Impact of primary care physicians working part-time on patient care: A scoping review.

BACKGROUND: Increasing numbers of primary care physicians (PCPs) are reducing their working hours. This decline may affect the workforce and the care provided to patients. OBJECTIVES: This scoping review aims to determine the impact of PCPs working part-time on quality of patient care. METHODS: A systematic search was conducted using the databases PubMed, CINAHL, Embase, and the Cochrane Library. Peer-reviewed, original articles with either quantitative, qualitative or mixed methods designs, published after 2000 and written in any language were considered. The search strings combined the two concepts: part-time work and primary care. Studies were included if they examined any effect of PCPs working part-time on quality of patient care. RESULTS: The initial search resulted in 2,323 unique studies. Abstracts were screened, and information from full texts on the study design, part-time and quality of patient care was extracted. The final dataset included 14 studies utilising data from 1996 onward. The studies suggest that PCPs working part-time may negatively affect patient care, particularly the access and continuity of care domains. Clinical outcomes and patient satisfaction seem mostly unaffected or even improved. CONCLUSION: There is evidence of both negative and positive effects of PCPs working part-time on quality of patient care. Approaches that mitigate negative effects of part-time work while maintaining positive effects should be implemented.

Improving collaboration between specialists and general practitioners in services for individuals with chronic spinal cord injury living in rural areas of Switzerland: Baseline results from the SCI-Co study.

CONTEXT/OBJECTIVE: Strategies to combine primary and specialized care are crucial to meet the needs of individuals with spinal cord injury (SCI) located in rural areas. We explored the collaboration between general practitioners (GPs) and SCI specialists who will participate in an intervention study to improve their collaboration. DESIGN: A questionnaire survey from August to October 2020. SETTING: Primary Care, Specialized SCI care. PARTICIPANTS: Eight GPs and 13 SCI specialists. INTERVENTIONS: Baseline results from the SCI-Co study. OUTCOME MEASURES: N/A. RESULTS: Overall, satisfaction ratings for the collaboration between GPs and SCI specialists were high, and all physicians agreed that they work together well. Especially, SCI specialists were satisfied in collaborating with GPs. Despite Switzerland's fragmented primary and secondary care system, only a few physicians reported about issues with delays and waiting lists. While GPs wanted to improve the quality of their referral, most SCI specialists reported being content with it. GPs were also discontent about discharge organization by specialists. CONCLUSION: Satisfaction with collaboration was high, both in GPs and specialists. Areas for improvement include discharge and referral processes.

Improvement Strategies for the Challenging Collaboration of General Practitioners and Specialists for Patients with Complex Chronic Conditions: A Scoping Review.

Introduction: Coordination of healthcare professionals seems to be particularly important for patients with complex chronic disease, as they present a challenging interplay of conditions and symptoms. As one solution, to counteract or prevent this, improving collaboration between general practitioners (GPs) and specialists has been the aim of studies by linking or coordinating their services along the continuum of care. This scoping review summarises role distributions and components of this collaboration that have potential for improvement for the care of patients with complex chronic conditions. Methods: Scoping review as a knowledge synthesis for components of collaboration and role distributions between medical specialists and GPs in intervention studies. The PubMed database was searched for literature from 2010-2020. Results: Literature search and reference screening generated 2,174 articles. 30 articles originating from 22 unique projects were included in our synthesis. In the interventions to improve collaboration, the GP is most commonly in charge of patient management and extends the scope of practice. The specialist provides support when needed. Clear definition of roles, resources for knowledge transfer and education from specialists are commonly utilised interventions. Typically, combinations of process and system changes addressing communication and coordination issues are applied. Most interventions improve provider and patient satisfaction, health outcomes, and reduce care fragmentation. Conclusion: This review showed that interventions to improve collaboration between GPs and medical specialists seem promising. Further efforts should be made to test and apply the findings systematically in broad clinical practice.

Role distribution and collaboration between specialists and rural general practitioners in long-term chronic care: a qualitative study in Switzerland.

