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2019 | 13 | 4 |

Tytuł artykułu

Clinical practice guidelines, quality indicators, and the true values of primary care

Treść / Zawartość

Warianty tytułu

Języki publikacji

EN

Abstrakty

EN
Despite the increasing popularity of the concepts known as person-centered care and the holistic approach, their implementation in real life is far from optimal. Patients’ priorities, preferences, and values are still too often neglected. The tendency to measure the outcomes of primary care just in terms of avoiding hospital admissions, reducing health care costs, and increasing adherence to treatment can cause problems and create distortion. Guidelines are too focused on single diseases and not patient-focused. Most guidelines have a “one-size-fits-all” mentality and do not build flexibility or contextualization into their recommendations. Quality indicators should be used with caution and wisdom, especially in primary care, as they are mainly related to a few common chronic diseases and this is not conducive to recognizing the vast range of health problems of our patients. Quality indicators can be useful as a starting point for discussions about quality in primary care but not all the data that we have in our electronic clinical records can be used to derive good quality indicators and they cannot reflect the broad scope of primary care. Some core values are difficult to measure because doctors and nurses are pushed to spend too much time on the registration and administration of the required data rather than dedicate this time to the actual care of the patient. Person-centered health care is certainly one the visions of primary care and primary care doctors need to step up and lead the change. Rural primary care doctors, who traditionally adopt a less biomedical and more holistic approach than their urban counterparts, could become the pioneers in the implementation of this process.

Słowa kluczowe

Wydawca

-

Rocznik

Tom

13

Numer

4

Opis fizyczny

p.60-63,ref.

Twórcy

  • Center for Primary Health Care Research, Department of Clinical Sciences in Malmo, Lund University, Malmo, Sweden
  • European Rural and Isolated Practitioners Association (EURIPA)
  • European Rural and Isolated Practitioners Association (EURIPA)

Bibliografia

  • 1. Klinkman M, Van Weel C. Prospects for person‐centred diagnosis in general medicine. J Eval Clin Pract 2011; 17: 365–370.
  • 2. Valderas JM. Getting impatient about person-centred health care. Eur J Gen Pract 2013; 19: 141–142.
  • 3. De Sutter A, De Maeseneer J, Boeckxstaens P. Empowering patients to determine their own health goals. E Eur J Gen Pract 2013; 19:2: 75–76.
  • 4. Colleges WOoN, Academies, Physicians AAoGPF. ICPC-2-R: International Classification of Primary Care. New York: Oxford University Press, USA: 2005.
  • 5. Schrans D, Boeckxstaens P, De Sutter A, Willems S, Avonts D, Christiaens T, et al. Is it possible to register the ideas, concerns and expectations behind the reason for encounter as a means of classifying patient preferences with ICPC-2? Prim Health Care Res Dev 2018; 19: 1–6.
  • 6. Schrans D, Avonts D, Christiaens T, Willems S, De Smet K, van Boven K, et al. The search for person-related information in general practice: a qualitative study. Fam Pract 2016; 33: 95–99.
  • 7. Roberts RG, Wynn-Jones J. Research and rural; EGPRN and EURIPA-finding common ground. October 2013, Malta. Eur J Gen Pract 2015; 21: 77–81.
  • 8. Petrazzuoli F, Ungan M. Rural medicine in the world: a focus on rural primary care in Europe. Turkiye Klinikleri Family Medicine-Special Topics 2018; 9: 256–261.
  • 9. Kotseva K, De Bacquer D, Jennings C, Gyberg V, De Backer G, Rydén L, et al. Time trends in lifestyle, risk factor control, and use of evidence-based medications in patients with coronary heart disease in Europe: Results from 3 EUROASPIRE surveys, 1999–2013. Glob Heart 2017; 12: 315–322. e3.
  • 10. Heuschmann PU, Kircher J, Nowe T, Dittrich R, Reiner Z, Cifkova R, et al. Control of main risk factors after ischaemic stroke across Europe: data from the stroke-specific module of the EUROASPIRE III survey. Eur J Prev Cardiol 2015; 22: 1354–1362.
  • 11. Boeckxstaens P, Willems S, Lanssens M, Decuypere C, Brusselle G, Kühlein T, et al. A qualitative interpretation of challenges associated with helping patients with multiple chronic diseases identify their goals. JOC 2016; 6: 120–126.
  • 12. Lionis C, Stoffers HE, Hummers-Pradier E, Griffiths F, Rotar-Pavlic D, Rethans JJ. Setting priorities and identifying barriers for general practice research in Europe. Results from an EGPRW meeting. Fam Pract 2004; 21: 587–593.
  • 13. Shaneyfelt TM, Centor RM. Reassessment of clinical practice guidelines: go gently into that good night. JAMA 2009; 301: 868–869.
  • 14. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 2005; 294: 716–724.
  • 15. Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. BMJ (Clinical research ed) 2012; 345: e5205.
  • 16. Roland M. Linking physicians’ pay to the quality of care – a major experiment in the United Kingdom. N Engl J Med 2004; 351: 1448–1454.
  • 17. Starfield B. Is patient-centered care the same as person-focused care? Perm J 2011; 15: 63.
  • 18. Roland M, Guthrie B. Quality and outcomes framework: what have we learnt? BMJ (Clinical research ed) 2016; 354: i4060.
  • 19. Iacobucci G. Quality and outcomes framework faces radical reshape in England but will be retained. BMJ online 2018; 362.
  • 20. Francis R. Report of the Mid Staffordshire NHS Foundation Trust public inquiry: executive summary. Vol. 947. London: The Stationery Office; 2013.
  • 21. Bloche MG. Scandal as a sentinel event – recognizing hidden cost-quality trade-offs. N Engl J Med 2016; 374: 1001–1003.
  • 22. Arvidsson E, Dijkstra R, Klemenc-Ketis Z. Measuring quality in primary healthcare - opportunities and weaknesses. Zdr Varst 2019; 58: 101–103.
  • 23. Allen J, Gay B, Crebolder H, Heyrman J, Svab I, Ram P. The European definitions of the key features of the discipline of general practice: the role of the GP and core competencies. Br J Gen Pract 2002; 52: 526–527.
  • 24. Kernick D, Chew-Graham CA, O’Flynn N. Clinical assessment and management of multimorbidity: NICE guideline. Br J Gen Pract 2017; 67: 235–236.

Typ dokumentu

Bibliografia

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Identyfikator YADDA

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