A Manpower Policy for Primary Health Care

Scheffler, Richard M.; Weisfeld, N; Ruby, G; Estes, E. Harvey

doi:10.1056/nejm197805112981905

Cited by 78 publications

(7 citation statements)

References 2 publications

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“…12 As a result of these findings, continuity was viewed as important in the training of physicians and became a com¬ ponent of residency program accreditation during the 1970s and 1980s.1317 The earliest residency studies were con¬ ducted within family practice, pediatrics, and obstetrics and gynecology programs and often examined continuity from the perspective of one provider.12·18 l', Residents who as¬ sumed substantial responsibility for a specified group of patients over time or provided both outpatient and inpatient care were described as having experienced continu¬ ity.20 Eventually, "continuity clinics" were established in primary care residency programs as block time to accom¬ modate these experiences.16 However, studies that mea¬ sured continuity of care within a general surgery resi¬ dency were not found. Despite this lack of data, leaders in surgery frequently refer to continuity of care and its im¬ portance in the training of surgeons.2'-22 More recently, the topic has been discussed at the national level, particularly among members of the RRC and the Association of Pro¬ gram Directors in Surgery.23…”

Section: Methodsmentioning

confidence: 99%

Can Continuity-of-Care Requirements for Surgery Residents Be Demonstrated in the Current Teaching Environment?

Anderson

Albrecht

Anderson³

et al. 1996

Arch Surg

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In 1994, the Residency Review Committee in Surgery began evaluating the ability of programs to provide adequate continuity-of-care experiences to residents, based on 6 criteria requiring resident participation in each phase of a surgical patient's care. The Residency Review Committee document further described resident and patient experiences as being synonymous. No previous studies were found that examined the 6 criteria or compared them with the patient's experience with continuity. Study objectives were 2-fold: (1) to assess the 6 required continuity-of-care experiences provided to general surgery residents and (2) to compare resident experiences to the patient's experience with continuity. Surgery residents from 2 academic years, representing each postgraduate year, were studied. Patients had (1) undergone an operation involving a resident and (2) remained hospitalized for longer than 24 hours but less than 10 days. Data were collected from a retrospective randomized review of each patient's medical records. Of the 114 cases, 23.7% showed that the same resident participated in all phases of care. In the remaining cases, residents provided preoperative care in 70.2%, directed the postoperative hospitalized care in 86.8%, and provided postdischarge care in 37.7%. Patients saw an average +/- SD of 4.6 +/- 1.5 surgical providers during the entire course of their surgical care. In conclusion, continuity experiences were provided to surgery residents in varying quantities and combinations, with one quarter of the residents experiencing "perfect continuity." Resident continuity experiences and patient continuity were not synonymous. Although improved medical record documentation may have enhanced these results, continuity-of-care remains difficult to demonstrate in view of the current surgery teaching environment.

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Section: Methodsmentioning

confidence: 99%

Can Continuity-of-Care Requirements for Surgery Residents Be Demonstrated in the Current Teaching Environment?

Anderson

Albrecht

Anderson³

et al. 1996

Arch Surg

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“…Many dispensaries were not open full-time and over half were run by auxiliaries. [3][4][5][6] Since 1980, the Ministry of Health has gradually implemented the primary health care approach. The health offices and maternal child health centers were abolished and their functions incorporated into those of primary health care centers, which have increased yearly in number so that now such care extends throughout the Kingdom.…”

