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Benjamins J, de Vet E, de Mortier CA, Haveman-Nies A. The Effect of Using a Client-Accessible Health Record on Perceived Quality of Care: Interview Study Among Parents and Adolescents. J Particip Med 2024; 16:e50092. [PMID: 38652532 PMCID: PMC11077414 DOI: 10.2196/50092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 12/11/2023] [Accepted: 03/20/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Patient-accessible electronic health records (PAEHRs) are assumed to enhance the quality of care, expressed in terms of safety, effectiveness, timeliness, person centeredness, efficiency, and equity. However, research on the impact of PAEHRs on the perceived quality of care among parents, children, and adolescents is largely lacking. In the Netherlands, a PAEHR (Iuvenelis) was developed for preventive child health care and youth care. Parents and adolescents had access to its full content, could manage appointments, ask questions, and comment on written reports. OBJECTIVE This study aims to assess whether and how using this PAEHR contributes to perceived quality of care from a client's perspective. METHODS We chose a qualitative design with a phenomenological approach to explore how parents and adolescents perceived the impact of using a PAEHR on quality of care. In-depth interviews that simultaneously included 1 to 3 people were conducted in 2021. In total, 20 participants were included in the study, representing parents and adolescents, both sexes, different educational levels, different native countries, and all participating municipalities. Within this group, 7 of 13 (54%) parents had not previously been informed about the existence of a client portal. Their expectations of using the client portal, in relation to quality of care, were discussed after a demonstration of the portal. RESULTS Parents and adolescents perceived that using Iuvenelis contributed to the quality of care because they felt better informed and more involved in the care process than before the introduction of Iuvenelis. Moreover, they experienced more control over their health data, faster and simpler access to their health information, and found it easier to manage appointments or ask questions at their convenience. Parents from a migratory background, among whom 6 of 7 (86%) had not previously been informed about the portal, expected that portal access would enhance their understanding of and control over their care processes. The parents expressed concerns about equity because parents from a migratory background might have less access to the service. Nevertheless, portal usability was regarded as high. Furthermore, both parents and adolescents saw room for improvement in the broader interdisciplinary use of Iuvenelis and the quality of reporting. CONCLUSIONS Using Iuvenelis can contribute to the client-experienced quality of care, more specifically to perceived person centeredness, timeliness, safety, efficiency, and integration of care. However, some quality aspects, such as equity, still need addressing. In general, client information about the portal needs to be improved, specifically focusing on people in vulnerable circumstances, such as those from migratory backgrounds. In addition, to maximize the potential benefit of using Iuvenelis, stimulating a person-centered attitude among professionals is important. Considering the small number of adolescent participants (n=7), adding quantitative data from a structured survey could strengthen the available evidence.
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Affiliation(s)
- Janine Benjamins
- Chairgroup Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
- Icare JGZ, Meppel, Netherlands
- Stichting Jeugd Noord Veluwe, Nunspeet, Netherlands
| | - Emely de Vet
- Chairgroup Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
- University Collega Tilburg, Tilburg University, Tilburg, Netherlands
| | - Chloe A de Mortier
- Department of Health Services Research, Care and Public Health Research Institute, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- School of Health Professions Education, Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Knowledge Instiute of Medical Specialists, Utrecht, Netherlands
| | - Annemien Haveman-Nies
- Chairgroup Consumption and Healthy Lifestyles, Wageningen University & Research, Wageningen, Netherlands
- GGD Noord-en Oost Gelderland, Warnsveld, Netherlands
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2
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Cooper A, Edwards M, Davies F, Price D, Anderson P, Carson-Stevens A, Cooke M, Dale J, Donaldson L, Evans BA, Harrington B, Hepburn J, Hibbert P, Hughes TC, Porter A, Siriwardena AN, Watkins A, Snooks H, Edwards A. Programme theories to describe how different general practitioner service models work in different contexts in or alongside emergency departments (GP-ED): realist evaluation. Emerg Med J 2024; 41:287-295. [PMID: 38649248 PMCID: PMC11041563 DOI: 10.1136/emermed-2023-213426] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 02/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Addressing increasing patient demand and improving ED patient flow is a key ambition for NHS England. Delivering general practitioner (GP) services in or alongside EDs (GP-ED) was advocated in 2017 for this reason, supported by £100 million (US$130 million) of capital funding. Current