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Chaturvedi J, Stewart R, Ashworth M, Roberts A. Distributions of recorded pain in mental health records: a natural language processing based study. BMJ Open 2024; 14:e079923. [PMID: 38642997 PMCID: PMC11033644 DOI: 10.1136/bmjopen-2023-079923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/28/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVE The objective of this study is to determine demographic and diagnostic distributions of physical pain recorded in clinical notes of a mental health electronic health records database by using natural language processing and examine the overlap in recorded physical pain between primary and secondary care. DESIGN, SETTING AND PARTICIPANTS The data were extracted from an anonymised version of the electronic health records of a large secondary mental healthcare provider serving a catchment of 1.3 million residents in south London. These included patients under active referral, aged 18+ at the index date of 1 July 2018 and having at least one clinical document (≥30 characters) between 1 July 2017 and 1 July 2019. This cohort was compared with linked primary care records from one of the four local government areas. OUTCOME The primary outcome of interest was the presence of recorded physical pain within the clinical notes of the patients, not including psychological or metaphorical pain. RESULTS A total of 27 211 patients were retrieved. Of these, 52% (14,202) had narrative text containing relevant mentions of physical pain. Older patients (OR 1.17, 95% CI 1.15 to 1.19), females (OR 1.42, 95% CI 1.35 to 1.49), Asians (OR 1.30, 95% CI 1.16 to 1.45) or black (OR 1.49, 95% CI 1.40 to 1.59) ethnicities, living in deprived neighbourhoods (OR 1.64, 95% CI 1.55 to 1.73) showed higher odds of recorded pain. Patients with severe mental illnesses were found to be less likely to report pain (OR 0.43, 95% CI 0.41 to 0.46, p<0.001). 17% of the cohort from secondary care also had records from primary care. CONCLUSION The findings of this study show sociodemographic and diagnostic differences in recorded pain. Specifically, lower documentation across certain groups indicates the need for better screening protocols and training on recognising varied pain presentations. Additionally, targeting improved detection of pain for minority and disadvantaged groups by care providers can promote health equity.
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Affiliation(s)
- Jaya Chaturvedi
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mark Ashworth
- School of Population Health & Environmental Sciences, King's College, London, UK
| | - Angus Roberts
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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Walløe S, Beck M, Lauridsen HH, Morsø L, Simonÿ C. Quality in care requires kindness and flexibility - a hermeneutic-phenomenological study of patients' experiences from pathways including transitions across healthcare settings. BMC Health Serv Res 2024; 24:117. [PMID: 38254059 PMCID: PMC10801984 DOI: 10.1186/s12913-024-10545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The number of people living with chronic conditions is increasing worldwide, and with that, the need for multiple long-term complex care across care settings. Undergoing transitions across healthcare settings is both challenging and perilous for patients. Nevertheless, knowledge of what facilitates quality during transitions in healthcare settings from the lifeworld perspective of patients is still lacking. Therefore, we aimed to explore the lived experience in healthcare quality for Danish adult patients during healthcare pathways including transitions across settings. METHODS Within a hermeneutic-phenomenological approach, interviews were conducted with three women and five men with various diagnoses and care paths between 30 and 75 years of age. Data underwent a three phased thematic analysis leading to three themes. RESULTS Patients with various illnesses' experiences of quality of care is described in the themes being powerless in the face of illness; burdensome access and navigation; and being in need of mercy and striving for kindness. This highlights that patients' experiences of quality in healthcare pathways across settings interweaves with an overall understanding of being powerless at the initial encounter. Access and navigation are burdensome, and system inflexibility adds to the burden and enhances powerlessness. However, caring care provided through the kindness of healthcare professionals supports patients in regaining control of their condition. CONCLUSIONS This hermeneutical-phenomenological study sheds light on the lived experiences of people who are at various stages in their care paths with transitions across healthcare settings. Although our findings are based on the lived experiences of 8 people in a Danish context, in light of the discussion with nursing theory and other research, the results can be reflected in two main aspects: I) kind and merciful professional relationships and II) system flexibility including access and navigation, were essential for their experiences of care quality during healthcare transitions. This is important knowledge when striving to provide patients with a clear voice regarding quality in care pathways stretching across settings.
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Affiliation(s)
- Sisse Walløe
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, J. B. Winsløws Vej 9 a, 3. Floor, 5000, Odense C, Denmark.
- Department of Physio- and Occupational Therapy, Research- and Implementation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Fælledvej 2C, 4200, Slagelse, Denmark.
| | - Malene Beck
- Department of Paediatrics, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark
| | - Henrik Hein Lauridsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 39, 5230, Odense, Denmark
| | - Lars Morsø
- Department of Clinical Research, Research Unit OPEN, University of Southern Denmark, J. B. Winsløws Vej 9 a, 3. Floor, 5000, Odense C, Denmark
| | - Charlotte Simonÿ
- Department of Health, Institute of Regional Health Research, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
- Research- and Implementation Unit PROgrez, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Fælledvej 2C, 4200, Slagelse, Denmark
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Kruys E, Wu CJJ. Hospital doctors' and general practitioners' perspectives of outpatient discharge processes in Australia: an interpretive approach. BMC Health Serv Res 2023; 23:1225. [PMID: 37940986 PMCID: PMC10634127 DOI: 10.1186/s12913-023-10221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Unnecessary delays in patient discharge from hospital outpatient clinics have direct consequences for timely access of new patients and the length of outpatient waiting times. The aim of this study was to gain better understanding of hospital doctors' and general practitioners' perspectives of the barriers and facilitators when discharging from hospital outpatients to general practice. METHODS An interpretative approach incorporating semi-structured interviews with 15 participants enabled both hospital doctors and general practitioners to give their perspectives on hospital outpatient discharge processes. RESULTS Participants mentioned various system problems hampering discharge from hospital outpatient clinics to general practice, such as limitations of electronic communication tools, workforce and workload challenges, the absence of agreed discharge principles, and lack of benchmark data. Hospital clinicians may keep patients under their care out of a concern about lack of follow-up and an inability to escalate timely hospital care following discharge. Some hospital clinicians may have a personal preference to provide ongoing care in the outpatient setting. Other factors mentioned were insufficient supervision of junior doctors, a patient preference to remain under hospital care, and the ease of scheduling follow-up appointments. An effective handover process requires protected time, a systematic approach, and a supportive clinical environment including user-friendly electronic communication and clinical handover tools. Several system improvements and models of care were suggested, such as agreed discharge processes, co-designed between hospitals and general practice. Recording and sharing outpatient discharge data may assist to inform and motivate hospital clinicians and support the training of junior doctors. General practitioners participating in the study were prepared to provide continuation of care but require timely clinical management plans that can be applied in the community setting. A hospital re-entry pathway providing rapid access to outpatient hospital resources after discharge could act as a safety net and may be an alternative to the standard 12-month review in hospital outpatient clinics. CONCLUSION Our study supports the barriers to discharge as mentioned in the literature and adds the perspectives of both hospital clinicians and general practitioners. Potential solutions were suggested including co-designed discharge policies, improved electronic communication tools and a rapid hospital review pathway following discharge.
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Affiliation(s)
- Edwin Kruys
- General Practice Liaison Unit, Sunshine Coast Hospital and Health Service, Birtinya, QLD4575, Australia
| | - Chiung-Jung Jo Wu
- School of Health, University of the Sunshine Coast, 1 Moreton Parade, Petrie, QLD, 4502, Australia.
- Royal Brisbane and Women's Hospital (RBWH), Herston, QLD, 4006, Australia.
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Snudden CM, Calanzani N, Archer S, Honey S, Pannebakker MM, Faher A, Chang A, Hamilton W, Walter FM. Can we do better? A qualitative study in the East of England investigating patient experience and acceptability of using the faecal immunochemical test in primary care. BMJ Open 2023; 13:e072359. [PMID: 37316310 DOI: 10.1136/bmjopen-2023-072359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES The faecal immunochemical test (FIT) is increasingly used in UK primary care to triage patients presenting with symptoms and at different levels of colorectal cancer risk. Evidence is scarce on patients' views of using FIT in this context. We aimed to explore patients' care experience and acceptability of using FIT in primary care. DESIGN A qualitative semi-structured interview study. Interviews were conducted via Zoom between April and October 2020. Transcribed recordings were analysed using framework analysis. SETTING East of England general practices. PARTICIPANTS Consenting patients (aged ≥40 years) who presented in primary care with possible symptoms of colorectal cancer, and for whom a FIT was requested, were recruited to the FIT-East study. Participants were purposively sampled for this qualitative substudy based on age, gender and FIT result. RESULTS 44 participants were interviewed with a mean age 61 years, and 25 (57%) being men: 8 (18%) received a positive FIT result. Three themes and seven subthemes were identified. Participants' familiarity with similar tests and perceived risk of cancer influenced test experience and acceptability. All participants were happy to do the FIT themselves and to recommend it to others. Most participants reported that the test was straightforward, although some considered it may be a challenge to others. However, test explanation by healthcare professionals was often limited. Furthermore, while some participants received their results quickly, many did not receive them at all with the common assumption that 'no news is good news'. For those with a negative result and persisting symptoms, there was uncertainty about any next steps. CONCLUSIONS While FIT is acceptable to patients, elements of communication with patients by the healthcare system show potential for improvement. We suggest possible ways to improve the FIT experience, particularly regarding communication about the test and its results.
