To describe activities and outcomes of a cross-team capacity building strategy that took place over a five-year funding period within the broader context of 12 community-based primary health care (CBPHC) teams.

In 2013, the Canadian Institutes of Health Research funded 12 CBPHC Teams (12-Teams) to conduct innovative cross-jurisdictional research to improve the delivery of high-quality CBPHC to Canadians. This signature initiative also aimed to enhance CBPHC research capacity among an interdisciplinary group of trainees, facilitated by a collaboration between a capacity building committee led by senior researchers and a trainee-led working group.

After the committee and working group were established, capacity building activities were organized based on needs and interests identified by trainees of the CBPHC Teams. This paper presents a summary of the activities accomplished, as well as the outcomes reported through an online semistructured survey completed by the trainees toward the end of the five-year funding period. This survey was designed to capture the capacity building and mentorship activities that trainees either had experienced or would like to experience in the future. Descriptive and thematic analyses were conducted based on survey responses, and these findings were compared with the existing core competencies in the literature.

Since 2013, nine webinars and three online workshops were hosted by trainees and senior researchers, respectively. Many of the CBPHC Teams provided exposure for trainees to innovative methods, CBPHC content, and showcased trainee research. A total of 27 trainees from 10 of the 12-Teams responded to the survey (41.5%). Trainees identified key areas of benefit from their involvement in this initiative: skills training, networking opportunities, and academic productivity. Trainees identified gaps in research and professional skill development, indicating areas for further improvement in capacity building programs, particularly for trainees to play a more active role in their education and preparation.

To develop a proactive person-centered care approach for persons with (multiple) chronic diseases in general practice, and to explore the impact on ‘Quadruple aims’: experiences of patients and professionals, patient outcomes and costs of resources use.

The management of people with multiple chronic diseases challenges health care systems designed around single disease. Patients with multimorbidity often receive highly fragmented care that may lead to inefficient, ineffective and potentially harmful treatments and neglect of essential health needs. A more comprehensive, person-centered approach is advocated for persons with multiple morbidities. However, examples on how to provide more person-centered care and evidence of its impact are scarce. A group of Dutch general practitioners (GPs) took the initiative to develop such a care approach.

Mixed methods with a development and pilot-testing phase. The proactive person-centered approach will be developed using an action-based research design consisting of multiple plan-act-observe-reflect-adjust cycles. In each cycle, experiences of patients and primary care professionals from 13 practices will be collected via interviews, observations and focus groups. Starting point for the first cycle is a ‘person-centered consultation’ of up to 1 h in which the GP discusses the health status and health care needs of the patient. Furthermore, shared decisions between GP and patient are made on treatment goals and follow-up. In the pilot-test phase, a nested case cohort study allows to explore the impact of the new approach on ‘Quadruple aim’ outcomes comparing persons with and without exposure to the new care approach.

This study will provide a proactive person-centered approach for persons with multimorbidity in primary care and estimate its potential impact on quadruple outcomes.

We developed a self-report tool to assess patients’ experiences with lifestyle services in team-based primary care and pilot tested the questionnaire as part of a lifestyle intervention study to reverse metabolic syndrome.

Older client satisfaction questionnaires have been generally inadequate for quality improvement purposes, as they have been focused mainly on interpersonal skills of providers and/or in the context of one disease. New approaches to assessing the patient experience of lifestyle programs in primary care are needed and could inform quality improvement efforts over time.

The first phase in developing the questionnaire involved a group-administered questionnaire distributed to 38 healthcare providers in five groups to prioritize variables to include in the survey. Concepts were taken from a previous review of available questionnaires assessing primary care services. The draft questionnaire was reviewed by 11 participants from a lifestyle program using think-aloud cognitive interviewing techniques. The modified self-administered questionnaire (paper and online versions) was then pilot tested with 164 recipients of a nutrition and physical activity intervention program.

Providers ranked the top variables to include in the questionnaire as: ‘trust,’ ‘general communication,’ ‘first-contact accessibility,’ ‘whole-person care,’ and ‘respectfulness.’ After cognitive interviewing and revisions, 21 multiple choice and two open-ended questions were used for pilot testing. Pilot testing identified additional minor wording changes that were needed for clarity, a decreased number of questions for redundant concepts, and decreased options for ceiling effects, resulting in 20 multiple choice and one open-ended question.

