Search

PURPOSE This mixed methods study sought to describe the extent to which family physicians in urban communities serve socially vulnerable patients and to better understand their practices, their challenges, and the structural supports that could facilitate their patient care. METHODS We conducted a quantitative analysis of questionnaire data from 100% of US physicians recertifying for family medicine from 2017 to 2020. We conducted qualitative analysis of in-depth interviews with 22 physician owners of urban, small, independent practices who reported that the majority of their patients were socially vulnerable. RESULTS In 2020, in urban areas across the United States, 19.3% of family physicians served in independent practices with 1 to 5 clinicians, down from 22.6% in 2017. Nearly one-half of these physicians reported that >10% of their patients were socially vulnerable. Interviews with 22 physicians who reported that the majority of their patients were socially vulnerable revealed 5 themes: (1) substantial time spent addressing access issues and social determinants of health, (2) minimal support from health care entities, such as independent practice associations and health plans, and insufficient connection to community-based organizations, (3) myriad financial challenges, (4) serious concerns about the future, and (5) deep personal commitment to serving socially vulnerable patients in independent practice. CONCLUSIONS Small independent practices serving vulnerable patients in urban communities are surviving because deeply committed physicians are making personal sacrifices. Health equity-focused policies could decrease the burden on these physicians and bolster independent practices so that socially vulnerable patients continue to have options when seeking primary care. Key words: primary care; health equity; delivery of health care; independent practice; safety net https://doi.org/10.1370/afm.3068, INTRODUCTION Advancing health equity in the United States requires improved access to high-quality primary care, especially for socially vulnerable populations. (1) For the purpose of the present study, the term [...]

Byline: Cayden. Peixoto, Jonathan. Fitzsimon, Lisa. Hawkins, Judy. Hill Introduction: An estimated 20% of residents of Renfrew County, a rural and underserved community in Ontario, do not have a family [...]

