122 results found
Harris M, Kreindler J, El-Osta A, et al., 2021, Safe management of full-capacity live/mass events in COVID19 will require mathematical, epidemiological and economic modelling, Journal of the Royal Society of Medicine, ISSN: 0141-0768
Selhorst S, OToole RV, Slobogean GP, et al., 2021, Is a low-cost drill cover system non-inferior to conventional surgical drills for skeletal traction pin placement?, Journal of Orthopaedic Trauma, Pages: 1-1, ISSN: 0890-5339
The Drill Cover system was developed as a low-cost alternative to conventional surgical drills with specific applicability to low- and middle-income countries. However, the system may also be useful for the sterile placement of traction pins in the emergency department of high-income country hospitals. In September 2019, a US-based Level-1 trauma center began using the Drill Cover system to apply skeletal traction pins in patients with femoral shaft fractures. With these data, we performed a retrospective interrupted time series study to determine if the Drill Cover system was non-inferior to conventional surgical drills in terms of infections at the traction pin site. The study included 205 adult patients with femoral shaft fractures initially placed in skeletal traction using a conventional surgical drill (n=150, pre-intervention group) or the Drill Cover system (n=55, post-intervention group). The primary outcome was an infection at the site of skeletal traction pin placement that required surgery or antibiotics was compared between groups using a non-inferiority test with a one-sided alpha of 0.05 and a non-inferiority margin of 3%. No infections at the site of skeletal traction pin placement were found in either the pre-intervention or the post-intervention group (difference 0%, 95% CI: 0.0 to 1.4%, non-inferiority p-value<0.01). The results suggest that the Drill Cover system was non-inferior to conventional surgical drills regarding infections at the site of skeletal traction pins. The Drill Cover system may be a safe alternative to the more expensive surgical drills for skeletal traction pin placement in the emergency room environment.
Harris M, Saddi F, Parreira F, et al., 2021, Exploring front liners’ knowledge, participation and evaluation in the implementation of a pay for performance program (PMAQ) in primary health care in Brazil, Journal of Health, Organization and Management, ISSN: 0268-9235
Skopec M, Grillo A, Kureshi A, et al., 2020, Double standards in healthcare innovations: the case of mosquito net mesh for hernia repair, BMJ Innovations, Vol: 7, Pages: 482-490, ISSN: 2055-642X
With over two decades of evidence available including from randomised clinical trials, we explore whether the use of low-cost mosquito net mesh for inguinal hernia repair, common practice only in low-income and middle-income countries, represents a double standard in surgical care. We explore the clinical evidence, biomechanical properties and sterilisation requirements for mosquito net mesh for hernia repair and discuss the rationale for its use routinely in all settings, including in high-income settings. Considering that mosquito net mesh is as effective and safe as commercial mesh, and also with features that more closely resemble normal abdominal wall tissue, there is a strong case for its use in all settings, not just low-income and middle-income countries. In the healthcare sector specifically, either innovations should be acceptable for all contexts, or none at all. If such a double standard exists and worse, persists, it raises serious questions about the ethics of promoting healthcare innovations in some but not all contexts in terms of risks to health outcomes, equitable access, and barriers to learning.
