed patients (n=96) were satisfied with both accessibility and treatment. 92% of staff members (n=36) were satisfied with the working situation. Staff members conceptualized the PSS as an appropriate platform for the transformation into an effective patient-centred team. Improvement of health service delivery, professional development and team development took place concurrently. Managers perceived the healthcare reform as a rapid change, enforced through financial incentives and leading to prioritization conflicts between patient groups with different care needs. In comparison with publicly owned PHCCs (n=114), privately owned PHCCs (n=86) were characterized by: urban overrepresentation (54%); smaller population sizes (avg. 5932 vs. 9432 individuals); overrepresentation of individuals of working age (62% vs. 56%) and belonging to the second most affluent socioeconomic quintile (26% vs. 14%); better results in perceived patient quality (82.4 vs. 79.6 points); higher 3-month prescription rates of antibiotics per 100 individuals (6.0 vs. 5.1 prescriptions) with a larger variance (SD 2.78 vs. 1.50); lower prescription rates of benzodiazepines; lower rates for follow-ups of chronic disease. While antibiotic use decreased, the use of benzodiazepines increased on average for all PHCCs over time. Conclusions: The findings indicate a more efficient use of all competences at the PHCC and the transformation into an effective team through the PSS. Prioritization conflicts between patient groups emerged after the healthcare reform and the question of the effect of the ownership type on quality could not be answered unambiguously. Further research is necessary to improve health service delivery and health system governance.
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| 3. |
- Maun, Andy, et al.
(författare)
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Effective teamwork in primary healthcare through a structured patient-sorting system - a qualitative study on staff members' conceptions
- 2014
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Ingår i: Bmc Family Practice. - : Springer Science and Business Media LLC. - 1471-2296. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Primary healthcare meets increased demands from an aging population concerning quality and availability while concurrently dealing with a growing shortage of general practitioners and imperfect efficiency in healthcare processes. Reorganization and team development can improve quality and performance but projects in primary care frequently do not attain the targeted results. By developing and introducing a structured patient-sorting system a primary healthcare centre in Western Sweden increased its access rate significantly and employed its medical professionals more efficiently. The aim of this study was to explore staff members' conceptions of the structured patient-sorting system in order to gain an inside perspective on this project. Methods: In this qualitative study 16 interviews were conducted over a period of two years and data was analysed using a phenomenographic approach to identify the various conceptions of the eleven participants. Results: Three categories of description were identified: The system was conceptualized as 1) a framework for the development of patient-centred processes that were clear and consistent, 2) a promotor of professional development and a shared ideal of cooperative practice and 3) a common denominator and catalyst in conflict management. In an overall perspective the system was conceived as being an appropriate platform for promoting transformation into an effective patient-centred primary healthcare team in which organizational development was perceived as a continuous participative process demanding the commitment of all team members. Conclusions: This study demonstrates that the introduction of a structured patient-sorting system makes it possible for several important change processes to take place concurrently: improvement of healthcare processes, empowerment of professionals and team development. It therefore indicates the importance of an appropriate, contextualized framework to support multiple concomitant quality improvement processes. Knowledge from this study can be used to assist and improve future implementations in primary healthcare centres.
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| 4. |
- Maun, Andy, et al.
(författare)
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Is the quality of primary healthcare services influenced by the healthcare centre's type of ownership?-An observational study of patient perceived quality, prescription rates and follow-up routines in privately and publicly owned primary care centres
- 2015
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Ingår i: Bmc Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Primary healthcare in Sweden has undergone comprehensive reforms, including freedom of choice regarding provider, freedom of establishment and increased privatisation aiming to meet demands for quality and availability. In this system privately and publicly owned primary care centres with different business models (for-profit vs non-profit) coexist and compete for patients, which makes it important to study whether or not the type of ownership influences the quality of the primary healthcare services. Methods: In this retrospective observational study (April 2011 to January 2014) the patient perceived quality, the use of antibiotics and benzodiazepine derivatives, and the follow-up routines of certain chronic diseases were analysed for all primary care centres in Region Vastra Gotaland. The outcome measures were compared on a group level between privately owned (n = 86) and publicly owned (n = 114) primary care centres (PCC). Results: In comparison with the group of publicly owned PCCs, the group of privately owned PCCs were characterized by: a smaller, but continuously growing share of the population served (from 32 to 36 %); smaller PCC population sizes (avg. 5932 vs. 9432 individuals); a higher fraction of PCCs located in urban areas (57 % vs 35 %); a higher fraction of listed citizens in working age (62 % vs. 56 %) and belonging to the second most affluent socioeconomic quintile (26 % vs. 14 %); higher perceived patient quality (82.4 vs. 79.6 points); higher use of antibiotics (6.0 vs. 5.1 prescriptions per 100 individuals in a quarter); lower use of benzodiazepines (DDD per 100 patients/month) for 20-74 year olds (278 vs. 306) and >74 year olds (1744 vs. 1791); lower rates for follow-ups of chronic diseases (71.2 % vs 74.6 %). While antibiotic use decreased, the use of benzodiazepines increased for both groups over time. Conclusions: The findings of this study cannot unambiguously answer the question of whether or not the quality is influenced by the healthcare centre's type of ownership. It can be questioned whether the reform created conditions that encouraged quality improvements. Tendencies of an (unintended) unequal distribution of the population between the two groups with disparities in age, socio-economy and geography might lead to unpredictable effects. Further studies are necessary for evidence-informed policy-making.
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| 5. |
- Maun, Andy, et al.
(författare)
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Primary healthcare in transition -- a qualitative study of how managers perceived a system change.
- 2013
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Ingår i: BMC health services research. - : Springer Science and Business Media LLC. - 1472-6963. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Primary healthcare in Sweden has undergone widespread reforms in recent years, including freedom of choice regarding provider, freedom of establishment and increased privatisation. The key aims of the reforms were to strengthen the role of the patient and improve performance in terms of access and responsiveness. The aim of this study was to explore how managers at publicly owned primary healthcare centres perceived the transition of the primary healthcare system and the impact it has had on their work.
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| 6. |
- Maun, Andy
(författare)
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The art of doing almost nothing: How a core taijiquan principle can help us to understand turning points in therapeutic processes
- 2014
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Ingår i: Journal of Alternative and Complementary Medicine. - : Mary Ann Liebert Inc. - 1075-5535 .- 1557-7708. ; 20:2, s. 77-78
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Tidskriftsartikel (refereegranskat)abstract
- Health care professionals usually strive to reach turning points in therapeutic processes in order to help patients manage a problem or difficult situation. The professional aligns with the patient's needs through what can be described as "the art of doing almost nothing": listening, noticing, thinking, waiting, witnessing, and preventing harm. This process is similar to the Taijiquan principle of alignment illustrated in the yin-yang symbol taijitu. For both therapeutic process and Taijiquan, mastery is characterized through the phenomenon that the closer one gets to the turning point, the less visible are the practitioner's efforts in terms of observable action. © Copyright 2014, Mary Ann Liebert, Inc. 2014.
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