Introduction The World Health Organization (WHO) defines universal health coverage (UHC) as ensuring that 'all people have access to needed health services ... of sufficient quality to be effective while [...], Problem Slovenia's model of primary health care relied on reactive, episodic care and was ill-equipped to address the country's burden of disease dominated by noncommunicable diseases. Approach The government has developed a multidisciplinary, community-based, prevention-oriented service delivery model for primary health care. A compulsory family medicine residency programme was introduced in 2000, and from 2004 screening and control of chronic diseases were established in family medicine practices. Health promotion centres were established, providing group interventions to support healthy lifestyles. After 2011, registered nurses were introduced to conduct screening for chronic diseases, provide counselling and manage patients with stable noncommunicable diseases. Local setting In 1992, the government transformed Slovenia's health financing scheme to a social insurance system based on mandatory payroll taxes. The system enabled private provision of health services, although primary care was mostly provided by publicly funded community health centres. A strong gatekeeping role was introduced. Relevant changes Despite spending less on health than the European Union (EU) average, by 2013 Slovenia's life expectancy was higher than the average for EU countries. The increase was due in part to rapidly declining infant and under-five mortality and a faster decline in premature mortality due to chronic diseases. Lessons learnt Slovenia's approach was enabled by strong public health and governance structures, along with accountability mechanisms that monitored outcomes and took corrective action when necessary. New programmes were piloted, creating a strong evidence base that facilitated obtaining sustainable financing, while national roll-out was supported by regional branches of the National Institute of Public Health. [phrase omitted] [phrase omitted] Probleme Le modele slovene de soins de sante primaires reposait sur une prise en charge episodique et reactive. En outre, il n'etait pas equipe pour faire face au fardeau des maladies du pays, domine par des affections non transmissibles. Approche Le gouvernement a developpe un modele de prestation de services multidisciplinaire, communautaire et axe sur la prevention pour les soins de sante primaires. Un programme obligatoire de residence en medecine familiale a ete instaure en 2000 et, a partir de 2004, un systeme de depistage et de suivi des maladies chroniques a ete mis en place dans les cabinets de medecine familiale. Des centres de promotion de la sante ont ete crees afin d'effectuer des interventions de groupe destinees a encourager l'adoption d'un mode de vie sain. Des 2011, des infirmieres agreees ont ete chargees de mener des actions de depistage des maladies chroniques, de fournir des conseils et de gerer les patients presentant des affections non transmissibles stables. Environnement local En 1992, le gouvernement a transforme le regime slovene de financement de la sante en systeme d'assurance sociale base sur des taxes obligatoires prelevees sur les salaires. Ce systeme a entraine l'apparition de prestations privees de services de sante, bien que les soins primaires soient principalement prodigues par des centres de sante communautaires finances par l'Etat. Une fonction de controle efficace a ete etablie. Changements significatifs Malgre des depenses en soins de sante inferieures a la moyenne de l'Union europeenne (UE), l'esperance de vie slovene en 2013 etait plus elevee que celle observee dans les autres pays de l'UE. Cette augmentation s'expliquait en partie par une diminution rapide de la mortalite chez les nourrissons et les enfants de moins de cinq ans, ainsi que par une acceleration de la baisse des deces prematures lies a des maladies chroniques. Lemons tirees L'approche de la Slovenie a ete rendue possible par de solides structures de gouvernance et de sante publique, mais aussi par des mecanismes de responsabilite qui ont suivi les resultats et pris des mesures correctives le cas echeant. De nouveaux programmes ont ete testes et ont engendre une base factuelle stable qui a facilite l'obtention de financements durables, tandis que le deploiement a l'echelle nationale a regu le soutien des antennes regionales de l'Institut national de sante publique. [phrase omitted] Situacion El modelo de atencion primarla de la salud de Eslovenia se basaba en el cuidado paliativo y episodico, y no estaba bien equipado para atender a todas las enfermedades del pais, que eran en su mayoria enfermedades no transmisibles. Enfoque El Gobierno ha elaborado un modelo de prestacion de servicios multidisciplinarios, comunitarios y orientados a la prevencion para la atencion primaria de la salud. En 2000, se adopto un programa de residencia obligatorio en medicina familiar y, a partir de 2004, se establecio un programa de deteccion y de control de las enfermedades cronicas en los consultorios de medicina familiar. Se establecieron centros de promocion de la salud, en los que se realizan intervenciones en grupo para apoyar estilos de vida saludables. A partir de 2011, se introdujeron enfermeras tituladas para realizar examenes de deteccion de enfermedades cronicas, prestar asesoramiento y atender a pacientes con enfermedades estables no transmisibles. Marco regional En 1992, el Gobierno transformo el plan de financiamiento de la salud de Eslovenia en un sistema de seguro social basado en impuestos obligatorios sobre las nominas. El sistema permitia la prestacion privada de servicios sanitarios, aunque la atencion primaria se prestaba principalmente en centros de salud comunitarios que se financiaban con fondos publicos. Ademas, se adopto una funcion importante de control de acceso. Cambios importantes Aunque el gasto en salud es inferior en comparacion con la media de la Union Europea (UE), en 2013, la esperanza de vida de Eslovenia era superior a la media de los paises de la UE. El incremento se debio en parte a la reduccion rapida de la mortalidad de infantes y de ninos menores de cinco anos y a una disminucion mas rapida de la mortalidad prematura por enfermedades cronicas. Lecciones aprendidas El enfoque de Eslovenia fue posible gracias a las estructuras solidas de salud publica y de gobernanza, junto con los mecanismos de rendicion de cuentas que supervisaban los resultados y adoptaban medidas correctivas cuando era necesario. Se probaron nuevos programas, lo que creo una base de evidencia solida que facilito la obtencion de un financiamiento sostenible, mientras que las filiales regionales del Instituto Nacional de Salud Publica apoyaron la puesta en marcha a nivel nacional.