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Affiliation(s)
- Claudia M Snudden
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Natalia Calanzani
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Academic Primary Care, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK
| | - Stephanie Archer
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephanie Honey
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Merel M Pannebakker
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Anissa Faher
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Aina Chang
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Willie Hamilton
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Fiona M Walter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Janssen M, Fluit CRMG, Lubbers RR, Cornelissen SA, de Graaf J, Scherpbier ND. Learning collaboration at the primary-secondary care interface: a dual-method study to define design principles for interventions in postgraduate training programmes. BMC MEDICAL EDUCATION 2023; 23:308. [PMID: 37138295 PMCID: PMC10158135 DOI: 10.1186/s12909-023-04254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Collaboration between primary and secondary care (PSCC) is important to provide patient-centered care. Postgraduate training programmes should provide training to learn PSCC. With a design based research (DBR) approach design principles can be formulated for designing effective interventions in specific contexts. The aim of this study is to determine design principles for interventions aimed to learn PSCC in postgraduate training programmes. METHODS DBR is characterised by multi-method studies. We started with a literature review on learning collaboration between healthcare professionals from different disciplines within the same profession (intraprofessional) to extract preliminary design principles. These were used to inform and feed group discussions among stakeholders: trainees, supervisors and educationalists in primary and secondary care. Discussions were audiotaped, transcribed and analysed using thematic analysis to formulate design principles. RESULTS Eight articles were included in the review. We identified four preliminary principles to consider in the design of interventions: participatory design, work process involvement, personalised education and role models. We conducted three group discussions with in total eighteen participants. We formulated three design principles specific for learning PSCC in postgraduate training programmes: (1) The importance of interaction, being able to engage in a learning dialogue. (2) Facilitate that the learning dialogue concerns collaboration. (3) Create a workplace that facilitates engagement in a learning dialogue. In the last design principle we distinguished five subcategories: intervention emphasises the urge for PSCC and is based on daily practice, the presence of role models, the work context creates time for learning PSCC, learning PSCC is formalised in curricula and the presence of a safe learning environment. CONCLUSION This article describes design principles for interventions in postgraduate training programmes with the aim to learn PSCC. Interaction is key in learning PSCC. This interaction should concern collaborative issues. Furthermore, it is essential to include the workplace in the intervention and make adjacent changes in the workplace when implementing interventions. The knowledge gathered in this study can be used to design interventions for learning PSCC. Evaluation of these interventions is needed to acquire more knowledge and adjust design principles when necessary.
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Affiliation(s)
- Marijn Janssen
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands.
| | - Cornelia R M G Fluit
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roel R Lubbers
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands
- Obstetrics and Gynaecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sylvia A Cornelissen
- Department of Internal Medicine Nijmegen, Radboud University Medical Center, Geert Grooteplein Zuid 10, PO box 9101, postal route 463, Nijmegen, 6500 HB, The Netherlands
- Department Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jacqueline de Graaf
- Radboudumc Health Academy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nynke D Scherpbier
- Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, Groningen, The Netherlands
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Pratiwi AB, Padmawati RS, Mulyanto J, Willems DL. Patients values regarding primary health care: a systematic review of qualitative and quantitative evidence. BMC Health Serv Res 2023; 23:400. [PMID: 37098522 PMCID: PMC10131468 DOI: 10.1186/s12913-023-09394-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 09/15/2022] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Accessible and high-quality primary health care (PHC) is fundamental to countries moving towards universal health coverage. In order to improve the quality of patient-centered care provided in PHC, a comprehensive understanding of patients' values is crucial to address any gaps in the health care system. This systematic review aimed to identify patients' values relevant to PHC. METHODS We searched primary qualitative and quantitative studies about patients' values related to primary care in PubMed and EMBASE (Ovid) from 2009 to 2020. The studies' quality was assessed using Joanna Briggs Institute (JBI) Critical Appraisal Checklist for both quantitative and qualitative studies and Consolidated Criteria for Reporting Qualitative Studies (COREQ) for qualitative studies. A thematic approach was used in the data synthesis. OUTCOME The database search resulted in 1,817 articles. A total of 68 articles were full-text screened. Data were extracted from nine quantitative and nine qualitative studies that met the inclusion criteria. The participants of the studies were mainly the general population in high-income countries. Four themes emerged from the analysis: patients' values related to privacy and autonomy; values associated with the general practitioners including virtuous characteristics, knowledge and competence; values involving patient-doctor interactions such as shared decision-making and empowerment; and core values related to the primary care system such as continuity, referral, and accessibility. CONCLUSIONS This review reveals that the doctor's personal characteristics and their interactions with the patients are critical considerations concerning the primary care services from the patients' point of view. The inclusion of these values is essential to improve the quality of primary care.
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Affiliation(s)
- Agnes Bhakti Pratiwi
- Department of Ethics, Law, and Humanities, Faculty of Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands.
- Department of Medical Education and Bioethics, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Retna Siwi Padmawati
- Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
- Center for Bioethics and Medical Humanities, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Joko Mulyanto
- Department of Public Health and Community Medicine, Faculty of Medicine, Universitas Jenderal Soedirman, Purwokerto, Indonesia
- Department of Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Dick L Willems
- Department of Ethics, Law, and Humanities, Faculty of Medicine, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
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Bennett MJ, Center JR, Perry L. Exploring barriers and opportunities to improve osteoporosis care across the acute-to-primary care interface: a qualitative study. Osteoporos Int 2023:10.1007/s00198-023-06748-0. [PMID: 37093239 DOI: 10.1007/s00198-023-06748-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 04/05/2023] [Indexed: 04/25/2023]
Abstract
This qualitative study interviewed general practitioners, patients, and FLS clinicians and identified key challenges facing stakeholders seeking to improve post-fracture osteoporosis care. Local policies and care pathways as an initial strategy may address information and service delivery issues across the acute-primary care divide. INTRODUCTION Fracture liaison services (FLS) can be effective for secondary fracture prevention, but long-term adherence to therapies remains suboptimal. Few studies have explored how services manage the transition between tertiary and primary post-fracture care. This study mapped service processes and factors influencing integration of post-clinic care, identifying barriers, supports, and opportunities for seamless healthcare. METHODS Qualitative descriptive study using semi-structured interviews with FLS stakeholders at two metropolitan hospitals in New South Wales (NSW) and surrounding general practices. RESULTS Seven FLS clinicians, 11 general practitioners (GPs), and seven patients were interviewed. Six key themes emerged on the transition of patient care from tertiary to primary care (PC). Interprofessional communication issues and role ambiguity posed threats to seamless care. Delayed, absent, inaccessible, or poor-quality communication frustrated GPs, while FLS clinicians lacked confidence in existing communication systems and desired bidirectional communication with PC. GPs were confident managing osteoporosis, but FLS clinicians had limited confidence that patients would discuss osteoporosis with their GP and that GPs would action recommendations. Effective PC follow-up required a positive GP-patient relationship and that patients perceived a need to engage with PC. Patient understanding of osteoporosis (influenced by patient education, knowledge, beliefs, and health behaviours) affected PC attendance. Limited public awareness of osteoporosis and healthcare policy deficits contributed to care gaps. CONCLUSION Key challenges were identified facing stakeholders seeking to improving post-clinic osteoporosis care. Development and implementation of local, integrated acute-community policies and care pathways as an initial intervention may address information and service delivery issues across the acute-PC divide.
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Affiliation(s)
- Michael J Bennett
- The Garvan Institute of Medical Research, 384 Victoria St, NSW, Darlinghurst, Australia.
- St George and Sutherland Clinical School, UNSW Medicine, Sydney, Australia.
- Prince of Wales Hospital & Community Health Services, NSW, Randwick, Australia.
| | - Jacqueline R Center
- School of Clinical Medicine, Faculty of Medicine and Health, St Vincent's Healthcare Clinical Campus, UNSW, Sydney, Australia
- The Garvan Institute of Medical Research, 384 Victoria St, NSW, Darlinghurst, Australia
| | - Lin Perry
- Faculty of Health, University of Technology Sydney, NSW, Ultimo, Australia
- Prince of Wales Hospital & Community Health Services, NSW, Randwick, Australia
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Aydin S, Crone MR, Siebelink BM, Numans ME, Vermeiren RRJM, Westenberg PM. Informative value of referral letters from general practice for child and adolescent mental healthcare. Eur Child Adolesc Psychiatry 2023; 32:303-315. [PMID: 34417876 PMCID: PMC9970945 DOI: 10.1007/s00787-021-01859-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/08/2021] [Indexed: 11/29/2022]
Abstract
Although referral letters (RLs) form a nodal point in a patient's care journey, little is known about their informative value in child and adolescent mental healthcare. To determine the informative value of RLs to child and adolescent psychiatry, we conducted a chart review in medical records of minors registered at specialized mental healthcare between January 2015 and December 2017 (The Netherlands). Symptoms indicated in RLs originating from general practice (N = 723) were coded and cross-tabulated with the best estimate clinical classifications made in psychiatry. Results revealed that over half of the minors in the sample were classified in concordance with at least one reason for referral. We found fair to excellent discriminative ability for indications made in RLs concerning the most common psychiatric classifications (95% CI AUC: 60.9-70.6 for anxiety disorders to 90.5-100.0 for eating disorders). Logistic regression analyses suggested no statistically significant effects of gender, age, severity or mental healthcare history, with the exception of age and attention deficit hyperactivity disorders (ADHD), as RLs better predicted ADHD with increasing age (OR = 1.14, 95% CI 1.03-1.27). Contextual problems, such as difficulties studying, problems with parents or being bullied were indicated frequently and associated with classifications in various disorder groups. To conclude, general practitioners' RLs showed informative value, contrary to common beliefs. Replication studies are needed to reliably incorporate RLs into the diagnostic work-up.
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Affiliation(s)
- S Aydin
- Department of Developmental and Educational Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands.
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Centre, Oegstgeest, The Netherlands.
| | - M R Crone
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - B M Siebelink
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Centre, Oegstgeest, The Netherlands
| | - M E Numans
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
| | - R R J M Vermeiren
- Department of Child and Adolescent Psychiatry, LUMC Curium, Leiden University Medical Centre, Oegstgeest, The Netherlands
- Youz, Parnassia Group, Rotterdam, The Netherlands
| | - P M Westenberg
- Department of Developmental and Educational Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
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Wong GJ, Lau J, Chew E, Chow WM, Choo J, Tan KK. Patients’ perception of colorectal cancer surveillance in the community: an exploratory study. BMC Public Health 2022; 22:2122. [DOI: 10.1186/s12889-022-14485-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 10/29/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
All patients who underwent curative resection for colorectal cancer (CRC) are frequently reviewed in tertiary institutions to ensure timely detection of any disease recurrence. There has been no local study that evaluated the feasibility of monitoring their condition in the community as a possible new model of care. This study henceforth seeks to understand CRC patients’ views and receptiveness of having their surveillance consultations conducted in a community setting.
Methods
We convenience sampled Stage I and II CRC patients who were within five years post-operation in the outpatient clinics. An open-ended questionnaire aimed at elucidating their perception towards cancer surveillance in a community setting was administered. Content analysis was used to group and quantify responses from participants.
