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1 – 10 of over 23000Hong Qin, Gayle L. Prybutok, Victor R. Prybutok and Bin Wang
The purpose of this paper is to develop, validate, and use a survey instrument to measure and compare the perceived quality of three types of US urgent care (UC) service…
Abstract
Purpose
The purpose of this paper is to develop, validate, and use a survey instrument to measure and compare the perceived quality of three types of US urgent care (UC) service providers: hospital emergency rooms, urgent care centres (UCC), and primary care physician offices.
Design/methodology/approach
This study develops, validates, and uses a survey instrument to measure/compare differences in perceived service quality among three types of UC service providers. Six dimensions measured the components of service quality: tangibles, professionalism, interaction, accessibility, efficiency, and technical quality.
Findings
Primary care physicians’ offices scored higher for service quality and perceived value, followed by UCC. Hospital emergency rooms scored lower in both quality and perceived value. No significant difference was identified between UCC and primary care physicians across all the perspectives, except for interactions.
Research limitations/implications
The homogenous nature of the sample population (college students), and the fact that the respondents were recruited from a single university limits the generalizability of the findings.
Practical implications
The patient’s choice of a health care provider influences not only the continuity of the care that he or she receives, but compliance with a medical regime, and the evolution of the health care landscape.
Social implications
This work contributes to the understanding of how to provide cost effective and efficient UC services.
Originality/value
This study developed and validated a survey instrument to measure/compare six dimensions of service quality for three types of UC service providers. The authors provide valuable data for UC service providers seeking to improve patient perceptions of service quality.
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Galen H. Smith and Teresa L. Scheid
The race concordance hypothesis suggests that matching patients and health providers on the basis of race improves communication and patients’ perceptions of health care, and by…
Abstract
Purpose
The race concordance hypothesis suggests that matching patients and health providers on the basis of race improves communication and patients’ perceptions of health care, and by extension, encourages patients to seek and utilize health care, which may reduce health disparities. However, relatively few studies have examined the impact of race concordance on the utilization of health services. This chapter is grounded on Andersen’s Emerging Model of Health Services Utilization (Phase 4) and extends that model to include race concordance.
Methodology/approach
The data were collected from a stratified random sample of adult beneficiaries enrolled in North Carolina Medicaid’s primary care case management delivery system in 2006–2007. Propensity score matching techniques were used to sort respondents on their propensity for race concordance and indices were constructed to generate key control variables. Poisson regression was used to examine the impact of race concordance on the utilization of primary care and emergency room care, under the assumption that race concordance would increase the use of primary care and decrease the use of emergency care for minority patients.
Findings
While blacks (compared to whites) used less primary care and had more emergency care visits, race concordance was not a statistically significant predictor of either primary care or emergency room use. However, patients’ satisfaction with their primary care providers was associated with significantly fewer primary care and emergency care visits while trust in one’s provider was associated with more primary care visits.
Research implications
The study findings suggest that the central premises of the race concordance hypothesis require further study to confirm the assumption that better patient – primary care provider relationships result in less utilization of more costly and resource-intensive forms of health care.
Value of chapter
The study makes a valuable contribution by expanding the relatively small body of literature dedicated to exploring the impact of race concordance on health services utilization. Additionally, by virtue of researching the experience of Medicaid enrollees, the study controls for health insurance status.
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Bronwyn Howell and Carolyn Cordery
Policy reforms to primary health care delivery in New Zealand required government-funded firms overseeing care delivery to be constituted as nonprofit entities with governance…
Abstract
Policy reforms to primary health care delivery in New Zealand required government-funded firms overseeing care delivery to be constituted as nonprofit entities with governance shared between consumers and producers. This paper examines the consumer and producer interests in these firmsʼ allocation of ownership and control utilising theories of competition. Consistent with pre-reform patterns of ownership and control, provider interests appear to have exerted effective control over these entitiesʼ formation and governance in all but a few cases where community (consumer) control pre-existed. Their ability to do so is implied from the absence of a defined ownership stake and the changes to incentives facing the different stakeholding groups. It appears that the pre-existing patterns will prevail and further intervention will be required if policy-makers are to achieve their underlying aims.
Scott A. Davis, Daniel Frayne, Jessica McSurdy, Annabel O. Franz and David Mark McCord
In the USA, integrated care remains largely aspirational; a majority of Americans receive mental health care entirely within the primary medical care outpatient setting. A new…
Abstract
Purpose
In the USA, integrated care remains largely aspirational; a majority of Americans receive mental health care entirely within the primary medical care outpatient setting. A new instrument, the Multidimensional Behavioral Health Screen (MBHS) ( McCord, 2020) was developed specifically to address this gap by systematically screening for a broad array of mental health issues in every patient, every visit. The goal of this current feasibility study was to evaluate the perceptions of the primary medical care providers regarding the usefulness and practicality of the MBHS, a necessary step toward broad-based implementation.
