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Aberle B, McQuillen E, Hudson L, Marentette E, Urquhart K, Enoex K, Benkert R. Nursing roles and responsibilities conducted by registered nurse/BSN student dyads across ambulatory clinical sites in medically underserved communities. J Prof Nurs 2024; 51:101-108. [PMID: 38614667 DOI: 10.1016/j.profnurs.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/19/2024] [Accepted: 01/25/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND Increasingly, registered nurses (RNs) are incorporated into ambulatory care teams. Yet, limited research exists on the roles of RNs across these settings. PURPOSE The purpose of this study was to examine the roles performed by RNs (and their senior BSN students) in primary care and public health settings. METHODS Working with nine RN preceptors, 15 students tracked all patient visits during a 150-h immersion experience using the Typhon™ clinical-tracking software. RESULTS The BSN student/RN dyads conducted 1218 patient visits completing 8536 RN roles in 15 distinct categories. Most patients were African American and female (n = 736; 60.1 %) with an average age of 38.4 (SD 22.12). Patient demographics varied by site. The most common roles performed by the RN/student dyad were health assessment, behavioral health screening, and telehealth. Roles of the RNs and the student level of independence were significantly different across sites (Fisher's Exact test [p < .001]). CONCLUSIONS Our results argue that RNs are providing substantial value to these FQHC and public heath settings. An academic/practice partnership, including a shared curricular review, can provide a strategic advantage for educators to ensure that health systems realize the unique roles for RNs and educators provide 21st century education.
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Affiliation(s)
- Belinda Aberle
- College of Nursing, Wayne State University, Detroit, MI, United States of America
| | - Elizabeth McQuillen
- College of Nursing, Wayne State University, Detroit, MI, United States of America
| | - Leon Hudson
- School of Medicine, Wayne State University, United States of America
| | - Elizabeth Marentette
- College of Nursing, Wayne State University, Detroit, MI, United States of America
| | | | - Kristy Enoex
- School of Medicine, Wayne State University, United States of America
| | - Ramona Benkert
- College of Nursing, Wayne State University, Detroit, MI, United States of America.
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Kolltveit BCH, Oftedal BF, Thorne S, Lomborg K, Graue M. Experiences of an interprofessional follow-up program in primary care practice. BMC Health Serv Res 2024; 24:238. [PMID: 38395910 PMCID: PMC10885432 DOI: 10.1186/s12913-024-10706-9] [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: 02/22/2023] [Accepted: 02/11/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND An integrative cooperation of different healthcare professional is a key component for high quality health services. With an aging population and many with long-term conditions, more health tasks and follow-up care are being transferred to primary care and locally where people live. Interprofessional collaboration among providers of different professional designations will be of increasing importance to optimizing primary care capacity in years to come. There is a call for further exploration of models of interprofessional collaboration that might be applicable in Norwegian primary care. The aim of this study was to explore experiences of interprofessional collaboration between primary care physicians and nurses working in primary care by applying an intervention for people with type 2 diabetes. Specifically, this study was designed to strengthen and gain deeper insight into interprofessional collaboration between primary care physicians and nurses in primary care settings. METHODS We applied Interpretive Description as a research strategy. The participants within this study were primary care physicians and nurses from four different primary care practices in the western and eastern parts of Norway. We used semi-structured telephone interviews for collecting the data between January and September 2021. RESULTS The analysis revealed two key features of the primary care physicians and the nurses experience with interprofessional collaboration in primary care practices. The first involved managing the influence of discrepancies in their expectations of IPC and the second involved becoming aware of the competence they developed that allowed for better complementarity consultation. CONCLUSIONS This study indicates that interprofessional collaboration in primary care practice requires that primary care physicians and nurses clarify their expectations and, in turn, determine how flexible they can become in changing their usual primary care practices. Moreover, findings reveal that nurses and primary care physicians had discrepancies in expectations of how interprofessional collaboration should be carried out in primary care practice. However, both the nurses and primary care physicians appreciated the blending of complementary competencies and skills that facilitated a more collaborative care practice. They experienced that this interprofessional collaboration represented an essential quality improvement in the primary care services. TRIAL REGISTRATION The trial is registered 03/09/2019 in ClinicalTrials.gov (ID: NCT04076384).
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Affiliation(s)
- Beate-Christin Hope Kolltveit
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
- Vossevangen medical centre, Voss, Norway.
| | | | - Sally Thorne
- School of Nursing, University of British Columbia, Vancouver, CA, Canada
| | - Kirsten Lomborg
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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Schütz Leuthold M, El-Hakmaoui F, Senn N, Cohidon C. General Practitioner's Experience of Public-Private Partnerships to Develop Team-Based Care: A Qualitative Study. Int J Public Health 2023; 68:1606453. [PMID: 38033765 PMCID: PMC10681929 DOI: 10.3389/ijph.2023.1606453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives: A tripartite public-private partnership was established between GPs' practices, public health authorities and a university department of family medicine, to develop multidisciplinary teams and integrate nurses into GPs' practices. The present paper describes the points of view of the GPs involved in this collaboration. Methods: We conducted a qualitative study, with data coming from eight interviews with GPs, one from each practice. We also used the facilitator's project diary to complete the discussion. Results: The principal issue discussed was the financial aspects of the collaboration. GPs are generally satisfied, but time spent coordinating with nurses and transferring activities made them fear financial losses. Secondly, the partnership with public health authorities was well appreciated, but not clear enough. Some aspects of the partnership, such as referring patient to the nurse should have been better defined et controlled. The last aspect was the academic support. It allowed reducing GPs' workload in training nurses and supporting the project implementation within the GPs' practice. Conclusion: GPs have a positive point of view of such public-private partnership and saw an opportunity to be involved in developing public health policies.
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Affiliation(s)
- Muriel Schütz Leuthold
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Fatima El-Hakmaoui
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Nicolas Senn
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Christine Cohidon
- Department of Family Medicine, Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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Ramachandran M, Brinton C, Wiljer D, Upshur R, Gray CS. The impact of eHealth on relationships and trust in primary care: a review of reviews. BMC PRIMARY CARE 2023; 24:228. [PMID: 37919688 PMCID: PMC10623772 DOI: 10.1186/s12875-023-02176-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Given the increasing integration of digital health technologies in team-based primary care, this review aimed at understanding the impact of eHealth on patient-provider and provider-provider relationships. METHODS A review of reviews was conducted on three databases to identify papers published in English from 2008 onwards. The impact of different types of eHealth on relationships and trust and the factors influencing the impact were thematically analyzed. RESULTS A total of 79 reviews were included. Patient-provider relationships were discussed more frequently as compared to provider-provider relationships. Communication systems like telemedicine were the most discussed type of technology. eHealth was found to have both positive and negative impacts on relationships and/or trust. This impact was influenced by a range of patient-related, provider-related, technology-related, and organizational factors, such as patient sociodemographics, provider communication skills, technology design, and organizational technology implementation, respectively. CONCLUSIONS Recommendations are provided for effective and equitable technology selection, application, and training to optimize the impact of eHealth on relationships and trust. The review findings can inform providers' and policymakers' decision-making around the use of eHealth in primary care delivery to facilitate relationship-building.
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Affiliation(s)
- Meena Ramachandran
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada.
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Christopher Brinton
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Michael G. DeGroote School of Medicine, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - David Wiljer
- Education Technology Innovation, University Health Network, 190 Elizabeth St, Toronto, ON, M5G 2C4, Canada
- Department of Psychiatry, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
- Centre for Addiction and Mental Health, 1000 Queen St W, Toronto, ON, M6J 1H4, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, 1 Bridgepoint Dr, Toronto, ON, M4M 2B5, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, M5T 3M6, Canada
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Chaves ACC, Scherer MDDA, Conill EM. What contributes to Primary Health Care effectiveness? Integrative literature review, 2010-2020. CIENCIA & SAUDE COLETIVA 2023; 28:2537-2551. [PMID: 37672445 DOI: 10.1590/1413-81232023289.15342022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 01/11/2023] [Indexed: 09/08/2023] Open
Abstract
Primary Health Care (PHC) intends to rearrange services to make it more effective. Nevertheless, effectiveness in PHC is quite a challenge. This study reviews several articles regarding the effectiveness improvements in PHC between 2010 and 2020. Ninety out of 8,369 articles found in PubMed and the Virtual Health Library databases search were selected for thematic analysis using the Atlas.ti® 9.0 software. There were four categories identified: strategies for monitoring and evaluating health services, organizational arrangements, models and technologies applied to PHC. Studies concerning the sensitive conditions indicators were predominant. Institutional assessment programs, PHC as a structuring policy, appropriate workforce, measures to increase access and digital technologies showed positive effects. However, payment for performance is still controversial. The expressive number of Brazilian publications reveals the broad diffusion of PHC in the country and the concern on its performance. These findings reassure well-known aspects, but it also points to the need for a logical model to better define what is intended as effectiveness within primary health care as well as clarify the polysemy that surrounds the concept. We also suggest substituting the term "resolvability", commonly used in Brazil, for "effectiveness".
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Liu L, Chien AT, Singer SJ. Enabling System Functionalities of Primary Care Practices for Team Dynamics in Transformation to Team-Based Care: A Qualitative Comparative Analysis (QCA). Healthcare (Basel) 2023; 11:2018. [PMID: 37510459 PMCID: PMC10379116 DOI: 10.3390/healthcare11142018] [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: 05/23/2023] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Team-based primary care has been shown to be an important initiative for transforming primary care to achieve whole-person care, enhance health equity, and reduce provider burnout. Organizational approaches have been explored to better implement team-based care but a thorough understanding of the role of system functions is lacking. We aimed to identify the combinations of system functionalities in primary care practices that most enable effective teamwork. We used a novel method, qualitative comparative analysis (QCA), to identify cross-case patterns in 19 primary care practices in the Harvard Academic Innovations Collaborative (AIC), an initiative for transforming primary care practices by establishing teams and implementing team-based care. QCA findings identified that primary care practices with strong team dynamics exhibited strengths in three operational care process functionalities, including management of abnormal test results, cancer screening and medication management for high-priority patients, care transitions, and in health information technology (HIT) functionality. HIT functionality alone was not sufficient to achieve the desired outcomes. System functionalities in a primary care practice that support physicians and their teams in identifying patients with urgent and complex acute illnesses requiring immediate response and care and overcoming barriers to collaboration within and across institutional settings, may be essential for sustaining strong team-based primary care.
