Suchergebnisse

Background Greece is hit hard by the state debt crisis. This calls for comprehensive reforms to restore sustainable and balanced growth. Healthcare is one of the public sectors needing reform. The European Union (EU) Task Force for Greece asked the authors to assess the situation of primary care and to make recommendations for reform. Primary healthcare is especially relevant in that it might increase the efficiency of the healthcare system, and improve access to good quality healthcare. Approach Assessment of the state of primary care in Greece was made on the basis of existing literature, site visits in primary care and consultations with stakeholders. Results The governance of primary care (and healthcare in general) is fragmented. There is no system of gatekeeping or patient lists. Private payments (formal and informal) are high. There are too many physicians, but too few general practitioners and nurses, and they are unevenly spread across the country. As a consequence, there are problems of access, continuity, co-ordination and comprehensiveness of primary care. Conclusions The authors recommend the development of a clear vision and development strategy for strengthening primary care. Stepped access to secondary care should be realised through the introduction of mandatory referrals. Primary care should be accessible through the lowest possible out-of-pocket payments. The roles of purchaser and provider of care should be split. Quality of care should be improved through development of clinical guidelines and quality indicators. The education of health professionals should put more emphasis on primary care and medical specialists working in primary care should be (re-)trained to acquire the necessary competences to satisfy the job descriptions to be developed for primary care professionals. The advantages of strong primary care should be communicated to patients and the wider public.

Background Greece is hit hard by the state debt crisis. This calls for comprehensive reforms to restore sustainable and balanced growth. Healthcare is one of the public sectors needing reform. The European Union (EU) Task Force for Greece asked the authors to assess the situation of primary care and to make recommendations for reform. Primary healthcare is especially relevant in that it might increase the efficiency of the healthcare system, and improve access to good quality healthcare. Approach Assessment of the state of primary care in Greece was made on the basis of existing literature, site visits in primary care and consultations with stakeholders. Results The governance of primary care (and healthcare in general) is fragmented. There is no system of gatekeeping or patient lists. Private payments (formal and informal) are high. There are too many physicians, but too few general practitioners and nurses, and they are unevenly spread across the country. As a consequence, there are problems of access, continuity, co-ordination and comprehensiveness of primary care. Conclusions The authors recommend the development of a clear vision and development strategy for strengthening primary care. Stepped access to secondary care should be realised through the introduction of mandatory referrals. Primary care should be accessible through the lowest possible out-of-pocket payments. The roles of purchaser and provider of care should be split. Quality of care should be improved through development of clinical guidelines and quality indicators. The education of health professionals should put more emphasis on primary care and medical specialists working in primary care should be (re-)trained to acquire the necessary competences to satisfy the job descriptions to be developed for primary care professionals. The advantages of strong primary care should be communicated to patients and the wider public.

Background Greece is hit hard by the state debt crisis. This calls for comprehensive reforms to restore sustainable and balanced growth. Healthcare is one of the public sectors needing reform. The European Union (EU) Task Force for Greece asked the authors to assess the situation of primary care and to make recommendations for reform. Primary healthcare is especially relevant in that it might increase the efficiency of the healthcare system, and improve access to good quality healthcare. Approach Assessment of the state of primary care in Greece was made on the basis of existing literature, site visits in primary care and consultations with stakeholders. Results The governance of primary care (and healthcare in general) is fragmented. There is no system of gatekeeping or patient lists. Private payments (formal and informal) are high. There are too many physicians, but too few general practitioners and nurses, and they are unevenly spread across the country. As a consequence, there are problems of access, continuity, co-ordination and comprehensiveness of primary care. Conclusions The authors recommend the development of a clear vision and development strategy for strengthening primary care. Stepped access to secondary care should be realised through the introduction of mandatory referrals. Primary care should be accessible through the lowest possible out-of-pocket payments. The roles of purchaser and provider of care should be split. Quality of care should be improved through development of clinical guidelines and quality indicators. The education of health professionals should put more emphasis on primary care and medical specialists working in primary care should be (re-)trained to acquire the necessary competences to satisfy the job descriptions to be developed for primary care professionals. The advantages of strong primary care should be communicated to patients and the wider public.

