Participants described both advantages and disadvan- tages of the new PHC models. Overall they believed these models ultimately improved patient care, but for different reasons. For example, prevention was iden- tified as a main advantage: “I’m all for primaryhealthcare and preventive medicine, and I think that these models promote that.” Another participant noted the benefit of adding allied health professionals: “Everyone brings a different perspective to the table ... [they] all see it through a different lens.” New methods of compensation were noted as an advantage to patient care. “I think the potential is there to spend more time with patients and be compensated appropriately, as opposed to what you would have to do as a fee-for- service family doctor.” Funding for electronic medical records (EMRs) was also believed to improve patient care: “When you’re using an EMR it can pop up and give you reminders to make sure you do a colon cancer screen this visit, or do a mammogram.”
responding to healthcare needs that organically arise in their context. The interventions arise out of community need. Because of its deep embeddedness in the local grassroots community, the congregational ecology model arguably provides a useful nexus for churches’ contribution in PHC where community participation is critical. However, the challenge is to practically discern some models of bridging the church as a separate community institution connecting with the rest of the people in a community in a systematic way in PHC. James (2009) observed that churches’ interventions tend to mostly benefit church members, which is contrary to true community development. In many instances, there is contrary evidence to the simplistic assumptions that churches play a neutral community development role in activities such as PHC. Therefore, it is critical to assess some practical church-driven programmes to determine the models of how churches are connecting with communities in primaryhealth in an impartial way.
Background: One third of all Australians live outside of its major cities. Access to health services and health outcomes are generally poorer in rural and remote areas relative to metropolitan areas. In order to improve access to services, many new programs and models of service delivery have been trialled since the first National Rural Health Strategy in 1994. Inadequate evaluation of these initiatives has resulted in failure to garner knowledge, which would facilitate the establishment of evidence-based service models, sustain and systematise them over time and facilitate transfer of successful programs. This is the first study to systematically review the available published literature describing innovative models of comprehensive primaryhealthcare (PHC) in rural and remote Australia since the development of the first National Rural Health Strategy (1993–2006). The study aimed to describe what health service models were reported to work, where they worked and why.
The key aim of this study is to explore individual patient perceptions of existing primaryhealthcare professionals (general practitioners, nurses, allied health professionals and ambulance paramedics) in four discrete rural and remote service locations (RRMA 5-7). The services represent the four main variants of primaryhealthcare delivery in north Queensland and include both GP and non-GP led models of care. The objectives are the identification and investigation of:
There is a strong correlation between NHS countries and high adoption rates for ePrescribing. This is consistent with the finding on the adoption of eHealth in the recent EC research and this finding was confirmed in this study. Another interesting finding was that most NHS countries have undertaken national pilot ePrescribing projects for many years, in contrast to many SIS countries and TCs that are beginning the journey. A single health authority with a clear hierarchical structure seems to be a key factor in explaining why NHS countries have the highest adoption rates. Other factors specific to each country also play a key role, such as the organisation, legislation and regulation of national eHealth services, and stakeholder engagement in the health domain, but a thorough investigation of these fac- tors requires further study.
A graphical loglinear Rasch model (GLLRM) was fitted to the proposed subscales . The item screening pro- cedure described by Kreiner and Christensen (2011)  was used to identify subscales with adequate fit. Overall model fit was evaluated using Andersen’s conditional likelihood ratio (CLR) test , which assesses measure- ment invariance across groups defined by total score, gender, and age. Individual item fit was assessed by com- paring observed and expected item rest-score correla- tions [28, 38, 39] and by conditional versions of the infit and outfit item fit statistics [28, 38]. A thorough tech- nical description of the criteria used to determine item fit is presented in Kreiner and Christensen (2011) . Measurement precision was evaluated using standard error of measurement (SEM) for the derived scales [33, 40]. The measurement models resulting from the above described procedures were tested in the 1-year follow-up data and the predictive validity of the original 33-item and the reduced versions were compared. Predictive validity evidence refers to the level of correlation between sum- mated domain scores and the anchor item, which is assessed by studying associations between changes in the
Human resources and training. Geriatricians are experts in caring for frail seniors; however, there will never be enough geriatricians to provide care to even a small majority of these patients. Family physicians need to be comfortable and capable of providing care to frail seniors in any care setting. For this reason it is crucial that core family medicine residents receive training in the care of frail seniors and are comfort- able dealing with patients with multiple comorbidi- ties and with seeing patients at home. Practising FPs should also optimize their knowledge and skills given the demographic imperative experienced in most practices. There are barriers that prevent FPs from providing care outside of traditional comprehensive practices. Governments and health policy planners need to reduce these obstacles.