INTRODUCTION: This study explores general practitioners' (GPs') and medical specialists' perceptions of role distribution and collaboration in the care of patients with chronic conditions, exemplified by spinal cord injury. METHODS: Semi-structured interviews with GPs and medical specialists caring for individuals with spinal cord injury in Switzerland. The physicians we interviewed were recruited as part of an intervention study. We used a hybrid framework of inductive and deductive coding to analyse the qualitative data. RESULTS: Six GPs and six medical specialists agreed to be interviewed. GPs and specialists perceived the role of specialists similarly, namely as an expert and support role for GPs in the case of specialised questions. Specialists' expectations of GP services and what GPs provide differed. Specialists saw the GPs' role as complementary to their own responsibilities, namely as the first contact for patients and gatekeepers to specialised services. GPs saw themselves as care managers and guides with a holistic view of patients, connecting several healthcare professionals. GPs were looking for relations and recognition by getting to know specialists better. Specialists viewed collaboration as somewhat distant and focused on processes and patient pathways. Challenges in collaboration were related to unclear roles and responsibilities in patient care. CONCLUSION: The expectations for role distribution and responsibilities differ among physicians. Different goals of GPs and specialists for collaboration may jeopardise shared care models. The role distribution should be aligned according to patients' holistic needs to improve collaboration and provide appropriate patient care.

Shared responsibility between general practitioners and highly specialized physicians in chronic spinal cord injury: Study protocol for a nationwide pragmatic nonrandomized interventional study.

INTRODUCTION: To improve the continuity of care for persons with spinal cord injury (SCI) living in peripheral areas, collaboration between general practitioners (GPs) and specialists is needed. This pragmatic non-randomized interventional study assesses feasibility and effectiveness of a new primary care model based on this collaboration. METHODS: The intervention is medical education on SCI related topics offered by specialists to GPs practicing in rural areas. Outcomes are assessed and analyzed in physicians and patients. Group allocation of persons with SCI follows intention-to-treat principle with intervention group being those in close proximity to a participating GP. RESULTS: It is expected that ten GPs and sixteen specialists will take part in the study's intervention. An average difference in "Doctor's opinion on collaboration questionnaire" score (mean 44; SD ± 12) from baseline after two years post-intervention in the group of participating GPs is hypothesized at P-value level <0.05; meanwhile, the control group remains at an average score of 56. Of persons with SCI (n = 395), 230 are expected to take part in the study at baseline. An average modified "Spinal Cord Injury-Secondary Conditions Scale" change in score from baseline to 24 months post intervention is expected to fall from 12.0 to 9.0 in the intervention group and to stay at 12.0 in the control group. CONCLUSION: The study aims to improve patients' outcomes and providers' experience with delivery of care for persons with SCI, as compared to current best practice. TRIAL REGISTRATION: ClinicalTrials.gov, NCT04071938. Registered August 28, 2018, https://www.clinicaltrials.gov/ct2/show/NCT04071938.

A systematic review of outcome measures in initial rehabilitation of individuals with newly acquired spinal cord injury: providing evidence for clinical practice guidelines.

INTRODUCTION: A newly acquired spinal cord injury (SCI) has an impact on various aspects of a patients' functioning. Outcome measures represent an important component of initial rehabilitation to assess patients' overall status and their progress, simplify clinical communication and support clinical decision-making. The aim of this review was to create an evidence base for developing clinical practice guidelines using systematic literature review to evaluate assessment instruments used in acute/subacute SCI rehabilitation. EVIDENCE ACQUISITION: PubMed, CINAHL, Cochrane Library and LIVIVO databases were searched using the MeSH terms and key words of the Spinal Cord Injury Research Evidence (SCIRE). Studies on outcome measures with patients in the acute/subacute phase of SCI, published in English or German from January 2013 until December 2018 were included. Two reviewers independently screened articles and when a consensus was not reached two further reviewers were consulted. To determine publication quality of systematic reviews, validation and observation studies, AMSTAR, COSMIN and STROBE checklists were applied. EVIDENCE SYNTHESIS: A total of 2533 records were retrieved, 71 potentially eligible articles identified, and 33 articles finally included. One validation and one observational study met all quality criteria. One systematic review received eight from a maximum of 11 points for publication quality (AMSTAR). Ten of 19 validation studies were deemed as "excellent" or "good" (COSMIN), but some were hampered by the low number of study participants. From the 29 reviewed assessments 28 were recommended and one was not. Seven of 13 observational studies received a rating equal or higher to 20 out of a maximum of 22 points (STROBE). Assessments covered neuro-musculoskeletal, sensory and pain, mental and skin structures and functions, as well as activity, participation and quality of life. CONCLUSIONS: In the field of initial SCI rehabilitation, scientifically sound assessments covering different aspects of the bio-psychosocial model of the ICF are available. According to COSMIN, validation studies struggled with quality, whereas observational studies and systematic studies performed well. The review results support the evidence-based selection of outcome measures for assessing the initial rehabilitation of patients with acute and subacute SCI. These results represent an update for recommendations for clinical guidelines on standardized rehabilitation outcome documentation.