Design/methodology/approach
The MBHS was given to 101 consenting patients in a primary medical outpatient setting, each of whom was then seen by one of six participating primary care providers (PCPs). Providers completed a brief survey rating the ease of use, understandability, helpfulness and perceived accuracy of the MBHS after each patient visit and a final summary survey at the conclusion of the study.
Findings
Ratings were very positive overall, and the MBHS was clearly preferred to the traditional screening measures (Patient Health Questionnaire-9 [PHQ-9] and Generalized Anxiety Disorder-7 [GAD-7]). Providers offered suggestions for improvement and particularly for implementation.
Research limitations/implications
The small sample size (101 patients and 6 PCPs) and limited geographical reach may limit generalizability. Surveying providers using similar methodology should be done with larger numbers of providers and more diverse primary medical care settings.
Practical implications
This study provides evidence that the MBHS may be significantly effective in operationalizing the integrated care model in United States (US) healthcare systems.
Social implications
The MBHS, a new behavioral health screening tool, was perceived by providers as useful in identifying mental health issues and guiding treatment decisions in the primary care setting.
Originality/value
This paper identifies a novel screening instrument that implements new and emerging models of psychological dysfunction in a practical way in primary medical care, making integrated care a reality rather than an aspiration.
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Marji Erickson Warfield, Morgan K. Crossman, Ann Martha Neumeyer, Julie O’Brien and Karen A. Kuhlthau
The transition from pediatric to adult health care is challenging for youth with autism spectrum disorder (ASD). Many tools have been developed to facilitate transition but…
Abstract
Purpose
The transition from pediatric to adult health care is challenging for youth with autism spectrum disorder (ASD). Many tools have been developed to facilitate transition but studies have not assessed their utility or readiness to be implemented in primary care practices. The purpose of this paper is to rate existing health care transition tools to identify tools ready for use in primary care clinics and develop a set of transition principles.
Design/methodology/approach
Four pediatric and family medicine providers from community health centers reviewed 12 transition tools and provided ratings and in-depth responses about the usefulness and feasibility of each tool through online surveys and telephone interviews. A conference call was used to discuss the findings and develop a set of transition principles.
Findings
The top rated tools included three youth self-management tools, two tools focused on ASD information and one tool focused on communication. No one tool was top rated by all providers and none of the tools was ready to be implemented without revisions. The transition principles developed focused on the use of selected tools to involve all youth in regular conversations about transition at every well child visit beginning at age 14 and adapting that process for youth with special needs.
Originality/value
This study is unique in asking primary care providers to assess the applicability of incorporating existing and publicly available transition tools in their own practices and developing a set of transition principles.
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Identifies the factors associated with the over utilisation of emergency services or the under utilisation of primary care services. Uses a two year abstraction of medical records…
Abstract
Identifies the factors associated with the over utilisation of emergency services or the under utilisation of primary care services. Uses a two year abstraction of medical records containing 2035 visits across 253 children under the age of two. Shows that parents who used less primary care services and too much emergency care provision were often black, single unsupported mother from low income families with low education and little insurance. Cites barriers as location, lack of transport and cost.
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Thomas Andersson, Nomie Eriksson and Tomas Müllern
The purpose of the paper is to describe and analyze differences in patients' quality perceptions of private and public primary care centers in Sweden.
Abstract
Purpose
The purpose of the paper is to describe and analyze differences in patients' quality perceptions of private and public primary care centers in Sweden.
Design/methodology/approach
The article explores the differences in quality perceptions between patients of public and private primary care centers based on data from a large patient survey in Sweden. The survey covers seven dimensions, and in this paper the measure Overall impression was used for the comparison. With more than 80,000 valid responses, the survey covers all primary care centers in Sweden which allowed for a detailed analysis of differences in quality perceptions among patients from the different categories of owners.
Findings
The article contributes with a detailed description of different types of private owners: not-for-profit and for profit, as well as corporate groups and independent care centers. The results show a higher quality perception for independent centers compared to both public and corporate groups.
Research limitations/implications
The small number of not-for-profit centers (21 out of 1,117 centers) does not allow for clear conclusions for this group. The results, however, indicate an even higher patient quality perception for not-for-profit centers. The study focus on describing differences in quality perceptions between the owner categories. Future research can contribute with explanations to why independent care centers receive higher patient satisfaction.
Social implications
The results from the study have policy implications both in a Swedish as well as international perspective. The differentiation between different types of private owners made in this paper opens up for interesting discussions on privatization of healthcare and how it affects patient satisfaction.
Originality/value
The main contribution of the paper is the detailed comparison of different categories of private owners and the public owners.