Australia has a complex public/private mix for both primary and hospital-based care. PHC services typic- ally include general practitioners (GPs) working in private practice and to varying degrees, other health professionals, including nurses and allied health professionals. In addition to these mainstream PHC services, there are other PHC services designed specifically to meet the needs of particular popula- tions. These include (but are not limited to) Aboriginal Community Controlled Health Organisa- tions (ACCHOs), migrant and refugee health services, prison health services, sexual health services. The uni- versal health system is FFS and remunerates GPs, specialist doctors and limited services from some al- lied health staff, often with client co-payments. In addition, incentive payments for nurses and priority target activities (e.g. chronic disease management plans) are funded at the federal level; separately from state/territory funded community health services and public hospitals. Public hospital services are free at the point of delivery, but often have substantial wait- ing lists. They are grouped into Local Hospital Net- works (LHNs) (also known as Local Health Networks, Local Health Districts, Hospital and Health Services, and Metropolitan Health Services), which provide in-patient, out-patient and off-site medical, nursing and allied health services, including co-location in PHC. LHNs play significant roles in community health services but these vary between states. Private health insurance does not cover medical services in PHC but partially covers additional costs in private hospitals and allied health, which often have reduced waiting lists .
This article outlines some limitations of these models and argues for the development of a transdiagnostic model, based on developments in our work in primarycare youth services, which can be generalised to adult populations. Such models aim to ensure that consumers receive the right intensity of care at the right time. The adjunct use of technology within services could also improve service accessibility and outcomes monitoring, and help to improve the efficiency of resource allocation based on consumer need.
clinical governance should be understood as both internal and external: internal to PCOs themselves and external to the small businesses that are operated by independent contractors within PCOs. PCOs (primarycare trusts (PCTs) in England and Local Health Boards (LHBs) in Wales) are statutory public sector organisations responsible for purchasing or providing almost all healthcare for their populations. Within them, independent contractors (general practitioners (GPs), dentists, optometrists and pharmacists) provide most pri- mary healthcare. They are both part of and dis- tinct from the PCO. Independent contractors do not wish to be managed, hence their choice of independence. Yet PCOs are expected to guide and direct the development and quality of pri- mary care, though they lack the management tools to do so directly. They rely instead on the terms of the contracts, which they administer on behalf of the government, and persuasion.
In Australia, the first Aboriginal PHC service was established in 1971  and there are now over 150 Aboriginal Community Controlled Health services across the country . In New Zealand, health re- form in the early 1990’s led to the development of Māori health providers. This has resulted in a com- bination of national and locally controlled Māori led initiatives that are committed to improving Māori health . In Canada, the enactment of the Health Transfer Policy in the late 1980’s initiated the transfer of existing community-based and regional health ser- vices into First Nation and Inuit control [11, 12], and more recently the establishment of First Nations and Inuit Health Authorities . In the United States, the provision of health services for American Indians and Alaska Natives began as early as the nineteenth Century and continued through the 1930’s, 1950’s and 1970’s with a number of policy reforms, culminating in what is now known as the Indian Health Services [14–16].
We found that lower-income patients within an aca- demic FHT were more likely to use the allied health services available. While a “dose-response effect” was not apparent, this remains an important finding, demon- strating equitable access across socioeconomic status. While there has been recent literature demonstrating that newer models of primarycare in Ontario are provid- ing care to healthier and wealthier populations, 3 this is,
such as specialists’ care or hospital care . In fact, Allard et al. (2011) suggest that FFS would be the opti- mal payment system if primarycare physicians all had a high diagnostic ability and were relatively altruistic in their desire to provide high-quality care, or if patients’ outcomes were measured and considered in the pay- ments. However, it is more likely that there is heterogen- eity amongst physicians in relation to those two aspects. In addition, in a context such as the one in Ontario, where primarycare physicians have various payment op- tions, physicians may choose the primarycare model that is most beneficial in relation to their skills and altruism levels, given the characteristics of their patient population (which they can also choose). In fact, other researchers who examined physicians’ levels of altruism found heterogeneity and differences in optimal payment methods, depending on a physician’s altruism [36–39]. It has also been found that quantities of care provided were closer to the optimum for subjects with higher levels of altruism and that mixed payment alleviated the negative effects associated with the incentives in each type of payment mechanism .
Implementation of effective health service interven- tions to improve chronic disease outcomes in Aboriginal and Torres Strait Islander populations is complex. Factors that contribute to chronic illness relate to the characteristics of Indigenous populations, infrastruc- ture in Indigenous communities and the capacity of health services to respond to Indigenous health issues. Characteristics of Indigenous populations that contribute to poor health outcomes include the social determinants of health, environmental factors and intergenerational grief and trauma caused by colonisation and racism . Compared with urban areas, there is less access to com- prehensive primaryhealthcare services in rural and re- mote locations and greater challenges with accessing specialist care [6, 7]. Workforce supply, skills and capacity to respond to health needs in a culturally competent manner, poor orientation, inappropriate service delivery models, lack of knowledge of chronic disease care guidelines, poor access to information technology and lack of resources are all barriers to effective chronic disease interventions in Indigenous Aboriginal and Torres Strait Islander populations [8–10].