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Affiliation(s)
- Lingrui Liu
- Center for Evidence and Practice Improvement, Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services, Rockville, MD 20857, USA
| | - Alyna T. Chien
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA;
- Division of General Pediatrics, Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Sara J. Singer
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA;
- Stanford Graduate School of Business, Stanford, CA 94305, USA
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Hu PL, Tan CYL, Nguyen NHL, Wu RR, Bahadin J, Nadkarni NV, Tan NC. Integrated care teams in primary care improve clinical outcomes and care processes in patients with non-communicable diseases. Singapore Med J 2023; 64:423-429. [PMID: 35706106 PMCID: PMC10395801 DOI: 10.11622/smedj.2022067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 08/18/2020] [Indexed: 11/18/2022]
Abstract
Introduction Primary care physicians face the increasing burden of managing multimorbidities in an ageing population. Implementing an integrated care team (ICT) with defined roles and accountability to share consultation tasks is an emerging care model to address this issue. This study compared outcomes with ICT versus usual care for patients with multimorbidities in primary care. Methods Data was retrospectively extracted from the electronic medical records (EMRs) of consecutive adult Asian patients empanelled to ICT and those in UC at a typical primary care clinic (polyclinic) in eastern Singapore in 2018. The study population had hypertension, and/or hyperlipidaemia and/or type 2 diabetes mellitus (T2DM). Clinical outcomes included the proportion of patients (ICT vs. UC) who attained their treatment goals after 12 months. Process outcomes included the proportion of patients who completed annual diabetic eye and foot screenings, where applicable. Results Data from 3,302 EMRs (ICT = 1,723, UC = 1,579) from January 2016 to September 2017 was analysed. The ICT cohort was more likely to achieve treatment goals for systolic blood pressure (SBP) (adjusted odds ratio [AOR] = 1.52, 95% confidence interval [CI] = 1.38-1.68), low-density lipoprotein cholesterol (AOR = 1.72, 95% CI = 1.49-1.99), and glycated haemoglobin (AOR = 1.28, 95% CI = 1.09-1.51). The ICT group had higher uptake of diabetic retinal screening (89.1% vs. 83.0%, P < 0.001) and foot screening (85.2% vs. 77.9%, P < 0.001). Conclusion The ICT model yielded better clinical and process outcomes than UC, with more patients attaining treatment goals.
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Affiliation(s)
- Pei Lin Hu
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
| | - Cynthia Yan-Ling Tan
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
| | | | - Rebekah Ryanne Wu
- Department of Medicine, Duke University, Durham, NC, USA
- Programme in Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Programme, Singapore
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Nelson C. Integrated care and the behavioral health primary care provider. JAAPA 2023; 36:40-43. [PMID: 37368852 DOI: 10.1097/01.jaa.0000937328.12743.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
ABSTRACT Primary care remains the main setting for delivery of psychiatric care. An integrated approach improves the ability of primary care providers (PCPs) to care for complex patients with behavioral health needs. This article describes integrated care and how physician associates/assistants can gain additional training to become behavioral health specialists.
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Affiliation(s)
- Christopher Nelson
- Christopher Nelson practices at Health Plus Clinic in Springville, Utah. The author has disclosed no potential conflicts of interest, financial or otherwise
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Baldwin LM, Katers LA, Sullivan MD, Gordon DB, James A, Tauben DJ, Arbabi S. Lessons from the implementation of a trauma center-based program to support primary care providers in managing opioids and pain after trauma hospitalization. Trauma Surg Acute Care Open 2023; 8:e001038. [PMID: 36844370 PMCID: PMC9944266 DOI: 10.1136/tsaco-2022-001038] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/07/2023] [Indexed: 02/22/2023] Open
Abstract
Background Decreasing exposure to prescription opioids is critical to lowering risk of opioid misuse, overdose and opioid use disorder. This study reports a secondary analysis of a randomized controlled trial implementing an opioid taper support program directed to primary care providers (PCPs) of patients discharged from a level I trauma center to their homes distant from the center, and shares lessons for trauma centers in supporting these patients. Methods This longitudinal descriptive mixed-methods study uses quantitative/qualitative data from trial intervention arm patients to examine implementation challenges and outcomes: adoption, acceptability, appropriateness, feasibility, fidelity. In the intervention, a physician assistant (PA) contacted patients after discharge to review their discharge instructions and pain management plan, confirm their PCP's identity and encourage PCP follow-up. The PA reached out to the PCP to review the discharge instructions and offer ongoing opioid taper and pain management support. Results The PA reached 32 of 37 patients randomized to the program. Of these 32, 81% discussed topics not targeted by the intervention (eg, social/financial). The PA identified and reached a PCP's office for only 51% of patients. Of these, all PCP offices (100% adoption) received one to four consults (mean 1.9) per patient (fidelity). Few consults were with PCPs (22%); most were with medical assistants (56%) or nurses (22%). The PA reported that it was not routinely clear to patients or PCPs who was responsible for post-trauma care and opioid taper, and what the taper instructions were. Conclusions This level I trauma center successfully implemented a telephonic opioid taper support program during COVID-19 but adapted the program to allow nurses and medical assistants to receive it. This study demonstrates a critical need to improve care transition from hospitalization to home for patients discharged after trauma. Level of evidence Level IV.
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Affiliation(s)
- Laura-Mae Baldwin
- Department of Family Medicine and the Harborview Injury Prevention & Research Center, University of Washington, Seattle, Washington, USA
| | - Laura A Katers
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Mark D Sullivan
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Debra B Gordon
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
| | - Adrienne James
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA
| | - David J Tauben
- Department of Anesthesiology & Pain Medicine, University of Washington, Seattle, Washington, USA,Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Saman Arbabi
- Department of Surgery, University of Washington, Seattle, Washington, USA
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10
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Zunich R, Roberts MC, Blanchard C, Muluneh B, Carlson RB, Helms T. Scoping Review to Inform the Future Development of a Measure for Team-Based Care in Oncology. JCO Oncol Pract 2023; 19:e43-e52. [PMID: 36475754 DOI: 10.1200/op.22.00308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Team-based care is the delivery of health services to an individual by at least two health care providers working collaboratively to achieve optimal care. Participants on the National Cancer Institute and the ASCO Teams in the Cancer Care Delivery Project have defined 13 key principles to serve as the foundation for a successful team; however, it is unclear whether there exist measures of these key principles. METHODS A scoping literature search was conducted for each key principle on PubMed and Embase to identify existing measures for key principles. Articles of interest were exported to a citation manager, Sciwheel, cataloged by the key principle. Existing measures were extracted via a two-stage screening process, with an abstract review followed by a full-text review. RESULTS Fifteen unique measures were identified, with items extrapolated for 12 of the 13 key principles. Measures were not exclusive and could represent more than one key principle. The number of measures varied per principle from zero to five, with Team Composition and Diversity yielding no existing measure. CONCLUSION The long-term goal is to compile and edit these measures, to create a comprehensive measure to be used in various team-based oncology care settings, and to address areas for improvement, ultimately optimizing patient care.
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Affiliation(s)
- Rada Zunich
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Megan C Roberts
- Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Carrie Blanchard
- Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | - Benyam Muluneh
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC
| | - Rebecca Beth Carlson
- Health Sciences Library, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Taylor Helms
- Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC
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McCarville EE, Martin MA, Pratap PL, Pinsker E, Seweryn SM, Peters KE. Understanding the relationship between care team perceptions about CHWs and CHW integration within a US health system, a qualitative descriptive multiple embedded case study. BMC Health Serv Res 2022; 22:1587. [PMID: 36575412 PMCID: PMC9793519 DOI: 10.1186/s12913-022-08723-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/23/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Community health workers (CHW) have grown in prominence within the healthcare sector, yet there is no clear consensus regarding a CHW's role, purpose, and value within health systems. This lack of consensus has the potential to affect how CHWs are perceived, utilized, and ultimately integrated within the healthcare sector. This research examines clinical care teams that currently employ CHWs to (1) understand how members of the care team perceive CHWs' purpose and value, and (2) consider how perceptions of CHWs are related to CHW integration within health care teams. METHODS Researchers conducted a qualitative descriptive multiple embedded case study at the University of Illinois at Chicago's Hospital and Health Science System (UI Health). The embedded subunits of analysis were teams within UI Health that are currently employing CHWs to assist with the provision of clinical care or services to patients. Data were collected via semi-structured interviews and document review. RESULTS In total, 6 sub-units were enrolled to participate, and 17 interviews were conducted with CHWs (n = 9), and administrators or health care providers (n = 8). Reported perceptions of CHWs were inconsistent across respondents. CHWs roles were not always understood, and the CHW's purpose and value was perceived differently by different members of the care team. Moreover, evaluation metrics did not always capture CHWs' value to the health care system. In some cases, care teams were more aligned around a shared understanding of the CHW's roles and purpose within the care team. When perceptions regarding CHWs were both positive and aligned, respondents reported higher levels of integration within the healthcare system. CONCLUSIONS Alignment in a care team's perception of a CHW's role, purpose, and value within the health system could play an important role in the integration of CHWs within healthcare teams.
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Affiliation(s)
- Erin E. McCarville
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, School of Public Health, 1603 W Taylor Street, Chicago, IL 60612 USA
| | - Molly A. Martin
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, Institute for Health Research and Policy, 1747 West Roosevelt Road, Chicago, IL 60608 USA
| | - Preethi Lakshmi Pratap
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, School of Public Health, 1603 W Taylor Street, Chicago, IL 60612 USA
| | - Eve Pinsker
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, School of Public Health, 1603 W Taylor Street, Chicago, IL 60612 USA
| | - Steven M. Seweryn
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, School of Public Health, 1603 W Taylor Street, Chicago, IL 60612 USA
| | - Karen E. Peters
- grid.185648.60000 0001 2175 0319University of Illinois at Chicago, Institute for Health Research and Policy, 1747 West Roosevelt Road, Chicago, IL 60608 USA
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Eder M, Jacobsen R, Peterson KA, Solberg LI. Quality and team care response to the pandemic stresses in high performing primary care practices: A qualitative study. PLoS One 2022; 17:e0278410. [PMID: 36454787 PMCID: PMC9714700 DOI: 10.1371/journal.pone.0278410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To learn how high performing primary care practices organized care for patients with diabetes during the initial months of the COVID-19 pandemic. PARTICIPANTS AND METHODS Semi-structured interviews were conducted between August 10 and December 10, 2020 with 16 leaders from 11 practices that had top quartile performance measures for diabetes outcomes pre-COVID. Each clinic had completed a similar interview and a survey about the existence of care management systems associated with quality outcomes before the pandemic. Transcript analysis utilized a theoretical thematic analysis at the semantic level. RESULTS The pandemic disrupted the primary care practices' operations and processes considered important for quality prior to the pandemic, particularly clinic reliance on proactive patient care. Safety concerns resulted from the shift to virtual visits, which produced documentation gaps and led practices to reorder their use of proactive patient care processes. Informal interactions with patients also declined. These practices' challenges were mitigated by technical, informational and operational help from the larger organizations of which they were a part. Care management processes had to accommodate both in-person and virtual visits. CONCLUSION These high performing practices demonstrated an ability to adapt their use of proactive patient care processes in pursuing quality outcomes for patients with diabetes during the pandemic. Continued clinic transformation and improvements in quality within primary care depend on the ability to restructure the responsibilities of care team members and their interactions with patients.
