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Article

Henna M. Leino

The purpose of this paper is to increase understanding of the status, vulnerability and needs of the health-care and nursing service customers’ (hereafter, care service…

Abstract

Purpose

The purpose of this paper is to increase understanding of the status, vulnerability and needs of the health-care and nursing service customers’ (hereafter, care service customers’) loved ones.

Design/methodology/approach

The position and vulnerabilities of secondary customers of care services are studied and examples provided by reviewing empirical research reported in the care service literature. A conceptual discussion is developed on the “customer” concept in an extended sense, beyond the focal customers. The “primary customer” and “secondary customer” concepts are employed to supplement the extant discussion on customer units and ecosystems.

Findings

Secondary customers are exposed to secondary vulnerability and their well-being is affected by the services provided primarily to their loved ones. The most recurring needs of secondary customers concern psychosocial support, communication and information and cultural sensitivity.

Practical implications

New perspectives on understanding the “customer” concept in an extended sense. This assists in supporting the customers’ dynamic activities and processes within the customer ecosystems. To address care service customers’ loved ones’ vulnerabilities and needs and to support their well-being, they should also be recognised as customers – “secondary customers” – with patients being the “primary customers”.

Social implications

The results are especially relevant when considering services’ influences on vulnerable customers’ ecosystems and on individuals within them. It is important to recognise that beyond a vulnerable customer, several secondary customers may be exposed to secondary vulnerability, needing support.

Originality/value

The paper is apparently the first to connect the constructs “primary” and “secondary customer” and customer vulnerability to the customer ecosystem discussion. Also, essential future research questions are provided.

Details

Journal of Services Marketing, vol. 31 no. 7
Type: Research Article
ISSN: 0887-6045

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Article

Aimee O'Farrell, Geoff McCombe, John Broughan, Áine Carroll, Mary Casey, Ronan Fawsitt and Walter Cullen

In many healthcare systems, health policy has committed to delivering an integrated model of care to address the increasing burden of disease. The interface between…

Abstract

Purpose

In many healthcare systems, health policy has committed to delivering an integrated model of care to address the increasing burden of disease. The interface between primary and secondary care has been identified as a problem area. This paper aims to undertake a scoping review to gain a deeper understanding of the markers of integration across the primary–secondary interface.

Design/methodology/approach

A search was conducted of PubMed, SCOPUS, Cochrane Library and the grey literature for papers published in English using the framework described by Arksey and O'Malley. The search process was guided by the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA).

Findings

The initial database search identified 112 articles, which were screened by title and abstract. A total of 26 articles were selected for full-text review, after which nine articles were excluded as they were not relevant to the research question or the full text was not available. In total, 17 studies were included in the review. A range of study designs were identified including a systematic review (n = 3), mixed methods study (n = 5), qualitative (n = 6) and quantitative (n = 3). The included studies documented integration across the primary–secondary interface; integration measurement and factors affecting care coordination.

Originality/value

Many studies examine individual aspects of integration. However, this study is unique as it provides a comprehensive overview of the many perspectives and methodological approaches involved with evaluating integration within the primary–secondary care interface and primary care itself. Further research is required to establish valid reliable tools for measurement and implementation.

Details

Journal of Integrated Care, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 1476-9018

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Article

S.W. Mercer and D.J. Murphy

The Consultation and Relational Empathy (CARE) Measure is a validated tool for assessing the patients' perception of the doctors' communication in primary care. The…

Abstract

Purpose

The Consultation and Relational Empathy (CARE) Measure is a validated tool for assessing the patients' perception of the doctors' communication in primary care. The present study aims to evaluate the potential usefulness of the CARE Measure in secondary care in a single Hospital Trust in Scotland.

Design/methodology/approach

A total of 1,015 out‐patients attending 25 consultants across ten specialities anonymously completed the questionnaire immediately after their appointment. Overall satisfaction, estimated consultation length, satisfaction with consultation length, and demographic and socio‐economic variables were also recorded.

Findings

The number of missing values and “not applicable” responses to the ten CARE Measure items was extremely low (3.4 per cent). Almost 90 per cent of patients felt the CARE Measure items were of major importance. The measure had a high internal reliability (Cronbach's alpha 0.94) and reduced to a single factor. Overall CARE Measure score correlated with overall satisfaction (r=0.7, p<0.0001), whether patients would recommend the doctor (r=0.6, p<0.0001), and satisfaction with consultation length (r=0.6, p<0.0001). Multi‐regression analysis showed that personal continuity of care, consultation length, and patient age positively influenced CARE Measure score, but the effect size was small. Patients' gender, marital status, general health, and socio‐economic factors did not influence scores. Reliability analysis indicated that 40 patients were required per doctor in order to achieve an overall reliability co‐efficient of above 0.7.