evidence shows no overall improvement in addressing demand and reducing waiting times, but considerable variation in how different service models operate, subject to local context. METHODS We conducted mixed-methods analysis using inductive and deductive approaches for qualitative (observations, interviews) and quantitative data (time series analyses of attendances, reattendances, hospital admissions, length of stay) based on previous research using a purposive sample of 13 GP-ED service models (3 inside-integrated, 4 inside-parallel service, 3 outside-onsite and 3 with no GPs) in England and Wales. We used realist methodology to understand the relationship between contexts, mechanisms and outcomes to develop programme theories about how and why different GP-ED service models work. RESULTS GP-ED service models are complex, with variation in scope and scale of the service, influenced by individual, departmental and external factors. Quantitative data were of variable quality: overall, no reduction in attendances and waiting times, a mixed picture for hospital admissions and length of hospital stay. Our programme theories describe how the GP-ED service models operate: inside the ED, integrated with patient flow and general ED demand, with a wider GP role than usual primary care; outside the ED, addressing primary care demand with an experienced streaming nurse facilitating the 'right patients' are streamed to the GP; or within the ED as a parallel service with most variability in the level of integration and GP role. CONCLUSION GP-ED services are complex . Our programme theories inform recommendations on how services could be modified in particular contexts to address local demand, or whether alternative healthcare services should be considered.
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Affiliation(s)
- Alison Cooper
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Michelle Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Freya Davies
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Delyth Price
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Pippa Anderson
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Andrew Carson-Stevens
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Matthew Cooke
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Jeremy Dale
- Warwick Medical School, University of Warwick, Coventry, UK
| | | | | | - Barbara Harrington
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Julie Hepburn
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | | | - Alison Porter
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Alan Watkins
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Helen Snooks
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Adrian Edwards
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
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Davies F, Edwards M, Price D, Anderson P, Carson-Stevens A, Choudhry M, Cooke M, Dale J, Donaldson L, Evans BA, Harrington B, Harris S, Hepburn J, Hibbert P, Hughes T, Hussain F, Islam S, Pockett R, Porter A, Siriwardena AN, Snooks H, Watkins A, Edwards A, Cooper A. Evaluation of different models of general practitioners working in or alongside emergency departments: a mixed-methods realist evaluation. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-152. [PMID: 38687611 DOI: 10.3310/jwqz5348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Background Emergency healthcare services are under intense pressure to meet increasing patient demands. Many patients presenting to emergency departments could be managed by general practitioners in general practitioner-emergency department service models. Objectives To evaluate the effectiveness, safety, patient experience and system implications of the different general practitioner-emergency department models. Design Mixed-methods realist evaluation. Methods Phase 1 (2017-8), to understand current practice: rapid realist literature review, national survey and follow-up key informant interviews, national stakeholder event and safety data analysis. Phase 2 (2018-21), to collect and analyse qualitative (observations, interviews) and quantitative data (time series analysis); cost-consequences analysis of routine data; and case site data for 'marker condition' analysis from a purposive sample of 13 case sites in England and Wales. Phase 3 (2021-2), to conduct mixed-methods analysis for programme theory and toolkit development. Results General practitioners commonly work in emergency departments, but delivery models vary widely in terms of the scope of the general practitioner role and the scale of the general practitioner service. We developed a taxonomy to describe general practitioner-emergency department service models (Integrated with the emergency department service, Parallel within the emergency department, Outside the emergency department on the hospital site) and present a programme theory as principal output of the study to describe how these service models were observed to operate. Routine data were of variable quality, limiting our analysis. Time series analysis demonstrated trends across intervention sites for: increased time spent in the emergency department; increased emergency department attendances and reattendances; and mixed results for hospital admissions. Evidence on patient experience was limited but broadly supportive; we identified department-level processes to optimise the safety