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Affiliation(s)
- Milton Eder
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- * E-mail:
| | - Rachel Jacobsen
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Kevin A. Peterson
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Leif I. Solberg
- HealthPartners Institute, Bloomington, Minnesota, United States of America
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Wesson DE, Mathur V, Tangri N, Hamlett S, Bushinsky DA, Boulware LE. Primary Medical Care Integrated with Healthy Eating and Healthy Moving is Essential to Reduce Chronic Kidney Disease Progression. Am J Med 2022; 135:1051-1058. [PMID: 35576995 DOI: 10.1016/j.amjmed.2022.04.015] [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] [Received: 03/29/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/27/2022]
Abstract
Increasing adverse outcomes in patients with chronic kidney disease reflect growth of patients with early-stage chronic kidney disease and their increasing per population rates of these outcomes. Progression of chronic kidney disease, more than current level of kidney function, is the primary driver of adverse chronic kidney disease-related outcomes. Racial/ethnic minorities progress faster to end-stage kidney disease with greater risk for adverse outcomes. Diabetes and hypertension cause two-thirds of end-stage kidney disease, for which primary medical care integrated with healthy eating and increased physical activity (healthy moving) slows chronic kidney disease progression. Patients with early-stage chronic kidney disease are appropriately managed by primary care practices but most lack infrastructure to facilitate this integration that reduces adverse chronic kidney disease-related outcomes. Individuals of low socioeconomic status are at greater chronic kidney disease risk, and flexible regulatory options in Medicaid can fund infrastructure to facilitate healthy eating and healthy moving integration with primary medical care. This integration promises to reduce chronic kidney disease-related adverse outcomes, disproportionately in racial/ethnic minorities, and thereby reduce chronic kidney disease-related health disparities.
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Affiliation(s)
- Donald E Wesson
- Dell Medical School - The University of Texas at Austin; Donald E Wesson Consulting, LLC, Dallas, Texas.
| | | | - Navdeep Tangri
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
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14
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Ndateba I, Wong ST, Beaumier J, Burge F, Martin-Misener R, Hogg W, Wodchis W, McGrail K, Johnston S. Primary care practice characteristics associated with team functioning in primary care settings in Canada: A practice-based cross-sectional survey. J Interprof Care 2022; 37:352-361. [PMID: 35880781 DOI: 10.1080/13561820.2022.2099359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Team-based care is recognized as a foundational building block of high-performing primary care. The purpose of this study was to identify primary care practice characteristics associated with team functioning and examine whether there is relationship between team composition or size and team functioning. We sought to answer the following research questions: (1) are primary care practice characteristics associated with team functioning; and (2) does team composition or size influence team functioning. This cross-sectional correlational study was conducted in Fraser East, British Columbia, Eastern Ontario Health Unit, Ontario and Central Zone, Nova Scotia in Canada. Data were collected from primary care practices using an organization survey and the Team Climate Inventory (TCI) as a measure team functioning. The independent variables of interest were: physicians' payment model, internal clinic meetings to discuss clinical issues, care coordination through informal and ad hoc exchange, care coordination through electronic medical records and sharing clinic mission, values and objectives among health professionals. Potentially confounding variables were as follows: team size, composition, and practice panel size. A total of 63 practices were included in these analyses. The overall mean score of team climate was 73 (SD: 10.75) out of 100. Regression analyses showed that care coordination through human interaction and sharing the practice's mission, values, and objectives among health professionals were positively associated with higher functioning teams. Care coordination through electronic medical records and larger team size were negatively associated with team climate. This study provides baseline data on what practice characteristics are associated with highly functioning teams in Canada.
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Affiliation(s)
- Innocent Ndateba
- School of Nursing, University of British Columbia, Vancouver, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Jonathan Beaumier
- School of Nursing, University of British Columbia, Vancouver, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | | | | | - William Hogg
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Walter Wodchis
- University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sharon Johnston
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
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15
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Oyegoke S, Gigli KH. Evaluation of the Culture of Safety and Quality in Pediatric Primary Care Practices. J Patient Saf 2022; 18:e753-e759. [PMID: 35617600 DOI: 10.1097/pts.0000000000000942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purposes of this article were to describe the perceptions of the culture of safety in pediatric primary care and evaluate whether organizational factors and staff roles are associated with perceptions of the culture of safety. METHODS We conducted a secondary data analysis using 2020 Agency for Healthcare Research and Quality Medical Office Survey on Patient Safety Culture to examine the culture of safety and quality in pediatric primary care practices. We used descriptive statistics and calculated differences in perceptions of patient safety and quality based on practice size, ownership, and staff roles using bivariate and logistic regressions. RESULTS The sample included 99 pediatric primary care practices and 1228 staff (physicians n = 169, advanced practice providers n = 70, nurses n = 338, and administration/management n = 651). The "teamwork" domain had the highest positive ratings (≥81.6% positive responses), whereas the "work pressure and pace" domain had the lowest positive ratings (≤28.6% positive response). There were no differences in perceptions of safety or quality based on practice size or ownership. However, there were differences based on staff roles, specifically between administration/management and direct care staff. CONCLUSIONS Overall, perceptions of the culture of safety and quality in pediatric primary care practices were positive. Differences in perceptions existed based on staff role. Future studies are needed to determine whether differences are clinically meaningful and how to narrow differences in perceptions among staff and improve of the culture of safety as a mechanism to improve the safety and quality of pediatric primary care.
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Affiliation(s)
| | - Kristin Hittle Gigli
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
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16
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DePuccio MJ, Sullivan EE, Breton M, McKinstry D, Gaughan AA, McAlearney AS. The Impact of COVID-19 on Primary Care Teamwork: a Qualitative Study in Two States. J Gen Intern Med 2022; 37:2003-2008. [PMID: 35412178 PMCID: PMC9002024 DOI: 10.1007/s11606-022-07559-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The emergence of coronavirus disease 2019 (COVID-19) disrupted how primary care physicians (PCPs) and their staff delivered team-based care. OBJECTIVE To explore PCPs' perspectives about the impact of stay-at-home orders and the increased use of telemedicine on interactions and working relationships with their practice staff during the first 9 months of the pandemic. DESIGN Qualitative research. PARTICIPANTS Participants included PCPs from family and community medicine, general internal medicine, and pediatrics. APPROACH One-on-one, semi-structured video interviews with 42 PCPs were conducted between July and December 2020. Physicians were recruited from 30 primary care practices in Massachusetts and Ohio using a combination of purposeful, convenience, and snowball sampling. Interview questions focused on work changes and work relationships with other staff members during the pandemic as well as their experiences delivering telemedicine. All interviews were audio-recorded, transcribed verbatim, and coded using deductive and inductive approaches. KEY RESULTS Across respondents and states, the context of the pandemic was reported to have four major impacts on primary care teamwork: (1) staff members' roles were repurposed to support telemedicine; (2) PCPs felt disconnected from staff; (3) PCPs had difficulty communicating with staff; and (4) many PCPs were demoralized during the pandemic. CONCLUSIONS The lack of in-person contact, and less synchronous communication, negatively impacted PCP-staff teamwork and morale during the pandemic. These challenges further highlight the importance for practice leaders to recognize and attend to clinicians' relational and work-related needs as the pandemic continues.
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Affiliation(s)
- Matthew J DePuccio
- Department of Health Systems Management, College of Health Sciences, Rush University, Chicago, IL, USA.
| | - Erin E Sullivan
- Sawyer School of Business, Suffolk University, Boston, MA, USA.,Center for Primary Care, Harvard Medical School, Boston, MA, USA
| | - Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Canada
| | | | - Alice A Gaughan
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA.,Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA
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17
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Reich K, Butterworth SW, Coday M, Bailey JE. Integrating Lay Health Coaches Into Primary Care: Acceptability, Credibility, and Effectiveness From the Provider Perspective. Cureus 2022; 14:e25457. [PMID: 35774723 PMCID: PMC9239298 DOI: 10.7759/cureus.25457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2022] [Indexed: 11/25/2022] Open
Abstract
The purpose of this mixed-methods, cross-sectional study was to assess the acceptability, effectiveness, and credibility of lay health coaches from the perspective of primary care personnel during coach integration into primary care teams through the Management of Diabetes in Everyday Life (MODEL) study. Surveys of 46 primary care clinic personnel were conducted in June 2017 and July 2017 to assess the acceptability, effectiveness, and credibility of lay health coaches in the clinics. Clinic personnel rated coach acceptability, impact, and credibility on a five-point Likert scale as 3.78, 3.76-4.04, and 3.71-3.95, respectively. Additionally, interviews revealed support for a team-based approach and recognition of the potential of coaches to enhance care. In the interviews clinic personnel also reported a lack of provider time to counsel patients as well as a need for improved provider-coach communication.
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18
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Docherty MA, Richard MP. Achieving person-centred care through a team-based care ecosystem approach. Healthc Manage Forum 2022; 35:179-184. [PMID: 35387502 DOI: 10.1177/08404704221078975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The implementation of Person-Centred Care (PCC) by primary care teams is complex. Framed through the Quadruple Aim, successful healthcare system redesigns result in improved health outcomes of individuals and populations, reduce costs, and ensure an engaged and productive workforce. However, how can primary care teams achieve the Quadruple Aim? This article provides a learning and performance framework to support PCC through a Team-Based Care (TBC) ecosystem approach. We developed our approach using action research to improve TBC orientations, workshops, and consultations for teams and their leaders in Urgent Primary Care Centres and Primary Care Networks in Canada. This paper provides a synthesis of our experience in the context of the relevant evidence. We aim to share our efforts and acknowledge that our experience is still ongoing and complemented by ongoing improvement activities by others in the TBC ecosystem.