Cash-Gibson L, Harris M, Guerra G, et al., 2020, A novel conceptual model and heuristic tool to strengthen understanding and capacities for health inequalities research, Health Research Policy and Systems, Vol: 18, Pages: 1-12, ISSN: 1478-4505
BackgroundDespite increasing evidence on health inequalities over the past decades, further efforts to strengthen capacities to produce research on this topic are still urgently needed to inform effective interventions aiming to address these inequalities. To strengthen these research capacities, an initial comprehensive understanding of the health inequalities research production process is vital. However, most existing research and models are focused on understanding the relationship between health inequalities research and policy, with less focus on the health inequalities research production process itself. Existing conceptual frameworks provide valuable, yet limited, advancements on this topic; for example, they lack the capacity to comprehensively explain the health (and more specifically the health inequalities) research production process at the local level, including the potential pathways, components and determinants as well as the dynamics that might be involved. This therefore reduces their ability to be empirically tested and to provide practical guidance on how to strengthen the health inequalities research process and research capacities in different settings. Several scholars have also highlighted the need for further understanding and guidance in this area to inform effective action.MethodsThrough a critical review, we developed a novel conceptual model that integrates the social determinants of health and political economy perspectives to provide a comprehensive understanding of how health inequalities research and the related research capacities are likely to be produced (or inhibited) at local level.ResultsOur model represents a global hypothesis on the fundamental processes involved, and can serve as a heuristic tool to guide local level assessments of the determinants, dynamics and relations that might be relevant to better understand the health inequalities research production process and the related research capacities.ConclusionsThis type of
Harris M, Bourquin B, Ettehad D, 2020, International crisis-led healthcare innovation in response to the COVID-19 pandemic, London, UK, Publisher: NHS Confederation
The COVID-19 pandemic and associated lockdown measures have permeated close to all aspects of daily life, with immediate and profound effects on population health and its wider determinants. Across the globe there has been an explosion of innovation in response to the crisis, enabled by a sense of common purpose, the unfreezing of rigid organisational structures, processes and regulations, and huge increases in public expenditure.This report outlines some of the crisis-led innovations that have helped countries to cope during the first wave of COVID-19 infections and that may shape the ‘new normal’ in the years to come.It collates a number of innovations into six domains (stuff, staff, space, systems, surveillance and society), an adapted version of Farmer’s 4 S’s, which distils the elements that ‘make all the difference in saving lives during an outbreak’.This paper was written by external authors between June and September 2020. As such, it does not necessarily represent the views of the NHS Confederation or its members.
Al-Saffar M, Hayhoe B, Harris M, et al., 2020, Children as frequent attenders in primary care: a systematic review, BJGP Open, Vol: 4, ISSN: 2398-3795
Background: Frequent paediatric attendances make up a large proportion of the general practitioner (GP) workload. Currently no systematic reviews on frequent paediatric attendances in primary care exists. Aim: To identify the socio-demographic and clinical characteristics of children who attend primary care frequently. Design and setting: A systematic review.Methods: The electronic databases MEDLINE, EMBASE and PsycINFO were searched up to January 2020, using terms relating to frequent attendance in primary care settings. Studies were eligible if they considered children frequently attending in primary care (0-19 years). Relevant data were extracted and analysed by narrative synthesis.Results: Six studies, of overall fair quality, were included in the review. Frequent attendance was associated with presence of psycho-social and mental health problems, younger age, school absence, presence of chronic conditions, and high level of anxiety in their parents.Conclusions: Various sociodemographic and medical characteristics of children were associated with frequent attendance in primary care. Research on interventions needs to account for the social context and community characteristics. Integrating GP services with mental health and social care could potentially provide a response to medical and psycho-social needs of frequently attending children and their families.