Background Greece is hit hard by the state debt crisis. This calls for comprehensive reforms to restore sustainable and balanced growth. Healthcare is one of the public sectors needing reform. The European Union (EU) Task Force for Greece asked the authors to assess the situation of primary care and to make recommendations for reform. Primary healthcare is especially relevant in that it might increase the efficiency of the healthcare system, and improve access to good quality healthcare. Approach Assessment of the state of primary care in Greece was made on the basis of existing literature, site visits in primary care and consultations with stakeholders. Results The governance of primary care (and healthcare in general) is fragmented. There is no system of gatekeeping or patient lists. Private payments (formal and informal) are high. There are too many physicians, but too few general practitioners and nurses, and they are unevenly spread across the country. As a consequence, there are problems of access, continuity, co-ordination and comprehensiveness of primary care. Conclusions The authors recommend the development of a clear vision and development strategy for strengthening primary care. Stepped access to secondary care should be realised through the introduction of mandatory referrals. Primary care should be accessible through the lowest possible out-of-pocket payments. The roles of purchaser and provider of care should be split. Quality of care should be improved through development of clinical guidelines and quality indicators. The education of health professionals should put more emphasis on primary care and medical specialists working in primary care should be (re-)trained to acquire the necessary competences to satisfy the job descriptions to be developed for primary care professionals. The advantages of strong primary care should be communicated to patients and the wider public.

This open access book is a practical introduction to multilevel modelling or multilevel analysis (MLA) – a statistical technique being increasingly used in public health and health services research. The authors begin with a compelling argument for the importance of researchers in these fields having an understanding of MLA to be able to judge not only the growing body of research that uses it, but also to recognise the limitations of research that did not use it. The volume also guides the analysis of real-life data sets by introducing and discussing the use of the multilevel modelling software MLwiN, the statistical package that is used with the example data sets. Importantly, the book also makes the training material accessible for download – not only the datasets analysed within the book, but also a freeware version of MLwiN to allow readers to work with these datasets. The book's practical review of MLA comprises: Theoretical, conceptual, and methodological background Statistical background The modelling process and presentation of research Tutorials with example datasets Multilevel Modelling for Public Health and Health Services Research: Health in Context is a practical and timely resource for public health and health services researchers, statisticians interested in the relationships between contexts and behaviour, graduate students across these disciplines, and anyone interested in utilising multilevel modelling or multilevel analysis. "Leyland and Groenewegen's wealth of teaching experience makes this book and its accompanying tutorials especially useful for a practical introduction to multilevel analysis." ̶ Juan Merlo, Professor of Social Epidemiology, Lund University "Comprehensive and insightful. A must for anyone interested in the applications of multilevel modelling to population health". ̶ S. (Subu) V. Subramanian, Professor of Population Health and Geography, Harvard University ; For researchers and students with a basic mastery of ordinary least squares and logistic regression Discusses multilevel analysis in context of public health, health services research, and epidemiology Includes an online component where users can download the datasets analyzed in the book, and also a freeware version of the multilevel modelling software MLwiN ​​​​​​​Can be used as part of a course on multilevel modelling, or as a self-training text