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Affiliation(s)
- Marcia A Docherty
- 8204Vancouver Island Health Authority, Victoria, British Columbia, Canada
- 31904Fielding Graduate University, Santa Barbara, California, USA
| | - Myrianne P Richard
- 8204Vancouver Island Health Authority, Victoria, British Columbia, Canada
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19
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Schiavoni KH, Lawrence J, Xue J, Kotelchuck M, Boudreau AA. Pediatric Practice Transformation and Long-Acting Reversible Contraception (LARC) Use in Adolescents. Acad Pediatr 2022; 22:296-304. [PMID: 34758402 DOI: 10.1016/j.acap.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/27/2021] [Accepted: 10/31/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Long acting reversible contraceptives (LARCs) are recommended as highly effective for adolescents. Although the uptake of LARCs has increased, overall use remains low due to barriers for both providers and patients. We evaluate whether pediatric medical home transformation, including implant placement in pediatrics, may increase LARC use or decrease adolescent pregnancy rates. METHODS Retrospective interrupted time-series analysis of adolescents ages 11 to 19 years at 2 pediatric practices in academically affiliated community health centers during 2005-2015. The intervention practice underwent medical home transformation including team-based care with family planning and health coaching, youth-friendly policies, and contraceptive implant placement. The control practice continued usual care. Differential changes in population event rates were evaluated using a segmented longitudinal regression model. RESULTS The study population included 4946 adolescent females at the intervention practice and 1992 at the control practice. Following practice transformation, LARC use increased significantly more at the intervention practice compared to the control (1.73 versus 0.28 events per 1000 patients quarterly P = 0.004). Pregnancy rate declined at both practices without temporal correlation to the LARC intervention. During the medical home transformation period, the intervention practice showed a greater decline in pregnancy rate, though this difference did not reach statistical significance (2.01 versus 0.81 events per 1000 patients quarterly P = 0.090). CONCLUSIONS Adolescents had higher LARC use where implant placement was offered within the pediatric practice as part of medical home transformation. Although LARC did not impact pregnancy rate, the process of practice transformation may have accelerated its decline through heightened adolescent health focus.
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Affiliation(s)
- Katherine H Schiavoni
- Massachusetts General Hospital, Department of Pediatrics (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass; Mass General Brigham, Population Health Management (KH Schiavoni), Somerville, Mass; Harvard Medical School (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass.
| | - Jourdyn Lawrence
- Harvard T. H. Chan School of Public Heath, Department of Social and Behavioral Sciences (J Lawrence), Boston, Mass
| | - Jiayin Xue
- Massachusetts General Hospital, Department of Pediatrics (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass; Harvard Medical School (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass
| | - Milton Kotelchuck
- Massachusetts General Hospital, Department of Pediatrics (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass; Harvard Medical School (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass
| | - Alexy Arauz Boudreau
- Massachusetts General Hospital, Department of Pediatrics (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass; Harvard Medical School (KH Schiavoni, J Xue, M Kotelchuck, and AA Boudreau), Boston, Mass
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20
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Davis MM, Schneider JL, Petrik AF, Miech EJ, Younger B, Escaron AL, Rivelli JS, Thompson JH, Nyongesa D, Coronado GD. Clinic Factors Associated With Mailed Fecal Immunochemical Test (FIT) Completion: The Difference-Making Role of Support Staff. Ann Fam Med 2022; 20:123-129. [PMID: 35346927 PMCID: PMC8959740 DOI: 10.1370/afm.2772] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 07/22/2021] [Accepted: 08/17/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Mailed fecal immunochemical test (FIT) programs can facilitate colorectal cancer (CRC) screening. We sought to identify modifiable, clinic-level factors that distinguish primary care clinics with higher vs lower FIT completion rates in response to a centralized mailed FIT program. METHODS We used baseline observational data from 15 clinics within a single urban federally qualified health center participating in a pragmatic trial to optimize a mailed FIT program. Clinic-level data included interviews with leadership using a guide informed by the Consolidated Framework for Implementation Research (CFIR) and FIT completion rates. We used template analysis to identify explanatory factors and configurational comparative methods to identify specific combinations of clinic-level conditions that uniquely distinguished clinics with higher and lower FIT completion rates. RESULTS We interviewed 39 clinic leaders and identified 58 potential explanatory factors representing clinic workflows and the CFIR inner setting domain. Clinic-level FIT completion rates ranged from 30% to 56%. The configurational model for clinics with higher rates (≥37%) featured any 1 of the following 3 factors related to support staff: (1) adding back- or front-office staff in past 12 months, (2) having staff help patients resolve barriers to CRC screening, and (3) having staff hand out FITs/educate patients. The model for clinics with lower rates involved the combined absence of these same 3 factors. CONCLUSIONS Three factors related to support staff differentiated clinics with higher and lower FIT completion rates. Adding nonphysician support staff and having those staff provide enabling services might help clinics optimize mailed FIT screening programs.
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Affiliation(s)
- Melinda M Davis
- Oregon Rural Practice-Based Research Network, Department of Family Medicine, and School of Public Health, Oregon Health & Science University, Portland, Oregon
| | | | - Amanda F Petrik
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Edward J Miech
- Regenstrief Institute, Center for Health Services Research, Indianapolis, Indiana
| | - Brittany Younger
- AltaMed Institute for Health Equity, AltaMed Health Services Corporation, Los Angeles, California
| | - Anne L Escaron
- AltaMed Institute for Health Equity, AltaMed Health Services Corporation, Los Angeles, California
| | - Jennifer S Rivelli
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jamie H Thompson
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Denis Nyongesa
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Gloria D Coronado
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
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21
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Nguyen AM, Paul MM, Shelley DR, Albert SL, Cohen DJ, Bonsu P, Wyte-Lake T, Blecker S, Berry CA. Ten Common Structures and Processes of High-Performing Primary Care Practices. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:E639-E644. [PMID: 34654020 PMCID: PMC8781214 DOI: 10.1097/phh.0000000000001451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Structures (context of care delivery) and processes (actions aimed at delivery care) are posited to drive patient outcomes. Despite decades of primary care research, there remains a lack of evidence connecting specific structures/processes to patient outcomes to determine which of the numerous recommended structures/processes to prioritize for implementation. The objective of this study was to identify structures/processes most commonly present in high-performing primary care practices for chronic care management and prevention. We conducted key informant interviews with a national sample of 22 high-performing primary care practices. We identified the 10 most commonly present structures/processes in these practices, which largely enable 2 core functions: mobilizing staff to conduct patient outreach and helping practices avoid gaps in care. Given the costs of implementing and maintaining numerous structures/processes, our study provides a starting list for providers to prioritize and for researchers to investigate further for specific effects on patient outcomes.
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Affiliation(s)
- Ann M. Nguyen
- Center for State Health Policy, Rutgers University, New Brunswick, New Jersey (Dr Nguyen); Department of Population Health, NYU Langone Health, New York City, New York (Drs Paul, Albert, Blecker, and Berry); Department of Policy and Public Health Management, New York University School of Global Public Health, New York City, New York (Dr Shelley); and Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon (Drs Cohen and Wyte-Lake and Ms Bonsu)
| | - Margaret M. Paul
- Center for State Health Policy, Rutgers University, New Brunswick, New Jersey (Dr Nguyen); Department of Population Health, NYU Langone Health, New York City, New York (Drs Paul, Albert, Blecker, and Berry); Department of Policy and Public Health Management, New York University School of Global Public Health, New York City, New York (Dr Shelley); and Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon (Drs Cohen and Wyte-Lake and Ms Bonsu)
| | - Donna R. Shelley
- Center for State Health Policy, Rutgers University, New Brunswick, New Jersey (Dr Nguyen); Department of Population Health, NYU Langone Health, New York City, New York (Drs Paul, Albert, Blecker, and Berry); Department of Policy and Public Health Management, New York University School of Global Public Health, New York City, New York (Dr Shelley); and Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon (Drs Cohen and Wyte-Lake and Ms Bonsu)
| | - Stephanie L. Albert
- Center for State Health Policy, Rutgers University, New Brunswick, New Jersey (Dr Nguyen); Department of Population Health, NYU Langone Health, New York City, New York (Drs Paul, Albert, Blecker, and Berry); Department of Policy and Public Health Management, New York University School of Global Public Health, New York City, New York (Dr Shelley); and Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon (Drs Cohen and Wyte-Lake and Ms Bonsu)
| | - Deborah J. Cohen
- Center for State Health Policy, Rutgers University, New Brunswick, New Jersey (Dr Nguyen); Department of Population Health, NYU Langone Health, New York City, New York (Drs Paul, Albert, Blecker, and Berry); Department of Policy and Public Health Management, New York University School of Global Public Health, New York City, New York (Dr Shelley); and Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon (Drs Cohen and Wyte-Lake and Ms Bonsu)
| | - Pam Bonsu
- Center for State Health Policy, Rutgers University, New Brunswick, New Jersey (Dr Nguyen); Department of Population Health, NYU Langone Health, New York City, New York (Drs Paul, Albert, Blecker, and Berry); Department of Policy and Public Health Management, New York University School of Global Public Health, New York City, New York (Dr Shelley); and Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon (Drs Cohen and Wyte-Lake and Ms Bonsu)
| | - Tamar Wyte-Lake
- Center for State Health Policy, Rutgers University, New Brunswick, New Jersey (Dr Nguyen); Department of Population Health, NYU Langone Health, New York City, New York (Drs Paul, Albert, Blecker, and Berry); Department of Policy and Public Health Management, New York University School of Global Public Health, New York City, New York (Dr Shelley); and Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon (Drs Cohen and Wyte-Lake and Ms Bonsu)
| | - Saul Blecker
- Center for State Health Policy, Rutgers University, New Brunswick, New Jersey (Dr Nguyen); Department of Population Health, NYU Langone Health, New York City, New York (Drs Paul, Albert, Blecker, and Berry); Department of Policy and Public Health Management, New York University School of Global Public Health, New York City, New York (Dr Shelley); and Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon (Drs Cohen and Wyte-Lake and Ms Bonsu)
| | - Carolyn A. Berry
- Center for State Health Policy, Rutgers University, New Brunswick, New Jersey (Dr Nguyen); Department of Population Health, NYU Langone Health, New York City, New York (Drs Paul, Albert, Blecker, and Berry); Department of Policy and Public Health Management, New York University School of Global Public Health, New York City, New York (Dr Shelley); and Department of Family Medicine, Oregon Health & Science University School of Medicine, Portland, Oregon (Drs Cohen and Wyte-Lake and Ms Bonsu)
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22
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Team-Based Care in Patients with Chronic Limb-Threatening Ischemia. Curr Cardiol Rep 2022; 24:217-223. [PMID: 35129740 DOI: 10.1007/s11886-022-01643-2] [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] [Accepted: 11/18/2021] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Team-based care has been proposed as a tool to improve health care delivery, especially for the treatment of complex medical conditions. Chronic limb-threatening ischemia (CLTI) is a complex disease associated with significant morbidity and mortality which often involves the care of multiple specialty providers. Coordination of efforts across the multiple physician specialists, nurses, wound care specialists, and administrators is essential to providing high-quality and efficient care. The aim of this review is to discuss the multiple facets of care of the CLTI patient and to describe components important for a team-based care approach. RECENT FINDINGS Observational studies have reported improved outcomes when using a team-based care approach in the care of the patients with CLTI, including reduction in mean wound healing times, decreasing rate of amputations, and readmissions. Team-based care can streamline care of CLTI patients by raising awareness, facilitating early recognition, and providing prompt vascular assessment, revascularization, and surveillance. This approach has the potential to improve patient outcomes and reduce downstream health care costs.