Results
Twenty-five participants agreed to participate in the study. Only 48% of the participants felt that having phlebotomy procedures in a community or home setting was acceptable. Participants were less willing to be reviewed by a physician who is not their primary surgeon, with only 32% agreeable to seeing a different doctor for surveillance if given a choice. However, most participants were open to having a telephone consultation in place of a physical face-to-face consultation before (72%) and after (76%) going through medical imaging.
Conclusions
Participants remained keen to be managed by their primary surgeons and were hesitant towards having their follow-up surveillance consultations in community and primary care settings. Further studies should be conducted to understand whether these perceptions are generalisable, and if more can be done to change public perception towards the role of community and primary care institutions.
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Feddersen H, Søndergaard J, Andersen L, Munksgaard B, Primdahl J. Barriers and facilitators for coherent rehabilitation among people with inflammatory arthritis – a qualitative interview study. BMC Health Serv Res 2022; 22:1347. [DOI: 10.1186/s12913-022-08773-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
People with chronic diseases have contact with several different professionals across hospital wards, municipality services and general practice and often experience lack of coherence. The purpose was to explore perceived barriers and facilitators to coherent rehabilitation pathways for health care users with inflammatory arthritis and how coherence can be improved.
Methods
Semi-structured individual interviews were conducted before a planned inpatient rehabilitation stay, 2-3 weeks and 4-6 months after discharge. Thematic reflexive analysis guided the analysis of data. Concepts of person-centred care, complex adaptive systems and integrated care were applied in the interpretations.
Results
In all, 11 participants with IA were included. There was one overarching theme, The importance of a person-centred approach, illuminating the significance of professionals who respect healthcare user’ preferences. To use a person-centred approach, demands professionals who are interested in exploring the persons own values, preferences and experiences and incorporate these when planning care and rehabilitation.Connected to the overarching theme, three sub-themes were derived; 1) Experiences of empowerment and dis-empowerment, covering that most want to be in control and act themselves, but felt overwhelmed and lost energy and they tended to give up; 2) Experiences of communication and coordination, encompass how people feel forced to take on coordination and communication tasks themselves although they do not always feel qualified for this. Some asked for a coordination person and 3) Facing everyday life after discharge, covering how initiatives taken by professionals were not always experienced as helpful after discharge. Some gave up and some tried to find alternative paths themselves.
Conclusion
Professionals taking a person-centred approach facilitated coherent rehabilitation pathways. This encompassed care with respect for individual needs and professionals who empowered patients to self-management. Furthermore, to be aware that interprofessional communication and coordination need to take place both between professional within the same department, between departments and between professionals in different sectors.
After discharge, some patients were challenged in their everyday life when trying to follow the advice from the professionals. Professionals, who do not use a person-centred approach, hinder coherence. Patients thus feel compelled to take on communication and coordination tasks.
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Alnawafleh AH, Abu-Helalah M, Kayyali G. Experiences of Primary Health Care Clients in Jordan: Qualitative Study. THE OPEN PUBLIC HEALTH JOURNAL 2022; 15. [DOI: 10.2174/18749445-v15-e2208200] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/14/2022] [Accepted: 07/14/2022] [Indexed: 04/16/2024]
Abstract
Objective:
This paper aims to understand the experiences of clients in utilising primary health care services in Jordan.
Design:
A qualitative study.
Methods:
Three focus group interviews with 22 clients who sought medical advice at primary health care clinics. The data were analysed thematically.
Results:
Findings were summarized in three main themes: 1) Clients’ experiences with general practitioners; 2) Causes of not seeking advice at clinics; 3) Clients’ perceptions of the physicians’ capabilities and professionalism. There was comfort and full access to primary health care (PHC) service, although clients were not satisfied sometimes. This is due to the absence, inadequate, and poor quality of the service. This may lead to several visits without getting the service required.
Conclusion:
Listening to the experiences of the clients and users of PHC identifies what works and what does not work in the service and improves the quality. Measuring the experiences of the users and the satisfaction of the clients is an important aspect of quality.
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12
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Looman N, de Graaf J, Thoonen B, van Asselt D, de Groot E, Kramer A, Scherpbier N, Fluit C. Designing the learning of intraprofessional collaboration among medical residents. MEDICAL EDUCATION 2022; 56:1017-1031. [PMID: 35791303 PMCID: PMC9543842 DOI: 10.1111/medu.14868] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/30/2022] [Accepted: 07/04/2022] [Indexed: 05/21/2023]
Abstract
BACKGROUND To preserve quality and continuity of care, collaboration between primary-care and secondary-care physicians is becoming increasingly important. Therefore, learning intraprofessional collaboration (intraPC) requires explicit attention during postgraduate training. Hospital placements provide opportunities for intraPC learning, but these opportunities require interventions to support and enhance such learning. Design-Principles guide the design and development of educational activities when theory-driven Design-Principles are tailored into context-sensitive Design-Principles. The aim of this study was to develop and substantiate a set of theory-driven and context-sensitive Design-Principles for intraPC learning during hospital placements. METHODS Based on our earlier research, we formulated nine theory-driven Design-Principles. To enrich, refine and consolidate these principles, three focus group sessions with stakeholders were conducted using a Modified Nominal Group Technique. Next, two work conferences were conducted to test the feasibility and applicability of the Design-Principles for developing intraPC educational activities and to sharpen the principles into a final set of Design-Principles. RESULTS The theoretical Design-Principles were discussed and modified iteratively. Two new Design-Principles were added during focus group 1, and one more Design-Principle was added during focus group 2. The Design-Principles were categorised into three clusters: (i) Culture: building collaborative relations in a psychologically safe context where patterns or feelings of power dynamics between primary and secondary care physicians can be discussed; (ii) Connecting Contexts: making residents and supervisors mutually understand each other's work contexts and activities; and (iii) Making the Implicit Explicit: having supervising teams act as role models demonstrating intraPC and continuously pursuing improvement in intraPC to make intraPC explicit. Participants were unanimous in their view that the Design-Principles in the Culture cluster were prerequisites to facilitate intraPC learning. CONCLUSION This study led to the development of 12 theory-driven and context-sensitive Design-Principles that may guide the design of educational activities to support intraPC learning during hospital placements.
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Affiliation(s)
- Natasja Looman
- Department of Primary and Community CareRadboudumcNijmegenThe Netherlands
| | | | - Bart Thoonen
- Department of Primary and Community CareRadboudumcNijmegenThe Netherlands
| | | | - Esther de Groot
- Julius Center for Health Sciences and Primary CareUMC UtrechtUtrechtThe Netherlands
| | - Anneke Kramer
- Department of Public health and Primary CareLeiden UMCLeidenThe Netherlands
| | - Nynke Scherpbier
- Department of General Practice and Elderly CareUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Cornelia Fluit
- Department for Research in Learning and EducationRadboudumc Health AcademyNijmegenThe Netherlands
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13
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Iqbal N, Huynh C, Maidment I. Systematic literature review of pharmacists in general practice in supporting the implementation of shared care agreements in primary care. Syst Rev 2022; 11:88. [PMID: 35546411 PMCID: PMC9091138 DOI: 10.1186/s13643-022-01933-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Rising demand for healthcare continues to impact all sectors of the health service. As a result of the growing ageing population and the burden of chronic disease, healthcare has become more complex, and the need for more efficient management of specialist medication across the healthcare interface is of paramount importance. With the rising number of pharmacists working in primary care in clinical roles, is this a role that pharmacists could support to ensure the successful execution of shared care agreement (SCA) in primary care for these patients? AIM OF THE REVIEW Systematic review to identify activities and assess the interventions provided by pharmacists in primary care on SCA provision and how it affects health-related quality of life (HRQoL) for patients. METHOD Primary studies in English which tested the intervention or obtained views of stakeholders related to pharmacist input to shared care agreement within primary care were included. The following electronic databases were systematically searched from the date of inception to November 2021: AMED®, CINAHL®, Cochrane Database of Systematic Reviews (CDSR), EMBASE®, EMCARE®, Google Scholar, HMIC®, MEDLINE®, PsycINFO®, Scopus and Web of Science®. Grey literature sources were also searched. The search was adapted according to the respective database-specific search tools. It was searched using a combination of Medical Subject Heading terms (MeSH), free-text search terms and Boolean operators. RESULTS A total of 5244 titles/abstracts were screened after duplicates were removed, and 64 full articles were assessed for eligibility. On examination of full text, no studies met the inclusion criteria for this review. CONCLUSION This review highlights the need for further research to evaluate how pharmacists in general practice can support the safe and effective integration of specialist medication in primary care with the use of SCA. SYSTEMATIC REVIEW REGISTRATION NIHR PROSPERO No: 2020 CRD42020165363 .
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Affiliation(s)
- Naveed Iqbal
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK.
| | - Chi Huynh
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK
| | - Ian Maidment
- Aston Pharmacy School, College of Health and Life Sciences, Aston University, Aston Triangle, Birmingham, B4 7ET, UK
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14
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Litchfield I, Kingston B, Narga D, Turner A. The move towards integrated care: Lessons learnt from managing patients with multiple morbidities in the UK. Health Policy 2022; 126:777-785. [DOI: 10.1016/j.healthpol.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022]
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15
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Spagnolo J, Breton M, Sasseville M, Sauvé C, Clément JF, Fleet R, Tremblay MC, Rodrigue C, Lebel C, Beauséjour M. Exploring the implementation and underlying mechanisms of centralized referral systems to access specialized health services in Quebec. BMC Health Serv Res 2021; 21:1345. [PMID: 34915871 PMCID: PMC8674406 DOI: 10.1186/s12913-021-07286-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 11/09/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND In 2016, Quebec, a Canadian province, implemented a program to improve access to specialized health services (Accès priorisé aux services spécialisés (APSS)), which includes single regional access points for processing requests to such services via primary care (Centre de répartition des demandes de services (CRDS)). Family physicians fill out and submit requests for initial consultations with specialists using a standardized form with predefined prioritization levels according to listed reasons for consultations, which is then sent to the centralized referral system (the CRDS) where consultations with specialists are assigned. We 1) described the APSS-CRDS program in three Quebec regions using logic models; 2) compared similarities and differences in the components and processes of the APSS-CRDS models; and 3) explored contextual factors influencing the models' similarities and differences. METHODS We relied on a qualitative study to develop logic models of the implemented APSS-CRDS program in three regions. Semi-structured interviews with health administrators (n = 9) were conducted. The interviews were analysed using a framework analysis approach according to the APSS-CRDS's components included in the initially designed program, Mitchell and Lewis (2003)'s logic model framework, and Chaudoir and colleagues (2013)'s framework on contextual factors' influence on an innovation's implementation. RESULTS Findings show the APSS-CRDS program's regional variability in the implementation of its components, including its structure (centralized/decentralized), human resources involved in implementation and operation, processes to obtain specialists' availability and assess/relay requests, as well as monitoring methods. Variability may be explained by contextual factors' influence, like ministerial and medical associations' involvement, collaborations, the context's implementation readiness, physician practice characteristics, and the program's adaptability. INTERPRETATION Findings are useful to inform decision-makers on the design of programs like the APSS-CRDS, which aim to improve access to specialists, the essential components for the design of these types of interventions, and how contextual factors may influence program implementation. Variability in program design is important to consider as it may influence anticipated effects, a next step for the research team. Results may also inform stakeholders should they wish to implement similar programs to increase access to specialized health services via primary care.
