Academic literature on the topic 'Economic aspects of Group medical practice'
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Journal articles on the topic "Economic aspects of Group medical practice":
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Bliss, Joy A., and Gregory G. Caputy. "The business education of Canadian plastic surgeons." Canadian Journal of Plastic Surgery 4, no. 1 (September 1996): 1–10. http://dx.doi.org/10.1177/229255039600400103.
Abstract:
Business and economic aspects of a medical practice are rapidly becoming more complex. Physicians are at a crossroads in the manner by which medical and surgical care will be delivered in Canada, at the very base of which are the business aspects and management of health care. The purpose of this research study was to determine the business acumen of plastic surgeons in active practice. The resource base was Canadian plastic surgeons who are members of the Canadian Society of Plastic Surgeons. The intent of the questionnaire research study was to evaluate whether these surgeons perceive this area as necessary and whether they feel adequately prepared to manage this aspect of their practice. The findings of the research indicate that the plastic surgeons surveyed did perceive a need for business acumen in the practice of medicine. The majority felt they were not prepared adequately to deal with the business side of operating a medical practice and perceived a need for basic knowledge in the area of business. The implications of this research are that medical education has ignored this important aspect of preparing a physician to practise medicine in the present economic environment. Educational materials to structure and systematically disseminate business resource information need to be developed so that this group would be able to deal adequately with business-related problems when faced with them in medical practice. Due to the specialty-specific nature of the business needs, this education should likely occur during residency or fellowship training.
2
Black, Douglas. "Expensive Medical and Surgical Technology." International Journal of Technology Assessment in Health Care 5, no. 3 (July 1989): 308–12. http://dx.doi.org/10.1017/s0266462300007376.
Abstract:
The very title - “Expensive Medical and Surgical Technology” - expresses in coded form a myth that is widely prevalent among those who consider the political and economic aspects of health care. Strangely, it is a myth that finds favor mainly at the extreme ends of the range of attitudes toward health care. Monetarists see it as an incentive toward increasing private provision of health care, while extreme egalitarians see it as another example of unjust privilege. The content of the myth is that there is a definable group of costly procedures, which can somehow be isolated from the general practice of medicine and surgery, after which such procedures can either be made the subject of special private provision or, alternatively, discarded from a rationed system of health care.
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McKenna, M., and A. Abdelaal. "Group & save sampling in lumbar decompression: A review into current practice." Journal of Perioperative Practice 31, no. 1-2 (November 22, 2020): 15–17. http://dx.doi.org/10.1177/1750458920950664.
Abstract:
The risks, benefits and technical aspects of surgery require careful consideration. One element of this is the requirement of postoperative blood transfusion. Patients who undergo elective lumbar decompression are at a low risk of requiring a postoperative transfusion yet undergo multiple preoperative group & save tests. For those who are at a low risk of bleeding, a single group & save sample may be adequate. This review analysed the postoperative blood loss and transfusion rate associated with lumbar decompression surgery without fusion in one institution. A subsequent cost analysis and review of the literature was performed. The aim was to assess whether single group & save sampling, within the context of lumbar decompression, was cost effective and amenable to the patient without impacting patient care. Average blood loss was estimated as a drop in Hb of 12.3g/dl. Six patients (14%) had Hb loss of over 20g/dl. No patients underwent a blood transfusion. Through examination of medical records, we found that 65% of patients (35) were suitable for single group & save sampling, estimating a saving of £2415.95 (53%). Selective group & save testing holds economic potential and safeguards patients from undergoing unnecessary testing. The next step after this review would be a prospective multi-centre study.
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Springer, Svenja, Peter Sandøe, Thomas Bøker Lund, and Herwig Grimm. "“Patients’ interests first, but … ”–Austrian Veterinarians’ Attitudes to Moral Challenges in Modern Small Animal Practice." Animals 9, no. 5 (May 15, 2019): 241. http://dx.doi.org/10.3390/ani9050241.
Abstract:
Small veterinary practice is experiencing steady improvement in diagnostics and therapies which enable veterinarians to offer evermore advanced medical care for their patients. This focus group study of veterinarians (n = 32) examined the impact of these improvements and the potential challenges they introduce in small animal practice. It shows that while advanced diagnostics and therapies deliver benefits in patient care, they also add complexities to decision-making. Although the veterinarians participating in the study were aware of their duty to act in the best interests of the animal, their decisions were highly dependent on factors such as the client’s financial background and the emotional bond between client and animal, as well as the veterinarian’s place of work, and level and field of specialization, and certain economic aspects of the practice. The overall conclusion is that small animal veterinarians are increasingly torn between serving the best interests of the animal, medical feasibility and contextual factors related to the client, the veterinarian, and professional colleagues. Further, the findings suggest that services are not only oriented towards the provision of medical care in a strict medical sense. On top of this, veterinarians need to deal with various expectations and wishes of clients which influence their decision-making. As it will be shown, factors like the possibility of referring patients to specialist veterinarians or prompt diagnostic results influence their decision-making.
