The creative potential of health work to develop an integrated care model in Brazilian primary health care  

In November 2015, at the 3rd World Congress on Integrated Care and 8th National Congress of Integrated Medicine, “Co-producing High Quality People-Centered Integrated Care for ALL”, Debora Santos presented her PhD research on primary health care teams in Alagoas, the most unequal state in Brazil. According to Debora Santos, while Brazil's Unified Health System (SUS) is headed by principles of integrated care, in practice a biomedical conception of health typically prevails instead of one focused on integrated care. Therefore, the objective of her research was to identify potential ways to develop an integrated care model of primary health care ...

Era 3 for Medicine and Health Care

In this Viewpoint, Berwick discusses 2 “eras” of the medical profession and offers changes that would be useful to move into a new “moral era.”

Constant conflict roils the health care landscape, including issues related to the Affordable Care Act, electronic health records, payment changes, and consolidation of hospitals and health plans. The morale of physicians and other clinicians is in jeopardy.

Measurement of the Patient Experience: Clarifying Facts, Myths, and Approaches

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is a 32-item tool administered after discharge to a random sample of adult inpatients, creating standardized, publicly reported metrics that allow fair comparisons of patient experience in hospitals across the nation.

The 11 HCAHPS measures derived from the survey reported on the Hospital Compare website assess how well nurses and physicians communicate with patients, how responsive hospital staff are to patients’ needs, how well hospital staff help patients manage pain, how well the staff communicates with patients about new medicines, whether key information is provided at discharge, how smoothly ...

Integrating health care and housing to promote healthy aging.

In recent decades, the influence between health status and social conditions has been broadly studied; one of the conditions that has been strongly linked to health status has been housing.

Population ageing and the increase of chronic conditions are two of the drivers that have made that housing conditions become an important factor influencing health.

Many different proposals have been made regarding home care, most of them trying to take hospital care to patient’s home; in this post, some different aspects are discussed, mainly related to what Medicare could do in order to improve housing conditions and its influence ...

Integrating funds for health and social care: an evidence review

Objectives

Integrated funds for health and social care are one possible way of improving care for people with complex care requirements. If integrated funds facilitate coordinated care, this could support improvements in patient experience, and health and social care outcomes, reduce avoidable hospital admissions and delayed discharges, and so reduce costs. In this article, we examine whether this potential has been realized in practice.

Methods

We propose a framework based on agency theory for understanding the role that integrated funding can play in promoting coordinated care, and review the evidence to see whether the expected effects are realized in practice ...

The Patient-Centered Medical Home’s Impact on Cost and Quality: Annual Review of Evidence, 2014-15

The Patient-Centered Medical Home (PCMH) is a model of primary care that is patient-centred, comprehensive, coordinated, accessible and committed to quality and safety. In the PCMH, the primary care team coordinates care for patients and guides them in their journeys across the health care system.  In February 2016, the Patient-Centered Primary Care Collaborative, a not-for-profit membership organization, published a review titled "The Patient-Centered Medical Home's Impact on Cost and Quality", which provides a summary of PCMH cost and utilisation outcomes in the United States. The review includes peer-reviewed studies, state government evaluations, industry reports and independent federal program evaluations ...

Achieving Effective Universal Health Coverage And Diagonal Approaches To Care For Chronic Illnesses

Health systems in low- and middle-income countries were designed to provide episodic care for acute conditions. However, the burden of disease has shifted to be overwhelmingly dominated by chronic conditions and illnesses that require health systems to function in an integrated manner across a spectrum of disease stages from prevention to palliation. Low- and middle-income countries are also aiming to ensure health care access for all through universal health coverage. This article proposes a framework of effective universal health coverage intended to meet the challenge of chronic illnesses. It outlines strategies to strengthen health systems through a “diagonal approach.” We ...

Primary Care and Public Health Services Integration in Brazil’s Unified Health System

Objectives: We examined associations between transdisciplinary collaboration, evidence-based practice, and primary care and public health services integration in Brazil’s Family Health Strategy. We aimed to identify practices that facilitate service integration and evidence-based practice.

Methods: We collected cross-sectional data from community health workers, nurses, and physicians (n = 262). We used structural equation modeling to assess providers’ service integration and evidence-based practice engagement operationalized as latent factors. Predictors included endorsement of team meetings, access to and consultations with colleagues, familiarity with community, and previous research experience.

Results: Providers’ familiarity with community and team meetings positively influenced evidence-based practice engagement and ...

Health-system reform and universal health coverage in Latin America

Starting in the late 1980s, many Latin American countries began social sector reforms to alleviate poverty, reduce socioeconomic inequalities, improve health outcomes, and provide financial risk protection. In particular, starting in the 1990s, reforms aimed at strengthening health systems to reduce inequalities in health access and outcomes focused on expansion of universal health coverage, especially for poor citizens. In Latin America, health-system reforms have produced a distinct approach to universal health coverage, underpinned by the principles of equity, solidarity, and collective action to overcome social inequalities. In most of the countries studied, government financing enabled the introduction of supply-side interventions ...

The patient-as-partner approach in health care: a conceptual framework for a necessary transition.

A new model to enforce the partnership between patients and healthcare professionals has been developed at the University of Montreal’s Faculty of Medicine. Their patient-as-partner approach is rooted in patient-centered perspectives that have inspired previous initiatives like shared decision making, therapeutic education, expert patient and self-management. The main contribution of “Montreal model” is to consider the patient as a caregiver of himself and, as such, a genuine member of the treatment team, endowed with competencies and limitations just like any other member of the team.
This article describes the theoretical basis and summarize the main achievements of this innovative ...