The latest articles profiled by the Primary Health Care Research & Information Service include:
- Some ideas for improving the organisation of primary care services
- A caution on the use of smart phones in healthcare settings
- A call for wider use of nurse practitioners in primary care.
Making primary care exciting again
Petra Bywood writes:
Healthcare systems worldwide have struggled to cope with the growing demands of an ageing population, increasing burden of chronic disease and rising costs of providing quality health care.
Strong primary health care and the patient-centred medical home are well accepted as essential elements of an effective and efficient health care system and are reflected globally in health policies (eg Australia’s National Health Reform Agreement and the US Affordable Care Act).
In a recent article in the New England Journal of Medicine, Barnes et al have injected a shot of enthusiasm into primary care, outlining a number of ideas for improvement that are based on delivery of high-quality integrated care.
Using a ‘day at the office’ scenario, the authors described how a multidisciplinary team of professionals might start the day with a ‘team huddle’ to discuss the day’s patient list and develop an action plan to deliver care to the community of patients. Smaller teamlets then coordinate the processes for the day.
They identified three key points that motivate health professionals to be engaged and energised and invest in their work: 1) a global payment system that links hospitals to primary care practices; 2) real responsibility to work at the top of their practice and create opportunity for professional development; and 3) accountability for their performance.
New and expanded roles in primary care are critical elements of this exciting new face of primary care. Designated time for virtual appointments (eg telehealth and email consultations) and shared appointments (eg pregnant women, diabetes patients) may free up doctors’ time to focus on patients with complex conditions.
The authors suggest that, if we are to understand the “upstream determinants of downstream sickness”, primary care needs to be extended beyond the doors of the medical home into the community and to bridge the gap between primary care and other components of health (eg, social care, community health). This transformation will require strong leadership, teamwork and a keen willingness to change.
• Barnes KA, Kroening-Roche JC and Comfort BW (2012). The developing vision of primary care, New England Journal of Medicine, 367(10): 891-893.
Distracting: an assessment of smartphone usage in health care work settings
Amanda Carne writes:
Watch out all you ‘angry bird’ devotees…[tongue firmly pressed in cheek]…these ‘smartphones’ could be the downfall of humankind.
Smartphones (mobile phones with additional functions similar to personal digital assistant (PDA) devices) are an anywhere, anytime device. They are always with us, always on, assisting us both at work and home.
In this article, Gill and colleagues describe how smartphones are becoming central to everyday life, as they serve as a means to fulfil tasks both at work and home, and in health care work settings this presents both opportunities and challenges.
In America in 2009, 64% of physicians used smartphones, with this expected to reach 81% by the end of 2012. However, the benefits – including improved medication safety in primary care – could be “…severely undermined if abuse and overuse are not kept in check”.
In this practice-focused research paper, the myriad of health care-related software applications were examined. While smartphones form the basis of our electronically connected life, the authors found that smartphones compromise not just security and privacy, but also quality of patient care, and efficiency.
Smartphones can distract health care employees from tasks involving decision-making, and can potentially interfere with effective health care provision.
Distraction, mistakes, errors, or omissions caused by smartphone use in the health care setting could have fatal repercussions.
By establishing usage policies that guide health care employees in the appropriate time and place to use these devices, the negative effects of smartphones in the health care workplace could be reduced.
Gill and colleagues offer a conceptual framework of best practice to regulate the use of smartphones in health care work settings and provide guidelines to assist in creating the policies for the use of smartphones in a health care workplace that will not only reduce the risks but also improve efficiency.
• Gill PS, Kamath A, & Gill TS. (2012). Distraction: an assessment of smartphone usage in health care work settings, Risk Management and Healthcare Policy, 5, 105-114.
Meeting global needs in primary care with nurse practitioners
Jodie Oliver-Baxter writes:
It is time for nurses and GPs to put aside their differences and grasp the opportunity to work together towards a common goal; the provision of high-quality primary care that is both safe and accessible, according to Barbara Riegel and colleagues from the University of Pennsylvania, School of Nursing.
The authors argue that nurses constitute an underused and undervalued workforce with the potential to help improve the health of patient populations worldwide. Nurses make up the largest health-care workforce across the globe from which to draw primary care providers.
Although the nurse practitioner movement developed around 50 years ago, currently only 23 countries formally recognise the nurse practitioner role. In 2010 the US had 55,000 nurse practitioners, the UK 3,200; and in Australia there were 320 in 2008. In some countries nurses already have increased autonomy like in Hong Kong where nurse practitioners work independently in nurse-run clinics, and in Botswana where they lead rural and urban clinics in underserved areas.
There is likely to be an increased demand for nurse practitioners worldwide given that primary care physician workforce numbers are waning due to dwindling enthusiasm for primary care roles and under subscribing of primary care programs in medical training.
In the current political climate which identifies primary health care as the vehicle for health reform in Australia (and worldwide) nurse practitioners are recognised as having the expertise to deal specifically with the challenges of improving integration of health care for populations that are ageing and with increasing chronic diseases.
It is too simplistic a statement to imply that more effective use of the existing supply of nurses and nurse practitioners is the answer.
Barriers to professional growth for nurse practitioners and the effect on job satisfaction are commented on, including issues related to intraprofessional practice relationships and collegiality.
However what this article lacks is a focus on factors that facilitate this much-needed growth of the nurse practitioner role.
Access to primary care is a critical global issue and the more effective use of nurses and nurse practitioners, to the fullest of their knowledge and skills, is argued as a better solution than the traditional solution of increasing the supply of primary care doctors.
• Riegel, B., Sullivan-Marx, E., Fairman, J. (2012). Meeting global needs in primary care with nurse practitioners. The Lancet. Volume 380, pp. 449- 50
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