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Stefanicka-Wojtas, Dorota, Marta Duda-Sikuła, and Donata Kurpas. "Personalised medicine – best practices exchange and personal health implementation in European regions – a qualitative study concept under the Regions4PerMed (h2020) project." Medical Science Pulse 14, no. 1 (June 30, 2020): 1–8. http://dx.doi.org/10.5604/01.3001.0014.2475.
Abstract:
Personalised medicine (PM) is the adaptation of medical treatment to an individual patient. More importantly, PM offers the potential to detect disease earlier when it is easier to treat effectively. PM is beginning to overcome the limitations of traditional medicine. In PM there are many potential benefits and facilitators but also many barriers. The goals of the Regions4PerMed project are to set up the first interregional cooperation on PM, align strategies and financial instruments, and most importantly, identify primary barriers in personal medicine adoption in the health care system and systematic actions to remove as many of them as possible to create a future where PM is fully integrated into real life settings. Each key action activity will be followed by a focus group or semi-structured qualitative interview. The questions asked during the research will concern barriers and facilitators of PM implementation in the country of a subject and will concern: medical big data and electronic medical records; health technology in connected and integrated care; the health industry; facilitate the innovation flow in health care; socio-economic aspects. The qualitative study outcomes are supposed to bring more qualitative data to the discussion. They could be implemented to the daily practice of the health care system’s stakeholders through the best practices transferred to all five key strategic areas of the Regions4PerMed project.
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Svistushkin, V. M., G. N. Nikiforova, A. V. Zolotova, and V. A. Stepanova. "Using of topical bacterial lysates in modern clinical practice." Meditsinskiy sovet = Medical Council, no. 6 (May 12, 2021): 49–56. http://dx.doi.org/10.21518/2079-701x-2021-6-49-56.
Abstract:
Acute and chronic infectious and inflammatory diseases of the upper respiratory tract occupy a leading position in the structure of the pathology of the world’s population and remain the most frequent reason for patients seeking medical care. The prevalence and frequency of this disease in this nosological group makes a decisive contribution to the structure of the causes of temporary disability, which entails significant negative social and economic consequences. In this aspect, the spread of resistance of pathogens to etiotropic drugs and the insufficient arsenal of pathogenetic drugs stimulate the medical community to search for alternative approaches to the treatment of patients with respiratory pathology. One of these therapeutic areas is the use of immunomodulators, the most commonly used group of which are bacterial lysates. In the modern literature, sufficiently convincing data have been accumulated on the effectiveness of the use of bacterial lysates of systemic action, as a result of which the immune cells of the gastrointestinal tract are activated, which in turn leads to the restoration of autoregulation of the immune response throughout the body, and a decrease in the frequency of infectious and allergic diseases. The latest developments of domestic pharmacologists are topical bacterial lysates, the principle of which is based on the local activation of mucosal immunity in the respiratory tract. The undoubted advantage is that bacterial lysates, with all their effectiveness, do not harm the human microbiome, practically do not cause side reactions, combine well with other drugs, and can also be used at any stage of the disease, including for prophylactic purposes.
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Movig, Kris LL, Antoine CG Egberts, Albert W. Lenderink, and Hubert GM Leufkens. "Selective Prescribing of Spasmolytics." Annals of Pharmacotherapy 34, no. 6 (June 2000): 716–20. http://dx.doi.org/10.1345/aph.19267.
Abstract:
BACKGROUND: Daily clinical practice often differs largely from the clinical trial setting, so extrapolation of outcomes from trial data, such as safety, effectiveness, and economic outcomes, can be deceptive. Prescribers may intend to treat a selected group of patients with new drugs; this practice could result in significant bias in assessing outcomes of these agents during their use in daily clinical practice. OBJECTIVE: To evaluate what type of patient received tolterodine compared with the spasmolytic drugs previously marketed (oxybutynin, flavoxate, emepronium). DESIGN: An observational, follow-up study. SETTING: Eighteen collaborating community pharmacies. PATIENTS: Aged ≥18 years, noninstitutionalized; initial therapy with tolterodine, oxybutynin, flavoxate, or emepronium. RESULTS: Tolterodine was often used as a second-line and even as a third-line treatment, and was prescribed to a “polluted” population in terms of concomitant psychotropic medication. Tolterodine users were 7.5 times more likely to have received another spasmolytic drug (RR 7.5, 95% CI 4.8 to 11.9). In addition, these patients more frequently used antiparkinsonian drugs (RR 4.1, 95% CI 1.6 to 10.4) as well as antipsychotic drugs (RR 2.9, 95% CI 1.4 to 6.2). There was a small difference in concomitant use of antidepressants and benzodiazepines between patients receiving tolterodine versus those taking other spasmolytic drugs. CONCLUSIONS: Tolterodine is prescribed for a population differing from that receiving previously marketed spasmolytic drugs. Selective prescribing should be recognized when evaluating new drugs in daily clinical practice. Policy makers, such as pharmacy and therapeutics committees, should consider this aspect in their formulary decisions since selective prescribing can lead to unjustified conclusions about a drug's therapeutic effects (e.g., efficacy, safety, cost-effectiveness).