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23
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Flores BE, Fernandez AA, Wang CP, Bobadilla R, Hernandez L, Jain MK, Turner BJ. Educating Primary Care Providers and Associate Care Providers About Hepatitis C Screening of Baby Boomers: a Multi-practice Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:217-223. [PMID: 32588350 DOI: 10.1007/s13187-020-01805-2] [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: 06/11/2023]
Abstract
Chronic hepatitis C virus (HCV) increases the risk for hepatocellular carcinoma. Despite higher prevalence of HCV in persons born 1945-1965 (baby boomer), screening has not been widely adopted. Both primary care providers (PCPs) and associate care providers (ACPs) need to be educated about the rationale and methods to screen for HCV. In five Federally Qualified Health Centers serving low-income Hispanic communities, PCPs and ACPs attended a 50-min training lecture about HCV epidemiology, screening methods, and evaluation. Using a 12-item questionnaire, knowledge and attitudes were compared for PCPs and ACPs at baseline (pre-test) and following training (post-test). A higher proportion of PCPs correctly answered 3 of 6 knowledge questions on both pre-test and post-test but ACPs' showed more improvement in knowledge (all P < 0.05). ACPs had more favorable attitudes about linking patients to care on pre- and post-tests than PCPs, and ACPs' attitudes improved on all 6 items versus 4 for PCPs. Both PCPs and ACPs improved knowledge and attitudes after training about HCV screening but ACPs had more favorable attitudes than PCPs. Engaging the entire primary care practice team in learning about HCV screening promotes knowledge and attitudes necessary for successful implementation.
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Affiliation(s)
- Bertha E Flores
- School of Nursing, UT Health San Antonio, San Antonio, TX, 78229-3900, USA
| | - Andrea A Fernandez
- School of Nursing, UT Health San Antonio, San Antonio, TX, 78229-3900, USA
| | - Chen-Pin Wang
- Population Health, UT Health San Antonio, San Antonio, TX, USA
- Center for Research to Advance Community Health (ReACH), UT Health San Antonio, San Antonio, TX, USA
| | - Raudel Bobadilla
- Center for Research to Advance Community Health (ReACH), UT Health San Antonio, San Antonio, TX, USA
| | - Ludivina Hernandez
- Center for Research to Advance Community Health (ReACH), UT Health San Antonio, San Antonio, TX, USA
| | | | - Barbara J Turner
- Gehr Center for Health Systems Science and Innovation, Keck School of Medicine, University of Southern California, 2020 Zonal Dr IRD 322, Los Angeles, CA, 91202, USA.
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24
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Kornbluth L, Kaplan CP, Diamond L, Karliner LS. Communication methods between outpatients with limited-English proficiency and ancillary staff: LASI study results. PATIENT EDUCATION AND COUNSELING 2022; 105:246-249. [PMID: 34023171 PMCID: PMC8868014 DOI: 10.1016/j.pec.2021.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Describe communication methods between primary care ancillary staff, including front desk administrative staff and medical assistants (MAs), and patients with limited-English proficiency (LEP). METHODS Patients with LEP completed a telephone survey after a primary care visit including questions about communication with ancillary staff (n = 1029). To inform practice improvements and lend qualitative perspective to these quantitative data, we subsequently conducted semi-structured interviews with ancillary staff and physicians. RESULTS Professional interpreter use was minimal with ancillary staff (<4%). Among patients who did not use their preferred language with bilingual staff, about one-third reported using English to communicate, despite most (≥ 80%) speaking English 'not well' or 'not at all.' In semi-structured interviews, ancillary staff felt basic English sufficient for most patient communication. However, physicians reported taking on extra visit tasks to compensate for the communication barriers between ancillary staff and patients with LEP. CONCLUSIONS Use of professional interpretation by front desk staff and MAs was minimal. This led many patients with LEP to 'get by' with limited English when communicating with ancillary staff, in turn increasing burden on the physician visit. PRACTICE IMPLICATIONS Future interventions should focus on increasing use of professional interpretation by outpatient ancillary staff when communicating with LEP patients.
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Affiliation(s)
- Lily Kornbluth
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco (UCSF), USA.
| | - Celia P Kaplan
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco (UCSF), USA; Multiethnic Health Equity Research Center, Division of General Internal Medicine, University of California San Francisco (UCSF), USA
| | - Lisa Diamond
- Department of Psychiatry and Behavioral Sciences, Immigrant Health and Cancer Disparities Service, Memorial Sloan-Kettering Cancer Center, USA
| | - Leah S Karliner
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco (UCSF), USA; Multiethnic Health Equity Research Center, Division of General Internal Medicine, University of California San Francisco (UCSF), USA
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Marrast L, Congliaro J, Doonachar A, Rogers A, Block L, LaVine N, Fornari A. Developing a team-based assessment strategy: direct observation of interprofessional team performance in an ambulatory teaching practice. MEDEDPUBLISH 2021. [DOI: 10.12688/mep.17422.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: High functioning interprofessional teams may benefit from understanding how well (or not so well) a team is functioning and how teamwork can be improved. A team-based assessment can provide team insight into performance and areas for improvement. Though individual assessment via direct observation is common, few residency programs in the United States have implemented strategies for interprofessional team (IPT) assessments. Methods: We piloted a program evaluation via direct observation for a team-based assessment of an IPT within one Internal Medicine residency program. Our teams included learners from medicine, pharmacy, physician assistant and psychology graduate programs. To assess team performance in a systematic manner, we used a Modified McMaster-Ottawa tool to observe three types of IPT encounters: huddles, patient interactions and precepting discussions with faculty. The tool allowed us to capture team behaviors across various competencies: roles/responsibilities, communication with patient/family, and conflict resolution. We adapted the tool to include qualitative data for field notes by trained observers that added context to our ratings. Results: We observed 222 encounters over four months. Our results support that the team performed well in measures that have been iteratively and intentionally enhanced – role clarification and conflict resolution. However, we observed a lack of consistent incorporation of patient-family preferences into IPT discussions. Our qualitative results show that team collaboration is fostered when we look for opportunities to engage interprofessional learners. Conclusions: Our observations clarify the behaviors and processes that other IPTs can apply to improve collaboration and education. As a pilot, this study helps to inform training programs of the need to develop measures for, not just individual assessment, but also IPT assessment.
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O'Brien MJ, Stephen JJ, Norton KL, Meehan TP, Vojta D, Ackermann RT. Integrating diabetes technologies with team-based primary care for type 2 diabetes: A pilot trial. Prim Care Diabetes 2021; 15:1104-1106. [PMID: 34301495 PMCID: PMC9172266 DOI: 10.1016/j.pcd.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 06/21/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
This pilot trial studied a novel intervention that integrated diabetes technologies into team-based primary care for type 2 diabetes. We found clinically significant reductions in blood pressure, weight, and glucose. The latter two were statistically significant.
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Affiliation(s)
- Matthew J O'Brien
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States.
| | - John J Stephen
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | | | | | | | - Ronald T Ackermann
- Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States; Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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Integration of Primary Care Teams Within the Examination Room: A Qualitative Study of Advanced Team-Based Care. J Ambul Care Manage 2021; 45:63-72. [PMID: 34812755 DOI: 10.1097/jac.0000000000000402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Multidisciplinary teams deliver high-quality care in complex primary care environments. Using qualitative interviews, we explored the interpersonal dynamics of care team members from 2 models-traditional team-based care and "advanced team-based care" (aTBC). Two differentiating themes emerged-the ways care teams learned and collaborated. aTBC participants described learning from each other and integrating their roles and tasks more so than the traditional model. These differences have implications for patient care and care team member well-being. Our results provide a framework for improving team-based care models and for further research on the impact of adaptive learning and integration in primary care settings.
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Burnout in French General Practitioners: A Nationwide Prospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212044. [PMID: 34831796 PMCID: PMC8624683 DOI: 10.3390/ijerph182212044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 11/08/2021] [Accepted: 11/15/2021] [Indexed: 01/04/2023]
Abstract
Background: We aimed to evaluate the prevalence of burnout among French general practitioners in private practice and to study the risk and protective factors of burnout. Methods: A nationwide cross-sectional study was conducted with French GPs working in a private practice in France who were asked to fulfil an internet questionnaire. We used the secure internet application REDCap®. Exclusion criteria were only working in a hospital, substitute doctors, and internship students. There was a putative sample size of 88,886 GPs. We retrieved the Maslach Burnout Inventory (MBI), occupational characteristics (type of installation, emergency regulated shifts, night shifts, university supervisor, weekly hours worked, seniority), and personal characteristics such as age, gender, marital status, and number of children. Results: We included 1926 GPs among the 2602 retrieved questionnaires. A total of 44.8% of French liberal GPs were experiencing burnout, with 4.8% (95%CI 3.9–5.9%) experiencing severe burnout. The risk factors of severe burnout were male gender (RR = 1.91, 95%CI 1.15–3.16), working in a suburban area (5.23, 2.18–12.58), and having more than 28 appointments per day (1.95, 1.19–3.19). Working more than 50 h weekly showed a tendency to increase the risk of severe burnout (1.55, 0.93–2.59, p = 0.095), with a significant increase in the risk of low and moderate burnout (1.31, 1.02–1.67 and 1.86, 1.34–2.57, respectively). Protective factors were mainly resident training, which decreased the risk of both low, moderate, and severe burnout (0.65, 0.51–0.83; 0.66, 0.48–0.92; and 0.42, 95%CI 0.23–0.76, respectively). Performing home visits decreased the risk of severe burnout (0.25, 0.13–0.47), as did group practice for intermediate level of burnout (0.71, 0.51–0.96). Conclusion: GPs are at a high risk of burnout, with nearly half of them in burnout, with burnout predominantly affecting males and those between the ages of 50 and 60 years old. The main risk factors were a high workload with more than 28 appointments per day or 50 h of work per week, and the main protective factors were related to social cohesion such having a teaching role and working in a group practice with back-office support.
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Assessment of Primary Care Content in a Nursing Curriculum: Identification of Gaps and Strategies for Integration. Nurse Educ 2021; 47:E7-E11. [PMID: 34482342 DOI: 10.1097/nne.0000000000001086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because of the rapidly emerging need for more RNs in primary care, schools of nursing are challenged with preparing students for these roles. PURPOSE The purpose of the project was to use the Faculty Primary Care Assessment Tool to evaluate the extent of primary care content in the prelicensure curriculum and identify strategies for primary care content integration. METHODS A quality improvement approach was used for this evaluation. Thirty-one faculty (44%) completed the Faculty Primary Care Assessment Tool. RESULTS The majority of the content items were scored between 1.55 and 3.4, indicating minimal integration of primary care concepts. Courses that had high integration of primary care content were leadership and psychiatric-mental health courses. CONCLUSIONS Our findings provide a valuable tool to assist with the integration of primary care content in the prelicensure curriculum.
