Complexity In Primary Care

The daily work of General Practitioners can seem at once simple and immensely complicated. The routine nature of the consultation appears on the surface to be straightforward, but carries within it myriad layers of meaning. The options for diagnosis and treatment within a single consultation, or when combined in the overall pattern of the day, can seem huge. A basic understanding of complexity theory can provide GPs with a way to face the more bewildering aspects of their job. This book provides a concise and clear introduction to complexity, tailored specifically for the primary care environment. GPs and their colleagues throughout primary care will find this book assists them in working more efficiently, more effectively and more enjoyably.

Improving our nation's healthcare system is a challenge which, because of its scale and complexity, requires a creative approach and input from many different fields of expertise. Lessons from engineering have the potential to improve both the efficiency and quality of healthcare delivery. The fundamental notion of a high-performing healthcare system-one that increasingly is more effective, more efficient, safer, and higher quality-is rooted in continuous improvement principles that medicine shares with engineering. As part of its Learning Health System series of workshops, the Institute of Medicine's Roundtable on Value and Science-Driven Health Care and the National Academy of Engineering, hosted a workshop on lessons from systems and operations engineering that could be applied to health care. Building on previous work done in this area the workshop convened leading engineering practitioners, health professionals, and scholars to explore how the field might learn from and apply systems engineering principles in the design of a learning healthcare system. Engineering a Learning Healthcare System: A Look at the Future: Workshop Summary focuses on current major healthcare system challenges and what the field of engineering has to offer in the redesign of the system toward a learning healthcare system.

This book presents case-based descriptions of models for the inclusive, multispecialty and multidisciplinary clinical care of complex cases. Cases range from primary care patients with complex systemic medical and psychiatric comorbidity, to those requiring specialty care, to those with potentially terminal illnesses. While each category and case has its unique requirements often necessitating different models of care, the commonalities in approaching complex clinical situations is underscored. Extended case narratives written by the treating physicians, summarizing both the course of clinical care and physicians' reflections on the challenges of managing complex patients, comprise the bulk of the book. Five additional chapters on systems issues associated with care of complex patients, together with a chapter on end of life considerations, a narrative analysis of the physicians reflections about complex patients, and a concluding chapter are prominently included to anchor the case narratives. Written by experts in the field, these descriptions form unique models for assessing and treating complex cases. Integrated Care for Complex Patients is a useful guide for all health practitioners and health administrators who are responsible for clinically complex cases, including physicians in primary care and psychiatry, physician assistants and nurse practitioners, and psychologists.

Ask for a definition of primary care, and you are likely to hear as many answers as there are health care professionals in your survey. Primary Care fills this gap with a detailed definition already adopted by professional organizations and praised at recent conferences. This volume makes recommendations for improving primary care, building its organization, financing, infrastructure, and knowledge baseâ€"as well as developing a way of thinking and acting for primary care clinicians. Are there enough primary care doctors? Are they merely gatekeepers? Is the traditional relationship between patient and doctor outmoded? The committee draws conclusions about these and other controversies in a comprehensive and up-to-date discussion that covers: The scope of primary care. Its philosophical underpinnings. Its value to the patient and the community. Its impact on cost, access, and quality. This volume discusses the needs of special populations, the role of the capitation method of payment, and more. Recommendations are offered for achieving a more multidisciplinary education for primary care clinicians. Research priorities are identified. Primary Care provides a forward-thinking view of primary care as it should be practiced in the new integrated health care delivery systemsâ€"important to health care clinicians and those who train and employ them, policymakers at all levels, health care managers, payers, and interested individuals.

This book is an introduction to health care as a complex adaptive system, a system that feeds back on itself. The first section introduces systems and complexity theory from a science, historical, epistemological, and technical perspective, describing the principles and mathematics. Subsequent sections build on the health applications of systems science theory, from human physiology to medical decision making, population health and health services research. The aim of the book is to introduce and expand on important population health issues from a systems and complexity perspective, highlight current research developments and their implications for health care delivery, consider their ethical implications, and to suggest directions for and potential pitfalls in the future.

Statistics and evidence-based medicine are assessed in most postgraduate and undergraduate medical examinations and degrees in health sciences. All clinicians have to acquire skills in this area. This book aims to provide a brief overview of basic medical statistics and the numerical aspects of evidence-based medicine to give realistic worked examples to illustrate the interpretation of studies relevant to clinical practice and to allow examination practice. It aims to cover all major topics covered in the undergraduate and postgraduate examinations. Each chapter begins with an overview and summary of the main points followed by worked examples and exercises with full answers. It will be ideal for all postgraduate medical examination candidates. Other clincians and undergraduate students in medicine and health sciences will also find it useful.

Considering the frameworks of thinking that underpin medicine, and general practice in particular, this title describes how complexity theory can illuminate and explain what goes on in general practice on a daily basis.

"Many people believe that healthcare is the example par excellence of a complex adaptive system (CAS). It has a daunting range of diverse stakeholders (citizens, taxpayers, politicians, policymakers, providers, managers, clinicians, patients and patient groups), spans the public and private sectors and delivers care across many settings and through varied types of organisations (public health settings, community centres, hospitals, aged-care facilities, and family or general practices, for example). The individuals delivering care, and the groups, teams, networks, bodies and organisations through which they provide services, interact in intricate configurations, longitudinally. Said that way, certain consequences arise. The system, of necessity, will be adapting to circumstances over time, behaviours won't necessarily be predictable, the sum of the parts will be greater and different from the individual elements making up the system, and the inputs and outputs will not match because relationships within the system are not straightforward-they are non-linear. The complexity science approach to understanding, acting on, and researching health systems is becoming increasingly popular. It is therefore timely to release an analysis of complexity and its characteristics, and apply them to healthcare."--Website.

Implementing safety practices in healthcare saves lives and improves the quality of care: it is therefore vital to apply good clinical practices, such as the WHO surgical checklist, to adopt the most appropriate measures for the prevention of assistance-related risks, and to identify the potential ones using tools such as reporting & learning systems. The culture of safety in the care environment and of human factors influencing it should be developed from the beginning of medical studies and in the first years of professional practice, in order to have the maximum impact on clinicians' and nurses' behavior. Medical errors tend to vary with the level of proficiency and experience, and this must be taken into account in adverse events prevention. Human factors assume a decisive importance in resilient organizations, and an understanding of risk control and containment is fundamental for all medical and surgical specialties. This open access book offers recommendations and examples of how to improve patient safety by changing practices, introducing organizational and technological innovations, and creating effective, patient-centered, timely, efficient, and equitable care systems, in order to spread the quality and patient safety culture among the new generation of healthcare professionals, and is intended for residents and young professionals in different clinical specialties.

In response to a request by the Health Care Financing Administration (HCFA), the Institute of Medicine proposed a study to examine definitions of serious or complex medical conditions and related issues. A seven-member committee was appointed to address these issues. Throughout the course of this study, the committee has been aware of the fact that the topic addressed by this report concerns one of the most critical issues confronting HCFA, health care plans and providers, and patients today. The Medicare+Choice regulations focus on the most vulnerable populations in need of medical care and other services-those with serious or complex medical conditions. Caring for these highly vulnerable populations poses a number of challenges. The committee believes, however, that the current state of clinical and research literature does not adequately address all of the challenges and issues relevant to the identification and care of these patients.