Practical implications

Secondary care patients across a range of specialities have endorsed the CARE Measure as a relevant tool. It has high face and concurrent validity, internal and structural reliability and is not subject to major influences by demographic or socio‐economic factors. These findings support the feasibility and reliability of the CARE Measure in secondary care.

Originality/value

This pilot study indicates that the CARE Measure is considered by most patients to be of high relevance to everyday out‐patient consultations in secondary care.

Details

Clinical Governance: An International Journal, vol. 13 no. 4
Type: Research Article
ISSN: 1477-7274

Keywords

Abstract

Purpose

Integrated care models have shown to deliver efficient healthcare, but implementation has proven to be difficult. The Support Consultation is an integrated care model, which enables full integration by bundled payment, insurer involvement, predefined care pathways and strengthening of primary care. The purpose of this paper is to provide an indication of the improvements in healthcare delivery after implementation of this proposed model and to create a base for extension to similar interfaces between primary and secondary care.

Design/methodology/approach

A retrospective study was used to compare the effect on the number of referred patients with non-acute cardiac complaints and the cost effectiveness before and after implementation of the Support Consultation. Patients who previously would have been referred to the cardiologist were now discussed between general practitioner and cardiologist in a primary care setting.

Findings

The first consecutive 100 patients (age 55±16 years, male 48 percent), discussed in the Support Consultation, were analyzed. Implementation of the Support Consultation resulted in a net costs (program costs and referral costs) reduction of 61 percent compared with usual care. All involved parties were positive about the program.

Research limitations/implications

The Support Consultation has the ability to provide more effective healthcare delivery and to reduce net costs. The setting of the current study can be used as example for other specialties in countries with a similar healthcare system.

Originality/value

This study provides the potential cost savings after implementation of an integrated care model, based on real-life data.

Details

Journal of Integrated Care, vol. 27 no. 4
Type: Research Article
ISSN: 1476-9018

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Article

Ala Szczepura

Considers the changes which are being implemented in primary care, and the patterns which are now beginning to emerge. Examines the changing context within which practices…

Abstract

Considers the changes which are being implemented in primary care, and the patterns which are now beginning to emerge. Examines the changing context within which practices now function (both political and managerial), and considers the power which GPs are beginning to exert, as well as the impact which they may have on the interface between primary and secondary care. Examines the systems being developed for assuring quality in general practice. Predicts an explosion in the need for appropriate information for management and for medical audit in UK primary care, because the context within which general practitioners (GPs) deliver primary care in the NHS is changing rapidly. It is only now becoming evident that this turbulence may well offer major new opportunities to GPs, as well as permanently altering the balance of power in the NHS between primary and secondary care.

Details

International Journal of Health Care Quality Assurance, vol. 5 no. 1
Type: Research Article
ISSN: 0952-6862

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Article

Malcolm Firth, Frank Hanily and Paul Garratt

This paper identifies the challenges of interpreting and implementing appropriate eligibility criteria and assessment processes in adult mental health services, with…

Abstract

This paper identifies the challenges of interpreting and implementing appropriate eligibility criteria and assessment processes in adult mental health services, with reference to an inner‐city Trust's own protocols. Central guidance, local interpretation and professional judgment are all legitimate contributions, but also confound both the concept and processes of entry to service.

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Article

Hugh Rayner

The Medical Director of an NHS Hospital Trust in the Midlands gives a personal account of his thinking about integrated care and its importance in the immediate future. He…

Abstract

The Medical Director of an NHS Hospital Trust in the Midlands gives a personal account of his thinking about integrated care and its importance in the immediate future. He underlines that integrated care requires a shift in behaviour, culture and attitudes, and outlines helpful approaches which can stimulate and support this. He illustrates the way change has been approached in local services, with particular emphasis on supporting self‐care and on primary care/secondary care partnership (or vertical integration).