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V K Singhal, Shalini Ray, Priyanka Sachdeva, and Vishesh Yadav. "A Study on Gender Preferences and its Sociocultural aspects among Married Women (18-45years) in Rural Gurugram." International Healthcare Research Journal 3, no. 5 (August 24, 2019): 185–88. http://dx.doi.org/10.26440/ihrj/0305.08270.
Abstract:
INTRODUCTION: Declining sex ratio is a major concern worldwide, especially in a developing country like India. The role of sociocultural factors in gender preference is known since ages. The skewed sex ratio in India is attributed to selective female feticides and misuse of technological advancements. This also has a strong influence on contraceptive acceptance among couples.
OBJECTIVES: The present study was conducted to explore the contraceptive use, gender preferences and its determinants among married women in rural Gurgaon.
MATERIALS AND METHODS: A cross-sectional study was conducted among married women (18-45years) residing in the rural field practice area of SGT medical college and hospital, Gurugram. The sample size was found to be 400. Systematic random sampling technique was used to recruit the study participants. Pre- tested, pre-designed questionnaire was used for data collection.
RESULTS AND DISCUSSION: Among 400 married women, current contraceptive usage among study population was found to be 58.25%. The most common method of contraception used by the study subjects was intrauterine contraceptive device. The preference for male child was found among 49.5% women. The reasons cited for such preference were propagation of family name (48.2%), financial dependability in the old age (34%), social responsibilities are carried out by males (25.3%) and males are lesser economic liability (31%). Lower age group of mother, nulliparity, Hindu religion, lower educational status and lower socioeconomic status were found to be the determinants of male child preference in the present study.
CONCLUSION: There is need of awareness and education amongst women and both the genders deserve equal respect without any preferences.
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Maric, Nadja, Dragan Stojiljkovic, Zorana Pavlovic, and Miroslava Jasovic-Gasic. "Factors influencing the choice of antidepressants: A study of antidepressant prescribing practice at University psychiatric clinic in Belgrade." Vojnosanitetski pregled 69, no. 4 (2012): 308–13. http://dx.doi.org/10.2298/vsp1204308m.
Abstract:
Background/Aim. Antidepressants are a widely used class of drugs. The aim of this study was to investigate different aspects of antidepressant prescribing practice at University Psychiatric Clinic in Belgrade. Methods. This cross-sectional study was carried out by retrospective analysis of the patient's medical charts. The study included all patients with antidepressant prescribed at discharge during 2009 (n = 296). The evaluation was focused on patient- related factors (socio-demographic and illness related), psychiatrist-related factors (sex and duration of working experience) and drug related factors (type of antidepressant, dose, polypharmacy and reimbursement by national health insurance). Results. Antidepressants were prescribed for unipolar depression (F32-34, ICD X) either without comorbidity (46.2%) or with comorbidity (24.7%), mostly as a monotherapy (91% had one antidepressant), to the patients who were 65% female, aged 50.1 ? 8.9, most of them with 12 years of education (52.6%), married (69.3%) and employed (55.9%). The majority of patients had a history of two hospitalizations (Med 2; 25th-75th perc. 1-4) during nine years (Med 9; 25th-75th perc. 2-15) after the first episode of depression. Among them, 19% were found to be suicidal in a lifetime. The single most prescribed antidepressant was sertraline (20.4%), followed by fluoxetine (13.3%) and maprotiline (11.7%). Utilization of antidepressants was positively correlated with the rate of reimbursement (p < 0.01). The most prescribed antidepressant group was selective serotonin reuptake inhibitors (SSRI) (47.8%), followed by tricyclic antidepresants (TCA) (25.3%) and new antidepressants - venlafaxine, tianeptine, mirtazapine, bupropion, trazodone (15.1%). Most of the drugs were prescribed in doses which are at the lower end of the recommended dose-range. Regarding severity of the actual depressive episode, TCA were prescribed for severe depression with psychotic features, while SSRI were choice for episodes with moderate symptom severity (p = 0.01). Psychiatrists with longer working age (20-30 years) hesitated to prescribe new antidepressants in comparison to younger colleagues (p = 0.01). Conclusion. Economic issues in Serbia as developing country influence the choice of antidepressants, as well as a psychiatrist?s working age and severity of depression. However, SSRI are the drugs of the first choice, as it was shown in most of the developed countries nowadays.
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Gupta, Anmol K., Anita Thakur, Tripti Chauhan, and Nidhi Chauhan. "A study to determine socio demographic corelates of reproductive tract infection amongst women of reproductive age group." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 8 (July 23, 2020): 3463. http://dx.doi.org/10.18203/2320-1770.ijrcog20203342.