de Medeiros OL, Barreto JOM, Harris M, et al., 2020, Delivering maternal and childcare at primary healthcare level: The role of PMAQ as a pay for performance strategy in Brazil, PLoS One, Vol: 15, ISSN: 1932-6203
BACKGROUND: Improving access and quality in health care is a pressing issue worldwide and pay for performance (P4P) strategies have emerged as an alternative to enhance structure, process and outcomes in health. In 2011, Brazil adopted its first P4P scheme at national level, the National Programme for Improving Primary Care Access and Quality (PMAQ). The contribution of PMAQ in achieving the Sustainable Development Goals related to maternal and childcare remains under investigated in Brazil. OBJECTIVE: To estimate the association of PMAQ with the provision of maternal and childcare in Brazil, controlling for socioeconomic, geographic and family health team characteristics. METHOD: We used cross-sectional quantile regression (QR) models for two periods, corresponding to 33,368 Family Health Teams (FHTs) in the first cycle and 39,211 FHTs in the second cycle of PMAQ. FHTs were analysed using data from the Brazilian Ministry of Health (SIAB and CNES) and the Brazilian Institute for Geography and Statistics (IBGE). RESULTS: The average number of antenatal consultations per month were positively associated with PMAQ participating teams, with larger effect in the lower tail (10th and 25th quantiles) of the conditional distribution of the response variable. There was a positive association between PMAQ and the average number of consultations under 2 years old per month in the 10th and 25th quantiles, but a negative association in the upper tail (75th and 90th quantiles). For the average number of physician consultations for children under 1 year old per month, PMAQ participating teams were positively associated with the response variable in the lower tail, but different from the previous models, there is no clear evidence that the second cycle gives larger coefficients compared with first cycle. CONCLUSION: PMAQ has contributed to increase the provision of care to pregnant women and children under 2 years at primary healthcare level. Teams with lower average number of ante
Younan H-C, Junghans C, Harris M, et al., 2020, Maximising the impact of social prescribing on population health in the era of COVID-19, Journal of the Royal Society of Medicine, Vol: 113, Pages: 377-382, ISSN: 0141-0768
Zhou J, Blaylock R, Harris M, 2020, Systematic review and narrative synthesis of the quality of early abortion services provided in low- and middle-income country primary care clinics – potential for reverse innovation and application in the UK context, Globalization and Health, Vol: 16, Pages: 1-11, ISSN: 1744-8603
Background: In the UK, according to the 1967 Abortion Act, all abortions must be approved by two doctors, reported to the Department of Health and Social Care (DHSC), and be performed by doctors within licensed premises. Removing abortion from the criminal framework could permit new service delivery models. We explore service delivery models in primary care settings that can improve accessibility without negatively impacting the safety and efficiency of abortion services. Novel service delivery models are common in low-and-middle income countries (LMICs) due to resource constraints, and services are sometimes by trained, mid-level providers via “task-shifting”. The aim of this study is to explore the quality of early abortion services provided in primary care of LMICs and explore the potential benefits of extending their application to the UK context. Methods: We searched MEDLINE, EMBASE, Global Health, Maternity and Infant Care, CINAHL, and HMIC for studies published from September 1994 to February 2020, with search terms “nurses”, “midwives”, “general physicians”, “early medical/surgical abortion”. We included studies that examined the quality of abortion care in primary care settings of low-and-middle-income countries (LMICs), and excluded studies in countries where abortion is illegal, and those of services provided by independent NGOs. We conducted a thematic analysis and narrative synthesis to identify indicators of quality care at structural, process and outcome levels of the Donabedian model. Results: A total of 21 indicators under 8 subthemes were identified to examine the quality of service provision: law and policy, infrastructure, technical competency, information provision, client-provider interactions, ancillary services, complete abortions, client satisfaction. Our analysis suggests that structural, process and outcome indicators follow a mediation pathway of the Donabedian model. This revie
Zhou J, Blaylock R, Harris M, 2020, Systematic review of early abortion services in low- and middle-income country primary care: potential for reverse innovation and application in the UK context., Global Health, Vol: 16