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Knop M, Mueller M, Niehaves B. Investigating the Use of Telemedicine for Digitally Mediated Delegation in Team-Based Primary Care: Mixed Methods Study. J Med Internet Res 2021; 23:e28151. [PMID: 34435959 PMCID: PMC8430853 DOI: 10.2196/28151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 06/24/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022] Open
Abstract
Background Owing to the shortage of medical professionals, as well as demographic and structural challenges, new care models have emerged to find innovative solutions to counter medical undersupply. Team-based primary care using medical delegation appears to be a promising approach to address these challenges; however, it demands efficient communication structures and mechanisms to reinsure patients and caregivers receive a delegated, treatment-related task. Digital health care technologies hold the potential to render these novel processes effective and demand driven. Objective The goal of this study is to recreate the daily work routines of general practitioners (GPs) and medical assistants (MAs) to explore promising approaches for the digital moderation of delegation processes and to deepen the understanding of subjective and perceptual factors that influence their technology assessment and use. Methods We conducted a combination of 19 individual and group interviews with 12 GPs and 14 MAs, seeking to identify relevant technologies for delegation purposes as well as stakeholders’ perceptions of their effectiveness. Furthermore, a web-based survey was conducted asking the interviewees to order identified technologies based on their assessed applicability in multi-actor patient care. Interview data were analyzed using a three-fold inductive coding procedure. Multidimensional scaling was applied to analyze and visualize the survey data, leading to a triangulation of the results. Results Our results suggest that digital mediation of delegation underlies complex, reciprocal processes and biases that need to be identified and analyzed to improve the development and distribution of innovative technologies and to improve our understanding of technology use in team-based primary care. Nevertheless, medical delegation enhanced by digital technologies, such as video consultations, portable electrocardiograms, or telemedical stethoscopes, can counteract current challenges in primary care because of its unique ability to ensure both personal, patient-centered care for patients and create efficient and needs-based treatment processes. Conclusions Technology-mediated delegation appears to be a promising approach to implement innovative, case-sensitive, and cost-effective ways to treat patients within the paradigm of primary care. The relevance of such innovative approaches increases with the tremendous need for differentiated and effective care, such as during the ongoing COVID-19 pandemic. For the successful and sustainable adoption of innovative technologies, MAs represent essential team members. In their role as mediators between GPs and patients, MAs are potentially able to counteract patients’ resistance toward using innovative technology and compensate for patients’ limited access to technology and care facilities.
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Affiliation(s)
- Michael Knop
- Chair of Information Systems, University of Siegen, Siegen, Germany
| | - Marius Mueller
- Chair of Information Systems, University of Siegen, Siegen, Germany
| | - Bjoern Niehaves
- Chair of Information Systems, University of Siegen, Siegen, Germany
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Framing the Integration of Community Health Workers Into Health Care Systems Along Health Care and Community Spectrums. J Ambul Care Manage 2021; 44:271-280. [PMID: 34347715 DOI: 10.1097/jac.0000000000000396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research calls for community health worker (CHW) integration within health systems, yet there is no agreement regarding what CHW integration is or guidance for how it can be achieved. This study examines factors associated with CHW integration in community and health care settings using a qualitative descriptive multiple-embedded case study of CHW teams at the University of Illinois at Chicago. Data were collected via semistructured interviews/document review and analyzed using thematic coding and quantitative content analysis. Factors associated with higher clinical integration included culture, communication, protocols, and training while higher community integration was associated with accessibility, relationships, and empathy.
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Optimizing Huddle Engagement Through Leadership and Problem Solving Within Primary Care: Results from a Cluster-Randomized Trial. J Gen Intern Med 2021; 36:2292-2299. [PMID: 33501530 PMCID: PMC8342734 DOI: 10.1007/s11606-020-06487-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Leaders play a crucial role in implementing and sustaining changes in clinical practice, yet there is limited evidence on the strategies to engage them in team problem solving and communication. OBJECTIVE Examine the impact of an intervention focused on facilitating leadership during daily huddles on optimizing team-based care and improving outcomes. DESIGN Cluster-randomized trial using intention-to-treat analysis to measure the effects of the intervention (n = 13 teams) compared with routine practice (n = 16 teams). PARTICIPANTS Twenty-nine primary care clinics affiliated with a large integrated health system in the upper Midwest; representing differing practice types and geographic settings. INTERVENTION Full-day leadership training retreat for team leaders to facilitate of care team huddles. Biweekly coaching calls and two site visits with an assigned coach. MAIN MEASURES Primary outcomes of team development and function were collected, pre- and post-intervention using surveys. Patient satisfaction and quality outcomes were compared pre- and post-intervention as secondary outcomes. Leadership engagement and adherence to the intervention were also assessed. KEY RESULTS A total of 279 pre-intervention and 272 post-intervention surveys were completed. We found no impact on team development (- 0.98, 95% CI (- 3.18, 1.22)), improved team credibility (0.18, 95% CI (0.00, 0.35)), but worse psychological safety (- 0.19, 95% CI (- 0.38, 0.00)). No differences were observed in patient satisfaction; however, results were mixed among quality outcomes. Post hoc analysis within the intervention group showed higher adherence to the intervention was associated with improvement in team coordination (0.47, 95% CI (0.18, 0.76)), credibility (0.28, 95% CI (0.02, 0.53)), team learning (0.42, 95% CI (0.10, 0.74)), and knowledge creation (0.74, 95% CI (0.35, 1.13)) compared to teams that were less engaged. CONCLUSIONS Results of this evaluation showed that leadership training and facilitation were not associated with better team functioning. Additional components to the intervention tested may be necessary to enhance team functioning. TRIAL REGISTRATION Clinicaltrials.gov Identifier NCT03062670. Registration Date: February 23, 2017. URL: https://clinicaltrials.gov/ct2/show/NCT03062670.
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Lall D, Engel N, Devadasan N, Horstman K, Criel B. Team-based primary health care for non-communicable diseases: complexities in South India. Health Policy Plan 2021; 35:ii22-ii34. [PMID: 33156934 PMCID: PMC7646724 DOI: 10.1093/heapol/czaa121] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2020] [Indexed: 12/26/2022] Open
Abstract
Chronic non-communicable diseases (NCDs), such as diabetes and cardiovascular diseases, have reached epidemic proportions worldwide. Health systems, especially those in low- and middle-income countries, such as India, struggle to deliver quality chronic care. A reorganization of healthcare service delivery is needed to strengthen care for chronic conditions. In this study, we evaluated the implementation of a package of tailored interventions to reorganize care, which were identified following a detailed analysis of gaps in delivering quality NCD care at the primary care level in India. Interventions included a redesign of the workflow at primary care clinics, a redistribution of tasks, the introduction of patient information records and the involvement of community health workers in the follow-up of patients with NCDs. An experimental case study design was chosen to study the implementation of the quality improvement measures. Three public primary care facilities in rural South India were selected. Qualitative methods were used to gain an in-depth understanding of the implementation process and outcomes of implementation. Observations, field notes and semi-structured interviews with staff at these facilities (n = 15) were thematically analysed to identify contextual factors that influenced implementation. Only one of the primary health centres implemented all components of the intervention by the end of 9 months. The main barriers to implementation were hierarchical arrangements that inhibited team-based care, the amount of time required for counselling and staff transfers. Team cohesion, additional staff and staff motivation seem to have facilitated implementation. This quality improvement research highlights the importance of building relational leadership to enable team-based care at primary care clinics in India. Redesigned organization of care and task redistribution is important solutions to deliver quality chronic care. However, implementing these will require capacity building of local primary care teams.
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Affiliation(s)
- Dorothy Lall
- Institute of Public Health, 3009, II-A Main, 17th Cross, KR Rd, Siddanna Layout, Banashankari Stage II, Banashankari, Bengaluru, Karnataka, 560070 India
| | - Nora Engel
- Department of Health, Ethics & Society, CAPHRI Care and Public Health Research Institute, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Narayanan Devadasan
- Institute of Public Health, 3009, II-A Main, 17th Cross, KR Rd, Siddanna Layout, Banashankari Stage II, Banashankari, Bengaluru, Karnataka, 560070 India
| | - Klasien Horstman
- Department of Health, Ethics & Society, CAPHRI Care and Public Health Research Institute, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Bart Criel
- Institute of Tropical Medicine, Nationalestraat 155, Antwerpen 2000, Belgium
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Wright LE, Baus A, Calkins A, Hartman-Adams H, Conn ME, Eason S, Kennedy-Rea S. Case Study of a Comprehensive Team-Based Approach to Increase Colorectal Cancer Screening. JOURNAL OF APPALACHIAN HEALTH 2021; 3:86-96. [PMID: 35770036 PMCID: PMC9192119 DOI: 10.13023/jah.0303.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction Colorectal cancer is the second leading cause of cancer deaths among men and women in West Virginia. In addition, 51% of all colorectal cancers diagnosed in West Virginia from 2012 to 2016 were detected at either regional (31%) or distant (20%) stages indicating a need for improved early detection. Methods West Virginia University Cheat Lake Physicians participated in the West Virginia Program to Increase Colorectal Cancer Screening, a program of Cancer Prevention and Control at the WVU Cancer Institute. As a result, Cheat Lake Physicians assembled a team of health care professionals to implement evidence-based interventions and system changes including provider assessment and feedback, patient reminders, accurate data capture, and tracking of CRC screening tests. Results These efforts resulted in a 15.8% increase in colorectal cancer screening rates within one year of implementation. Additionally, the clinic achieved a 66% return rate for Fecal Immunochemical Test kits, an inexpensive, stool-based colorectal cancer screening test. Implications The utilization of a team-based approach to patient care yields positive results that can be carried over to other cancer and disease prevention efforts in primary care clinics.
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Affiliation(s)
| | - Adam Baus
- West Virginia University School of Public Health
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Schraeder K, Dimitropoulos G, Allemang B, McBrien K, Samuel S. Strategies for improving primary care for adolescents and young adults transitioning from pediatric services: perspectives of Canadian primary health care professionals. Fam Pract 2021; 38:329-338. [PMID: 33128378 PMCID: PMC8211142 DOI: 10.1093/fampra/cmaa113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Family physicians and other members of the primary health care (PHC) team may be ideally positioned to provide transition care to adolescents and young adults (AYAs; aged 12-25 years) exiting pediatric specialty services. Potential solutions to well-known challenges associated with integrating PHC and specialty care need to be explored. OBJECTIVE To identify strategies to transition care by PHC professionals for AYAs with chronic conditions transitioning from pediatric to adult-oriented care. METHODS Participants were recruited from six Primary Care Networks in Calgary, Alberta. A total of 18 semi-structured individual interviews were completed, and transcribed verbatim. Data were analyzed using a qualitative description approach, involving thematic analysis. RESULTS Participants offered a range of strategies for supporting AYAs with chronic conditions. Our analysis resulted in three overarching themes: (i) educating AYAs, families, and providers about the critical role of primary care; (ii) adapting existing primary care supports for AYAs and (iii) designing new tools or primary care practices for transition care. CONCLUSIONS Ongoing and continuous primary care is important for AYAs involved with specialty pediatric services. Participants highlighted a need to educate AYAs, families and providers about the critical role of PHC. Solutions to improve collaboration between PHC and pediatric specialist providers would benefit from additional perspectives from providers, AYAs and families. These findings will inform the development of a primary care-based intervention to improve transitional care.