Abstract:
Background: Reproductive tract infection (RTI) is a public health problem, especially in developing country like India. The associated odium with this reproductive morbidity is often a stumbling block in seeking health care. The aim was to study the prevalence of RTI symptoms and its socio-demographic corelates.Methods: A cross-sectional study was undertaken in the rural field practice area of department of community medicine, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India, from July 2018 to September 2018. Total sample size calculated was 410. Random sampling was used to select eligible couple to whom a predesigned, pretested, semi-structured and anonymous interview schedule was administered after taking consent.Results: The prevalence of self-reported reproductive tract infections was found to be 41.2%. The prevalence was more in lower socio-economic classes, and it was statistically significant. Other socio-demographic corelates (age, education, occupation) did not showed any significant association.Conclusions: The reproductive tract infections prevalence is found to be considerably high in the women of reproductive age group. The frequency was higher among multigravida women and those using cloth during menstrual periods. RTIs are usually spurned by women and even the health care providers, so there is a need to give due consideration to this aspect of reproductive health.
Dissertations / Theses on the topic "Economic aspects of Group medical practice":
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Muir, Lauretta, and n/a. "The impact of economic theory on the art of clinical practice : a study of science, meaning, and health." University of Otago. Dunedin School of Medicine, 2006. http://adt.otago.ac.nz./public/adt-NZDU20060911.160405.
Abstract:
In being philosophically based this thesis is concerned with understanding the human condition with particular reference to matters of meaning and how these find expression in systems of government and social policy.
This study is based on the premise that concepts determine how the world is viewed and people use a variety of conceptual schemes to answer different classes of questions. Scientific endeavour is based in a scheme that enables questions about the material world to be answered. It cannot however answer classes of questions related to many features of human lives as its methods necessitate the development and use of abstractions and generalisations that are ill-equipped by design to determine what is important to people and what motivates and satisfies them. Therefore, the reality of any particular individual or group cannot be adequately understood in scientific terms.
The thesis examines the scientific conceptual framework and minimalist abstractions of the medical model and the quasi-scientific conceptual frameworks of economics and identifies their conceptual limits. It shows that if the medical model is assumed to provide a complete representation of realities in health and is uncritically used as the basis of medical practice it has the potential to overlook the patient as a person and distance medical practice from its social roots which can lead to adverse outcomes for both clinical practice and medicine itself. It also observes that the economic scheme has conceptual limits that create their own distorted representations of reality. A similar dislocation in the meaning of people�s lives occurs when abstractions are made by adopting concepts from other schemes based in science, such as the medical model, without any awareness of their conceptual limits. Further distortions occur when these other accounts are turned into economic ones. Not only is the patient as a person overlooked, so is the patient as an entity.
In light of these observations the thesis examines health reforms that have taken place in New Zealand, whereby the economic scheme has been given dominance in the development of public policy and set the parameters for rationality and what can acceptably be said. It shows that in not recognising features of meaning these parameters have led to health sector reforms that have had unintended and adverse consequences for clinical practice, as shown in the particular case of reforms of maternity services. Furthermore these reforms have severed the health sector from its social roots and moral frameworks and created barriers between it and government so that health sector problems that cannot be understood using economic parameters cannot be addressed in forums where public policy is developed.
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Tucker, Melody A. "A Time Study of Audiological Practice Patterns and the Impact of Reimbursement Changes from Third Part Payers." Scholar Commons, 2001. https://scholarcommons.usf.edu/etd/1543.
Abstract:
The primary objective of the project was to survey audiologists in clinical practice setting to determine the amount of time taken to perform various audiologic tests using Current Procedural Terminology, (CPT) codes to define these tests and if these CPT codes were felt to be adequate. Audiologists were also asked to respond regarding possible impact and reimbursement changes in their clinical practices related to managed care. Responses of audiologists were analyzed to determine: a) adequacy of CPT codes; b)average time to perform various audiologic tests; c) impact managed care onclinical practice; and d) changes in reimbursement as a result of managed care.
The survey was designed to determine the type of work setting, typical job duty, average monthly caseload and hours per day spent on patient care for each respondent. The survey with a cover letter explaining the purpose was mailed to 93 audiologists in clinical setting in the state of Florida. Five were returned undeliverable, and 39 of the remaining 88 were returned either completed or partially completed.
The survey results revealed over 71% of the audiologists felt the current CPT codes were adequate. Time spent performing traditional audiologic tests, such as comprehensive audiometric evaluations and impedance testing, was fairly consistent. Greater time variability occurred in tests used to determine vestibular function. Over three-quarters of the respondents believed managed care has had a negative impact on their clinical practices, while 11% believe they have been positively impacted. Approximately 82% of the audiologists have had reductions in reimbursement as a result of managed care, while 10% have seen no change and 5% have enjoyed slightly greater reimbursement.