The modified self-administered patient experience questionnaire to assess lifestyle services in primary care has undergone rigorous development. Further validation is needed. The assessment of patient experience of lifestyle programs can be used to supplement other data to assess the overall effectiveness of such programs.

To describe variation in task shifting from GPs to practice assistants/nurses in 34 countries and to explain differences by analysing associations with characteristics of the GPs and their practices and features of the health care systems.

Redistribution of tasks and responsibilities in primary care are driven by changes in demand, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill-mix of primary care teams. These developments are hampered by barriers between professional domains.

Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7,200 general practitioners (GPs) in 34 countries. Task shifting is measured through a composite score of GPs’ self-reported shifting of tasks. Independent variables at GP and practice level are as follows: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are as follows: demand for and supply of care, nurse prescribing, and professionalisation of practice assistants/nurses. Multilevel analysis is used to account for clustering of GPs in countries.

Countries vary in the degree of task shifting. Regarding GP and practice characteristics, use of electronic health records and availability of support staff in the practice are positively associated with task shifting and GPs’ working hours negatively, in line with our hypotheses. Age of the GPs is, contrary to our hypothesis, positively related to task shifting. These variables explain 11% of the variance at GP level. Two country variables are related to task shifting: a lower percentage of practices without support staff in a country and nurse prescribing rights coincide with more task shifting. The percentage of practices without support staff has the strongest relationship, explaining 73% of the country variation.

An increasing number of blood tests are being performed in primary care. Informing patients of results takes up a considerable proportion of practice-staff time. The use of new technologies may be more time-efficient for staff but little is known about the acceptability to patients.

To determine patient attitudes towards the use of three technologies – short message service (SMS), webpage and e-mail – for the delivery of laboratory results.

Structured interview.

Two hundred patients were interviewed in two general practices in Lothian, Scotland. Satisfaction with current methods and preferred methods of obtaining test-results were assessed. Patients were asked about their current access to different technologies and their favourability to using such technologies for receiving results and their views on appropriate content and information security. Results were analyzed by age, sex and educational attainment using χ2 test.

A total of 79.5% of patients had mobile phones, 53% used SMS, 46.5% had internet, and 37.5% used e-mail. E-mail, SMS and webpage was the favoured delivery system for 53.3%, 37.1% and 33.3%, respectively.

Patients were favourable towards e-mail but not SMS or a webpage. The main concern over the three technologies was information security. New technology may be useful for delivering results but patients will have to be persuaded that any such system is reliable and secure.

This paper describes findings from a study that evaluated the implementation and impact of case management for long-term conditions (CMLTC) in 10 primary care trusts (PCTs).

Patients who have long-term conditions and complex health and social needs may require case management to deliver and coordinate their care from a range of agencies.

A cross-sectional postal survey of managers with lead responsibility for CMLTC in each PCT is adopted to describe the implementation of services. A retrospective cohort analysis of longitudinal routinely collected admission data for patients enrolled within the CMLTC service (nine months before and nine months after the entry; n = 867) is used to measure their impact.

The organisation of case management varied between PCTs in some aspects despite a high level of coordination across the geographical area. Mean emergency admissions and associated length of stay (LOS) for patients reduced significantly in the nine months after the service entry. There were a number of fairly robust positive and negative influences on these outcome measures in the regression analysis. Most patients with a history of emergency admissions experienced a marked improvement over time. However, most of those without any or with few admissions experienced an increase in admissions and corresponding LOS. Furthermore, a proportion of frequent service users with particular diagnoses also experienced an increase or remained at a high level. A very modest effect was shown with regard to the features of case management arrangements. For each day spent in hospital before service entry, patients are predicted to experience a reduction of nearly one day after. The main contributor explaining increases in LOS for emergency admissions was the number of primary and secondary diagnoses. Each added diagnosis is associated with a 2.4-day increase in LOS, everything else being equal.

Australia and England show high rates of psychological distress and mental health problems in young people. Both are high-income countries and have stated their intention to improve the delivery of health care to young people in primary care settings. Australia has an international reputation for improving care through innovative services and educational initiatives. England has taken a different direction and has concentrated more on developing policy and making recommendations to improve access for young people.