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Affiliation(s)
- Jessica Spagnolo
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada.,Centre de recherche Charles-LeMoyne, Université de Sherbrooke - Campus Longueuil, 150, place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada.,Centre de recherche Charles-LeMoyne, Université de Sherbrooke - Campus Longueuil, 150, place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada
| | - Martin Sasseville
- Centre de recherche Charles-LeMoyne, Université de Sherbrooke - Campus Longueuil, 150, place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada
| | - Carine Sauvé
- Centre intégré de santé et de services sociaux (CISSS) de la Montérégie-Centre, 3141 Boulevard Taschereau Bureau 220, Greenfield Park, QC, J4V 2H2, Canada
| | - Jean-François Clément
- Centre de recherche Charles-LeMoyne, Université de Sherbrooke - Campus Longueuil, 150, place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada.,Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC, J1K 2R1, Canada
| | - Richard Fleet
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Québec, QC, G1V 0A6, Canada.,Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Pavillon Landry-Poulin, 2525 chemin de la Canardière, Québec, QC, G1J 0A4, Canada
| | - Marie-Claude Tremblay
- Department of Family and Emergency Medicine, Faculty of Medicine, Université Laval, Pavillon Ferdinand-Vandry, 1050, Avenue de la Médecine, Québec, QC, G1V 0A6, Canada.,Centre de recherche en santé durable, Centre intégré universitaire de santé et services sociaux (CIUSSS) de la Capitale-Nationale, Pavillon Landry-Poulin, 2525 chemin de la Canardière, Québec, QC, G1J 0A4, Canada
| | - Cloé Rodrigue
- Centre de recherche Charles-LeMoyne, Université de Sherbrooke - Campus Longueuil, 150, place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada.,Centre intégré de santé et de services sociaux (CISSS) de la Montérégie-Centre, 3141 Boulevard Taschereau Bureau 220, Greenfield Park, QC, J4V 2H2, Canada
| | - Camille Lebel
- Department of Surgery, Faculty of Medicine, Université de Montréal, C.P, 6128, succursale Centre-ville, Montréal, QC, H3C 3J7, Canada
| | - Marie Beauséjour
- Department of Community Health Sciences, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada. .,Centre de recherche Charles-LeMoyne, Université de Sherbrooke - Campus Longueuil, 150, place Charles-Le Moyne, C. P. 200, Longueuil, QC, J4K 0A8, Canada. .,Department of Surgery, Faculty of Medicine, Université de Montréal, C.P, 6128, succursale Centre-ville, Montréal, QC, H3C 3J7, Canada.
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Coppola N, Baldares S, Blasi A, Bucci R, Spagnuolo G, Mignogna MD, Leuci S. Referral Patterns in Oral Medicine: A Retrospective Analysis of an Oral Medicine University Center in Southern Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212161. [PMID: 34831914 PMCID: PMC8622603 DOI: 10.3390/ijerph182212161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/07/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022]
Abstract
Referral of a patient from one healthcare provider to another is an important part of the medical practice. The aim of this study was to analyze the referral process to the Oral Medicine Unit in a university-based tertiary center in Southern Italy. A chart review of new referrals to the Oral Medicine Unit during a 24-month period was conducted. The following data were recorded: demographic characteristics, medical history, number of physicians seen prior to Oral Medicine assessment, referral source, diagnostic procedures ordered by referrals, reason for referral, site of lesion/condition, final diagnosis. Then, the rates of correct identification for health-care professionals and the appropriateness of the reference diagnosis based on the disease were calculated with descriptive statistic indicators. There were 583 new first consultations. A total of 62.9% of patients were referred by general dental practitioners, 27.4% by physicians, and 9.7% did not have a referral. The most common diseases for referral were immune-mediated diseases (39.6%) and oro-facial pain disorders (25.2%). Only 28.5% of patients had a correct provisional diagnosis. The results of this study show the need to implement curricula in the field of oral medicine among dentistry and medical students, and to support the continuing education among healthcare providers to reduce diagnostic delay for oral diseases.
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Affiliation(s)
- Noemi Coppola
- Oral Medicine Unit, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (N.C.); (S.B.); (G.S.); (M.D.M.); (S.L.)
| | - Stefania Baldares
- Oral Medicine Unit, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (N.C.); (S.B.); (G.S.); (M.D.M.); (S.L.)
| | - Andrea Blasi
- Oral Medicine Unit, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (N.C.); (S.B.); (G.S.); (M.D.M.); (S.L.)
- Correspondence: ; Tel.: +39-389-342-9887
| | - Rosaria Bucci
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Section of Orthodontics and Temporomandibular Disorders, University of Naples Federico II, 80131 Naples, Italy;
| | - Gianrico Spagnuolo
- Oral Medicine Unit, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (N.C.); (S.B.); (G.S.); (M.D.M.); (S.L.)
- Institute of Dentistry, I. M. Sechenov First Moscow State Medical University, 119435 Moscow, Russia
| | - Michele Davide Mignogna
- Oral Medicine Unit, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (N.C.); (S.B.); (G.S.); (M.D.M.); (S.L.)
| | - Stefania Leuci
- Oral Medicine Unit, Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy; (N.C.); (S.B.); (G.S.); (M.D.M.); (S.L.)
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17
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Rossouw L, Lalkhen H, Adamson K, Von Pressentin KB. The contribution of family physicians in coordinating care and improving access at district hospitals: The False Bay experience, South Africa. Afr J Prim Health Care Fam Med 2021; 13:e1-e4. [PMID: 34797119 PMCID: PMC8661290 DOI: 10.4102/phcfm.v13i1.3226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/23/2021] [Accepted: 09/30/2021] [Indexed: 11/08/2022] Open
Abstract
This short report describes three family physicians (FP)-led clinical governance interventions to strengthen the care access and coordination in an urban district hospital in Cape Town, South Africa. The actual experiences and their effects on health services are captured here. The report also describes a range of interventions from enhanced access to timely computer tomographic scans to determine definitive care, to creating a local referral forum between levels of care, which resulted in a renewed appreciation for the scope of services and illness burden managed by the district health system and to the establishment of an onsite echocardiology service at the local district hospital to enhance the identified burden of disease of the local community. Each of these interventions were planned and implemented based on local data in partnership with the team members at the different levels of care. By applying an inclusive and distributed leadership style as informed by care access to scarce resources was better coordinated for the local communities served. The importance of the building trusting relationships between FPs and referral hospital colleagues cannot be overemphasised. Family physicians should be integrated and collaborated in the clinical governance platforms across levels of care. The FP’s roles as primary care consultant and clinical governance leader are pivotal in enhancing service delivery efficiency and in providing quality healthcare.
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Affiliation(s)
- Liezel Rossouw
- Division of Family Medicine, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; and, False Bay District Hospital, Metro District Health Services, Western Cape Department of Health, Cape Town, South Africa; and, Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town.
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18
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Karačić J, Viđak M, Marušić A. Reporting violations of European Charter of Patients' Rights: analysis of patient complaints in Croatia. BMC Med Ethics 2021; 22:148. [PMID: 34749721 PMCID: PMC8573760 DOI: 10.1186/s12910-021-00714-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
Background The European Charter of Patients' Rights (ECPR) presents basic patients' rights in health care. We analysed the characteristics of patients' complaints about their rights submitted through the official complaints system and to a non-governmental organization in Croatia. Methods The official system for patients’complaints in Croatia does not have a common pathway but offers different modes for addressing patient complaints. In this cross-sectional study, we analysed the reports about patients’ complaints from the official regional committees sent to the Ministry of Health. We also analysed the complaints received by the Croatian Association for the Protection of Patient’s Rights (CAPR) and mapped them to the ECPR. Results The aggregated official data from the Ministry of Health in 2017 and 2018 covered only 289 individual complaints from 10 out of 21 counties. Complaints were most frequently related to secondary and tertiary healthcare institutions and details were not provided. CAPR received a total of 440 letters, out of which 207 contained 301 complaints about violations of patients’ rights in 2017–2018. The most common complaint was the Right of Access to health care (35.3%) from the ECPR, followed by the Right to Information (29.9%) and the Right to Safety (21.7%). The fewest complaints were about the Right to Complain (1.9%), Right to Innovation (1.4%), Right to Compensation (1.4%), and Right to Preventive Measures (1.0%). Conclusions Reporting and dealing with patients’ complaints about violations of their patients’ rights does not appear to be effective in a system with parallel but uncoordinated complaints pathways. Mapping patient's complaints to the ECPR is a useful tool to assess the perception of patients’ rights and to plan actions to improve the complaints system for effective health care.