BACKGROUND: In the UK, according to the 1967 Abortion Act, all abortions must be approved by two doctors, reported to the Department of Health and Social Care (DHSC), and be performed by doctors within licensed premises. Removing abortion from the criminal framework could permit new service delivery models. We explore service delivery models in primary care settings that can improve accessibility without negatively impacting the safety and efficiency of abortion services. Novel service delivery models are common in low-and-middle income countries (LMICs) due to resource constraints, and services are sometimes provided by trained, mid-level providers via "task-shifting". The aim of this study is to explore the quality of early abortion services provided in primary care of LMICs and explore the potential benefits of extending their application to the UK context. METHODS: We searched MEDLINE, EMBASE, Global Health, Maternity and Infant Care, CINAHL, and HMIC for studies published from September 1994 to February 2020, with search terms "nurses", "midwives", "general physicians", "early medical/surgical abortion". We included studies that examined the quality of abortion care in primary care settings of low-and-middle-income countries (LMICs), and excluded studies in countries where abortion is illegal, and those of services provided by independent NGOs. We conducted a thematic analysis and narrative synthesis to identify indicators of quality care at structural, process and outcome levels of the Donabedian model. RESULTS: A total of 21 indicators under 8 subthemes were identified to examine the quality of service provision: law and policy, infrastructure, technical competency, information provision, client-provider interactions, ancillary services, complete abortions, client satisfaction. Our analysis suggests that structural, process and outcome indicators follow a mediation pathway of the Donabedian model. This review
Abbara A, Joseph L, Ismail S, et al., 2020, A qualitative research study which explores humanitarian stakeholders’ views on healthcare access for refugees in Greece, International Journal of Environmental Research and Public Health, Vol: 17, ISSN: 1660-4601
Introduction: As of January 2020, 115,600 refugees remain in Greece; most are Afghani, Iraqi or Syrian nationals. This qualitative research study explores the views of key stakeholders providing healthcare for refugees in Greece between 2015 and 2018. The focus was on identifying key barriers and facilitators to healthcare access for refugees in Greece. Methods: 16 interviewees from humanitarian and international organisations operating in Greece were identified through purposive and snowball sampling. Semi-structured interviews were conducted between March and April 2018. Data were analysed using the Framework Method. Results: Key themes affecting healthcare access included the influence of socio-cultural factors (healthcare expectations, language, gender) and the ability of the Greek health system to respond to existing and evolving demands; these included Greece’s ongoing economic crisis, human resource shortages, weak primary healthcare system, legal barriers and logistics. The evolution of the humanitarian response from emergency to sustained changes to EU funding, coordination and comprehensiveness of services affected healthcare access for refugees. Conclusion: The most noted barriers cited by humanitarian stakeholders to healthcare access for refugees in Greece were socio-cultural and language differences between refugees and healthcare providers and poor coordination among stakeholders. Policies and interventions which address these could improve healthcare access for refugees in Greece with coordination led by the EU.
Hone T, Powell-Jackon T, Santos LMP, et al., 2020, Impact of the Programa Mais médicos (more doctors Programme) on primary care doctor supply and amenable mortality: quasi-experimental study of 5565 Brazilian municipalities, BMC Health Services Research, Vol: 20, ISSN: 1472-6963
BackgroundInvesting in human resources for health (HRH) is vital for achieving universal health care and the Sustainable Development Goals. The Programa Mais Médicos (PMM) (More Doctors Programme) provided 17,000 doctors, predominantly from Cuba, to work in Brazilian primary care. This study assesses whether PMM doctor allocation to municipalities was consistent with programme criteria and associated impacts on amenable mortality.MethodsDifference-in-differences regression analysis, exploiting variation in PMM introduction across 5565 municipalities over the period 2008–2017, was employed to examine programme impacts on doctor density and mortality amenable to healthcare. Heterogeneity in effects was explored with respect to doctor allocation criteria and municipal doctor density prior to PMM introduction.ResultsAfter starting in 2013, PMM was associated with an increase in PMM-contracted primary care doctors of 15.1 per 100,000 population. However, largescale substitution of existing primary care doctors resulting in a net increase of only 5.7 per 100,000. Increases in both PMM and total primary care doctors were lower in priority municipalities due to lower allocation of PMM doctors and greater substitution effects. The PMM led to amenable mortality reductions of − 1.06 per 100,000 (95%CI: − 1.78 to − 0.34) annually – with greater benefits in municipalities prioritised for doctor allocation and where doctor density was low before programme implementation.ConclusionsPMM potential health benefits were undermined due to widespread allocation of doctors to non-priority areas and local substitution effects. Policies seeking to strengthen HRH should develop and implement needs-based criteria for resource allocation.
