Stephanie Heinemann, MPH Good practices in primary care in Europe: a part of the QUALICOPC project...
11
Stephanie Heinemann, MPH Good practices in primary care in Europe: a part of the QUALICOPC project “The Future of Primary Care in Europe IV” Gothenburg conference September 3-4, 2012
-
Upload
elvin-james -
Category
Documents
-
view
214 -
download
0
Transcript of Stephanie Heinemann, MPH Good practices in primary care in Europe: a part of the QUALICOPC project...
Stephanie Heinemann, MPH
Good practices in primary care in Europe:a part of the QUALICOPC project
“The Future of Primary Care in Europe IV” Gothenburg conference
September 3-4, 2012
Stephanie Heinemann 2
A very short bit of QUALICOPC background
2825 GPs contacted by mail
2825 GPs contacted by mail
213Completed GP surveys
213Completed GP surveys
2614No Completed survey
2614No Completed survey
Negative response
20
Negative response
20
Patient survey pending
67
Patient survey pending
67
Consent revoked
23
Consent revoked
23
No address
10
No address
10
Pat. survey complete
113
Pat. survey complete
113
180 participating GPs180 participating GPs
QUALICOPC
Funding: European Commission (FP7)
PC data: 35 countries, ca. 7000 GPs, 70,000 patients
Work packages: patient perceived quality, GP task profiles and GP process quality, access and equity, costs, avoidable hospitalization and “good practices”.
The “good practices” work package focuses on identifying….
specific primary care organizational forms which are best fit to address the future challenges of primary care.
Stephanie Heinemann 3
How do we address the futures challenges of PC?
2825 GPs contacted by mail
2825 GPs contacted by mail
213Completed GP surveys
213Completed GP surveys
2614No Completed survey
2614No Completed survey
Negative response
20
Negative response
20
Patient survey pending
67
Patient survey pending
67
Consent revoked
23
Consent revoked
23
No address
10
No address
10
Pat. survey complete
113
Pat. survey complete
113
180 participating GPs180 participating GPs
“Strong primary care is often seen as a solution for the challenges that (European) health care systems face.”
Peter Groenewegen
Is “strong PC”… (Starfield 2012)
•first contact access and use
•person-focused care over time
•a large range of available services
•timely access to needed services
•coordination of care
…therefore also “good practice”?
Stephanie Heinemann 4
“Good practice” organizational forms in the literature
2825 GPs contacted by mail
2825 GPs contacted by mail
213Completed GP surveys
213Completed GP surveys
2614No Completed survey
2614No Completed survey
Negative response
20
Negative response
20
Patient survey pending
67
Patient survey pending
67
Consent revoked
23
Consent revoked
23
No address
10
No address
10
Pat. survey complete
113
Pat. survey complete
113
180 participating GPs180 participating GPs
Objective: Finding health system-level policies (e.g. financing) and practice-level organizational forms (e.g. workforce in PC practices) that are considered to be “good practices” in PC
Method: Literature review• Medline search• Primary care focus• Articles self-labeled as “good practices” or “best
practices”
Stephanie Heinemann 5
Results of Medline search for “good practices” in PC
2825 GPs contacted by mail
2825 GPs contacted by mail
213Completed GP surveys
213Completed GP surveys
2614No Completed survey
2614No Completed survey
Negative response
20
Negative response
20
Patient survey pending
67
Patient survey pending
67
Consent revoked
23
Consent revoked
23
No address
10
No address
10
Pat. survey complete
113
Pat. survey complete
113
180 participating GPs180 participating GPs
199 self-labeled “good practices” or “best practices” in primary care
Most articles refer to a specific sub-specialty seen in primary care• e.g. patients with low back pain
Some articles refer to meso-level activities• e.g. primary/secondary care interface
A few articles mention macro-level health policies• e.g. impact of primary health care on health systems
The searched-for literature on policies such as gatekeeping, capitation payment systems, broad task profiles, etc. could not be found.
Stephanie Heinemann 6
What do “good practice” articles have in common?