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Pinheiro, Isabel Cristina Barbosa. "Efeitos da Regula????o Econ??mico-Financeira nas Estrat??gias de Financiamento das Operadoras de Plano De Sa??de: cooperativas m??dicas versus medicinas de grupo." FECAP - Faculdade Escola de Com??rcio ??lvares Penteado, 2014. http://132.0.0.61:8080/tede/handle/tede/526.
Abstract:
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Previous issue date: 2014-01-24The Brazilian public health system is deficient and doesn't fully meet the needs of the population. As a result, the private health care market has grown in recent years, which has changed the role of the state from executive to regulator of that sector. Regulation includes tackling the economic and financial issue. Our study aimed to identify the behavior of financing strategies adopted by medical cooperatives and group medicines to meet the regulatory benchmarks of the supplementary health care sector in Brazil. The survey results show that the mandatory Guaranteeing Assets (Ativos Garantidores, AG), 1st regulatory moment, resulted in a significant increase of both the overall and the long term indebtedness indexes, which reveals the use of Third-party capital instead of Equity capital. Only the Medical Cooperatives featured increased Overall Indebtedness, which means that the Medical Cooperatives, unlike Group Medicines, are capitalized by third party funds rather than by Equity Capital. Both modalities adopted the strategy of increasing their long-term debt and reducing their short term debt (debt composition). With the introduction of the Health Guarantor Fund (Fundo Garantidor da Sa??de, FGS), 2nd regulatory moment, the Overall and Current Liquidity indexes decreased, showing that the goal of the FGS program to reduce financial guarantees and to improve working capital wasn't met. Medical Cooperatives managed to reduce their overall debt, whereas the overall debt of Group Medicines increased. We conclude that there was a balance between the Indebtedness indexes and Liquidity over the period and that operators who wish to remain in the market must comply with the rules, adapting and improving the quality of their management
A rede p??blica de sa??de no Brasil ?? prec??ria e n??o atende de forma plena ??s necessidades da popula????o. Consequentemente, o mercado privado de assist??ncia ?? sa??de tem crescido nos ??ltimos anos e com isso a fun????o do Estado vem se alterando, passando de executor para regulador deste setor de atividade. Um alvo da regula????o ?? a quest??o econ??mico-financeira. Nesse sentido, este trabalho tem como objetivo identificar o comportamento das estrat??gias de financiamento adotadas pelas cooperativas m??dicas e medicinas de grupo frente aos marcos regulat??rios do setor de sa??de suplementar no Brasil. Os resultados da pesquisa indicam que com a obrigatoriedade dos Ativos Garantidores - AG, 1?? momento regulat??rio, os ??ndices de Endividamento, tanto geral quanto de longo prazo tiveram um aumento significativo, o que indica a utiliza????o de Capital de Terceiros ao inv??s do Capital Pr??prio. Observou-se que apenas as Cooperativas M??dicas apresentaram um aumento no Endividamento Geral. Isso indicou que as Cooperativas M??dicas, diferentemente, das Medicinas de Grupo, se capitalizaram com recursos de terceiros ao inv??s do Capital Pr??prio. Notou-se que ambas as modalidades adotaram a estrat??gia de aumentar a d??vida de longo prazo e reduzir as de curto prazo (composi????o do endividamento). Com a institui????o do Fundo Garantidor da Sa??de - FGS, 2?? momento regulat??rio, os ??ndices de Liquidez Geral e Corrente diminu??ram, indicando que a proposta do programa FGS, de reduzir as garantias financeiras e melhorar o capital de giro, n??o ocorreu. Observou-se que para as Cooperativas M??dicas o endividamento geral diminuiu e em contrapartida para as Medicinas de Grupo aumentou. Contudo, conclui-se que houve um equil??brio entre os ??ndices de Endividamento e Liquidez ao longo do per??odo e que para as operadoras se manterem no mercado ter??o que atender as regras, adaptando-se e melhorando a qualidade da sua gest??o
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Bilazarian, Ani. "Primary Care Practice Structural Capabilities and Emergency Department Utilization Among High-Need High-Cost Patients." Thesis, 2021. https://doi.org/10.7916/d8-fx47-ja94.
Abstract:
Background
Primary care practices in the United States (US) are currently constrained in their ability to deliver high quality care due to population aging, insurance expansion, and an increasing prevalence of chronically ill patients. The nurse practitioner (NP) workforce plays a critical role in meeting the growing demands for primary care, particularly in rural and underserved areas. NPs are also more likely to deliver care to clinically and socially complex populations such as high-need high-cost (HNHC) patients. HNHC patients are adults who suffer from multiple chronic conditions and experience additional functional, behavioral, or socioeconomic needs. Despite comprising only 5% of the US population, HNHC patients account for nearly half of total health care expenditures and over 90% of Medicare expenditures. HNHC patients with behavioral health diagnoses such as depression or substance abuse face heightened challenges managing their conditions and consequentially have higher preventable spending and emergency department (ED) utilization compared to the overall HNHC population.
