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HOW DID YOU DO IT ?

HOW DID YOU DO IT ?. The critical priorities in the Family Medicine practices management in Italy and their solutions: the TUCORI study. Maria Milano, Giampaolo Collecchia, Lino Gambarelli, Paolo Longoni, Massimo Tombesi, Antonio Nicolucci CSeRMEG, Istituto Mario Negri. Background.

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HOW DID YOU DO IT ?

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  1. HOW DID YOU DO IT ? The critical priorities in the Family Medicine practices management in Italy and their solutions: the TUCORI study Maria Milano, Giampaolo Collecchia, Lino Gambarelli, Paolo Longoni, Massimo Tombesi, Antonio Nicolucci CSeRMEG, Istituto Mario Negri Maria Milano

  2. Background Many different organizational settings are nowadays possible in Italy and not much is known about the adopted procedures. Maria Milano

  3. Objectives The purpose of the TUCORI study is, first of all, to allow a peer review, then in two steps to identify critical prioritiesand analyze the adopted solutions. Maria Milano

  4. Methods • A peer review through a closed mailing list by Internet • 1st step: Hanlon method -> the most critical priorities in the organization and management of the GP’s practice • 2nd step: simplified Delphi method (it is still going on now) Maria Milano

  5. The critical priorities Topics Score (0-10) In this step we ask you to answer to the following question with a list of topics,from ascore 0 to 10 (i.e. 10 for a greater problem) Which are the most critical priorities in the organization and management of the GP’s practice? Maria Milano

  6. 9 26 age: 88,5 % (47-56) 42 52 years 61 Results 1st step 35GPs: Give the cell n. to patients77% Have a secretary 85,7% Have a nurse 34,3% Work in more than 1 practice 40% Solo practice 5,7% Patients records on the PC 77.1% Maria Milano

  7. 35GPs 64priorities classified in31 topics 5 Main domains Results 1st step Maria Milano

  8. The critical priorities Maria Milano

  9. Main Domains practice structure management practice clinical processes professional communication stakeholders difficulties personal GP’s development Maria Milano

  10. Discussion Increasing overwork -> better organization Management and professional communication problems Does the offer add people’s needs? Can people’s need be learnt? Can it be organized or can it be planned? How to find the pleasure of working without exhausting performances? Maria Milano

  11. Have a nice day! Maria Milano

  12. Maria Milano

  13. the moderator weeklythread with his own experience every participant fills in an open questionnaire The 2nd step study Simplified Delphi method: • efficacy (score 0,5-1,5) • effectiveness through the PEARL factors (score 0 or 1) for propriety, economic feasibility, acceptability, resource availability, legality) Maria Milano

  14. The open questionnaire • How does it work in your practice? • How long ? • Why have you adopted this method? • Is there anything you don’t like? What would you change? • What has stopped you from changing? Maria Milano

  15. The seven roles of a GP Charlotte Tulinius, MD, Ph.D., MHPE, senior researcher, Central Research Unit of GP, Copenhagen, Denmark Culture Art Freetime More? Reflection Development of self HealthAdvocate Communicator Manager Medical Expert Collaborator Scholar Maria Milano The doctor = Professional

  16. Practice clinical processes • Management of the urgencies • Chronic diseases management • Ambulatori dedicati • Patients records at home • Management of the polytherapies • Management of the prevention in the patients to risk • As I use of the computer • Sharing LG in the team • Audit Maria Milano

  17. Practice structure management • Management of the access to the study • Management of more medical studies • Secretary duties • Administrative management • Nurse duties • Intrusiveness and usefulness of the telephone • The pressure of the impatient patients Maria Milano

  18. Professional communication • Problems of communication in the team • Rules, dynamics and objectives • Chosen of the partners • Relationships with the operating others of the territory Maria Milano

  19. Professional economic demotivation • Professional Solitude • Management of the extra clinical working time for the research, the review of the patient’s records and to study • Insufficient time for the own general cultural increase • Management fatigue: the free time exists? • The pleasure to work without debilitating performances Personal GP’s development Maria Milano

  20. Stakeholders difficulties • Excessive administrative cargo of paper • Management of certifies of disease • Gestione note CUF/ LG e protocolli implementati da ASL • Relationships with the Local Health System • Problems doctor-lawyers • Inadequate sanitary programming Maria Milano

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