Report With the failure of vertical, disease- oriented models to provide sustained improvements in health outcomes, the need to develop integrated primarycare involving the most appropriate health prof- essionals for differing contexts is becom- ing apparent worldwide. Health system planning is required to develop policies on health professional training to achieve this. Advocating and offering appropriate incentives for, and coordination of, local opportunities within the health system also becomes paramount. The adaptability and generalist nature of family medicine allows it to respond to the unique needs of a given population. Family physicians with adequate financial and physical resources can function most effectively as members of interdisciplinary teams, thus providing valuable, comprehensive health services in any area of the world.
counseling, information on development, food, hygiene, adequate sleep, accident prevention, behavioral problems, drug safety. The study (Oliveira, 2015), when comparing the presence and extent of FHS attributes to the health of the child between FHS and UBS showed that FHS presents the attribute of integrality with a higher score, the UBS, it was pointed out that only some services are available in both units, such as vaccination and family planning.With this study, we can reflect the fragility in the management of common health conditions, in reach of preventable diseases, which the quality of life of the population can be put at risk, due to failures in the actions directed to the real health needs.It should be emphasized that integrality requires that services be adequately available and provided when necessary, through prevention, promotion and / or health recovery interventions, and those that seek to achieve recognition of the needs of the population. Research Findings (Silva, 2015), conducted at FHS in Minas Gerais, which aimed to evaluate the attributes of PHC, demonstrated that the available services and services provided were evaluated by adult users, caregivers and / or family members of children and professionals, to compare the difference in these three groups, the score issued by users pointed out that counseling is not contemplated.The available services received low score by the three groups, and the services provided received high scores by professionals and low scores by users. Scientific evidences, point out that integrality does not present itself in a resolutive way in view of the availability of child healthcare, point to the fragmentation of care, where attention models are limited, because there is still a lack of qualification in the work process and qualified
Finally, we consider the high level of interest in men- tal health issues to be an additional strength; this bodes well for future implementation of best practices. More than 80% of our survey respondents reported that they were interested or very interested in identifying or treat- ing mental health problems. It is possible, however, that those FPs with greater interest in mental health issues were more likely to respond to the survey than those with less interest. And although this response rate is similar to, if not higher than, those of other recent phy- sician surveys, 11,24,25 respondents were not necessarily
Finally, there would appear to be some consensus in relation to the services that are excluded from the standard benefits basket in the different countries reviewed. In the main, these include cosmetic surgery, products deemed not medically necessary, OTC drugs, vaccinations for travel and medical certificates. In certain countries, preventive health measures such as vaccination and screening programmes may also be excluded on the basis that such programmes concern population health and are, therefore, funded directly from general taxation. That said, the standard package of services is also a product of each country’s culture and value system. For example, the reimbursement of complementary treatments such as homeopathy, acupuncture and neural therapy in Switzerland is almost unique in Europe, presumably indicating strong public desire for such treatments. The reimbursement of balneotherapy (spa treatments) in Germany similarly represents traditional values in the country.
Still on the analysis of Caçador et al.,(2015), nurses bring in their reports that the work overload causes impacts on the quality of the care, occurring feelings of frustration and doubt about the full performance of the professional activities in the FHT. According to Pires et al. (2016), those professionals who work in teams tend to strengthen the bond with patients and when they include the participation of Community Health Agents (ACS), this contributes to reduce workloads within the service of health. The authors also elucidate that the organization of the work process in order to make educational actions feasible must be carried out collectively, compromising the entire team, generating satisfactory results in relation to performance, thus promoting good working relationships and patient recognition. As a way of organizing the work process and assisting in the educational practices of nurses, it is known that the National Policy on Permanent Education in Health brings a proposal for action capable of contributing to the necessary transformation of the training processes and pedagogical and health practices , also covering the organization of services (BRASIL, 2009). According to Roecker et al., (2013), permanent education strategies should be organized for the entire health team, considering that it is not only nurses that promote educational actions inside or outside health spaces, since the lack of information and lack of mastery appear in the speeches as a labor resource together with other professionals of the health team.
35.4% (n = 46) sometimes and 12.3% (n = 16) often. Regarding the health professionals’ care to the users’ speech, 43.8% (n = 57) reported they have always cared by them, while 33.1% (n = 43) said sometimes and 13.1% (n = 17) often. In reference to the health professionals’ knowledge on the patient’s history of life, 33.8% (n = 44) stated they sometimes know about it, while 30.0% (n = 39) said they never know, and 18.5% (n = 24) always. Regarding the home visits proposed and conducted by health professionals, 48.5% (n = 63) claimed they never do it, while 34.6% (n = 45) said they sometimes do and 13.1% (n = 17) said they rarely do it. With respect to the period of time that the user had attended the health service, 94.6% (n = 123) reported attending for over a year, while 2.3% (n = 3) reported attending between one and four months, and 2.3% (n = 3) between nine and twelve months. Concerning the professionals’ knowledge about the users’ financial reality, 49.2% (n = 64) claimed they have never shown this knowledge; while 27.7% (n = 36) sometimes, and 13.1% (n = 17) rarely. And finally, as to the health professionals’ orientation understanding by users during consultations, 42.3% (n = 55) reported they always understand it; 42.3% (n = 55) sometimes and 8.5% (n = 11) often.