Significant policy attention has been placed on enhancing primary care practices as a strategy to improve outcomes and reduce costs in HNHC patients. Structural capabilities are features of primary care practices (e.g., after-hours care or care coordination) which are needed to deliver high quality primary care and chronic disease management. Yet, to date little research has been done on structural capabilities in primary care practices where NPs deliver care to HNHC patients. The overall purpose of this dissertation is to understand how to enhance primary care delivery and structural capabilities to improve outcomes for HNHC patients. We have achieved the following specific aims: (1) Establish a clear definition of HNHC patients, (2) Identify existing primary care and payment models used among HNHC patients and evaluate their impact on ED utilization and costs, (3) Evaluate structural capabilities in NP primary care practices located in Health Professional Shortage Areas (HPSAs), and (4) Analyze the association between NP practice structural capabilities and ED utilization among HNHC patients with behavioral health conditions.
Dissertation Chapters and Key Findings
Chapter One includes an introduction to the landscape of current primary care delivery, the role of the NP workforce in expanding access, and the unique challenges of delivering care to HNHC patients. This chapter also discusses the conceptual framework guiding the dissertation, the specific aims of each study, and how each study will fill a gap in the literature.
Chapter Two (Aim 1) consists of a concept analysis of HNHC patients using the Walker and Avant framework. Three subgroups of HNHC patients were identified: adults over the age of 65 who suffer from multiple chronic conditions with functional or behavioral health needs, the frail elderly, and patients under 65 years old with a serious mental health condition or disability. Antecedents that predispose an individual to becoming a HNHC patient include challenges accessing timely care, low socioeconomic status, or unmet needs. Persistent high spending occurs as a result of poorly managed chronic diseases leading to acute exacerbations, preventable health service utilization, and fragmented care between the acute and primary care settings.
Chapter Three (Aim 2) is a systematic review of studies conducted from 2000-2020 on primary care and payment models used with HNHC patients. About half of the primary care models evaluated in the systematic review (11 out of 21 studies) showed no significant difference in ED utilization among HNHC patients. Care coordination and care management (15 out of 21 studies) demonstrated both positive and negative associations with ED utilization and costs. Primary care models that demonstrated significant reductions in ED utilization had shared features, including frequent follow-up, multidisciplinary team-based care, enhanced access, and care coordination.
Chapter Four (Aim 3) includes a cross-sectional study of NP survey data from 2018-2019 on practice structural capabilities linked with data on primary care shortages (i.e., HPSA designation). Bivariate analyses and multivariable regression models were used to compare NP characteristics and structural capabilities in HSPA practices compared to non-HPSA practices. The majority of NPs in our sample (61%) delivered care in HPSA practices. NP practices located in HPSAs were significantly more likely to deliver care coordination compared to non-HPSA practices. We found no significant difference in prevalence of registries, after-hours care, or shared communication systems.
Chapter Five (Aim 4) is a study of cross-sectional NP survey data from 2018-2019 on practice structural capabilities linked with Medicare Part A and Part B claims to identify HNHC patients and ED utilization. Multivariable Poisson models were used to estimate the association between ED utilization and structural capabilities in practices serving HNHC patients with behavioral health conditions including depression, alcohol use, and substance use disorder. Care coordination was associated with decreased rates of ED utilization among the overall HNHC population and those with alcohol use, but not among HNHC patients with depression or substance use disorders. Shared communication systems were associated with decreased rates of all-cause and preventable ED utilization among HNHC patients with alcohol use and substance use disorders.
Chapter 6 is a summary of findings across studies in this dissertation and will present the strengths, limitations, and contributions to science. This chapter will also discuss implications for policy, practice, and directions for future research.
Conclusion
HNHC patients face complex and wide-ranging medical, social, and behavioral health needs resulting in poor clinical outcomes and high costs. Enhancing primary care is an urgent goal for policymakers to improve disease management while reducing overall costs of care. Findings from these studies demonstrate that NPs practice in underserved areas and are significantly more likely to deliver care coordination in HPSA practices and to HNHC patients with behavioral health conditions. Care coordination has the potential to increase effectiveness of primary care delivery by tailoring models to target specific HNHC patients. Shared communication systems also show promise for improving primary care delivery and reducing ED utilization among HNHC patients with alcohol use and substance use disorders. Future research should continue to explore how structural capabilities may enable NPs to deliver timely, high quality, cost-effective primary care for HNHC patients.
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Lombard, Kristen Cronk. "Nurses' experiences of the practice of the PeerSpirit Circle model from a Gadamerian philosophical hermeneutic perspective." Thesis, 2013. http://hdl.handle.net/1805/3625.