Harris M, Tobias R, Schweikhardt J, 2020, Healthcare Public Health in Extreme Environments: the case of primary care in the Amazon., Healthcare Public Health, Editors: Gulliford, Jessop, Publisher: Oxford University Press
Aith F, Castilla Martínez M, Cho M, et al., 2020, Is COVID-19 a turning point for the health workforce?, Revista Panamericana de Salud Pública, Vol: 44, Pages: e102-e102, ISSN: 0030-0632
Buitendijk S, Ward H, Shimshon G, et al., 2020, COVID-19: an opportunity to rethink global cooperation in higher education and research, BMJ Global Health, Vol: 5, Pages: e002790-e002790, ISSN: 2059-7908
Harris M, Bhatti Y, Prabhu J, 2020, Frugal Innovation for Today’s and Tomorrow’s Crises, Stanford Social Sciences Review
Harris M, Bhatti Y, Buckley J, et al., 2020, Fast and frugal innovations in response to the COVID-19 pandemic., Nat Med, Vol: 26, Pages: 814-817
Haines A, de Barros EF, Berlin A, et al., 2020, National UK programme of community health workers for COVID-19 response, The Lancet, Vol: 395, ISSN: 0140-6736
Harris M, Dadwal V, Syed SB, 2020, Review of the reverse innovation series in globalization and health - where are we and what else is needed?, Globalization and Health, Vol: 16, ISSN: 1744-8603
Following advances in industrial strategy and organizational behaviour, as well as post-development debates in international relations, Globalization and Health launched the Reverse Innovation series in 2012, in order to forge an agenda to promote not just the innovativeness of low-income country health systems but to recognize current and advocate for future strengthened knowledge flow between the global south and global north. It was considered to be a timely antidote to a knowledge flow that has traditionally been characterised by unidirectionality of innovation and expertise. Since then, the series provides a repository of research, theory, commentary and debate through which a collective community of practice in Reverse Innovation might emerge and provide an evidence base to promote, support and mainstream this type of knowledge flow. In this Commentary, we review the series as a whole, explore what has been learnt and what needs to come next in terms of empirical research, business models, processes and theoretical contributions to inform reverse innovation.
Skopec M, Issa H, Reed J, et al., 2020, The role of geographic bias in knowledge diffusion: a systematic review and narrative synthesis, Research Integrity and Peer Review, Vol: 5, Pages: 1-14, ISSN: 2058-8615
Background: Descriptive studies examining publication rates and citation counts demonstrate a geographic skew towards high-income countries (HIC) and research from low- or middle-income countries (LMICs) is generally underrepresented. This has been suggested to be due in part to reviewers’ and editors’ preference toward HIC sources, however, in the absence of controlled studies it is impossible to assert whether there is bias or whether variations in the quality or relevance of the articles being reviewed explains the geographic divide. This study synthesizes the evidence from randomized and controlled studies that explore geographic bias in the peer review process. Methods: A systematic review was conducted to identify research studies that explicitly explore the role of geographic bias in the assessment of the quality of research articles. Only randomized and controlled studies were included in the review. Five databases were searched to locate relevant articles. A narrative synthesis of included articles was performed to identify common findings.Results: The systematic literature search yielded 3,501 titles from which twelve full texts were reviewed, and a further eight were identified through searching reference lists of the full texts. Of these articles, only three were randomized and controlled studies that examined variants of geographic bias. One study found that abstracts attributed to HIC sources elicited a higher review score regarding relevance of the research and likelihood to recommend the research to a colleague, than did abstracts attributed to LIC sources. Another study found that the predicted odds of acceptance for a submission to a computer science conference was statistically significantly higher for submissions from a “Top University.” Two of the studies showed the presence of geographic bias between articles from “high” or “low” prestige institutions. Conclusions: Two of the three included studie
Harris M, Skopec M, Issa H, 2020, REVERSE INNOVATION Global spread of innovations-direction is important Reply, BMJ-BRITISH MEDICAL JOURNAL, Vol: 368, ISSN: 1756-1833
Shimizu HE, Leonor Maria PS, Mauro Niskier S, et al., 2020, Perceptions about the “Mais Médicos” Program and the Academic Supervision Process, Revista Brasileira de Educação Médica, ISSN: 0100-5502
