Diabetes care provision in UK primary care practices

Background: Although most people with Type 2 diabetes receive their diabetes care in primary care, only a limited amount is known about the quality of diabetes care in this setting. We investigated the provision and receipt of diabetes care delivered in UK primary care. Methods: Postal surveys with all healthcare professionals and a random sample of 100 patients with Type 2 diabetes from 99 UK primary care practices. Results: 326/361 (90.3%) doctors, 163/186 (87.6%) nurses and 3591 patients (41.8%) returned a questionnaire. Clinicians reported giving advice about lifestyle behaviours (e.g. 88% would routinely advise about calorie restriction; 99.6% about increasing exercise) more often than patients reported having received it (43% and 42%) and correlations between clinician and patient report were low. Patients’ reported levels of confidence about managing their diabetes were moderately high; a median (range) of 21% (3% to 39%) of patients reporting being not confident about various areas of diabetes selfmanagement. Conclusions: Primary care practices have organisational structures in place and are, as judged by routine quality indicators, delivering high quality care. There remain evidence-practice gaps in the care provided and in the self confidence that patients have for key aspects of self management and further research is needed to address these issues. Future research should use robust designs and appropriately designed studies to investigate how best to improve this situation

Incremental Cost Estimates for the Patient-Centered Medical Home

Based on data from thirty-five primary care practices, analyzes the costs associated with the medical home model, in which primary care practices also provide care coordination, patient education, and related services. Considers implications

Overcoming Challenges to Teamwork in Patient-Centered Medical Homes: A Qualitative Study

There is emerging consensus that enhanced inter-professional teamwork is necessary for the effective and efficient delivery of primary care, but there is less practical information specific to primary care available to guide practices on how to better work as teams. The purpose of this study was to describe how primary care practices have overcome challenges to providing team-based primary care and the implications for care delivery and policy

Marshfield Clinic: Health Information Technology Paves the Way for Population Health Management

Highlights Fund-defined attributes of an ideal care delivery system and best practices, including an internal electronic health record, primary care teams, physician quality metrics and mentors, and standardized care processes for chronic care management

Maternal Care Practices, Immunization, and their Associations with Gastroenteritis among Infants in North Tapanuli, North Sumatera

Background:Gastroenteritis is the inflammation in gastric and small intestinal mucosal membrane indicated by the symptoms as diarrhea, nausea, vomit and light fever accompanied by appetite loss and uneasy feeling in the stomach. Gastroenteritis in infants is caused by several factors, including bacterial or viral infections, and food intolerance. This study aimed to investigate the associations of maternal care practices and immunization with the incidence of gastroenteritis among infants in North Tapanuli, North Sumatera. Subjects and Method: This was a case control study conducted in North Tapanuli, North Sumatera. A sample of 94 infants aged 7 to 12 months was selected for this study, consisting of 47 infants with gastroenteritis and 47 infants without gastroenteritis. The dependent variable was gastroenteritis. The independent variables were maternal care practice(dietary and health) as well as immunization status. The data were collected by questionnaire and analyzed by a multiple logistic regression model. Results:The incidence of gastroenteritis in infants was associated with incorrect mater¬nal dietary care practice(OR=8.20; 95% CI=2.58 to 26.31; p<0.001), improper maternal health care practice (OR=5.02; 95% CI= 1.54 to 16.32; p= 0.007), and absence of immunization (OR= 4.60; 95% CI= 3.42 to 15.96; p= 0.016). Conclusion: Maternal dietary and health care practices and immunization are associated with the incidence of gastroenteritis among infants. Keywords: gastroenteritis, dietary, health, maternal care practice, immunization, infant

Episodic use: Practices of care in self-tracking

The development of self-tracking technologies has resulted in a burst of research considering how self-tracking practices manifest themselves in everyday life. Based on a 5-month-long photo elicitation study of Danish self-trackers, we argue that no matter how committed people might be to tracking their activities, their use of self-tracking technologies can be best described as episodic rather than continuous. Using Annemarie Mol’s theoretical framework for understanding care practices as a lens, we show how episodic use can be interpreted through the logic of care. By using self-tracking devices episodically, users employ strategies of care in a way that can be productive and useful. These strategies often come in conflict with the logics of choice that underlie the design of many self-tracking technologies. We argue that this has consequences for the way self-tracking devices need to be imagined, designed, and introduced as part of workplace and insurance-type tracking programs

Good care practices can mitigate the negative effects of poverty and low maternal schooling on children's nutritional status

This study uses data from a representative survey of households with preschoolers in Accra, Ghana to (1) examine the importance of care practices for children's height-for-age z-scores (HAZ); and (2) identify subgroups of children for whom good maternal care practices may be particularly important. Good caregiving practices related to child feeding and use of preventive health services were a strong determinant of children's HAZ, specially among children from the two lower income terciles and children whose mothers had less than secondary schooling. In this population, good care practices could compensate for the negative effects of poverty and low maternal schooling on children's HAZ. Thus, effective targeting of specific education messages to improve child feeding practices and use of preventive health care could have a major impact on reducing childhood malnutrition in Accra.Health services. ,Child care. ,Child Feeding. ,Poverty. ,

Use of risk adjustment in setting budgets and measuring performance in primary care I: how it works

Summary points: Primary care groups and general practices will be funded largely through capitation based formulas, and their performance will be monitored more closely. Current methods of funding primary care trusts and general practices, and of monitoring their performance, do not take into account differences in case mix. Risk adjustment methods have been developed in the United States to allow measurement ofcase mix and morbidity of primary care populations. Risk adjustment methods are now being used to set capitation rates for health services in the United States

Foster Care in California: Achievements and Challenges

Examines changes in California's foster care policies, processes, and practices; progress since 2000 in reducing the number of children in foster care; contributing factors; and remaining challenges, including issues of payments and aging out

Locating Care Ethics Beyond the Global North

In care ethics, caring is seen to be embedded in practice and locally contingent. However, despite a large and thriving literature on care practices as they vary across the globe, the implications of the different meanings and geohistories of care for the ethics of care have hardly been addressed. Rather, most theorisations of care ethics have implicitly conceptualised care as a universal practice or drawn on care as practised in the global North. This paper argues that care ethics needs emplacing, and that this emplacement should extend beyond sites in the global North so that feminist theories of care can take account of the diversity of care practices globally. Moreover, given the increasing globalisation of care, different notions of care are often and increasingly in dialogue with each other. As care is relational and enacted across space, the differences in care ethics between places have to be negotiated. This paper, therefore, calls not just for recognising multiplicity in care ethics or even multicultural care ethics, but for theorising the relations between different kinds of care and the ethics that drive them. Finally, both care relations and understandings of care are dynamic; they alter as people migrate, which also needs consideration. This paper argues that a relational and dynamic understanding of varied care offers new theoretical, political and empirical agendas both within geography and for feminist theory