Health Equity: 01/13/09

Tuesday, January 13, 2009

[EQ] A Scoping Literature Review of Collaboration between Primary Care and Public Health

A Scoping Literature Review of Collaboration between Primary Care and Public Health

Ruth Martin-Misener, Ruta Valaitis
A Report to the Canadian Health Services Research Foundation September 30, 2008

Available online PDF [38p.] at: http://fhs.mcmaster.ca/nursing/docs/MartinMisener-Valaitis-Review.pdf

The purpose of this scoping review was to determine what is known from existing primary studies, literature reviews and descriptive accounts about:

• structures and processes required to build successful collaborations between Public Health and Primary Care

• outcomes of collaborations between Public Health and Primary Care; and

• markers of successful collaboration between Public Health and Primary Care.

Content:

Executive Summary

Background

Definition of Terms

Purpose/Objectives

Methods.

Overall Search Strategy .

Electronic Databases

Website Search.

Hand-Searching of Key Journals

Key Informants.

Check of Reference Lists of Literature Reviews on PH and PC Collaboration

Inclusion / Exclusion Criteria and Review Process

Analysis

Results

Search Strategy Results

Overall Description of Relevant Papers.

Research Methods and Theories Used

Types of Collaboration

Precipitators of Collaboration

Key Health Issues Being Addresses

Activities Carried Out in Collaborations

Barriers and Facilitators to Collaboration between PH & PC

Markers of Successful Collaboration between PH & PC.

Outcomes of Successful Collaboration between PH & PC

Negative Outcomes of Collaboration

Risks of Collaboration

Other Outcomes of Collaboration

Discussion

Recommendations

Appendix A: Website Hand Search

Appendix B: Extraction form

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[EQ] The Remuneration of General Practitioners and Specialists in 14 OECD Countries: What are the Factors Influencing Variations across Countries?

The Remuneration of General Practitioners and Specialists in 14 OECD Countries:
What are the Factors Influencing Variations across Countries?

Rie Fujisawa and Gaetan Lafortune J

Health Working Papers OECD HEALTH WORKING PAPERS NO.41 December 2008

Organisation for Economic Co-operation and Development

Available online PDF [63p.] at: http://www.oecd.org/dataoecd/51/48/41925333.pdf

“………This paper provides a descriptive analysis of the remuneration of doctors in 14 OECD countries for which reasonably comparable data were available in OECD Health Data 2007
Austria, Canada, the Czech Republic, Denmark, Finland, France, Germany, Hungary, Iceland, Luxembourg, Netherlands, Switzerland, the United Kingdom and the United States.

Data are presented for general practitioners (GPs) and medical specialists separately, comparing remuneration levels across countries both on the basis of a common currency (US dollar, adjusted for purchasing power parity) and in relation to the average wage of all workers in each country. The study finds that there are large variations across countries in the remuneration levels of GPs, and even greater variations for specialists. Measured as a ratio to the average wage in each country, the remuneration of GPs varies from being two times greater in Finland and the Czech Republic, to three-and-a-half times greater in the United States and Iceland.

The remuneration of specialists varies even more, ranging from one-and-a-half times to two times higher than the average wage of all workers for salaried specialists in Hungary and the Czech Republic, to five to seven times higher for self-employed specialists in the Netherlands, the United States and Austria. Some of the variations in remuneration levels across countries may be explained by the use of different remuneration methods (e.g., salaries or fee-for-services for self-employed doctors), by the role of GPs as gatekeepers, by differences in workload (as measured by working time) and by the number of doctors per capita.

However, these institutional and supply-side factors cannot explain all of the variations. Furthermore, when comparing the remuneration of GPs and specialists in each country, this study finds that in nearly all countries, the remuneration of specialists has tended to increase more rapidly than that of GPs over the past decade, thereby widening the income gap. This growing remuneration gap has likely contributed to the rising number and share of specialists in most of these countries over the past decade, resulting in rising concerns about possible shortages of GPs. …”

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[EQ] Caring for people with chronic conditions

Caring for people with chronic conditions

A health system perspective

Published by Open University Press

European Observatory on Health Systems and Policies series, WHO 2008

Available online PDF [290p.] at: http://www.euro.who.int/Document/E91878.pdf

“…..New recognition of the multiplicity of influences on health, the variability in vulnerability and resilience of different individuals and population groups to threats to illness, and the emerging crisis of harm from iatrogenic causes is calling into question the adequacy of health systems to deal in conventional ways with illness burdens of people and populations. It may even call into question the adequacy of conventional ways of classifying illness. The current focus on chronic care management is one approach to dealing with this rapidly changing challenge of describing and understanding ‘disease’ in the 21st century. Whether it is the appropriate one remains to be seen.

A disease oriented approach to global health will almost certainly worsen global inequities, because socially disadvantaged people have greater burdens of diseases of all types. Eliminating or controlling diseases one by one is not likely to materially reduce the chances of another in vulnerable populations. It may also be unconscionable when the most serious shortfalls in achieving the Millennium Development Goals are in maternal and child health. Good primary care, which focuses on ALL health conditions with a comprehensive array of services, may be a much better approach to achieve equity in health as well as overall improvement in health.

In this excellent summary of challenges and approaches to dealing with chronic disease in Europe, the editors have done yeoman’s work in setting the stage for widespread deliberation of the issues in diseased-focused care. Some chapters frankly advocate (without evidence) for a focus on ‘chronic disease’ rather than on person-focused care with responsiveness to person-defined needs and priorities. But the introductory chapter and summary, as well as many of the other chapters provide a balanced view; the review indicates a lack of evidence of benefit of a focus on specific chronic diseases. We are still a long way away from knowledge, wisdom and political will to achieve effective, equitable, and efficient health services systems that improve the health of populations and subpopulations. …” [Professor Barbara Starfield MD, MPH John Hopkins Bloomberg School of Public Health]

Content

one Caring for people with chronic conditions: an introduction

Ellen Nolte and Martin McKee

two The burden of chronic disease in Europe

Joceline Pomerleau, Cécile Knai and Ellen Nolte

three Economic aspects of chronic disease and chronic disease management

Marc Suhrcke, Daragh K. Fahey and Martin McKee

four Integration and chronic care: a review

Ellen Nolte and Martin McKee

five Preventing chronic disease: everybody’s business

Thomas E. Novotny

six Supporting self-management

Mieke Rijken, Martyn Jones, Monique Heijmans and Anna Dixon

seven The human resource challenge in chronic care

Carl-Ardy Dubois, Debbie Singh and Izzat Jiwani

eight Decision support

Nicholas Glasgow, Isabelle Durand-Zaleski, Elisabeth Chan and Dhigna Rubiano

nine Paying for chronic disease care

Reinhard Busse and Nicholas Mays

ten Making it happen

Ellen Nolte and Martin McKee

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