Section: Primary Health Care Approachmentioning

confidence: 99%

Assessing Health Care Delivery in Saudi Arabia

Al-Swailem

1990

Ann Saudi Med

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This paper deals with the some of the important variable factors relating to health care in Saudi Arabia, with special emphasis on primary health. Other aspects considered are the financial influences in medical care, the availability of female Saudi and of expatriate physicians, and the special needs imposed by the annual pilgrimage, all of which influence health care delivery in Saudi Arabia. The bias and limitations which arise from the unqualified application of the physician-population ratio in determining the quality of health care in Saudi Arabia are also described. Recommendations are made for improving this overall ratio as well as better meeting the specific medical needs of the people through expansion of primary health care services.A-RF Al-Swailem, Assessing Health Care Delivery in Saudi Arabia. 1990; 10(1): 63-68The physician's traditional role has been to care for and when possible cure the sick, to stem the progression of disease, to minimize damage, to relieve pain and suffering, and to comfort at all times. These are major aspects for which physicians are trained. There is, however, another increasingly important role for physicians, that of the educator who can facilitate the early recognition and prevention of disease by promoting health-fostering attitudes.As the practice of medicine has become increasingly complex and effective, physicians no longer singlehandedly do everything required to treat their patients, much less take on all aspects of comprehensive care. They rely on a variety of trained personnel-nurses, laboratory technicians, radiographers, physiotherapists, pharmacists, and so forth.This means that in determining the needs for the efficient delivery of health care, two questions must be answered. First, how many of each category of health care personnel does a country need, in the short and long term? And second, what proportions will best meet the social mix and achieve the greatest economic efficiency? The answers depend on a steady flow of information about, and adequate appraisal of, health conditions in the country, the nature and magnitude of illness and their determinants, and the extent to which health requirements are part of overall socioeconomic development.One way to assess health care delivery is through ratios. In Saudi Arabia for the year 1407H (1987G), the physician-population ratio was 1:582; the nurse-population ratio, 1:276; the bed-population ratio, 3.3:1,000; and the primary health care center-population ratio, 1:7774. These are important statistics and indicate that Saudi Arabia has made great strides in the development of its health care delivery system.A physician-population ratio, which is a popular tool for assessing the quality of health care, is not by itself an accurate indicator of the health status of a country's population, although it may roughly reflect the level of development. Underdeveloped nations can have a ratio as low as 1:12,346 (Sri Lanka, 1983), while developed nations can have a ratio of 1:500 (U.S. A., 1982), but the ratios do not a...

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“…Primary care provides “an integrated, accessible health care services” for majority of “personal health care needs” [1, 2]. A good primary care system is associated with a more equitable distribution of health in populations [3].…”

Section: Introductionmentioning

confidence: 99%

Identifying heterogeneous health profiles of primary care utilizers and their differential healthcare utilization and mortality – a retrospective cohort study

et al. 2019

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Background Heterogeneity of population health needs and the resultant difficulty in health care resources planning are challenges faced by primary care systems globally. To address this challenge in population health management, it is critical to have a better understanding of primary care utilizers’ heterogeneous health profiles. We aimed to segment a population of primary care utilizers into classes with unique disease patterns, and to report the 1 year follow up healthcare utilizations and all-cause mortality across the classes. Methods Using de-identified administrative data, we included all adult Singapore citizens or permanent residents who utilized Singapore Health Services (SingHealth) primary care services in 2012. Latent class analysis was used to identify patient subgroups having unique disease patterns in the population. The models were assessed by Bayesian Information Criterion and clinical interpretability. We compared healthcare utilizations in 2013 and one-year all-cause mortality across classes and performed regression analysis to assess predictive ability of class membership on healthcare utilizations and mortality. Results We included 100,747 patients in total. The best model ( k = 6) revealed the following classes of patients: Class 1 “Relatively healthy” ( n = 58,213), Class 2 “Stable metabolic disease” ( n = 26,309), Class 3 “Metabolic disease with vascular complications” ( n = 2964), Class 4 “High respiratory disease burden” ( n = 1104), Class 5 “High metabolic disease without complication” ( n = 11,122), and Class 6 “Metabolic disease with multi-organ complication” ( n = 1035). The six derived classes had different disease patterns in 2012 and 1 year follow up healthcare utilizations and mortality in 2013. “Metabolic disease with multiple organ complications” class had the highest healthcare utilization (e.g. incidence rate ratio = 19.68 for hospital admissions) and highest one-year all-cause mortality (hazard ratio = 27.97). Conclusions Primary care utilizers are heterogeneous and can be segmented by latent class analysis into classes with unique disease patterns, healthcare utilizations and all-cause mortality. This information is critical to population level health resource planning and population health policy formulation. Electronic supplementary material The online version of this article (10.1186/s12875-019-0939-2) contains supplementary material, which is available to authorized users.

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A Manpower Policy for Primary Health Care

Cited by 78 publications

References 2 publications

Can Continuity-of-Care Requirements for Surgery Residents Be Demonstrated in the Current Teaching Environment?

Can Continuity-of-Care Requirements for Surgery Residents Be Demonstrated in the Current Teaching Environment?

Assessing Health Care Delivery in Saudi Arabia

Identifying heterogeneous health profiles of primary care utilizers and their differential healthcare utilization and mortality – a retrospective cohort study

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