To describe a Churchill Fellowship visit to Australia to observe initiatives in primary care based youth-friendly mental health care and to reflect upon the observations, comparing and contrasting with the English model.

The observations and reflections presented draw on field notes from site visits and meeting with key players, accessing web resources and referring to the literature, both grey and published.

Australia offers plurality in health care delivery and innovative responses to addressing youth mental health. There are two key approaches. The first is the development of services specializing in youth mental health. The second approach is to build capacity of existing primary care services to recognize the particular bio-psychosocial needs of adolescents (and their families). In contrast, England has tended to focus primarily on policy development and improving youth access.

The paper draws attention to a number of political, clinical and educational developments in both Australia and England. Both countries demonstrate different strategies in response to the high levels of psychological distress in young people. Learning from colleagues in other settings can inform our own practice. Ultimately responding to young people's mental health needs is best served by youth-friendly policy which prepares clinicians for effective practice, informed by applied research and supported by adequate resources. Investment in young people's health must be a priority for us all.

The turnover of rural doctors, including doctors who leave clinical practice in rural areas, may disrupt the continuity of care. Though strategies had been formulated to address the problems associated with low retention rates, they proved to be unrewarding. This study aimed to investigate how we could anticipate the loss of rural doctors to facilitate their retention in advance.

We conducted a cross-sectional survey and collected data from rural doctors in Jiangsu Province.

Research on the employment status of target admission graduates in Jiangsu.

Multi-stage stratified sampling methods were employed to select the respondents in this study. We selected 722 rural physicians, who represented all the rural physicians from Northern, Central, and Southern Jiangsu.

Factors affecting anticipated rural retention (odds ratios (OR)).

The anticipated rural retention rate was 72.8% for the 722 respondents from Jiangsu province. Economically developed work areas (ORCentral JS = 0.501, ORSouthern JS = 0.475), a higher monthly income (OR 3000∼ = 0.584, OR6000∼ = 0.255), and an advanced rank among counterparts (OR = 0.507) were protective factors for anticipated rural retention. Risk factors involved the monthly expenditure, mainly for socialization with others (OR = 1.856), working hours of more than 50 hours/week (OR = 2.076), assignment of outpatient work (OR = 1.991), and filing work (OR = 1.544) as the main tasks on a daily basis.

A combination of strategies, including the strengthening of economic incentive as well as the ability to deal with a heavy workload, could increase the recruitment and retention rate in Jiangsu Province.

The investigators aimed to assess the willingness of patients to utilize and pay for a proposed short message service- (SMS) based appointment scheduling service.

Telecommunication applications have been introduced to improve the delivery of healthcare services in developed countries; however, public-funded healthcare systems in developing countries like Nigeria are mostly unfamiliar with the use of such technologies for improving healthcare access.

We proposed a SMS-based (text message) appointment scheduling system to consenting subjects at an outpatients’ clinic and explored their willingness to utilize and pay for the service. Using semi-structured interview schedules, we collected information on: estimated arrival time, most important worry when seeking for healthcare services at public hospitals in the study setting, ownership of a mobile phone, willingness to utilize a SMS-based appointment for clinic visits and willingness to pay for the service. In addition, respondents were asked to suggest a tariff for the proposed system.

A total of 500 consecutively recruited patients aged 16–86 (42.1±15.4) years participated; 54% (n=270) were females. Waiting time ranged from 1–7.5 h (3.9±1.1). Two overlapping themes emerged as most important worries: crowded waiting rooms and long waiting time. Ownership of mobile phones was reported by 96.4% (n=482) of subjects. Nearly all favoured the proposed appointment scheduling system (n=486, 97.2%). Majority of patients who favoured the system were willing to pay for the service (n=484, 99.6%). Suggested tariff ranged from 0.03 to 20.83 (1.53±2.11) US dollars; 89.8% (n=349) of the subjects suggested tariffs that were greater than the prevailing retail cost of the proposed service. In sum, our findings indicate that patients in this study were willing to utilize and pay for a proposed SMS-based appointment scheduling system. The findings have implications for policies aimed at improving healthcare access and delivery of healthcare services at the primary care level in developing countries like Nigeria.