National primary care research & development centre

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Segal L, Dalziel K, Bolton T. A work force model to support the adoption of best practice care in chronic diseases a missing piece in clinical guideline implementation. Implementation Science 2008 3:35.

The development and implementation of an evidence-based approach to health workforce planning is a necessary step to achieve access to best practice chronic disease management. In its absence, the widely reported failure in implementation of clinical best practice guidelines is almost certain to continue. This paper describes a demand model to estimate the community-based primary care health workforce consistent with the delivery of best practice chronic disease management and prevention. The model takes a geographic region as the planning frame and combines data about the health status of the regional population by disease category and stage, with best practice guidelines to estimate the clinical skill requirement or competencies for the region. The translation of the skill requirement into a service requirement can then be modelled, incorporating various assumptions about the occupation group to deliver nominated competencies. The service requirement, when compared with current service delivery, defines the gap or surplus in services. The results of the model could be used to inform service delivery as well as a workforce supply strategy

Watson M. Going for gold: the health promoting general practice. Quality in Primary Care 2008 16 (3) 177-86.

The World Health Organization's Ottawa Charter for Health Promotion has been influential in guiding the development of 'settings' based health promotion. Over the past decade, settings such as schools have flourished and there has been a considerable amount of academic literature produced, including theoretical papers, descriptive studies and evaluations. However, despite its central importance, the health-promoting general practice has received little attention. This paper discusses: the significance of this setting for health promotion; how a health promoting general practice can be created; effective health promotion approaches; the nursing contribution; and some challenges that need to be resolved. In order to become a health promoting general practice, the staff must undertake a commitment to fulfil the following conditions: create a healthy working environment; integrate health promotion into practice activities; and establish alliances with other relevant institutions and groups within the community. The health promoting general practice is the gold standard for health promotion. Settings that have developed have had the support of local, national and European networks. Similar assistance and advocacy will be needed in general practice. This paper recommends that a series of rigorously evaluated, high-quality pilot sites need to be established to identify and address potential difficulties, and to ensure that this innovative approach yields tangible health benefits for local communities. It also suggests that government support is critical to the future development of health promoting general practices. This will be needed both directly and in relation to the capacity and resourcing of public health in general.

Wensing M,et al General practitioners' workload associated to practice size rather than chronic care organisation. Health Policy Online 2/7/2008;

Objective This study aimed to explore the associations between chronic care organisation and physician workload in primary care.Design Secondary analysis of observational data.Setting and participants One hundred and forty general practices from 10 European countries.Mean outcome measures The Chronic Care Model was used to specify measures for chronic care organisation in the practice. Practice size was operationalised as the number of yearly attending patients in the practice and physician workload as the mean number of physician working hours per 1000 yearly attending patients. Mixed linear regression analysis models were used.Results Some aspects of chronic care organisation seemed to be associated with physician workload. After controlling for practice size and non-physician staff, none of these effects remained significant. Physicians worked, on average, 1.29áh less per week for each additional 1000 patients yearly attending the practice. Each additional 0.1 full time equivalent assistance in the practice was associated with an increase of 1.6 physician working hours per week per 1000 patients.Conclusions Practice size rather than chronic care organisation determined physician workload. Larger practices might use physicians' time more efficiently compared to small practices, but reduced quality of care in larger practices could be an alternative interpretation of the findings





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А. Kozhevnikova, Assoc. Prof of the Department of English for Humanities (Samara State University), Member of Board of Experts for...
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