Details

Journal of Integrated Care, vol. 17 no. 1
Type: Research Article
ISSN: 1476-9018

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Article

Palaniappan Sundaram, Sati Sembhi and Peter Devlin

There is an increasing emphasis on strengthening links between the primary and specialist services in order to provide more effective care for patients. The aim of this…

Abstract

Purpose

There is an increasing emphasis on strengthening links between the primary and specialist services in order to provide more effective care for patients. The aim of this paper is to focus on a study to engage frontline, secondary care clinicians in a process of reflection on the role of link workers and to identify their view of priorities.

Design/methodology/approach

The paper adopts a mixed method study involving focus groups (qualitative method with deductive approach) followed by a survey (quantitative method with an interpretative approach).

Findings

The essential role of link workers in managing clinical throughput/flow and improving communication with general practitioners is highlighted. In contrast, crisis intervention and relapse prevention were identified to be of least importance, probably indicating the role of crisis teams and community teams in fulfilling these functions, respectively.

Practical implications

It has become apparent through this evaluation that there may be a need to strike a balance between the emphasis upon greater integration of this role with community mental health teams and closer collaboration with general practitioners.

Originality/value

The study is part of a service evaluation undertaken with a view to evaluating the role of link workers.

Details

The Journal of Mental Health Training, Education and Practice, vol. 7 no. 3
Type: Research Article
ISSN: 1755-6228

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Article

Salman Bin Naeem, Rubina Bhatti and Khurshid Ahmad

This study is a part of the doctoral dissertation that proposes concrete measures to improve health-care information outreach program for rural health-care professionals…

Abstract

Purpose

This study is a part of the doctoral dissertation that proposes concrete measures to improve health-care information outreach program for rural health-care professionals in primary and secondary health care in Punjab, Pakistan. This study aims to report on the barriers to accessing and using online health-care information from rural settings of the Punjab province of Pakistan.

Design/methodology/approach

A cross-sectional survey was conducted in primary and secondary health-care settings in the Punjab province of Pakistan. The study’s population consisted of the rural primary care physicians (PCPs), who were geographically dispersed across 2,873 different remote health-care settings across Punjab. These practice settings included 2,455 basic health units, 293 rural health centers, 89 tehsil headquarter hospitals and 36 district headquarter hospitals.

Findings

Limited internet access, non-availability of required equipment and lack of training facilities were identified as the main barriers. PCPs’ gender, previous enrollment in post-graduation programs and type of health-care facility were significant factors in the perceived barriers related to both “non-availability of required equipment” and “inadequate training facilities on the use of information resources”.

Practical implications

The findings of the study hold some important practical implications for different stakeholders. This study identifies and addresses the barriers to accessing and using health-care information for PCPs in rural settings. The success of the health-care information outreach program in Punjab, Pakistan, should rely on the eradication of these barriers.

Originality/value

To the best of the authors’ knowledge, this is the first large-scale study in Pakistan that assesses the barriers and proposes ways to overcome these barriers to effectively access and use health-care information.

Details

Information Discovery and Delivery, vol. 48 no. 4
Type: Research Article
ISSN: 2398-6247

Keywords

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Book part

Stuart Redding, Richard Hobbs, Catia Nicodemo, Luigi Siciliani and Raphael Wittenberg

Purpose: In this chapter, we examine the National Health Service (NHS) and Adult Social Care (ASC) in England, focussing on policies that have been introduced since 2000…

Abstract

Purpose: In this chapter, we examine the National Health Service (NHS) and Adult Social Care (ASC) in England, focussing on policies that have been introduced since 2000 and considering the challenges that providers face in their quest to provide a high standard and affordable health service in the near future.

Methodology/Approach: We discuss recent policy developments and published analysis covering innovations within major aspects of health care (primary, secondary and tertiary) and ASC, before considering future challenges faced by providers in England, highlighted by a 2017 UK Parliament Select Committee.

Findings: The NHS and ASC system have experienced tightening budgets and serious financial pressure, with historically low real-terms growth in health funding from central government and local authorities. Policymakers have tried to overcome these challenges with several policy innovations, but many still remain. With large-scale investment and reform, there is potential for the health and social care system to evolve into a modern service capable of dealing with the needs of an ageing population. However, if these challenges are not met, then it is set to continue struggling with a lack of appropriate facilities, an overstretched staff and a system not entirely appropriate for its patients.

Details

The Sustainability of Health Care Systems in Europe
Type: Book
ISBN: 978-1-83909-499-6

Keywords

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