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Affiliation(s)
- Jasna Karačić
- Cochrane Croatia, University of Split School of Medicine, Split, Croatia.
| | - Marin Viđak
- Cochrane Croatia, University of Split School of Medicine, Split, Croatia.,Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
| | - Ana Marušić
- Cochrane Croatia, University of Split School of Medicine, Split, Croatia.,Department of Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
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19
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Maguire S, Maloney D. The implementation of large-scale health system reform in identification, access and treatment of eating disorders in Australia. J Eat Disord 2021; 9:121. [PMID: 34583782 PMCID: PMC8480076 DOI: 10.1186/s40337-021-00476-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 09/14/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND It seems to be a truth universally acknowledged that pathways to care for people with eating disorders are inconsistent and difficult to navigate. This may, in part, be a result of the complex nature of the illness comprising both mental and medical ill-health across a broad range of severity. Care therefore is distributed across all parts of the health system resulting in many doors into the system, distributed care responsibility, without well developed or integrated pathways from one part of the system to another. Efforts in many parts of the world to redesign health service delivery for this illness group are underway, each dependent upon the local system structures, geographies served, funding sources and workforce availability. METHODS In NSW-the largest populational jurisdiction in Australia, and over three times the size of the UK-the government embarked six years ago on a program of whole-of-health system reform to embed identification and treatment of people with eating disorders across the lifespan and across the health system, which is largely publicly funded. Prior to this, eating disorders had not been considered a 'core' part of service delivery within the health system, meaning many patients received no treatment or bounced in and out of 'doorways'. The program received initial funding of $17.6 million ($12.5 million USD) increasing to $29.5 million in phase 2 and the large-scale service and workforce development program has been implemented across 15 geographical districts spanning almost one million square kilometres servicing 7.75 million people. CONCLUSIONS In the first five years of implementation there has been positive effects of the policy change and reform on all three service targets-emergency departments presentations, hospital admissions and community occasions of service as well as client hours. This paper describes the strategic process of policy and practice change, utilising well documented service design and change strategies and principles with relevance for strategic change within health systems in general.
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Affiliation(s)
- Sarah Maguire
- InsideOut Institute for Eating Disorders, The University of Sydney, Sydney, Australia.
- Sydney Local Health District, NSW Health, Sydney, Australia.
| | - Danielle Maloney
- InsideOut Institute for Eating Disorders, The University of Sydney, Sydney, Australia
- Sydney Local Health District, NSW Health, Sydney, Australia
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20
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Pendharkar SR, Blades K, Kelly JE, Tsai WH, Lien DC, Clement F, Woiceshyn J, McBrien KA. Perspectives on primary care management of obstructive sleep apnea: a qualitative study of patients and health care providers. J Clin Sleep Med 2021; 17:89-98. [PMID: 32975193 DOI: 10.5664/jcsm.8814] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Difficulties in providing timely access to care have prompted interest in primary care delivery models for obstructive sleep apnea (OSA). Sustainable implementation of such models requires codesign with input from key stakeholders. The purpose of this study was to identify patient and provider perspectives on barriers and facilitators to optimal, patient-centered management of OSA in a primary care setting. METHODS This study was conducted in Alberta, Canada. Data from key stakeholders were collected through an online survey of primary care providers (n = 119), focus groups and interviews with patients living with OSA (n = 28), and workshops with primary care and sleep providers (n = 36). Quantitative survey data were reported using descriptive statistics, and qualitative data were analyzed using an inductive thematic approach. RESULTS Several barriers were identified, including poor specialist access, variable primary care providers knowledge of OSA, and lack of clarity about provider roles for OSA management. Barriers contributed to patients being poorly informed about OSA, leading them to separate OSA from their overall health and eroding trust in the system. Suggestions for improvement included integration of care providers in a comprehensive model of care, facilitated by improved system navigation and more effective use of technology. Themes were consistent across data collection methods and between stakeholder groups. CONCLUSIONS Although primary care delivery models may improve access to OSA management, stakeholders identified important challenges in the current system. Innovative models of care, developed with input from patients and providers, may mitigate barriers and support optimal primary care management of OSA.
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Affiliation(s)
- Sachin R Pendharkar
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kenneth Blades
- Ward of the 21st Century, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jenny E Kelly
- Ward of the 21st Century, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Willis H Tsai
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Dale C Lien
- Respiratory Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Fiona Clement
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jaana Woiceshyn
- Haskayne School of Business, University of Calgary, Calgary, Alberta, Canada
| | - Kerry A McBrien
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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21
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Billings ME, Pendharkar SR. Alternative Care Pathways for Obstructive Sleep Apnea and the Impact on Positive Airway Pressure Adherence: Unraveling the Puzzle of Adherence. Sleep Med Clin 2020; 16:61-74. [PMID: 33485532 DOI: 10.1016/j.jsmc.2020.10.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The high burden of obstructive sleep apnea (OSA), combined with inadequate supply of sleep specialists and constraints on polysomnography resources, has prompted interest in alternative models of care to improve access and treatment effectiveness. In appropriately selected patients, ambulatory clinical pathways and use of nonphysicians or primary care providers to manage OSA can improve timely access and costs without compromising adherence or other clinical outcomes. Although initial studies show promising results, there are several potential barriers that must be considered before broad implementation, and further implementation research and economic evaluation studies are required.
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Affiliation(s)
- Martha E Billings
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington School of Medicine, UW Medicine Sleep Center at Harborview Medical Center, Box 359803, 325 Ninth Avenue, Seattle, WA 98104, USA.
| | - Sachin R Pendharkar
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, TRW Building, Room 3E23, 3280 Hospital Drive Northwest, Calgary, Alberta T2N 4Z6, Canada
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22
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Janssen M, Fluit CRMG, Sagasser MH, Kusters LHJ, Scherpbier-de Haan ND, de Graaf J. Competencies for collaboration between general practitioners and medical specialists: a qualitative study of the patient perspective. BMJ Open 2020; 10:e037043. [PMID: 32611744 PMCID: PMC7332184 DOI: 10.1136/bmjopen-2020-037043] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/16/2020] [Accepted: 05/18/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To explore the patient view of competencies essential for doctors to provide good collaboration at the primary-secondary care interface. DESIGN We used a qualitative research approach. Focus groups with patients were conducted to explore their opinions of doctors' competencies to provide good collaboration between primary and secondary care doctors. Transcripts were analysed using thematic analysis. SETTING Dutch primary-secondary care interface. PARTICIPANTS Sixteen participants took part in five focus groups. Patients treated in both primary and secondary care, defined as having a minimum of two contacts with their general practitioner and two contacts with a medical specialty in the last 6 months, were included. Psychiatric patients and children were excluded from this study. RESULTS Three groups of competencies were identified: (1) relationship building, both with patients and with other doctors; (2) transparent collaborating: be able to provide clarity on the process of collaboration and on roles and responsibilities of those involved and (3) reflective practising: to be willing to acknowledge mistakes, give and receive feedback and act as a lifelong learner. CONCLUSIONS This focus group study enhances our understanding of the patient perspective on doctors' collaborative competencies at the primary-secondary care interface. With this information, doctors can improve their collaborative skills to a level that would meet their patients' needs. Patients expect doctors to be able to build relationships and act as reflective practitioners. Including patients in the collaborative process by giving them a role that is appropriate to their abilities and by making collaboration more explicit could help to improve collaboration between general practitioners and medical specialists.
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Affiliation(s)
- Marijn Janssen
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
| | | | - Margaretha H Sagasser
- Network of GP Specialty Training Institute in The Netherlands, Utrecht, The Netherlands
| | - Loes H J Kusters
- Dutch Training Programme for Specialists in Elderly Care, Utrecht, The Netherlands
| | | | - Jacqueline de Graaf
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
- Radboudumc Health Academy, Radboudumc, Nijmegen, The Netherlands
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Dinsdale E, Hannigan A, O'Connor R, O'Doherty J, Glynn L, Casey M, Hayes P, Kelly D, Cullen W, O'Regan A. Communication between primary and secondary care: deficits and danger. Fam Pract 2020; 37:63-68. [PMID: 31372649 DOI: 10.1093/fampra/cmz037] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Timely and accurate communication between primary and secondary care is essential for delivering high-quality patient care. OBJECTIVE The aim of this study is to evaluate the content contained in both referral and response letters between primary and secondary care and measure this against the recommended national guidelines. METHODS Using an observational design, senior medical students and their general practice supervisors applied practice management software to identify 100 randomly selected adults, aged greater than 50 years, from a generated list of consults over a 2-year period (2013-2015). All data included in referral and response letters for these adults were examined and compared with the gold standard templates that were informed by international guidelines. RESULTS Data from 3293 referral letters and 2468 response letters from 68 general practices and 17 hospitals were analysed. The median time that had elapsed between a patient being referred and receiving a response letter was 4 weeks, ranging from 1 week for Emergency Department referral letters to 7 weeks for orthopaedic surgery referral letters. Referral letters included the reason for referral (98%), history of complaint (90%) and current medications (82%). Less commonly included were management prior to referral (65%) and medication allergies (57%). The majority of response letters included information on investigations (73%), results (70%) and follow-up plan (85%). Less commonly, response letters included medication changes (30%), medication lists (33%) and secondary diagnoses (13%). CONCLUSIONS Future research should be aimed at developing robust strategies to addressing communication gaps reported in this study.
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Affiliation(s)
- Elsa Dinsdale
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Ailish Hannigan
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Ray O'Connor
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Jane O'Doherty
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Liam Glynn
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Monica Casey
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Peter Hayes
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Dervla Kelly
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
| | - Walter Cullen
- School of Medicine, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - Andrew O'Regan
- Graduate Entry Medical School, Department of Education and Health Sciences, University of Limerick, Limerick, Ireland
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24
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The Patient-Held Active Record of Medication Status (PHARMS) study: a mixed-methods feasibility analysis. Br J Gen Pract 2020; 69:e345-e355. [PMID: 31015221 DOI: 10.3399/bjgp19x702413] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 11/21/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Medication errors frequently occur as patients transition between hospital and the community, and may result in patient harm. Novel methods are required to address this issue. AIM To assess the feasibility of introducing an electronic patient-held active record of medication status device (PHARMS) at the primary-secondary care interface at the time of hospital discharge. DESIGN AND SETTING A mixed-methods study (non-randomised controlled intervention, and a process evaluation of qualitative interviews and non-participant observation) among patients >60 years in an urban hospital and general practices in Cork, Ireland. METHOD The number and clinical significance of errors were compared between discharge prescriptions of the intervention (issued with a PHARMS device) and control (usual care, handwritten discharge prescription) groups. Semi-structured interviews were conducted with patients, junior doctors, GPs, and IT professionals, in addition to direct observation of the implementation process. RESULTS In all, 102 patients were included in the final analysis (intervention n = 41, control n = 61). Total error number was lower in the intervention group (median 1, interquartile range [IQR] 0-3) than in the control group (median 8, IQR (4-13.5, P<0.001), with the clinical significance score in the intervention group also being lower than the control group (median 2, IQR 0-4 versus median 11, IQR 5-20, P<0.001). The PHARMS device was found to be technically implementable using existing information technology infrastructure, and acceptable to all key stakeholders. CONCLUSION The results suggest that using PHARMS devices within existing systems in general practice and hospitals is feasible and acceptable to both patients and doctors, and may reduce medication error.