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Affiliation(s)
| | - Gina Dimitropoulos
- Faculty of Social Work
- Mathison Centre for Mental Health Research & Education
| | | | - Kerry McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Susan Samuel
- Department of Pediatrics, Cumming School of Medicine
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Ng CJ, Spomer N, Shearer R, LeBlanc A, Funk S, Manco-Johnson M, Branchford B, Warren B, Buckner TW, Cowell A, Moyer G, Wang M, Gibson E, Mashburn C. Improvements in Communication and Coordination of Care in a Hemophilia Treatment Center. Acta Haematol 2021; 144:672-677. [PMID: 33915533 DOI: 10.1159/000515350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/19/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In response to the increasing complexity of care for patients with bleeding disorders, we established new clinical teams for our hemophilia treatment center (HTC). AIMS We undertook a quality improvement project to improve the coordination and communication with our patients by establishing primary assignments of clinical staff to individual patients (primary teams). METHODS A quality improvement project group was formed that established the goals and assignment of primary teams. Patients were surveyed for their knowledge of their primary teams as well as their ability to schedule and contact their primary providers. As a measure of the effects on clinical staff, a balancing survey was also conducted among providers impacted by the clinical assignment of teams. RESULTS Our results demonstrate improvements across both coordination and communication as reported by patients. Additionally, the assignment of primary teams was met with high satisfaction and improvement in coordination and communication as reported by the clinical staff members of the HTC. CONCLUSIONS Initiation of a quality improvement project and the creation of a primary team system were feasible at a large HTC and resulted in improvements in both patient-reported and staff-reported outcomes of coordination and communication of care.
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Affiliation(s)
- Christopher J Ng
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Nancy Spomer
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Rick Shearer
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Audra LeBlanc
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sharon Funk
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marilyn Manco-Johnson
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Brian Branchford
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Beth Warren
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Tyler W Buckner
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amy Cowell
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Genevieve Moyer
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Michael Wang
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elizabeth Gibson
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Christine Mashburn
- Hemophilia and Thrombosis Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Khan AI, Barnsley J, Harris JK, Wodchis WP. Examining the extent and factors associated with interprofessional teamwork in primary care settings. J Interprof Care 2021; 36:52-63. [PMID: 33870838 DOI: 10.1080/13561820.2021.1874896] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Despite growing emphasis on adopting team-based models of primary care to facilitate patient access to a diverse range of care providers, our understanding of team functioning within primary care teams remains limited. This study examined interprofessional teamwork within primary care practices (Family Health Teams [FHT] and Community Health Centers - [CHC]) in Ontario and explored team-level and organizational factors associated with interprofessional teamwork. Interprofessional teamwork was measured using the Collaborative Practice Assessment Tool (CPAT), which was completed by providers in each participating team. The CPAT responses of 988 providers representing on average 12 professions (sd = 2.1) across 66 teams (44 FHTs and 22 CHCs) were included in the analysis. The average CPAT score was 46.6 (sd = 2.5). CHCs had significantly higher CPAT scores than FHTs (mdiff = 1.7, p = .02). Using diverse communication mechanisms to share information, increasing quality improvement capacities, and age of practice, had a statistically significant positive association with CPAT scores. Increasing team size, using centralized administrative processes, a high level of information exchange, and having a mixed governance board were significantly negatively associated with CPAT score. Findings illustrate factors associated with interprofessional teamwork and offer insight into the comparative performance of two team-based primary care models in Ontario.
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Affiliation(s)
- Anum Irfan Khan
- Institute of Health Policy, Management and Evaluation, Toronto, Canada
| | - Jan Barnsley
- Institute of Health Policy, Management and Evaluation, Toronto, Canada
| | | | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, Toronto, Canada.,Institute for Better Health - Trillium Health Partners, Canada
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Jan CFJ, Chang CJJ, Hwang SJ, Chen TJ, Yang HY, Chen YC, Huang CK, Chiu TY. Impact of team-based community healthcare on preventable hospitalisation: a population-based cohort study in Taiwan. BMJ Open 2021; 11:e039986. [PMID: 33593765 PMCID: PMC7888366 DOI: 10.1136/bmjopen-2020-039986] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES The objective of this study was to explore the impact of Taiwan's Family Practice Integrated Care Project (FPICP) on hospitalisation. DESIGN A population-based cohort study compared the hospitalisation rates for ambulatory care sensitive conditions (ACSCs) among FPICP participating and non-participating patients during 2011-2015. SETTING The study accessed the FPICP reimbursement database of Taiwan's National Health Insurance (NHI) administration containing all NHI administration-selected patients for FPICP enrolment. PARTICIPANTS The NHI administration-selected candidates from 2011 to 2015 became FPICP participants if their primary care physicians joined the project, otherwise they became non-participants. INTERVENTIONS The intervention of interest was enrolment in the FPICP or not. The follow-up time interval for calculating the rate of hospitalisation was the year in which the patient was selected for FPICP enrolment or not. PRIMARY OUTCOME MEASURES The study's primary outcome measures were hospitalisation rates for ACSC, including asthma/chronic obstructive pulmonary disease (COPD), diabetes or its complications and heart failure. Logistic regression was used to calculate the ORs concerning the influence of FPICP participation on the rate of hospitalisation for ACSC. RESULTS The enrolled population for data analysis was between 3.94 and 5.34 million from 2011 to 2015. Compared to non-participants, FPICP participants had lower hospitalisation for COPD/asthma (28.6‰-35.9‰ vs 37.9‰-42.3‰) and for diabetes or its complications (10.8‰-14.9‰ vs 12.7‰-18.1‰) but not for congestive heart failure. After adjusting for age, sex and level of comorbidities by logistic regression, participation in the FPICP was associated with lower hospitalisation for COPD/asthma (OR 0.91, 95% CI 0.87 to 0.94 in 2015) and for diabetes or its complications (OR 0.87, 95% CI 0.83 to 0.92 in 2015). CONCLUSION Participation in the FPICP is an independent protective factor for preventable ACSC hospitalisation. Team-based community healthcare programs such as the FPICP can strengthen primary healthcare capacity.
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Affiliation(s)
- Chyi-Feng Jeff Jan
- Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | | | - Shinn-Jang Hwang
- Family Medicine, National Yang-Ming Medical College, Taipei, Taiwan
- Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Taiwan Association of Family Medicine, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Family Medicine, National Yang-Ming Medical College, Taipei, Taiwan
- Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsiao-Yu Yang
- Department of Public Health and Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Yu-Chun Chen
- Family Medicine, National Yang-Ming Medical College, Taipei, Taiwan
- Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Cheng-Kuo Huang
- Taiwan Association of Family Medicine, Taipei, Taiwan
- Taiwan Medical Association, Taipei, Taiwan
| | - Tai-Yuan Chiu
- Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Family Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Taiwan Medical Association, Taipei, Taiwan
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Lee JK, McCutcheon LRM, Fazel MT, Cooley JH, Slack MK. Assessment of Interprofessional Collaborative Practices and Outcomes in Adults With Diabetes and Hypertension in Primary Care: A Systematic Review and Meta-analysis. JAMA Netw Open 2021; 4:e2036725. [PMID: 33576817 PMCID: PMC7881360 DOI: 10.1001/jamanetworkopen.2020.36725] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
IMPORTANCE Interprofessional collaborative practice (ICP), the collaboration of health workers from different professional backgrounds with patients, families, caregivers, and communities, is central to optimal primary care. However, limited evidence exists regarding its association with patient outcomes. OBJECTIVE To examine the association of ICP with hemoglobin A1C (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels among adults receiving primary care. DATA SOURCES A literature search of English language journals (January 2013-2018; updated through March 2020) was conducted using MEDLINE; Embase; Ovid IPA; Cochrane Central Register of Controlled Trials: Issue 2 of 12, February 2018; NHS Economic Evaluation Database: Issue 2 of 4, April 2015; Clarivate Analytics WOS Science Citation Index Expanded (1990-2018); EBSCOhost CINAHL Plus With Full Text (1937-2018); Elsevier Scopus; FirstSearch OAIster; AHRQ PCMH Citations Collection; ClinicalTrials.gov; and HSRProj. STUDY SELECTION Studies needed to evaluate the association of ICP (≥3 professions) with HbA1c, SBP, or DBP levels in adults with diabetes and/or hypertension receiving primary care. A dual review was performed for screening and selection. DATA EXTRACTION AND SYNTHESIS This systematic review and meta-analysis followed the PRISMA guideline for data abstractions and Cochrane Collaboration recommendations for bias assessment. Two dual review teams conducted independent data extraction with consensus. Data were pooled using a random-effects model for meta-analyses and forest plots constructed to report standardized mean differences (SMDs). For high heterogeneity (I2), data were stratified by baseline level and by study design. MAIN OUTCOMES AND MEASURES The primary outcomes included HbA1c, SBP, and DBP levels as determined before data collection. RESULTS A total of 3543 titles or abstracts were screened; 170 abstracts or full texts were reviewed. Of 50 articles in the systematic review, 39 (15 randomized clinical trials [RCTs], 24 non-RCTs) were included in the meta-analyses of HbA1c (n = 34), SBP (n = 25), and DBP (n = 24). The sample size ranged from 40 to 20 524, and mean age ranged from 51 to 70 years, with 0% to 100% participants being male. Varied ICP features were reported. The SMD varied by baseline HbA1c, although all SMDs significantly favored ICP (HbA1c <8, SMD = -0.13; P < .001; HbA1c ≥8 to < 9, SMD = -0.24; P = .007; and HbA1c ≥9, SMD = -0.60; P < .001). The SMD for SBP and DBP were -0.31 (95% CI, -0.46 to -0.17); P < .001 and -0.28 (95% CI, -0.42 to -0.14); P < .001, respectively, with effect sizes not associated with baseline levels. Overall I2 was greater than 80% for all outcomes. CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found that ICP was associated with reductions in HbA1c regardless of baseline levels as well as with reduced SBP and DBP. However, the greatest reductions were found with HbA1c levels of 9 or higher. The implementation of ICP in primary care may be associated with improvements in patient outcomes in diabetes and hypertension.
