Primary care provider preferences for working with a collaborative support team

Dobscha, Steven K.; Leibowitz, Ruth Q.; Flores, Jennifer A; Doak, Melanie N.; Gerrity, Martha S.

doi:10.1186/1748-5908-2-16

Cited by 16 publications

(14 citation statements)

References 19 publications

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“…Characteristics such as physician communication style, 42,43 better organizational climate, 44,45 and systematic improvements in practice access 46 are reported to promote efficiency and/or quality. We need to better understand what makes some practices high performing and what factors support greater efficiency.…”

Section: Resultsmentioning

confidence: 99%

Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada

Dahrouge

Hogg

Younger

et al. 2016

The Annals of Family Medicine

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PURPOSE The purpose of this study was to determine the relationship between the number of patients under a primary care physician's care (panel size) and primary care quality indicators. METHODSWe conducted a cross-sectional, population-based study of fee-forservice and capitated interprofessional and non-interprofessional primary health care practices in Ontario, Canada between April 2008 and March 2010, encompassing 4,195 physicians with panel sizes ≥1,200 serving 8.3 million patients. Data was extracted from multiple linked, health-related administrative databases and covered 16 quality indicators spanning 5 dimensions of care: access, continuity, comprehensiveness, and evidence-based indicators of cancer screening and chronic disease management. RESULTSThe likelihood of being up-to-date on cervical, colorectal, and breast cancer screening showed relative decreases of 7.9% (P <.001), 5.9% (P = .01), and 4.6% (P <.001), respectively, with increasing panel size (from 1,200 to 3,900). Eight chronic care indicators (4 medication-based and 4 screening-based) showed no significant association with panel size. The likelihood of individuals with a new diagnosis of congestive heart failure having an echocardiogram, however, increased by a relative 8.1% (P <.001) with higher panel size. Increasing panel size was also associated with a 10.8% relative increase in hospitalization rates for ambulatory-care-sensitive conditions (P = .04) and a 10.8% decrease in non-urgent emergency department visits (P = .004). Continuity was highest with medium panel sizes (P <.001), and comprehensiveness had a small decrease (P = .03) with increasing panel size. CONCLUSIONSIncreasing panel size was associated with small decreases in cancer screening, continuity, and comprehensiveness, but showed no consistent relationships with chronic disease management or access indicators. We found no panel size threshold above which quality of care suffered. Ann Fam Med 2016;14:26-33. doi: 10.1370/afm.1864. INTRODUCTIONG iven the central role that primary health care plays in creating a sustainable health care system, improving access to high quality primary health care is an international priority. 1 Where physician resources are scarce, one way to achieve better population coverage and ensure that all individuals have a primary care physician is to promote larger panel sizes, defined as the number of patients under the care of a primary care provider. There is, however, a concern that quality may decline at larger panel sizes. 2 Establishing the "ideal" panel size for a primary care physician by striking a balance between population access and quality of care is a key objective for decision-makers and clinicians. Setting a maximum size or range, however, is challenging because quality of care can be influenced by a large number of patient, provider, and contextual factors.Studies have reported significant correlations between larger panel sizes and shorter consultations, 3 fewer home visits, 4,5 and higher rates of referral to specialists. 6...

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Section: Resultsmentioning

confidence: 99%

Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada

Dahrouge

Hogg

Younger

et al. 2016

The Annals of Family Medicine

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“…These sessions introduced the intervention, included education about chronic pain and abbreviated training in shared decisionmaking skills, 31 and surveyed clinicians' communication preferences. 32 After enrolling in the study, intervention patients received an initial telephone contact, were mailed written materials, and received an assessment visit with the care manager. Assessments were usually performed face-to-face in primary care clinics but occasionally by telephone or videoconferencing.…”

Section: Interventionmentioning

confidence: 99%

Collaborative Care for Chronic Pain in Primary Care

Dobscha¹,

Corson²,

Perrin³

et al. 2009

JAMA

297

268

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HRONIC NONCANCER PAIN IS associated with considerable physical and psychosocial impairment, distress, comorbid depression, and increased health care use and costs. [1][2][3][4] Many primary care patients report chronic pain, 2,5,6 most commonly musculoskeletal pain. 2,7 Guidelines for chronic pain treatment have been developed. 8,9 However, implementation has been problematic, especially in busy primary care practices in which access to recommended treatment components may be limited.Multifaceted, collaborative interventions can promote guideline-concordant care and improve outcomes for chronic conditions in primary care. 10,11 These interventions, based on the chronic care model, 10 attempt to optimize patient and clinician interactions via education and activation while providing system support, including care management and clinician feedback. Several investigators have demonstrated improvements in pain intensity and pain-related function in studies of interventions using collaborative approaches. 12-14 However, one of these studies used a pre-post design, 14 and the

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“…Several studies have suggested that practice issues such as time constraints, a lack of access to a mental health specialist, and a lack of training and experience significantly increase clinicians' levels of discomfort when working with patients with depression (Bower & Rowland, 2006; Dobscha, Leibowitz, Flores, Doak, & Gerity, 2007; Hull, Jones, Tissier, Eldridge, & Maclaren, 2002; Meredith et al, 1999; Nutting et al, 2002; Onate, 2006; Sigel & Leiper, 2004; Starfield, Forest, Nutting, & von Schrader, 2002; Telford, Hutchinson, Rix, & Howe, 2002).…”

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confidence: 99%

Conditions That Influence a Primary Care Clinician's Decision to Refer Patients for Depression Care

Anthony

Baik

Bowers

et al. 2010

Rehabilitation Nursing

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The objective of this study was to identify conditions that influence primary care clinicians’ referral decisions related to depression care. Forty primary care clinicians (15 general internists, 10 nurse practitioners, and 15 family practice physicians) were included in this study. The clinicians participated in semistructured interviews and completed two quantitative instruments (with 33 items on depression treatment decision making and 32 items on provider attitudes toward psychosocial care). Data analysis revealed that several conditions influence a clinician’s decision to refer a depressed patient to a mental health specialist: the patient’s resources, the clinician’s comfort in prescribing antidepressants and counseling patients with depression, and familiarity with a mental health specialist and practice environment. The decision to refer a patient with depression to a mental health specialist is a complex process involving the clinician, patient, and practice-related issues. Understanding these relationships may provide strategies to improve depression care management and lead to the design of depression care quality-improvement interventions that accommodate primary care practice context. The findings from this study suggest a need to increase mental health training opportunities for primary care clinicians to strengthen their skills and comfort level in managing depressed patients and encourage the development of relationships between primary care clinicians and mental health specialists to facilitate timely and accessible mental health care for patients.

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Primary care provider preferences for working with a collaborative support team

Cited by 16 publications

References 19 publications

Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada

Primary Care Physician Panel Size and Quality of Care: A Population-Based Study in Ontario, Canada

Collaborative Care for Chronic Pain in Primary Care

Conditions That Influence a Primary Care Clinician's Decision to Refer Patients for Depression Care

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