2825 GPs contacted by mail
2825 GPs contacted by mail
213Completed GP surveys
213Completed GP surveys
2614No Completed survey
2614No Completed survey
Negative response
20
Negative response
20
Patient survey pending
67
Patient survey pending
67
Consent revoked
23
Consent revoked
23
No address
10
No address
10
Pat. survey complete
113
Pat. survey complete
113
180 participating GPs180 participating GPs
3 common elements of good practice/best practice in PC
1. Recommendation for action outline of care process for ADHD childrenbest-practice diagnostic procedures for GPs
2. Evidence base American Academy of Pediatrics guidelines
3. Underlying policy goal better outcomes for ADHD childrenless variation in diagnostic procedures
Working definition of good practice in primary care:
“Recommendations for appropriate action based upon evidence, bringing primary healthcare systems closer to reaching their policy goals”
Example from a sub-specialty area
Stephanie Heinemann 7
Which challenges and macro-level policy goals?
2825 GPs contacted by mail
2825 GPs contacted by mail
213Completed GP surveys
213Completed GP surveys
2614No Completed survey
2614No Completed survey
Negative response
20
Negative response
20
Patient survey pending
67
Patient survey pending
67
Consent revoked
23
Consent revoked
23
No address
10
No address
10
Pat. survey complete
113
Pat. survey complete
113
180 participating GPs180 participating GPs
Generic health system goalsOliver 2007
• National equity of access
• Cost containment
• Health improvement
• Responsiveness
• Patient choice
QuestionsHow does the concept of “strong PC” fit into health policy goals?
Should e.g. “large range of services” be regarded as a PC policy goal or rather a variation of PC policy?
Strong PCStarfield 2012
• First contact access and use
• Person-focused care over time
• Large range of available services
• Timely access to needed services
• Coordination of care
Stephanie Heinemann 8
Case study:Is mandatory GP-gatekeeping a good practice in PC? Systematic reviews Zenter 2010, Velasco Garrido 2011
Health system goals Mandatory GP-gatekeeping
National equity of access Not evaluated
Cost containment Gatekeeping reduces costs
Health improvement No evidence
Responsiveness Not evaluated
Patient choice Gatekeeping restricts patient choice
QuestionHow can we evaluate “good practices” if…•evidence is thin?•evidence shows that a policy fulfills only some policy goals?
Stephanie Heinemann 9
QUALICOPC adds empirical data about PC policy goals
Health system goals QUALICOPC data
National equity of access YES (Ghent)
Cost containment YES (Pisa, RIVM)
Health improvement YES (NIVEL, RIVM)
Responsiveness MAYBE (NIVEL, Fulda)
Patient choice YES (NIVEL, Fulda)
PC practice organization YES (Ljubjana)
Stephanie Heinemann 10
Further work
2825 GPs contacted by mail
2825 GPs contacted by mail
213Completed GP surveys
213Completed GP surveys
Negative response
20
Negative response
20
Patient survey pending
67
Patient survey pending
67
Consent revoked
23
Consent revoked
23
No address
10
No address
10
Pat. survey complete
113
Pat. survey complete
113
180 participating GPs180 participating GPs
Identifying good practices in PC will focus upon:
1. Analyzing QUALICOPC data with regards to policy goals
2.Identifying countries coming closest to meeting all goals
3.Contrasting these countries in terms of organizational structure
4.Identifying certain policies/structures universal to good practices
Stephanie Heinemann 11
References
2825 GPs contacted by mail
2825 GPs contacted by mail
213Completed GP surveys
213Completed GP surveys
Negative response
20
Negative response
20
Patient survey pending
67
Patient survey pending
67
Consent revoked
23
Consent revoked
23
No address
10
No address
10
Pat. survey complete
113
Pat. survey complete
113
180 participating GPs180 participating GPs
Oliver A. Inconsistent objectives--reflections on some selective health care policy developments in Europe. Health Econ Policy Law. 2007 Jan;2(Pt 1):93-106.
Starfield B. Primary care: an increasingly important contributor to effectiveness, equity, and efficiency of health services. SESPAS report 2012. Gac Sanit. 2012 Jan 20.
Velasco Garrido M, Zentner A, Busse R. The effects of gatekeeping: a systematic review of the literature. Scand J Prim Health Care. 2011 Mar;29(1):28-38.
Zentner A, Velasco Garrido M, Busse R. [Do primary care physicians acting as gatekeepers really improve health outcomes and decrease costs? A systematic review of the concept gatekeeping]. Gesundheitswesen. 2010 Aug-Sep;72(8-9):e38-44.
