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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
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

background
Background

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

Maria Milano

objectives
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

methods
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

the critical priorities
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

results 1 st step

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

results 1 st step7

35GPs

64priorities

classified in31 topics

5 Main domains

Results 1st step

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main domains
Main Domains

practice structure management

practice clinical processes

professional communication

stakeholders difficulties

personal GP’s development

Maria Milano

discussion
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

slide11

Have a nice day!

Maria Milano

the 2nd step study

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

the open questionnaire
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

the seven roles of a gp
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

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The doctor

= Professional

practice clinical processes
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

practice structure management
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

professional communication
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

personal gp s development

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

stakeholders difficulties
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