Introduction: Our objective, within the collaborative study SPHERE (Strengthening Public Health Research in Europe) is to give an overview of health services and health systems research in Europe, based on a search of the literature in PubMed and Embase. Method: The method used in this study consisted of: (i) A bibliometric analysis, and (ii) Classification of health services and systems research according to pre-defined criteria for a sample of 500 publications in the PubMed search. Results: Health services research is particularly strong in the Nordic countries. The number of publications on health services research has increased steadily between 1996 and 2004, 60% of the references found had a keyword related to 'patient'. More than one-third of the references had a keyword related to 'hospital'. The keyword 'general practitioner' occurred in 16% of the cases. The emphasis on this keyword was higher in those countries where the GP traditionally holds a strong position, but also in the new member states, Estonia and Slovenia. Of a smaller sample classified in depth; 57% addressed problems of efficiency and quality improvement; 27% focused on the organization of health care, cohesion and arrangement of supply according to needs and demands; only 10% addressed problems of inequalities and distribution of services. Conclusions: Health services research is a growing domain of research. As an applied discipline, health services research can be expected to closely follow political agendas. The majority of studies focus on improving the efficiency and quality of the system. Only 10% of the studies address inequalities in health utilization.

Background: Primary care is the first point of care, also for people with disabilities. The accessibility of primary care facilities is therefore very important. In this study we analysed comparative data on physical accessibility of general practices (GP practices) in 31 (mainly) European countries.Methods: We used data from the QUALICOPC study, conducted in 2011 among GPs in 34 (mainly European) countries and constructed a physical accessibility scale. We applied multilevel analysis to assess the differences between and within countries and to test hypotheses, related to characteristics of the practices and of the countries.Results: We found large differences between countries and a strong clustering of physical accessibility within countries. Physical accessibility was negatively related to the age of the GPs, and was less in single-handed and in inner city practices. Of the country variables only the length of the period of social democratic government participation during the previous decades was positively related to physical accessibility.Conclusion: A large share of the variation in physical accessibility of GP practices was on the level of countries. This means that national policies can be used to increase physical accessibility of GP practices.

BACKGROUND: Primary care is the first point of care, also for people with disabilities. The accessibility of primary care facilities is therefore very important. In this study we analysed comparative data on physical accessibility of general practices (GP practices) in 31 (mainly) European countries. METHODS: We used data from the QUALICOPC study, conducted in 2011 among GPs in 34 (mainly European) countries and constructed a physical accessibility scale. We applied multilevel analysis to assess the differences between and within countries and to test hypotheses, related to characteristics of the practices and of the countries. RESULTS: We found large differences between countries and a strong clustering of physical accessibility within countries. Physical accessibility was negatively related to the age of the GPs, and was less in single-handed and in inner city practices. Of the country variables only the length of the period of social democratic government participation during the previous decades was positively related to physical accessibility. CONCLUSION: A large share of the variation in physical accessibility of GP practices was on the level of countries. This means that national policies can be used to increase physical accessibility of GP practices. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06120-0.

Philosophies of life and Health Care Utilization in the Netherlands .This study investigates to what extent people's religious denomination relates to health care utilization. Religious denomination is seen as an indicator of a philosophy of life. We distinguish between Christian
and Islamic religious and post-modern philosophies of life. Given that modern medical science and ensuing health care interventions are widely accepted, we do not expect a relationship between philosophies of life and the utilization of regular sources of modern health care. However, we do
expect differences in areas where more controversy is possible, especially complementary and alternative medicine, but also preventive medicine. As expected, our results show philosophy of life differences in utilization for complementary and alternative medicine.

Choosing a personal budget: do differences in local policy concerning personal budgets lead to access inequalities? Dutch municipal authorities have a statutory duty to offer people who apply for support (by way of the Social Support Act) a choice between receiving support
in kind or in the form of a personal budget, but are free to set their own policy regarding who is offered a personal budget and how attractive the personal budget option is. This policy freedom may manifest itself in how actively local authorities inform applicants about the possibility of
a personal budget, the level of personal budget rates and the support local authorities offer in administering the personal budget.Earlier research has focused mainly on the characteristics of personal budget-holders (the micro-level). The present study not only considers the impact of
those individual characteristics, but also investigates what impact differences in the policy on personal budgets between local authorities (the meso-level) has on how well informed people are about personal budgets and on the extent to which this form of support is chosen. In a structured
verbal interview, we interviewed 1,026 applicants who had been ruled eligible for domestic help. Choosing a personal budget was an option for these applicants. The applicants lived in 70 municipalities for which we also had policy data, and we were therefore able to relate the data across
the municipalities. Since we used a clustered sample (first selecting municipalities and then applicants within them), multilevel analyses were performed.Older persons and people with a sudden onset disability were less often informed about the possibility of a personal budget than younger
people and people with a gradually deteriorating disability. Higher educated people were more often informed than low-educated people. Other characteristics at individual and policy level had no influence on the extent to which people were informed about the personal budget. The degree to
which people opt for a personal budget is explained mainly by the degree to which applicants were informed about this possibility. The inequality in choosing a personal budget between municipalities could be reduced relatively simply, by ensuring that people are properly informed.