Abstract:
Indiana University-Purdue University Indianapolis (IUPUI)The PeerSpirit Circle is a non-hierarchical, intentional, and relationship-centered practice of collaboration. There is a lack of scientific knowledge about the phenomenon of the PeerSpirit Circle in nursing or its potential impact on nursing practice, education, research, and the evolution of the profession and health care. The health care milieu is often entrenched in ways of being that do not support sustained change. For vitality to prosper and creativity to abound, paradigmatic shifts and new models of practice that emphasize collaboration are being called for. The purpose and aims of this phenomenological research study are to explore and give voice to the experiences of nurses who have participated in the PeerSpirit Circle model of practice with other nurses. The study includes interviews from five registered nurses from Canada and the United States conducted from 2009–2010 and interpreted from a Gadamerian philosophical hermeneutic perspective. The research findings reveal three themes: (1) experiencing the Circle container” where participants begin to understand the value of intentional preparation of the interpersonal space for safe human interaction and stronger collaboration—there are experiences of gathering, protecting, appreciating ritual, and sharing stories; (2) Experiencing space where protected space seems to be the essential element to inspire the presencing of participants with self and other, which in turn engenders genuine dialogue, a sense of sacred space, and freedom to be authentic; and (3) Experiencing our humanity, an unfolding theme, where participants experience reconnection with and understanding of their deeper humanity, stronger congruence with their core values, deeper experiences of caring and courage, personal and professional growth, and a profound appreciation for belonging to a lineage of nurses. The findings inspire a deeper understanding of barriers to congruence between values and action in nursing and nurses’ need to acknowledge, honor, support, and protect each other’s vulnerability. The implications for nursing practice, education, and research show that the PeerSpirit Circle model is a beneficial for use in all settings.
Books on the topic "Economic aspects of Group medical practice":
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Coddington, Dean C. Capitalizing medical groups: Positioning physicians for the future. New York: McGraw-Hill, 1998.
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Kirschman, David. Practitioner compensation in group practice and HMOs: A 1993 report. Tampa, Fla: Physician Executive Management Center, 1994.
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Kirschman, David. Practitioner compensation in group practice and HMOs: A 1994 report. Tampa, Fla: Physician Executive Management Center, 1994.
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Kirschman, David. Practitioner compensation in group practice and HMOs: A 1992 report. Tampa, Fla: Physician Executive Management Center, 1993.
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Kirschman, David. Practitioner compensation in group practice and HMOs: A 1991 report. Tampa, Fla: Physician Executive Management Center, 1992.
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Piepenburg, Marcus. Die Verteilungskonflikte zwischen Haus- und Fachärzten vor dem Hintergrund der Kostendämpfungspolitik: Eine Analyse des Verhaltens und der Strukturen von Ärzteverbänden auf der Grundlage der neuen politischen Ökonomie. Regensburg: Transfer, 2003.
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Tinsley, Reed. Physician practice mergers. [Chicago?]: AMA Press, 2001.
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Manning, Willard G. Use of outpatient mental health care: Trial of a prepaid group practice versus fee-for-service. Santa Monica, CA: Rand, 1986.
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Cresson-Steinauer, Geneviève. Cabinets médicaux de groupe à Genève: Approche sociologique. Lausanne: Réalites sociales, 1985.
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Schaub, Gary R. Selling or buying a medical practice. Oradell, N.J: Medical Economics Books, 1988.
Book chapters on the topic "Economic aspects of Group medical practice":
1
Patrick, Stephanie. "What Went Right? The Story of US Medicare Medical Nutrition Therapy." In The Economic, Medical/Scientific and Regulatory Aspects of Clinical Nutrition Practice: What Impacts What?, 137–58. Basel: KARGER, 2009. http://dx.doi.org/10.1159/000235676.
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Kondrup, Jens, and Janice M. Sorensen. "The Magnitude of the Problem of Malnutrition in Europe." In The Economic, Medical/Scientific and Regulatory Aspects of Clinical Nutrition Practice: What Impacts What?, 1–14. Basel: KARGER, 2009. http://dx.doi.org/10.1159/000235664.
3
Jensen, Gordon L. "Malnutrition in North America: Where Have We Been? Where Are We Going?" In The Economic, Medical/Scientific and Regulatory Aspects of Clinical Nutrition Practice: What Impacts What?, 15–28. Basel: KARGER, 2009. http://dx.doi.org/10.1159/000235665.
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Elia, M. "The Economics of Malnutrition." In The Economic, Medical/Scientific and Regulatory Aspects of Clinical Nutrition Practice: What Impacts What?, 29–40. Basel: KARGER, 2009. http://dx.doi.org/10.1159/000235666.
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Hoffer, L. John. "The Need for Consistent Criteria for Identifying Malnutrition." In The Economic, Medical/Scientific and Regulatory Aspects of Clinical Nutrition Practice: What Impacts What?, 41–52. Basel: KARGER, 2009. http://dx.doi.org/10.1159/000235667.
