Designing centralized waiting lists for attachment to a primary care provider: Considerations from a logic analysis

Access to a regular primary care provider is essential to quality care. In Canada, where 15 % of patients are unattached (i.e., without a regular provider), centralized waiting lists (CWLs) help attach patients to a primary care provider (family physician or nurse practitioner). Previous studies reveal mechanisms needed for CWLs to work, but focus mostly on CWLs for specialized health care. We aim to better understand how to design CWLs for unattached patients in primary care.In this study, a logic analysis compares empirical evidence from a qualitative case study of CWLs for unattached patients in seven Canadian provinces to programme theory derived from a realist review on CWLs. Data is analyzed using context-intervention-mechanism-outcome configurations.Results identify mechanisms involved in three components of CWL design: patient registration, patient prioritization, and patient assignment to a provider for attachment. CWL programme theory is revised to integrate mechanisms specific to primary care, where patients, rather than referring providers, are responsible for registering on the CWL, where prioritization must consider a broad range of conditions and characteristics, and where long-term acceptability of attachment is important. The study provides new insight into mechanisms that enable CWLs for unattached patients to work.     

中年级小学生笔迹工整性与自信心的关系研究

中文笔迹特征与人格特质关系密切，为了研究中年级小学生笔迹的工整性与自信心的关系，采用罗森博格《自信心量表》和中文笔迹评定材料对125名中年级小学生进行测试。结果发现：（1）中年级小学生自信者和自我感觉平常者比重大，约占95%，自卑者和超级自信者比重小，约占5%；(2)自信心和笔迹工整性正相关显著（r=0.24,P<0.05)；（3）笔迹工整性对自信心具有预测作用，笔迹工整性可解释自信心9.3%的变异（R2=0.093)；(4)笔迹工整性存在显著的性别差异(F=41.62,P<0.05)，男性笔迹得分的平均分显著低于女性。可以得出：（1）中年级小学生自信心状况整体良好；（2）受测者笔迹越工整，自信心越高；（3）笔迹工整性对自信心具有预测作用；（4）性别影响笔迹工整性，男生的笔记工整性不如女生。     

A comprehensive health service evaluation and monitoring framework

ObjectiveTo develop a framework for evaluating and monitoring a primary health care service, integrating hospital and community services.MethodA targeted literature review of primary health service evaluation frameworks was performed to inform the development of the framework specifically for remote communities. Key principles underlying primary health care evaluation were determined and sentinel indicators developed to operationalise the evaluation framework. This framework was then validated with key stakeholders.ResultsThe framework includes Donabedian's three seminal domains of structure, process and outcomes to determine health service performance. These in turn are dependent on sustainability, quality of patient care and the determinants of health to provide a comprehensive health service evaluation framework. The principles underpinning primary health service evaluation were pertinent to health services in remote contexts. Sentinel indicators were developed to fit the demographic characteristics and health needs of the population. Consultation with key stakeholders confirmed that the evaluation framework was applicable.ConclusionData collected routinely by health services can be used to operationalise the proposed health service evaluation framework. Use of an evaluation framework which links policy and health service performance to health outcomes will assist health services to improve performance as part of a continuous quality improvement cycle.