Abstract Background A growing number of countries are introducing some form of nurse prescribing. However, international reviews concerning nurse prescribing are scarce and lack a systematic and theoretical approach. The aim of this review was twofold: firstly, to gain insight into the scientific and professional literature describing the extent to and the ways in which nurse prescribing has been realised or is being introduced in Western European and Anglo-Saxon countries; secondly, to identify possible mechanisms underlying the introduction and organisation of nurse prescribing on the basis of Abbott's theory on the division of professional labor. Methods A comprehensive search of six literature databases and seven websites was performed without any limitation as to date of publication, language or country. Additionally, experts in the field of nurse prescribing were consulted. A three stage inclusion process, consisting of initial sifting, more detailed selection and checking full-text publications, was performed independently by pairs of reviewers. Data were synthesized using narrative and tabular methods. Results One hundred and twenty-four publications met the inclusion criteria. So far, seven Western European and Anglo-Saxon countries have implemented nurse prescribing of medicines, viz., Australia, Canada, Ireland, New Zealand, Sweden, the UK and the USA. The Netherlands and Spain are in the process of introducing nurse prescribing. A diversity of external and internal forces has led to the introduction of nurse prescribing internationally. The legal, educational and organizational conditions under which nurses prescribe medicines vary considerably between countries; from situations where nurses prescribe independently to situations in which prescribing by nurses is only allowed under strict conditions and supervision of physicians. Conclusions Differences between countries are reflected in the jurisdictional settlements between the nursing and medical professions concerning prescribing. In some countries, nurses share (full) jurisdiction with the medical profession, whereas in other countries nurses prescribe in a subordinate position. In most countries the jurisdiction over prescribing remains predominantly with the medical profession. There seems to be a mechanism linking the jurisdictional settlements between professions with the forces that led to the introduction of nurse prescribing. Forces focussing on efficiency appear to lead to more extensive prescribing rights.

OBJECTIVE: To prevent wrong surgery, the WHO 'Safe Surgery Checklist' was introduced in 2008. The checklist comprises a time-out procedure (TOP): the final step before the start of the surgical procedure where the patient, surgical procedure and side/site are reviewed by the surgical team. The aim of this study is to evaluate the extent to which hospitals carry out the TOP before anaesthesia in the operating room, whether compliance has changed over time, and to determine factors that are associated with compliance. DESIGN: Evaluation study involving observations. SETTING: Operating rooms of 2 academic, 4 teaching and 12 general Dutch hospitals. PARTICIPANTS: A random selection was made from all adult patients scheduled for elective surgery on the day of the observation, preferably involving different surgeons and different procedures. RESULTS: Mean compliance with the TOP was 71.3%. Large differences between hospitals were observed. No linear trend was found in compliance during the study period. Compliance at general and teaching hospitals was higher than at academic hospitals. Compliance decreased with the age of the patient, general surgery showed lower compliance in comparison with other specialties and compliance was higher when the team was focused on the TOP. CONCLUSIONS: Large differences in compliance with the TOP were observed between participating hospitals which can be attributed at least in part to the type of hospital, surgical specialty and patient characteristics. Hospitals do not comply consistently with national guidelines to prevent wrong surgery and further implementation as well as further research into non-compliance is needed.