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Parver, Alan K., and Sarah E. Mutinsky. "Enteral Nutrition Reimbursement – The Rationale for the Policy: The US Perspective." In The Economic, Medical/Scientific and Regulatory Aspects of Clinical Nutrition Practice: What Impacts What?, 53–70. Basel: KARGER, 2009. http://dx.doi.org/10.1159/000235668.
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Pahne, Norbert. "Enteral Nutrition Reimbursement – The Rationale for the Policy: The German Perspective." In The Economic, Medical/Scientific and Regulatory Aspects of Clinical Nutrition Practice: What Impacts What?, 71–78. Basel: KARGER, 2009. http://dx.doi.org/10.1159/000235669.
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Silver, Heidi J. "Food Modification versus Oral Liquid Nutrition Supplementation." In The Economic, Medical/Scientific and Regulatory Aspects of Clinical Nutrition Practice: What Impacts What?, 79–93. Basel: KARGER, 2009. http://dx.doi.org/10.1159/000235670.
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Torgerson, David J. "Cost-Effectiveness Analysis and Health Policy." In The Economic, Medical/Scientific and Regulatory Aspects of Clinical Nutrition Practice: What Impacts What?, 95–104. Basel: KARGER, 2009. http://dx.doi.org/10.1159/000235671.
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McKinlay, Alastair W. "Implementing Nutritional Standards: The Scottish Experience." In The Economic, Medical/Scientific and Regulatory Aspects of Clinical Nutrition Practice: What Impacts What?, 105–11. Basel: KARGER, 2009. http://dx.doi.org/10.1159/000235672.
Conference papers on the topic "Economic aspects of Group medical practice":
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Liu, Chengcheng. "Strategies on healthy urban planning and construction for challenges of rapid urbanization in China." In 55th ISOCARP World Planning Congress, Beyond Metropolis, Jakarta-Bogor, Indonesia. ISOCARP, 2019. http://dx.doi.org/10.47472/subf4944.
Abstract:
In the past 40 years, China has experienced the largest and fastest urbanization development in the world. The infrastructure, urban environment and medical services of cities have been improved significantly. The health impacts are manifested in the decrease of the incidence of infectious diseases and the significant increase of the life span of residents. However, the development of urbanization in China has also created many problems, including the increasing pollution of urban environment such as air, water and soil, the disorderly spread of urban construction land, the fragmentation of natural ecological environment, dense population, traffic congestion and so on. With the process of urbanization and motorization, the lifestyle of urban population has changed, and the disease spectrum and the sequence of death causes have changed. Chronic noncommunicable diseases have replaced acute infectious diseases and become the primary threat to urban public health. According to the data published by the famous medical journal The LANCET on China's health care, the economic losses caused by five major non-communicable diseases (ischemic heart disease, cerebrovascular disease, diabetes mellitus, breast cancer and chronic obstructive pulmonary disease) will reach US$23 trillion between 2012 and 2030, more than twice the total GDP of China in 2015 (US$11.7 trillion). Therefore, China proposes to implement the strategy of "Healthy China" and develop the policy of "integrating health into ten thousand strategies". Integrate health into the whole process of urban and rural planning, construction and governance to form a healthy, equitable and accessible production and living environment. China is building healthy cities through the above four strategies. The main strategies from national system design to local planning are as follows. First of all, the top-level design of the country. There are two main points: one point, the formulation of the Healthy China 2030 Plan determines the first batch of 38 pilot healthy cities and practices the strategy of healthy city planning; the other point, formulate and implement the national health city policy and issue the National Healthy City. The evaluation index system evaluates the development of local work from five aspects: environment, society, service, crowd and culture, finds out the weak links in the work in time, and constantly improves the quality of healthy city construction. Secondly, the reform of territorial spatial planning. In order to adapt to the rapid development of urbanization, China urban plan promote the reform of spatial planning system, change the layout of spatial planning into the fine management of space, and promote the sustainable development of cities. To delimit the boundary line of urban development and the red line of urban ecological protection and limit the disorderly spread of urban development as the requirements of space control. The bottom line of urban environmental quality and resource utilization are studied as capacity control and environmental access requirements. The grid management of urban built environment and natural environment is carried out, and the hierarchical and classified management unit is determined. Thirdly, the practice of special planning for local health and medical distribution facilities. In order to embody the equity of health services, including health equity, equity of health services utilization and equity of health resources distribution. For the elderly population, vulnerable groups and patients with chronic diseases, the layout of community health care facilities and intelligent medical treatment are combined to facilitate the "last kilometer" service of health care. Finally, urban repair and ecological restoration design are carried out. From the perspective of people-oriented, on the basis of studying the comfortable construction of urban physical environment, human behavior and the characteristics of human needs, to tackle "urban diseases" and make up for "urban shortboard". China is building healthy cities through the above four strategies. Committed to the realization of a constantly developing natural and social environment, and can continue to expand social resources, so that people can enjoy life and give full play to their potential to support each other in the city.