INTRODUCTION Extensive research has shown mentorship to be positively associated with faculty retention, career satisfaction and research productivity. (1-5) The Schulich School of Medicine & Dentistry at Western University, London, [...], Introduction: The Schulich School of Medicine & Dentistry in London, Ontario, has a mentorship program for all full-time faculty. The school would like to expand its outreach to physician faculty located in distributed medical education sites. The purpose of this study was to determine what, if any, mentorship distributed physician faculty currently have, to gauge their interest in expanding the mentorship program to distributed physician faculty and to determine their vision of the most appropriate design of a mentorship program that would address their needs. Methods: We conducted a mixed-methods study. The quantitative phase consisted of surveys sent to all distributed faculty members that elicited information on basic demographic characteristics and mentorship experiences/needs. The qualitative phase consisted of 4 focus groups of distributed faculty administered in 2 large and 2 small centres in both regions of the school's distributed education network: Sarnia, Leamington, Stratford and Hanover. Interviews were 90 minutes long and involved standardized semistructured questions. Results: Of the 678 surveys sent, 210 (31.0%) were returned. Most respondents (136 [64.8%]) were men, and almost half (96 [45.7%]) were family physicians. Most respondents (197 [93.8%]) were not formal mentors to Schulich faculty, and 178 (84.8%) were not currently being formally mentored. Qualitative analysis suggested that many respondents were involved in informal mentoring. In addition, about half of the respondents (96 [45.7%]) wished to be formally mentored in the future, but they may be inhibited owing to time constraints and geographical isolation. Consistently, respondents wished to have mentoring by a colleague in a similar practice, with the most practical being one-on-one mentoring. Conclusion: Our analysis suggests that the school's current formal mentoring program may not be applicable and will require modification to address the needs of distributed faculty. Introduction : L'Ecole de medecine et de dentisterie Schulich, a London en Ontario, offre un programme de mentorat a tout le personnel enseignant a temps plein. L'Ecole aimerait etendre son programme aux medecins enseignants des etablissements de formation medicale decentralisee. Le but de cette etude etait de determiner a quel mentorat, le cas echeant, ces medecins ont acces actuellement et d'etablir leur interet pour le programme de mentorat de l'Ecole et leur vision du programme le plus approprie pour repondre a leurs besoins. Methodes : Nous avons mene une etude en methodologie mixte. Lors de la phase quantitative, nous avons envoye des questionnaires a tous les medecins des etablissements de formation medicale decentralisee afin d'obtenir des renseignements sur les caracteristiques demographiques de base ainsi que les experiences et besoins de mentorat. La phase qualitative comprenait quatre groupes de discussion composes de medecins enseignants decentralises dans deux grands et deux petits centres des deux regions du reseau de formation decentralisee de l'Ecole, soit Sarnia, Leamington, Stratford et Hanover. Les entrevues etaient d'une duree de 90 minutes et se composaient de questions semi-structurees normalisees. Resultats : Sur les 678 questionnaires distribues, 210 (31 %) ont ete retournes. La plupart des repondants (136 [64,8 %]) etaient des hommes et presque la moitie (96 [45,7 %]) etaient des medecins de famille. La plupart des repondants (197 [93,8 %]) n'agissaient pas comme mentors officiels aupres du personnel enseignant de l'Ecole de medecine et de dentisterie Schulich et 178 (84,8 %) ne recevaient pas de mentorat officiel actuellement. L'analyse qualitative suggere que plusieurs repondants participaient a une forme quelconque de mentorat informel. De plus, environ la moitie des repondants (96 [45,7 %]) souhaitaient recevoir un mentorat officiel a l'avenir, mais avaient possiblement des contraintes liees au manque de temps et a l'isolement geographique. Les repondants ont systematiquement exprime le desir d'obtenir un mentorat d'un collegue dans une pratique similaire et un mentorat individualise, de facon pratique. Conclusion : Notre analyse suggere que le programme actuel de mentorat de l'Ecole n'est peut-etre pas applicable et necessitera des modifications pour repondre aux besoins du personnel enseignant decentralise.