of general practitioner-emergency department models. Limitations The quality, heterogeneity and extent of routine emergency department data collection during the study period limited the conclusions. Recruitment was limited by criteria for case sites (time series requirements) and individual patients (with 'marker conditions'). Pandemic and other pressures limited data collection for marker condition analysis. Data collected and analysed were pre pandemic; new approaches such as 'telephone first' and their relevance to our findings remains unexplored. Conclusion Findings suggest that general practitioner-emergency department service models do not meet the aim of reducing the overall emergency department waiting times and improving patient flow with limited evidence of cost savings. Qualitative data indicated that general practitioners were often valued as members of the wider emergency department team. We have developed a toolkit, based on our findings, to provide guidance for implementing and delivering general practitioner-emergency department services. Future work The emergency care data set has since been introduced across England to help standardise data collection to facilitate further research. We would advocate the systematic capture of patient experience measures and patient-reported outcome measures as part of routine care. More could be done to support the development of the general practitioner in emergency department role, including a core set of competencies and governance structure, to reflect the different general practitioner-emergency department models and to evaluate the effectiveness and cost effectiveness to guide future policy. Study registration This study is registered as PROSPERO CRD42017069741. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 15/145/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 10. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Freya Davies
- PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, UK
| | - Michelle Edwards
- PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, UK
| | - Delyth Price
- PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, UK
| | - Pippa Anderson
- Bangor Institute for Health and Medical Research, Bangor University, Wales, UK
| | | | - Mazhar Choudhry
- PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, UK
| | - Matthew Cooke
- Professor of Clinical Systems Design, Warwick Medical School, Warwick, UK
| | - Jeremy Dale
- Professor of Clinical Systems Design, Warwick Medical School, Warwick, UK
| | | | - Bridie Angela Evans
- PRIME Centre Wales, Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Shaun Harris
- Swansea Centre for Health Economics, School of Health and Social Care, Swansea University, Swansea, UK
| | - Julie Hepburn
- PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | - Faris Hussain
- PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, UK
| | - Saiful Islam
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Rhys Pockett
- Swansea Centre for Health Economics, School of Health and Social Care, Swansea University, Swansea, UK
| | - Alison Porter
- PRIME Centre Wales, Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Helen Snooks
- PRIME Centre Wales, Swansea University Medical School, Swansea University, Swansea, UK
| | - Alan Watkins
- PRIME Centre Wales, Swansea University Medical School, Swansea University, Swansea, UK
| | - Adrian Edwards
- PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, UK
| | - Alison Cooper
- PRIME Centre Wales, School of Medicine, Cardiff University, Cardiff, UK
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Almohaisen NA, Alsayari NM, Abid MH, Al Subhi NF, Al Masoudi A, AlGhazali OS, Woodman A. Improving patient experience by implementing an organisational culture model. BMJ Open Qual 2023; 12:bmjoq-2022-002076. [PMID: 37220993 DOI: 10.1136/bmjoq-2022-002076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 05/07/2023] [Indexed: 05/25/2023] Open
Abstract
A satisfactory patient care culture model can help improve most patients' quality of care in a hospital. This study aims to improve patients' experiences (PX) by implementing a culture model at King Abdul-Aziz Armed Forces Hospital in Dhahran, Saudi Arabia. To achieve the research aim, a set of interventions were implemented that included a patient and family advisory council, empathy training, recognition of the PX, leadership-patient interviews, PX champions and quality improvement. These interventions were further measured using the Hospital Consumer Assessment of Healthcare Providers and Systems survey in the inpatient, outpatient and emergency departments. The improvement project was conducted in 2020, focusing mainly on transforming the culture and launching activities targeting specific touchpoints identified as priority areas. After making these changes, the hospital saw improvements in all patient relationships, with an average score across all dimensions collectively increasing by more than 4%. The quality improvement project using the PX culture model approach demonstrated significant improvements. In addition, employee involvement in patient care has become a significant factor in improving the quality of care. The critical elements for improving the PX and culture included recognising staff and creating networks across the system through effective leadership, employee engagement and engagement of patients and their families.