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25
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Scaioli G, Schäfer WLA, Boerma WGW, Spreeuwenberg P, van den Berg M, Schellevis FG, Groenewegen PP. Patients' perception of communication at the interface between primary and secondary care: a cross-sectional survey in 34 countries. BMC Health Serv Res 2019; 19:1018. [PMID: 31888614 PMCID: PMC6937702 DOI: 10.1186/s12913-019-4848-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/17/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor communication between general practitioners (GPs) and medical specialists can lead to poorer quality, and continuity, of care. Our study aims to assess patients' perceptions of communication at the interface between primary and secondary care in 34 countries. It will analyse, too, whether this communication is associated with the organisation of primary care within a country, and with the characteristics of GPs and their patients. METHODS We conducted a cross-sectional survey among patients in 34 countries. Following a GP consultation, patients were asked two questions. Did they take to understand that their GP had informed medical specialists about their illness upon referral? And, secondly, did their GP know the results of the treatment by a medical specialist? We used multi-response logistic multilevel models to investigate the association of factors related to primary care, the GP, and the patient, with the patients' perceptions of communication at the interface between primary and secondary care. RESULTS In total, 61,931 patients completed the questionnaire. We found large differences between countries, in both the patients' perceptions of information shared by GPs with medical specialists, and the patients' perceptions of the GPs' awareness of the results of treatment by medical specialists. Patients whose GPs stated that they 'seldom or never' send referral letters, also less frequently perceived that their GP communicated with their medical specialists about their illness. Patients with GPs indicating they 'seldom or never' receive feedback from medical specialists, indicated less frequently that their GP would know the results of treatment by a medical specialist. Moreover, patients with a personal doctor perceived higher rates of communication in both directions at the interface between primary and secondary care. CONCLUSION Generally, patients perceive there to be high rates of communication at the interface between primary and secondary care, but there are large differences between countries. Policies aimed at stimulating personal doctor arrangements could, potentially, enhance the continuity of care between primary and secondary care.
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Affiliation(s)
- Giacomo Scaioli
- Department of Public Health Sciences, University of Turin, Piazza Polonia, 94, 10126, Torino, Italy
| | - Willemijn L A Schäfer
- Department of Surgery, Northwestern University, Feinberg School of Medicine, 633 N. St Clair Street, Chicago, IL, 60611, USA
| | - Wienke G W Boerma
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands
| | - Peter Spreeuwenberg
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands
| | - Michael van den Berg
- Department of Public Health, Amsterdam Public Health Research Institute, PO Box 22660, 1100 DD, Amsterdam, The Netherlands
| | - François G Schellevis
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| | - Peter P Groenewegen
- NIVEL (Netherlands Institute for Health Services Research), PO box 1568, 3500 BN, Utrecht, The Netherlands. .,Department of Sociology, P.O. Box 80.115, 3508 TC, Utrecht, The Netherlands. .,Department of Human Geography, Utrecht University, P.O. Box 80.115, 3508 TC, Utrecht, The Netherlands.
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Mash R, Steyn H, Bello M, von Pressentin K, Rossouw L, Hendricks G, Fouche G, Stapar D. The quality of feedback from outpatient departments at referral hospitals to the primary care providers in the Western Cape: a descriptive survey. S Afr Fam Pract (2004) 2019. [DOI: 10.1080/20786190.2019.1676021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Robert Mash
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
| | - Herma Steyn
- Department of Health, Western Cape, South Africa
| | - Muideen Bello
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
- Department of Health, Western Cape, South Africa
| | - Klaus von Pressentin
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
- Department of Health, Western Cape, South Africa
| | | | - Gavin Hendricks
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
- Department of Health, Western Cape, South Africa
| | | | - Dusica Stapar
- Division of Family Medicine and Primary Care, Stellenbosch University, Cape Town, South Africa
- Department of Health, Western Cape, South Africa
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27
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Fletcher J, Mumtaz S, Dera M, Cooper SC. Patient Experience in the Transition of Home Parenteral Nutrition Services Between Centers: Evaluation of a Transition Model. J Patient Exp 2019; 6:224-230. [PMID: 31535011 PMCID: PMC6739677 DOI: 10.1177/2374373518795423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In 2014, Dudley Group of Hospitals (DGH) underwent an organizational change that necessitated closure of their Home Parenteral Nutrition (HPN) service. University Hospitals Birmingham NHS Foundation Trust (UHBFT) transitioned 50 patients from DGH into their HPN service. The transition model included communication with patients, communication between centers (development of an HPN Patient Passport), and rapid follow-up on transition ensuring clinical care continued uninterrupted. AIM Evaluate patient experience and their level of satisfaction with our HPN transition model. METHOD A 19-point, mixed mode paper-based questionnaire was developed. Questionnaires were posted to 42 surviving patients still receiving HPN. RESULTS Response rate: 67%. Communication with patients: The transition was discussed with them, and they had appropriate contact details during the process-94%. Patients informed of patient transition meetings-97%. Attendance at meetings: DGH 89%, UHBFT 55%. Ongoing care at UHBFT: 86% very satisfied and 11% satisfied. Overall rating of the transition process: 79% very satisfied and 14% satisfied. Friends and Family Test: 82% "extremely likely" and 18% "likely" to recommend our services. CONCLUSION The transition model used was successful, with the majority of patients "very satisfied" with how the transition was managed and their ongoing care. Effective communication with patients and between the 2 centers was the key to success. To our knowledge, this is the first report of transition of care for HPN patients. It is proposed that this model may be used by other centers to plan for future HPN service transitions where necessary.
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Affiliation(s)
- Jane Fletcher
- University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Saqib Mumtaz
- University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
- Oxford University Hospitals, John Radcliffe Hospital, Headley Way, Oxford, UK
| | - Merceline Dera
- University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | - Sheldon C Cooper
- University Hospital Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
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28
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Walsh EK, Kirby A, Kearney PM, Bradley CP, Fleming A, O'Connor KA, Halleran C, Cronin T, Calnan E, Sheehan P, Galvin L, Byrne D, Sahm LJ. Medication reconciliation: time to save? A cross-sectional study from one acute hospital. Eur J Clin Pharmacol 2019; 75:1713-1722. [PMID: 31463579 DOI: 10.1007/s00228-019-02750-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/17/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Medication errors during transitional care are an important patient safety issue. Medication reconciliation is an established intervention to reduce such errors. Current evidence has not demonstrated an associated reduction in healthcare costs, however, with complexity and resource intensity being identified as issues. The aims of this study were to examine an existing process of medication reconciliation in terms of time taken, to identify factors associated with additional time, and to determine if additional time is associated with detecting errors of clinical significance. METHODS A cross-sectional study was conducted. Issues arising during medication reconciliation incurring a time burden additional to the usual process were logged and quantified by pharmacists. Regression analyses investigated associations between patient characteristics and clinically significant errors and additional time. Cost for additional time in terms of hospital pharmacist salary was calculated. RESULTS Eighty-nine patients were included. Having a personal record of medication at admission (OR 3.30, 95% CI: (1.05 to 10.42), p = 0.004) was a significant predictor of additional time. No significant associations were found between the occurrence of clinically significant error and additional time (p > 0.05). The most common reason for additional time was clarifying issues pertaining to primary care medication information. Projected annual 5-year costs for the mean additional time of 3.75 min were €1.8-1.9 million. CONCLUSIONS Spending additional time on medication reconciliation is associated with economic burden and may not yield benefit in terms of capturing clinically significant errors. There is a need to improve communication of medication information between primary and secondary care.
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Affiliation(s)
- Elaine K Walsh
- Department of General Practice, University College Cork, Cork, Ireland.
| | - Ann Kirby
- School of Economics, University College Cork, Cork, Ireland
| | | | - Colin P Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Aoife Fleming
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Kieran A O'Connor
- Department of Geriatric Medicine, Mercy University Hospital, Cork, Ireland
| | - Ciaran Halleran
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Timothy Cronin
- School of Pharmacy, University College Cork, Cork, Ireland
| | - Elaine Calnan
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Patricia Sheehan
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Laura Galvin
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Derina Byrne
- Department of Pharmacy, Mercy University Hospital, Cork, Ireland
| | - Laura J Sahm
- School of Pharmacy, University College Cork, Cork, Ireland
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29
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Johns G, Taylor B, John A, Tan J. Current eating disorder healthcare services - the perspectives and experiences of individuals with eating disorders, their families and health professionals: systematic review and thematic synthesis. BJPsych Open 2019; 5:e59. [PMID: 31530301 PMCID: PMC6646967 DOI: 10.1192/bjo.2019.48] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Eating disorders have the highest mortality rate of mental disorders and a high incidence of morbidity, but if diagnosed and treated promptly individuals can benefit from full recovery. However, there are numerous problems at the healthcare interface (i.e. primary and secondary care) for eating disorders. It is important to examine these to facilitate appropriate, seamless treatment and improve access to specialist care. AIMS To examine the current literature on the experiences and perspectives of those across healthcare interfaces for eating disorders, to include individuals with eating disorders, people close to or caring for those with eating disorders such as family and friends, and health professionals. METHOD To identify relevant papers, a systematic search of electronic databases was conducted. Other methods, including hand-searching, scanning reference lists and internet resources were also used. Papers that met inclusion criteria were analysed using a systematic methodology and synthesised using an interpretative thematic approach. RESULTS Sixty-three papers met the inclusion criteria. The methodological quality was relatively good. The included papers were of both qualitative (n = 44) and quantitative studies (n = 24) and were from ten different countries. By synthesising the literature of these papers, three dominant themes were identified, with additional subthemes. These included: 'the help-seeking process at primary care'; 'expectations of care and appropriate referrals' and 'opposition and collaboration in the treatment of and recovery from eating disorders'. CONCLUSIONS This review identifies both facilitators and barriers in eating disorder healthcare, from the perspectives of those experiencing the interface first hand. The review provides recommendations for future research and practice. DECLARATION OF INTEREST None.