Objective: The objective is to determine the use of health-care services (physician visits, emergency department use and hospitalisations) in rural areas and examine differences in four geographic areas on a [...]

As a solo primary care doctor, Melissa Lucarelli, MD, rarely turns down an opportunity to increase her practice's revenue. But that's what she did when, in 2015, Medicare introduced its [...]

Primary health care accessibility is a key evaluation indicator for health care delivery in Canada, (1) which has a health care system that is legislated and designed to provide reasonable, [...], OBJECTIVES: To determine whether socio-economic status (SES) and presence of a chronic condition are associated with the response a prospective patient receives when seeking a family physician (FP). METHODS: Scripted telephone calls (indicating higher or lower SES and presence or absence of a chronic condition) were made to all 327 FP offices in Nova Scotia (NS) requesting an appointment. The main outcome measures were the responses to callers seeking a FP: being accepted for an appointment or being offered further assistance if not accepted (e.g., walk-in clinic, alternative provider, and telehealth), as well as the callers' perception of the experience as positive, negative, or neutral. RESULTS: Only 9.9% of offices accepted callers as new patients. There were no statistically significant differences by SES or chronic condition in the proportion of calls resulting in an appointment. Callers indicating high SES were more likely to be provided further assistance than those with low SES (p = 0.06), and callers indicating a chronic condition reported a better overall experience than those without (p = 0.03). CONCLUSION: First contact accessibility for prospective new patients was low across NS. Lower SES was associated with fewer offers of additional assistance than higher SES. This is particularly troubling since those with lower SES may need additional support as they may have less access to resources and networks that could provide support. This study signals the need to improve general and equitable accessibility to primary care providers. KEY WORDS: Primary health care; general practice; chronic disease; social class; access to health care; health equity La traduction du resume se trouve a la fin de l'article. Can i Public Health 2017;108(5-6):e546-e550 OBJECTIFS : Determiner si le statut socioeconomique (SSE) et la presence d'un etat chronique sont associes a la reponse recue par un patient eventuel qui cherche un medecin de famille (MF). METHODE : Des appels telephoniques scriptes (mentionnant un SSE eleve ou faible et la presence ou l'absence d'un etat chronique) ont ete places aupres des 327 cabinets de MF de la Nouvelle-Ecosse pour demander un rendez-vous. Les principaux indicateurs de resultat etaient les reponses donnees aux personnes ayant appele pour demander un MF : l'offre d'un rendez-vous, l'offre d'assistance supplementaire si un rendez-vous n'etait pas disponible (p. ex. service de consultation sans rendez-vous, autre dispensateur, ligne telesante) et la perception de l'experience (positive, negative ou neutre) par la personne ayant appele. RESULTATS : Seulement 9,9 % des cabinets ont dit accepter de nouveaux patients. Il n'y a eu aucun ecart significatif selon le SSE ou l'etat chronique dans la proportion d'appels ayant donne lieu a un rendez-vous. Les personnes ayant appele en mentionnant un SSE eleve ont ete plus susceptibles de se faire offrir de l'assistance supplementaire que celles ayant mentionne un faible SSE (p = 0,06), et les personnes ayant appele en mentionnant un etat chronique ont dit avoir eu une meilleure experience dans l'ensemble que celles n'ayant pas mentionne d'etat chronique (p = 0,03). CONCLUSION : L'accessibilite au premier contact pour les nouveaux patients eventuels etait faible partout en Nouvelle-Ecosse. Le faible SSE etait associe a un moins grand nombre d'offres d'assistance supplementaire que le SSE eleve. C'est particulierement troublant, car les personnes de faible SSE peuvent avoir besoin d'aide supplementaire; en effet, elles peuvent avoir moins acces aux ressources et aux reseaux susceptibles de les appuyer. L'etude indique qu'il est necessaire d'ameliorer l'accessibilite en general et l'equite d'acces aux dispensateurs de soins primaires. MOTS CLES : soins de sante primaires; medecine generale; maladie chronique; classe sociale; acces aux soins de sante; equite en sante