Shimizu HE, Santos LMP, Sanchez MN, et al., 2020, Percepções acerca do Programa Mais Médicos e do Processo de Supervisão Acadêmica, Revista Brasileira de Educação Médica, Vol: 44, ISSN: 0100-5502
<jats:p>Abstract: Introduction: This study aims to analyze the perceptions of the involved actors about the “Mais Médicos” Program (PMM) and the academic supervision process, its strengths and weaknesses aiming to improve Primary Heath Care practices. Method: Qualitative study carried out through 05 in-depth interviews with PMM supervising doctors, and 24 interviews with unit managers, 12 Primary Heath Care coordinators, and 07 Secondary Health Care doctors. Results: Three thematic axes emerged from de analysis: benefits of the program for the municipalities and for the population; the challenges of the supervisory process and the difficulties of the fragmented health system. Conclusions: The actors’ perception of the “Mais Médicos” Program are positive, especially because it brought doctors to municipalities with vulnerable areas, where doctors did not go to and where they did not stay. Supervision is an important support for continuing in-service training; however, it requires a better articulation with the different levels of the health system management. The precariousness of the service network limits the performance of both doctors and supervisors, demonstrating that it is necessary to invest in a solid and effective care network. Moreover, it was once again evident that the population will face a shortage of doctors due to changes in health policies. It is necessary to build more comprehensive policies, that will not only result in sporadic provision of medical care. There is a need for continuous actions, better integrated to the healthcare networks, aiming at an efficient and effective healthcare system.</jats:p>
Skopec M, Issa H, Harris M, 2019, Delivering cost effective healthcare through reverse innovation., BMJ, Vol: 367, Pages: 1-5, ISSN: 1759-2151
Rocha T, da Silva N, Amaral P, et al., 2018, Geolocation of hospitalizations registered on the Brazilian National Health System’s Hospital Information System: a solution based on the R Statistical Software, Epidemiologia e Serviços de Saúde, Vol: 27, ISSN: 1679-4974
Goal:present a solution to allow the geolocation of hospitalizations processed together with the Hospital Information System of the Brazilian National Health System.Methods:with the purpose of spatializing the AIHs, a script was elaborated in language R, based on the microdatosus and CepR packages; the script was applied to all AIHs made in the state of Goiás referring to 2015; after downloading and pre-processing the data, the procedure for the spatialization of AIHs was detailed.Results:of the 361,213 AIHs processed, it was possible to extract 24,220 different postal codes (CEP); of this set of postal codes, 23,910 (98.7%) were geolocalized; these geolocalized CEPs allowed the spatialization of 97.7% of the AIHs registered in Goiás.Conclusion:it is possible to spatialize the AIHs with a high success rate; the method detailed in this document opens up a new range of possibilities for the design of evaluative studies, the formulation of policies and the planning of health actions.
Hayhoe BWJ, Cowling T, Pillutla V, et al., 2018, Integrating a nationally scaled workforce of community health workers in primary care: a modelling study, Journal of the Royal Society of Medicine, Vol: 111, Pages: 453-461, ISSN: 1758-1095
ObjectiveTo model cost and benefit of a national community health worker workforce.DesignModelling exercise based on all general practices in England.SettingUnited Kingdom National Health Service Primary Care.ParticipantsNot applicable.Data sourcesPublicly available data on general practice demographics, population density, household size, salary scales and screening and immunisation uptake.Main outcome measuresWe estimated numbers of community health workers needed, anticipated workload and likely benefits to patients.ResultsConservative modelling suggests that 110,585 community health workers would be needed to cover the general practice registered population in England, costing £2.22bn annually. Assuming community health workerss could engage with and successfully refer 20% of eligible unscreened or unimmunised individuals, an additional 753,592 cervical cancer screenings, 365,166 breast cancer screenings and 482,924 bowel cancer screenings could be expected within respective review periods. A total of 16,398 additional children annually could receive their MMR1 at 12 months and 24,716 their MMR2 at five years of age. Community health workerss would also provide home-based health promotion and lifestyle support to patients with chronic disease.ConclusionA scaled community health worker workforce integrated into primary care may be a valuable policy alternative. Pilot studies are required to establish feasibility and impact in NHS primary care.