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Affiliation(s)
- Gemma Johns
- Research Assistant, School of Medicine, Swansea University, UK
| | - Bridget Taylor
- Retired Psychiatric Nurse and currently a Lay Representative, Department of Medicine, Swansea University, UK
| | - Ann John
- Professor in Public Health and Psychiatry, Population Psychiatry, Suicide and Informatics, Swansea University Medical School, UK
| | - Jacinta Tan
- Clinical Associate Professor of Psychiatry, School of Medicine, Swansea University, UK
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30
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Why patients decline participation in an intervention to reduce re-hospitalization through patient activation: whom are we missing? Trials 2019; 20:82. [PMID: 30683140 PMCID: PMC6347805 DOI: 10.1186/s13063-019-3187-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 01/09/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite worldwide interest in reducing re-hospitalization, there is limited knowledge regarding characteristics of patients who chose to decline participation in such efforts and why. The aim is to explore reasons to decline participation in an intervention using motivational interviewing to reduce re-hospitalization through patient activation for persons with chronic obstructive pulmonary disease or heart failure. METHODS This study uses data from 385 patients who were asked about participating in a randomized controlled trial; of these, 232 declined participation. Data on age, gender, and diagnosis were collected for those who agreed to participate and those who declined. Reasons to decline participation were collected for those who were asked to participate but refused. The stated reasons to decline were analyzed using content analysis, and the categories identified were used for the statistical analysis. RESULTS The main reasons for declining participation were having sufficient support (17.5%), no need for support (16%), being too ill (14.6%), and lack of time for illness-related activities (14.2%). A statistically significant negative association between age and willingness to participate was found (odds ratio = - 0.03, 95% confidence interval 0.95-0.99). CONCLUSIONS Those who agreed to participate were younger than non-participants, and non-participants either lacked time for illness-related activities or did not have the energy needed to become involved in the intervention. TRIAL REGISTRATION ClinicalTrials.gov, NCT02823795 . Registered on 1 July 2016.
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31
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Johnston JL, Bennett D. Lost in translation? Paradigm conflict at the primary-secondary care interface. MEDICAL EDUCATION 2019; 53:56-63. [PMID: 30443926 DOI: 10.1111/medu.13758] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/01/2018] [Accepted: 09/10/2018] [Indexed: 06/09/2023]
Abstract
CONTEXT Historically, primary care (community and family) medicine has often been viewed as lower status than secondary care (hospital) practice. Current evidence suggests this pattern continues to impact medical practice and education. Medical education has however, yet to fully reflect this power dynamic, with undergraduate training in many institutions maintaining the hegemonic position of secondary care as the prime context for learning. METHODS In this paper, we present primary and secondary care as conflicting paradigms of medical practice. Using a sociocultural lens drawing on Figured Worlds theory, implications for medical education are explored. CONCLUSIONS We outline the two paradigms as having distinct epistemologies, identities and practices. Tensions at the primary-secondary care interface can, from a sociocultural perspective, be seen to impact developing identity and day-to-day clinical practice issues such as patient safety. We offer possibilities for engaging with paradigm conflict in meaningful ways and suggest potential changes for future educational policy and practice.
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Affiliation(s)
- Jennifer L Johnston
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland
| | - Deirdre Bennett
- Medical Education Unit, University College Cork, Cork, Ireland
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32
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Flink M, Tessma M, Cvancarova Småstuen M, Lindblad M, Coleman EA, Ekstedt M. Measuring care transitions in Sweden: validation of the care transitions measure. Int J Qual Health Care 2018; 30:291-297. [PMID: 29432554 PMCID: PMC5928451 DOI: 10.1093/intqhc/mzy001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/17/2018] [Indexed: 01/17/2023] Open
Abstract
Objective To translate and assess the validity and reliability of the original American Care Transitions Measure, both the 15-item and the shortened 3-item versions, in a sample of people in transition from hospital to home within Sweden. Design Translation of survey items, evaluation of psychometric properties. Setting Ten surgical and medical wards at five hospitals in Sweden. Participants Patients discharged from surgical and medical wards. Main outcome measure Psychometric properties of the Swedish versions of the 15-item (CTM-15) and the 3-item (CTM-3) Care Transition Measure. Results We compared the fit of nine models among a sample of 194 Swedish patients. Cronbach’s alpha was 0.946 for CTM-15 and 0.74 for CTM-3. The model indices for CTM-15 and CTM-3 were strongly indicative of inferior goodness-of-fit between the hypothesized one-factor model and the sample data. A multidimensional three-factor model revealed a better fit compared with CTM-15 and CTM-3 one factor models. The one-factor solution, representing 4 items (CTM-4), showed an acceptable fit of the data, and was far superior to the one-factor CTM-15 and CTM-3 and the three-factor multidimensional models. The Cronbach’s alpha for CTM-4 was 0.85. Conclusions CTM-15 with multidimensional three-factor model was a better model than both CTM-15 and CTM-3 one-factor models. CTM-4 is a valid and reliable measure of care transfer among patients in medical and surgical wards in Sweden. It seems the Swedish CTM is best represented by the short Swedish version (CTM-4) unidimensional construct.
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Affiliation(s)
- Maria Flink
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Tomtebodavägaen 18A, 17177 Stockholm, Sweden.,Department of Social Work, Karolinska University Hospital, C2:64, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Mesfin Tessma
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Tomtebodavägaen 18A, 17177 Stockholm, Sweden
| | - Milada Cvancarova Småstuen
- HiOA, Oslo and Akershus University College of Applied Sciences, Faculty of Health Sciences Department of Nursing and Health Promotion, Pilestredet 32, Oslo, Norway
| | - Marléne Lindblad
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Tomtebodavägaen 18A, 17177 Stockholm, Sweden.,Department of Health Care Sciences, Ersta Sköndal University College, Stigbergsgatan 30, Box 11189, 100 61 Stockholm, Sweden
| | - Eric A Coleman
- Division of Health Care Policy and Research, University of Colorado Denver Anschutz Medical Campus, 13199 East Montview Blvd., Suite 400 Campus, Box: F480 Aurora, CO 80045-7201, USA
| | - Mirjam Ekstedt
- Department of Learning, Informatics, Management, and Ethics, Karolinska Institutet, Tomtebodavägaen 18A, 17177 Stockholm, Sweden.,School of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Stagneliusgatan 14, 391 82 Kalmar, Sweden
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The interplay of context factors in hypnotic and sedative prescription in primary and secondary care-a qualitative study. Eur J Clin Pharmacol 2018; 75:87-97. [PMID: 30215101 PMCID: PMC6326988 DOI: 10.1007/s00228-018-2555-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 09/03/2018] [Indexed: 11/18/2022]
Abstract
Purpose Non-medical or contextual factors strongly influence physicians’ prescribing behavior and may explain why drugs, such as benzodiazepines and Z-drugs, are still frequently prescribed in spite of well-known adverse effects. This study aimed to explore which contextual factors influence the prescription of hypnotics and sedatives and to compare their role in primary and secondary care. Methods Understanding medical practices as games with specific rules and strategies and performed in a largely habitual, not fully conscious manner, we asked a maximum variation sample of 12 hospital doctors and 12 general practitioners (GPs) about their use of hypnotics and sedatives. The interviews were analyzed by qualitative content analysis. Results Hospital doctors’ and GPs’ use of hypnotics and sedatives was influenced by a variety of contextual factors, such as the demand of different patient groups, aims of management, time resources, or the role of nurses and peers. Negotiating patient demands, complying with administrative regulations, and finding acceptable solutions for patients were the main challenges, which characterized the game of drug use in primary care. Maintaining the workflow in the hospital and finding a way to satisfy both nurses and patients were the main challenges in secondary care. Conclusions Even if doctors try to act rationally, they cannot escape the interplay of contextual factors such as handling patient needs, complying with administrative regulations, and managing time resources. Doctors should balance these factors as if they were challenges in a complex game and reflect upon their own practices. Electronic supplementary material The online version of this article (10.1007/s00228-018-2555-9) contains supplementary material, which is available to authorized users.
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Green E, Knight S, Gott M, Barclay S, White P. Patients' and carers' perspectives of palliative care in general practice: A systematic review with narrative synthesis. Palliat Med 2018; 32:838-850. [PMID: 29343169 DOI: 10.1177/0269216317748862] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND General practitioners have overall responsibility for community care, including towards end of life. Current policy places generalists at the centre of palliative care provision. However, little is known about how patients and carers understand the general practitioner's role. AIMS To explore patient and carer perspectives of (1) the role of the general practitioner in providing palliative care to adult patients and (2) the facilitators and barriers to the general practitioner's capacity to fulfil this perceived role. DESIGN Systematic literature review and narrative synthesis. DATA SOURCES Seven electronic databases (MEDLINE, Embase, PsycINFO, BNI, CINAHL, Cochrane and HMIC) were searched from inception to May 2017. Two reviewers independently screened papers at title, abstract and full-text stages. Grey literature, guideline, hand searches of five journals and reference list/citation searches of included papers were undertaken. Data were extracted, tabulated and synthesised using narrative, thematic analysis. RESULTS A total of 25 studies were included: 14 employed qualitative methods, 8 quantitative survey methods and 3 mixed-methods. Five key themes were identified: continuity of care, communication between primary and secondary care, contact and accessibility, communication between general practitioner and patient, and knowledge and competence. CONCLUSION Although the terminology and context of general practice vary internationally, themes relating to the perceived role of general practitioners were consistent. General practitioners are considered well placed to provide palliative care due to their breadth of clinical responsibility, ongoing relationships with patients and families, and duty to visit patients at home and coordinate healthcare resources. These factors, valued by service users, should influence future practice and policy development.