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Carolyn Cordery, Rachel Baskerville and Brenda Porter
This paper seeks to analyse accountability relationships developed since the introduction of reforms requiring nonprofit primary health organisations (PHOs) to discharge holistic…
Abstract
Purpose
This paper seeks to analyse accountability relationships developed since the introduction of reforms requiring nonprofit primary health organisations (PHOs) to discharge holistic accountability.
Design/methodology/approach
Case study data were obtained principally through semi‐structured interviews with PHOs and their key stakeholders, observation of formal and informal meetings, and primary and secondary documents.
Findings
While government strategy requires these PHOs to discharge holistic accountability, prior hierarchical‐based practices linger. A major impediment to securing holistic accountability is the failure of the new strategy to define clearly how the funder and provider should share accountability for improving their community's health. The implementation of holistic accountability was retarded when funders' propensity to control outcomes coincided with providers' lack of enthusiasm for embracing a greater range of stakeholders. The history and structure of individual PHOs was a key indicator of whether they discharged hierarchical or holistic accountability.
Research limitations/implications
This case study research is context‐specific and may have limited applicability to other PHOs or jurisdictions. However, the study shows that when funders and providers build trust rather than depending on control, holistic accountability relationships can be developed.
Practical implications
Despite government intention that primary health care relationships will lead to holistic accountability, this will not occur until funders clearly define responsibilities and trust their service providers.
Originality/value
There is a paucity of research into government‐sponsored holistic accountability relationships with local nonprofit service providers. This research provides a unique contextual analysis of the perspectives of funders, providers and a wide group of stakeholders and the operationalisation of two different styles of accountability.
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Sara J. Singer, Jill Glassman, Alan Glaseroff, Grace A. Joseph, Adam Jauregui, Bianca Mulaney, Sara S. Kelly, Samuel Thomas, Stacie Vilendrer and Maike V. Tietschert
Purpose: While COVID-19 has upended lives, it has also catalyzed innovation with potential to advance health delivery. Yet, we know little about how the delivery system, and…
Abstract
Purpose: While COVID-19 has upended lives, it has also catalyzed innovation with potential to advance health delivery. Yet, we know little about how the delivery system, and primary care in particular, has responded and how this has impacted vulnerable patients. We aimed to understand the impact of COVID-19 on primary care practice sites and their vulnerable patients and to identify explanations for variation. Approach: We developed and administered a survey to practice managers and physician leaders from 173 primary care practice sites, October-November 2020. We report and graphically depict results from univariate analysis and examine potential explanations for variation in practices' process innovations in response to COVID-19 by assessing bivariate relationships between seven dependent variables and four independent variables. Findings: Among 96 (55.5%) respondents, primary care practice sites on average took more safety (8.5 of 12) than financial (2.5 of 17) precautions in response to COVID-19. Practice sites varied in their efforts to protect patients with vulnerabilities, providing care initially postponed, and experience with virtual visits. Financial risk, practice size, practitioner age, and emergency preparedness explained variation in primary care practices' process innovations. Many practice sites plan to sustain virtual visits, dependent mostly on patient and provider preference and continued reimbursement. Value: While findings indicate rapid and substantial innovation, conditions must enable primary care practice sites to build on and sustain innovations, to support care for vulnerable populations, including those with multiple chronic conditions and socio-economic barriers to health, and to prepare primary care for future emergencies.
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Ashley A. Dunham, Teresa L. Scheid and William P. Brandon
This chapter explores how primary care physicians deliver mental health treatment for Medicaid patients in one county in the United States, and how treatment may have changed…
Abstract
This chapter explores how primary care physicians deliver mental health treatment for Medicaid patients in one county in the United States, and how treatment may have changed after HMO enrollment with a mental health carve-out. We utilize Lipsky's theory of street-level bureaucracy to better understand how primary care physicians treat Medicaid patients for depression and what types of insurance arrangements support or inhibit that treatment. Exploratory interviews with 20 physicians revealed that the patient's status as a non-voluntary client, service system barriers and physicians’ commitment to treatment caused them to bear primary responsibility for the majority of depression care. Physicians were willing to act as advocates for their clients and viewed such advocacy as ethical given the lack of mental health parity. In general, primary care physicians were not familiar with new policies dictating mental health carve-outs for Medicaid patients, nor were they concerned with how mental health care was reimbursed for their patients. However, they were willing to provide mental health care even if they were not reimbursed. Physicians rely upon medication management to treat depression, and reimbursement plays a role in the amount of time spent with patients and in the coding used for the visit. Lipsky's (1980) theory of street-level bureaucracy provides a useful framework for understanding how physicians will act as advocates for their clients in the face of structural as well as resource constraints on health care.