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Affiliation(s)
- Noha A Almohaisen
- Continuous Quality Improvement and Patient Safety, General Directorate of Health Services, Ministry of Defense, Riyadh, Saudi Arabia
| | - Nayif M Alsayari
- Continuous Quality Improvement and Patient Safety, General Directorate of Health Services, Ministry of Defense, Riyadh, Saudi Arabia
| | - Muhammad Hasan Abid
- Continuous Quality Improvement and Patient Safety, Armed Forces Hospitals Administration, Taif, Makkah, Saudi Arabia
| | - Nada Foud Al Subhi
- Patient Experience Department, Armed Forces Hospital, Dhahran, Eastern Province, Saudi Arabia
| | - Aqeel Al Masoudi
- Hospital Administration, Armed Forces Hospital, Dhahran, Eastern Province, Saudi Arabia
| | - Ohood Saad AlGhazali
- Medical Statistics Department, Armed Forces Hospital, Dhahran, Eastern Province, Saudi Arabia
| | - Alexander Woodman
- Research Department, King Fahad Medical Complex, Dhahran, Eastern Province, Saudi Arabia
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McFadzean IJ, Edwards M, Davies F, Cooper A, Price D, Carson-Stevens A, Dale J, Hughes T, Porter A, Harrington B, Evans B, Siriwardena N, Anderson P, Edwards A. Realist analysis of whether emergency departments with primary care services generate 'provider-induced demand'. BMC Emerg Med 2022; 22:155. [PMID: 36068508 PMCID: PMC9450363 DOI: 10.1186/s12873-022-00709-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 08/16/2022] [Indexed: 11/28/2022] Open
Abstract
Background It is not known whether emergency departments (EDs) with primary care services influence demand for non-urgent care (‘provider-induced demand’). We proposed that distinct primary care services in EDs encourages primary care demand, whereas primary care integrated within EDs may be less likely to cause additional demand. We aimed to explore this and explain contexts (C), mechanisms (M) and outcomes (O) influencing demand. Methods We used realist evaluation methodology and observed ED service delivery. Twenty-four patients and 106 staff members (including Clinical Directors and General Practitioners) were interviewed at 13 EDs in England and Wales (240 hours of observations across 30 days). Field notes from observations and interviews were analysed by creating ‘CMO’ configurations to develop and refine theories relating to drivers of demand. Results EDs with distinct primary care services were perceived to attract demand for primary care because services were visible, known or enabled direct access to health care services. Other influencing factors included patients’ experiences of accessing primary care, community care capacity, service design and population characteristics. Conclusions Patient, local-system and wider-system factors can contribute to additional demand at EDs that include primary care services. Our findings can inform service providers and policymakers in developing strategies to limit the effect of potential influences on additional demand when demand exceeds capacity. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00709-2.
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Affiliation(s)
- I J McFadzean
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, Wales.
| | - M Edwards
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, Wales.
| | - F Davies
- PRIME Centre Wales, Cardiff University School of Medicine, Cardiff, Wales
| | - A Cooper
- PRIME Centre Wales, Cardiff University School of Medicine, Cardiff, Wales
| | - D Price
- PRIME Centre Wales, Cardiff University School of Medicine, Cardiff, Wales
| | - A Carson-Stevens
- PRIME Centre Wales, Cardiff University School of Medicine, Cardiff, Wales
| | - J Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Warwick, UK
| | - T Hughes
- John Radcliff Hospital, Oxford, UK
| | - A Porter
- Swansea University Medical School, Swansea University, Swansea, Wales
| | - B Harrington
- PRIME Centre Wales, Cardiff University School of Medicine, Cardiff, Wales
| | - B Evans
- Swansea University Medical School, Swansea University, Swansea, Wales
| | - N Siriwardena
- School of Health and Social Care, University of Lincoln, Lincoln, UK
| | - P Anderson
- Swansea University Medical School, Swansea University, Swansea, Wales
| | - A Edwards
- PRIME Centre Wales, Cardiff University School of Medicine, Cardiff, Wales
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Rashid A. Yonder #100: Nasal sprays, obstetric ultrasound, binge eating disorder, and emergency departments. Br J Gen Pract 2022; 72:391. [PMID: 35902253 PMCID: PMC9343027 DOI: 10.3399/bjgp22x720377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Ahmed Rashid
- GP and Professor of Medical Education, UCL Medical School, UCL, London. @Dr_A_Rashid
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