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Affiliation(s)
- Emilie Green
- 1 Department of Primary Care & Public Health Sciences, Division of Health & Social Care Research, King's College London, London, UK
| | - Selena Knight
- 1 Department of Primary Care & Public Health Sciences, Division of Health & Social Care Research, King's College London, London, UK
| | - Merryn Gott
- 2 Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Stephen Barclay
- 3 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Patrick White
- 1 Department of Primary Care & Public Health Sciences, Division of Health & Social Care Research, King's College London, London, UK
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Improving quality of referral letters from primary to secondary care: a literature review and discussion paper. Prim Health Care Res Dev 2017; 19:211-222. [PMID: 29212565 DOI: 10.1017/s1463423617000755] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Referral letters sent from primary to secondary or tertiary care are a crucial element in the continuity of patient information transfer. Internationally, the need for improvement in this area has been recognised. This aim of this study is to review the current literature pertaining to interventions that are designed to improve referral letter quality. METHODS A search strategy designed following a Problem, Intervention, Comparator, Outcome model was used to explore the PubMed and EMBASE databases for relevant literature. Inclusion and exclusion criteria were established and bibliographies were screened for relevant resources. RESULTS A total of 18 publications were included in this study. Four types of interventions were described: electronic referrals were shown to have several advantages over paper referrals but were also found to impose new barriers; peer feedback increases letter quality and can decrease 'inappropriate referrals' by up to 50%; templates increase documentation and awareness of risk factors; mixed interventions combining different intervention types provide tangible improvements in content and appropriateness. CONCLUSION Several methodological considerations were identified in the studies reviewed but our analysis demonstrates that a combination of interventions, introduced as part of a joint package and involving peer feedback can improve.
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Leach MJ, Lauche R, Zhang AL, Cramer H, Adams J, Langhorst J, Dobos G. Characteristics of herbal medicine users among internal medicine patients: A cross-sectional analysis. J Herb Med 2017. [DOI: 10.1016/j.hermed.2017.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Sampson R, MacVicar R, Wilson P. Improving the primary-secondary care interface in Scotland: a qualitative exploration of impact on clinicians of an educational complex intervention. BMJ Open 2017; 7:e016593. [PMID: 28652293 PMCID: PMC5541474 DOI: 10.1136/bmjopen-2017-016593] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To determine the impact on clinicians and any consequent influence on patient care of taking part in the bespoke interface-focused educational intervention. DESIGN Qualitative design. SETTING Primary and secondary care centres in NHS Highland health board area, Scotland. PARTICIPANTS 33 urban-based clinicians (18 general practitioners and 15 hospital specialists) in NHS Highland, Scotland. INTERVENTION An interface-focused educational intervention was carried out in primary and secondary care centres in NHS Highland health board area, Scotland. Eligible clinicians were invited to take part in the intervention which involved facilitated small group work, and use of a bespoke educational module. Subsequent one-to-one interviews explored the impact of the intervention. A standard thematic analysis was used, comprising an iterative process based on grounded theory. RESULTS Key themes that emerged included fresh insights (in relation to those individuals and processes across the interface), adoption of new behaviours (eg, being more empowered to directly contact a colleague, taking steps to reduce the others workload and changes in professional approach) and changes in terms of communication (including a desire to communicate more effectively, with use of different modes and methods). CONCLUSION The study highlighted key areas that may serve as useful outcomes for a large-scale randomised trial. Addressing issues identified in the study may help to improve interface relationships and benefit patient care.
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Affiliation(s)
- Rod Sampson
- General Practitioner, Cairn Medical Practice, Inverness, Scotland
| | - Ronald MacVicar
- Postgraduate Dean, NHS Education for Scotland, North of Scotland Region, Scotland
| | - Philip Wilson
- Professor of Primary Care and Rural Health, The Centre for Health Science, University of Aberdeen, Inverness, Scotland
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Sampson R, MacVicar R, Wilson P. Development of an interface-focused educational complex intervention. EDUCATION FOR PRIMARY CARE 2017; 28:265-273. [PMID: 28394242 DOI: 10.1080/14739879.2017.1309690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In many countries, the medical primary-secondary care interface is central to the delivery of quality patient care. There is prevailing interest in developing initiatives to improve interface working for the benefit of health care professionals and their patients. AIM To describe the development of an educational intervention designed to improve working at the primary-secondary care interface in NHS Scotland (United Kingdom) within the context of the Medical Research Council framework for the development and evaluation of complex interventions. METHODS A primary-secondary care interface focused Practice-based Small Group Learning (PBSGL) module was developed building upon qualitative synthesis and original research. A 'meeting of experts' shaped the module, which was subsequently piloted with a group of interface clinicians. Reflections on the module were sought from clinicians across NHS Scotland to provide contextual information from other areas. FINDINGS The PBSGL approach can be usefully applied to the development of a primary-secondary care interface-focused medical educational intervention.
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Affiliation(s)
- Rod Sampson
- a Cairn Medical Practice , Inverness , Scotland
| | - Ronald MacVicar
- b NHS Education for Scotland, Centre for Health Science , Inverness , Scotland
| | - Philip Wilson
- c Centre for Rural Health, University of Aberdeen , Aberdeen , Scotland.,d Centre for Health Science , Inverness , Scotland
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Valaker I, Norekvål TM, Råholm MB, Nordrehaug JE, Rotevatn S, Fridlund B. Continuity of care after percutaneous coronary intervention: The patient's perspective across secondary and primary care settings. Eur J Cardiovasc Nurs 2017; 16:444-452. [PMID: 28111970 PMCID: PMC5458873 DOI: 10.1177/1474515117690298] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Although patients may experience a quick recovery followed by rapid discharge after percutaneous coronary interventions (PCIs), continuity of care from hospital to home can be particularly challenging. Despite this fact, little is known about the experiences of care across the interface between secondary and primary healthcare systems in patients undergoing PCI. Aim: To explore how patients undergoing PCI experience continuity of care between secondary and primary care settings after early discharge. Methods: The study used an inductive exploratory design by performing in-depth interviews of 22 patients at 6–8 weeks after PCI. Nine were women and 13 were men; 13 were older than 67 years of age. Eight lived remotely from the PCI centre. Patients were purposively recruited from the Norwegian Registry for Invasive Cardiology. Interviews were analysed by qualitative content analysis. Findings: Patients undergoing PCI were satisfied with the technical treatment. However, patients experienced an unplanned patient journey across care boundaries. They were not receiving adequate instruction and information on how to integrate health information. Patients also needed help to facilitate connections to community-based resources and to schedule clear follow-up appointments. Conclusions and implications: As high-technology treatment dramatically expands, healthcare organisations need to be concerned about all dimensions of continuity. Patients are witnessing their own processes of healthcare delivery and therefore their voices should be taken into greater account when discussing continuity of care. Nurse-led initiatives to improve continuity of care involve a range of interventions at different levels of the healthcare system.
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Affiliation(s)
- Irene Valaker
- 1 Faculty of Health Studies, Western Norway University of Applied Sciences, Førde, Norway
| | - Tone M Norekvål
- 2 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,3 Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Maj-Britt Råholm
- 1 Faculty of Health Studies, Western Norway University of Applied Sciences, Førde, Norway
| | - Jan Erik Nordrehaug
- 3 Department of Clinical Science, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.,4 Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Svein Rotevatn
- 2 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,5 Norwegian Registry for Invasive Cardiology, Bergen, Norway
| | - Bengt Fridlund
- 2 Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.,6 School of Health and Welfare, Jönköping University, Jönköping, Sweden
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Providing palliative care for cardiovascular disease from a perspective of sociocultural diversity: a global view. Curr Opin Support Palliat Care 2016; 10:11-7. [PMID: 26808051 DOI: 10.1097/spc.0000000000000188] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW This article discusses the available information on providing palliative care for cardiovascular disease (CVD) for individuals from culturally and linguistically diverse populations, and argues the need for cultural competence and awareness of healthcare providers. RECENT FINDINGS The burden of CVD is increasing globally and access to palliative care for individuals and populations is inconsistent and largely driven by policy, funding models, center-based expertise and local resources. Culture is an important social determinant of health and moderates health outcomes across the life trajectory. Along with approachability, availability, accommodation, affordability and appropriateness, culture moderates access to services. Health disparities and inequity of access underscore the importance of ensuring services meet the needs of diverse populations and that care is provided by individuals who are culturally competent. In death and dying, the vulnerability of individuals, families and communities is most pronounced. Using a social-ecological model as an organising framework, we consider the evidence from the literature in regard to the interaction between the individual, interpersonal relationships, community and society in promoting access to individuals with cardiovascular disease. SUMMARY This review highlights the need for considering individual, provider and system factors to tailor and target healthcare services to the needs of culturally diverse populations. Beyond translation of materials, there is a need to understand the cultural dimensions influencing health-seeking behaviors and acceptance of palliative care and ensuring the cultural competence of health professionals in both primary and specialist palliative care.
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Sampson R, Barbour R, Wilson P. The relationship between GPs and hospital consultants and the implications for patient care: a qualitative study. BMC FAMILY PRACTICE 2016; 17:45. [PMID: 27074867 PMCID: PMC4831146 DOI: 10.1186/s12875-016-0442-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 04/06/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Improving the quality of care of at the medical primary-secondary care interface is both a national and a wider concern. In a qualitative exploration of clinicians' relationship at the interface, we want to study how both GPs and hospital specialists regard and behave towards each other and how this may influence patient care. METHOD A qualitative interview study was carried out in primary and secondary care centres in NHS Highland health board area, Scotland. Eligible clinicians (general practitioners and hospital specialists) were invited to take part in a semi-structured interview to explore the implications of interface relationships upon patient care. A standard thematic analysis was used, involving an iterative process based on grounded theory. RESULTS Key themes that emerged for clinicians included communication (the importance of accessing and listening to one another, and the transfer of soft intelligence), conduct (referring to perceived inappropriate transfer of workload at the interface, and resistance to this transfer), relationships (between interface clinicians and between clinicians and their patients), and unrealistic expectations (clinicians expressing idealistic hopes of what their colleagues at the other interface could achieve). CONCLUSION The relationship between primary and secondary care clinicians, and, in particular, difficulties and misunderstandings can have an influence upon patient care. Addressing key areas identified in the study may help to improve interface relationships and benefit patient care.
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Affiliation(s)
- Rod Sampson
- Cairn Medical Practice, 15 Culduthel Road, Inverness, IV2 4AG, Scotland.
| | - Rosaline Barbour
- The Open University, Walton Hall, Milton Keynes, Buckinghamshire, MK7 6AA, England
| | - Philip Wilson
- Centre for Rural Health, The Centre for Health Science, University of Aberdeen, Old Perth Road, Inverness, IV2 3JH, Scotland
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