Joseph L, Ismail S, Prior D, et al., 2018, Barriers to healthcare access for refugees in Greece, Publisher: OXFORD UNIV PRESS, Pages: 407-407, ISSN: 1101-1262
saddi F, Harris M, coelho G, et al., 2018, Perceptions and evaluations of front-line health workers regarding the Brazilian National Program for Improving Access and Quality to Primary Care (PMAQ): a mixed-method approach, Cadernos de Saúde Pública, Vol: 34, ISSN: 0102-311X
Although it is well known that a successful implementation depends on the front-liners’ knowledge and participation, as well as on the organizational capacity of the institutions involved, we still know little about how front-line health workers have been involved in the implementation of the Brazilian National Program for Improving Access and Quality to Primary Care (PMAQ). This paper develops a contingent mixed-method approach to explore the perceptions of front-line health workers - managers, nurses, community health workers, and doctors - regarding the PMAQ (2nd round), and their evaluations concerning health unit organizational capacity. The research is guided by three relevant inter-related concepts from implementation theory: policy knowledge, participation, and organizational capacity. One hundred and twenty-seven health workers from 12 primary health care units in Goiânia, Goiás State, Brazil, answered semi-structured questionnaires, seeking to collect data on reasons for adherence, forms of participation, perceived impact (open-ended questions), and evaluation of organizational capacity (score between 0-10). Content analyses of qualitative data enabled us to categorize the variables “level of perceived impact of PMAQ” and “reasons for adhering to PMAQ”. The calculation and aggregation of the means for the scores given for organizational capacity enabled us to classify distinct levels of organizational capacity. We finally integrated both variables (Perceived-Impact and Organizational-Capacity) through cross-tabulation and the narrative. Results show that nurses are the main type of professional participating. The low organizational capacity and little policy knowledge affected workers participation in and their perceptions of the PMAQ.
Majeed FA, Harris M, 2018, Importance of accessibility and opening hours to overall patient experience of general practice: analysis of repeated cross-sectional data from a national patient survey in England, British Journal of General Practice, Vol: 68, Pages: e469-e477, ISSN: 0960-1643
Background The UK government aims to improve the accessibility of general practices in England, particularly by extending opening hours in the evenings and at weekends. It is unclear how important these factors are to patients’ overall experiences of general practice.Aim To examine associations between overall experience of general practice and patient experience of making appointments and satisfaction with opening hours.Design and setting Analysis of repeated cross-sectional data from the General Practice Patient Surveys conducted from 2011–2012 until 2013–2014. These covered 8289 general practice surgeries in England.Method Data from a national survey conducted three times over consecutive years were analysed. The outcome measure was overall experience, rated on a five-level interval scale. Associations were estimated as standardised regression coefficients, adjusted for responder characteristics and clustering within practices using multilevel linear regression.Results In total, there were 2 912 535 responders from all practices in England (n = 8289). Experience of making appointments (β 0.24, 95% confidence interval [CI] = 0.24 to 0.25) and satisfaction with opening hours (β 0.15, 95% CI = 0.15 to 0.16) were modestly associated with overall experience. Overall experience was most strongly associated with GP interpersonal quality of care (β 0.34, 95% CI = 0.34 to 0.35) and receptionist helpfulness was positively associated with overall experience (β 0.16, 95% CI = 0.16 to 0.17). Other patient experience measures had minimal associations (β≤0.06). Models explained ≥90% of variation in overall experience between practices.
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