A Survey Of Primary Care Physicians In Eleven Countries, 2009: Perspectives On Care, Costs, And Experiences

Research and Evaluation, at Commonwealth Fund in New York City, USA.
Health Affairs (Impact Factor: 4.97). 11/2009; 28(6):w1171-83. DOI: 10.1377/hlthaff.28.6.w1171
Source: PubMed


This 2009 survey of primary care doctors in Australia, Canada, France, Germany, Italy, the Netherlands, New Zealand, Norway, Sweden, the United Kingdom, and the United States finds wide differences in practice systems, incentives, perceptions of access to care, use of health information technology (IT), and programs to improve quality. Response rates exceeded 40 percent except in four countries: Canada, France, the United Kingdom, and the United States. U.S. and Canadian physicians lag in the adoption of IT. U.S. doctors were the most likely to report that there are insurance restrictions on obtaining medication and treatment for their patients and that their patients often have difficulty with costs. We believe that opportunities exist for cross-national learning in disease management, use of teams, and performance feedback to improve primary care globally.

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Available from: Sandra Applebaum, Jan 02, 2014
    • "Thus, EHR systems could allow clinicians to obtain and store some standard measures of social and behavioral determinants to efficiently identify conditions that may modify diagnoses and treatment plans (Adler & Stead, 2015). Many developed countries are currently implementing EHR systems , but even though the rate of EHR adoption by physicians is in progress, it remains slow in most of these countries (Schoen et al., 2009;Schoen et al., 2012;Simon et al., 2006). In Canada, a network of interoperable EHR solutions is currently being implemented (Canada Health Infoway, 2006, 2012). "
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    ABSTRACT: In Canada, the healthcare system remains paper-laden, and EHR adoption by physicians lags behind many other industrial countries. Recent reviews identified individual and organizational factors as having the most important influence on EHR adoption and proposed taking a multidimensional perspective to study these adoption determinants. However, most studies have focused on physician EHR adoption measured at the individual level. Objectives First, we used a multilevel regression model to assess whether organizations' characteristics influenced physician behavioral intention to use EHR. Second, we sought to identify individual and organizational factors that explain physician intention. Methods We conducted a prospective cross-sectional study among physicians in 49 primary healthcare organizations in four regions of the province of Quebec (Canada). We first analyzed relationships between individual and organizational variables and intention. Second, we performed multilevel modeling to explore organizational characteristics' impact on physician intention to use EHR. Results 278 completed questionnaires were returned from the 31 organizations that had at least 5 participants (response rate: 39.8%). Questionnaires showed satisfactory psychometric properties. The multilevel modeling found no significant overall influence of organizational level on physician intention to use EHR. Second, six of the individual level constructs had a positive and strongly significant impact on physician intention. Conclusion In the Quebec context, organization-level seems to have no significant impact on EHR adoption by physicians. Hence, particular strategies are more likely to succeed if they target individual physicians rather than organizations.
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    • "In the past few years, policymakers have become more aware of the widening gap in primary care practice internationally, with Canada most often in the bottom half of international comparisons of access to primary care and quality improvement activities (Schoen et al. 2009, 2013). These measures of performance vary widely, however, between practices, models of care and jurisdictions. "
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    ABSTRACT: Information to help guide quality improvement activities in primary care should be readily available, routinely updated and include comparisons across groups, regions and jurisdictions. Primary care practice reports, developed jointly by the Institute for Clinical Evaluative Sciences and Health Quality Ontario, is one such effort. These data include practice demographics, the prevalence of common chronic conditions, the use of health services and measures of chronic disease prevention and management. All Ontario primary care physicians can register for the profiles online using a secure logon; the profiles are available only to them. Enhancements under development include new formats, targets and tools to support quality improvement.
    Preview · Article · Apr 2015 · Healthcare quarterly (Toronto, Ont.)
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    • "A responsive and comprehensive primary healthcare (PHC) system leads to a more efficient health system, lower rates of hospitalization, fewer health inequalities, better health outcomes and lower costs [1-3]. Despite the integral role of PHC for health systems, the World Health Report (2008) indicated that countries “are not performing as well as they could and as they should” when it comes to PHC [4]. "
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    ABSTRACT: In 2009, the Lebanese Ministry of Public Health (MOPH) launched the Primary Healthcare (PHC) accreditation program to improve quality across the continuum of care. The MOPH, with the support of Accreditation Canada, conducted the accreditation survey in 25 PHC centers in 2012. This paper aims to gain a better understanding of the impact of accreditation on quality of care as perceived by PHC staff members and directors; how accreditation affected staff and patient satisfaction; key enablers, challenges and strategies to improve implementation of accreditation in PHC. The study was conducted in 25 PHC centers using a cross-sectional mixed methods approach; all staff members were surveyed using a self-administered questionnaire whereas semi-structured interviews were conducted with directors. The scales measuring Management and Leadership had the highest mean score followed by Accreditation Impact, Human Resource Utilization, and Customer Satisfaction. Regression analysis showed that Strategic Quality Planning, Customer Satisfaction and Staff Involvement were associated with a perception of higher Quality Results. Directors emphasized the benefits of accreditation with regards to documentation, reinforcement of quality standards, strengthened relationships between PHC centers and multiple stakeholders and improved staff and patient satisfaction. Challenges encountered included limited financial resources, poor infrastructure, and staff shortages. To better respond to population health needs, accreditation is an important first step towards improving the quality of PHC delivery arrangement system. While there is a need to expand the implementation of accreditation to cover all PHC centers in Lebanon, considerations should be given to strengthening their financial arrangements as well.
    Full-text · Article · Feb 2014 · BMC Health Services Research
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