Sharing the care to improve access to primary care.

Department of Family and Community Medicine, University of California at San Francisco, San Francisco, USA.
New England Journal of Medicine (Impact Factor: 54.42). 05/2012; 366(21):1955-7. DOI: 10.1056/NEJMp1202775
Source: PubMed
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    ABSTRACT: The Indian Health Service (IHS), a federal agency, provides direct patient care to an estimated 1.9 million American Indian/Alaska Native patients across a large and decentralized network of health facilities. The IHS sought to implement HIV screening of adults and adolescents per national recommendations. The IHS facilities received technical support such as electronic clinical reminders (ECRs) and sample HIV-testing policies. To determine what facility-wide policy and practices were associated with high HIV screening rates. Survey of clinical directors of 61 federal health facilities on use of ECRs, testing policies/standing orders, and other factors associated with HIV screening. These results were correlated with HIV screening performance results for each facility as derived from the IHS national database. A total of 51 (84%) of 61 facilities were interviewed. In univariate analysis, factors that were correlated with higher rates of HIV screening were having an HIV screening standing order (unadjusted odds ratio [UOR] 8.7, 95% confidence interval [CI] 2.0-37.3), sexually transmitted disease (STD) screening standing order (UOR 5, CI 1.1-21.7), having an HIV ECR in place for a year or longer (UOR 10.2, CI 2.8-37.5), and inclusion of both providers and nurses in offering HIV screening (UOR 4.8, CI 1.4-16.7). In multivariate analysis, ECRs (adjusted odds ratio [AOR] 9.1, 95% CI 1.8-45.1) and STD standing orders (AOR 7.4, 95% CI 1.1-51.0) remained significantly associated with higher HIV screening. Policy and practice interventions such as ECRs and standing order/testing policies and delegation of screening are correlated with high HIV screening, are scalable across health networks, and will be used for improving other infectious disease screening indicators in such as STD and hepatitis C. © The Author(s) 2015.
    02/2015; DOI:10.1177/2325957415570744
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    ABSTRACT: There is emerging consensus that enhanced inter-professional teamwork is necessary for the effective and efficient delivery of primary care, but there is less practical information specific to primary care available to guide practices on how to better work as teams.
    Journal of General Internal Medicine 11/2014; 30(2). DOI:10.1007/s11606-014-3065-9 · 3.42 Impact Factor
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    ABSTRACT: World-wide, shortages of primary care physicians and an increased demand for services have provided the impetus for delivering team-based primary care. The diversity of the primary care workforce is increasing to include a wider range of health professionals such as nurse practitioners, registered nurses and other clinical staff members. Although this development is observed internationally, skill mix in the primary care team and the speed of progress to deliver team-based care differs across countries. This work aims to provide an overview of education, tasks and remuneration of nurses and other primary care team members in six OECD countries.
    International Journal of Nursing Studies 12/2014; 5(3). DOI:10.1016/j.ijnurstu.2014.11.014 · 2.25 Impact Factor


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