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Affiliation(s)
| | - Livia R. M. McCutcheon
- Star Wellness Family Practice, St Luke’s Family Medicine Residency, Bethlehem, Pennsylvania
- Nesbitt School of Pharmacy, Wilkes University, Wilkes-Barre, Pennsylvania
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Antibiotische Therapie: Behandlungsdauer häufiger Infekte in der Praxis. Laryngorhinootologie 2020; 99:755-756. [PMID: 33111289 DOI: 10.1055/a-1264-3815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Hartkopf KJ, Heimerl KM, McGowan KM, Arndt BG. Expansion and Evaluation of Pharmacist Services in Primary Care. PHARMACY 2020; 8:pharmacy8030124. [PMID: 32707794 PMCID: PMC7559880 DOI: 10.3390/pharmacy8030124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 02/06/2023] Open
Abstract
Challenges with primary care access and overextended providers present opportunities for pharmacists as patient care extenders for chronic disease management. The primary objective was to align primary care pharmacist services with organizational priorities and improve patient clinical outcomes. The secondary objective was to develop a technological strategy for service evaluation. An interdisciplinary workgroup developed primary care pharmacist services focused on improving performance measures and supporting the care team in alignment with ongoing population health initiatives. Pharmacist collaborative practice agreements (CPAs) were developed and implemented. An electronic dashboard was developed to capture service outcome measures. Blood pressure control to <140/90 mmHg was achieved in 74.15% of patients who engaged with primary care pharmacists versus 41.53% of eligible patients electing to follow usual care pathways. Appropriate statin use was higher in patients engaged with primary care pharmacists than in eligible patients electing to follow usual care pathways both for diabetes and ischemic vascular disease (12.4% and 2.2% higher, respectively). Seventeen of 54 possible process and outcome measures were identified and incorporated into an electronic dashboard. Primary care pharmacist services improve hypertension control and statin use. Service outcomes can be measured with discrete data from the electronic health record (EHR), and should align with organizational priorities.
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Affiliation(s)
- Katherine J. Hartkopf
- Department of Pharmacy, University of Wisconsin Health, Madison, WI 53792, USA; (K.M.H.); (K.M.M.)
- Correspondence:
| | - Kristina M. Heimerl
- Department of Pharmacy, University of Wisconsin Health, Madison, WI 53792, USA; (K.M.H.); (K.M.M.)
| | - Kayla M. McGowan
- Department of Pharmacy, University of Wisconsin Health, Madison, WI 53792, USA; (K.M.H.); (K.M.M.)
| | - Brian G. Arndt
- Department of Family Medicine and Community Health, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53706, USA;
- University of Wisconsin Health PATH Collaborative (Primary Care Academics Transforming Healthcare), Madison, WI 53705, USA
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Askerud A, Jaye C, McKinlay E, Doolan-Noble F. What is the answer to the challenge of multimorbidity in New Zealand? J Prim Health Care 2020; 12:118-121. [PMID: 32594978 DOI: 10.1071/hc20028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/21/2020] [Indexed: 11/23/2022] Open
Abstract
The increasing prevalence of multimorbidity, a growing ageing population and lack of success in addressing the negative effect of socioeconomic and cultural determinants of health are major challenges for New Zealand's primary care sector. Self-management support strategies, personalised care planning, integrated care and shared health records have all been proposed as mechanisms to address these challenges. The organisation of the health system, however, remains largely unchanged, with limited accommodation and few funding concessions made for the requirements of these different approaches and tools. As a result, the primary care system is no longer a good match for the population it serves. With one in four New Zealanders reporting multimorbidity, and people aged >65 years predicted to double in number by 2050, this article argues that over the next decade, New Zealand requires a health system focused on incorporating self-management support, personalised and integrated care and shared health records. This will require further educating of not only health professionals, but also patients in the purpose behind these approaches. In addition, it will mean transitioning to a primary care system more suited to the needs of people with long-term conditions. The key gain from a radical redesign will be a more equitable health system focused on a broader range of health needs.
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Affiliation(s)
- Anna Askerud
- University of Otago, Department of General Practice and Rural Health, Dunedin, New Zealand; and Corresponding author.
| | - Chrystal Jaye
- University of Otago, Department of General Practice and Rural Health, Dunedin, New Zealand
| | - Eileen McKinlay
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Fiona Doolan-Noble
- University of Otago, Department of General Practice and Rural Health, Dunedin, New Zealand
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Crabtree BF, Howard J, Miller WL, Cromp D, Hsu C, Coleman K, Austin B, Flinter M, Tuzzio L, Wagner EH. Leading Innovative Practice: Leadership Attributes in LEAP Practices. Milbank Q 2020; 98:399-445. [PMID: 32401386 DOI: 10.1111/1468-0009.12456] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Policy Points An onslaught of policies from the federal government, states, the insurance industry, and professional organizations continually requires primary care practices to make substantial changes; however, ineffective leadership at the practice level can impede the dissemination and scale-up of these policies. The inability of primary care practice leadership to respond to ongoing policy demands has resulted in moral distress and clinician burnout. Investments are needed to develop interventions and educational opportunities that target a broad array of leadership attributes. CONTEXT Over the past several decades, health care in the United States has undergone substantial and rapid change. At the heart of this change is an assumption that a more robust primary care infrastructure helps achieve the quadruple aim of improved care, better patient experience, reduced cost, and improved work life of health care providers. Practice-level leadership is essential to succeed in this rapidly changing environment. Complex adaptive systems theory offers a lens for understanding important leadership attributes. METHODS A review of the literature on leadership from a complex adaptive system perspective identified nine leadership attributes hypothesized to support practice change: motivating others to engage in change, managing abuse of power and social influence, assuring psychological safety, enhancing communication and information sharing, generating a learning organization, instilling a collective mind, cultivating teamwork, fostering emergent leaders, and encouraging boundary spanning. Through a secondary qualitative analysis, we applied these attributes to nine practices ranking high on both a practice learning and leadership scale from the Learning from Effective Ambulatory Practice (LEAP) project to see if and how these attributes manifest in high-performing innovative practices. FINDINGS We found all nine attributes identified from the literature were evident and seemed important during a time of change and innovation. We identified two additional attributes-anticipating the future and developing formal processes-that we found to be important. Complexity science suggests a hypothesized developmental model in which some attributes are foundational and necessary for the emergence of others. CONCLUSIONS Successful primary care practices exhibit a diversity of strong local leadership attributes. To meet the realities of a rapidly changing health care environment, training of current and future primary care leaders needs to be more comprehensive and move beyond motivating others and developing effective teams.
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Affiliation(s)
| | | | | | - DeANN Cromp
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute
| | - Clarissa Hsu
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute
| | - Katie Coleman
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute
| | - Brian Austin
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute
| | | | - Leah Tuzzio
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute
| | - Edward H Wagner
- MacColl Center for Health Care Innovation, Kaiser Permanente Washington Health Research Institute
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Joynt Maddox K, Bleser WK, Crook HL, Nelson AJ, Hamilton Lopez M, Saunders RS, McClellan MB, Brown N. Advancing Value-Based Models for Heart Failure: A Call to Action From the Value in Healthcare Initiative's Value-Based Models Learning Collaborative. Circ Cardiovasc Qual Outcomes 2020; 13:e006483. [PMID: 32393125 DOI: 10.1161/circoutcomes.120.006483] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Heart failure (HF) is a leading cause of hospitalizations and readmissions in the United States. Particularly among the elderly, its prevalence and costs continue to rise, making it a significant population health issue. Despite tremendous progress in improving HF care and examples of innovation in care redesign, the quality of HF care varies greatly across the country. One major challenge underpinning these issues is the current payment system, which is largely based on fee-for-service reimbursement, leads to uncoordinated, fragmented, and low-quality HF care. While the payment landscape is changing, with an increasing proportion of all healthcare dollars flowing through value-based payment models, no longitudinal models currently focus on chronic HF care. Episode-based payment models for HF hospitalization have yielded limited success and have little ability to prevent early chronic disease from progressing to later stages. The available literature suggests that primary care-based longitudinal payment models have indirectly improved HF care quality and cardiovascular care costs, but these models are not focused on addressing patients' longitudinal chronic disease needs. This article describes the efforts and vision of the multi-stakeholder Value-Based Models Learning Collaborative of The Value in Healthcare Initiative, a collaboration of the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University. The Learning Collaborative developed a framework for a HF value-based payment model with a longitudinal focus on disease management (to reduce adverse clinical outcomes and disease progression among patients with stage C HF) and prevention (an optional track to prevent high-risk stage B pre-HF from progressing to stage C). The model is designed to be compatible with prevalent payment models and reforms being implemented today. Barriers to success and strategies for implementation to aid payers, regulators, clinicians, and others in developing a pilot are discussed.
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Affiliation(s)
- Karen Joynt Maddox
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, and Center for Health Economics and Policy, Institute for Public Health at Washington University, St. Louis, MO (K.J.M.)
| | - William K Bleser
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Hannah L Crook
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Adam J Nelson
- Duke Clinical Research Institute, Duke University, Durham, NC (A.J.N.)
| | - Marianne Hamilton Lopez
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Robert S Saunders
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Mark B McClellan
- Robert J. Margolis, MD, Center for Health Policy, Duke University, Washington, DC and Durham, NC (W.K.B., H.L.C., M.H.L., R.S.S., M.B.M.)
| | - Nancy Brown
- American Heart Association, Dallas, TX (N.B.)
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Crabtree BF, Miller WL, Howard J, Rubinstein EB, Tsui J, Hudson SV, O'Malley D, Ferrante JM, Stange KC. Cancer Survivorship Care Roles for Primary Care Physicians. Ann Fam Med 2020; 18:202-209. [PMID: 32393555 PMCID: PMC7213992 DOI: 10.1370/afm.2498] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 06/27/2019] [Accepted: 08/13/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Despite a burgeoning population of cancer survivors and pending shortages of oncology services, clear definitions and systematic approaches for engaging primary care in cancer survivorship are lacking. We sought to understand how primary care clinicians perceive their role in delivering care to cancer survivors. METHODS We conducted digitally recorded interviews with 38 clinicians in 14 primary care practices that had national reputations as workforce innovators. Interviews took place during intense case study data collection and explored clinicians' perspectives regarding their role in cancer survivorship care. We analyzed verbatim transcripts using an inductive and iterative immersion-crystallization process. RESULTS Divergent views exist regarding primary care's role in cancer survivor care with a lack of coherence about the concept of survivorship. A few clinicians believed any follow-up care after acute cancer treatment was oncology's responsibility; however, most felt cancer survivor care was within their purview. Some primary care clinicians considered cancer survivors as a distinct population; others felt cancer survivors were like any other patient with a chronic disease. In further interpretative analysis, we discovered a deeply ingrained philosophy of whole-person care that creates a professional identity dilemma for primary care clinicians when faced with rapidly changing specialized knowledge. CONCLUSIONS This study exposes an emerging identity crisis for primary care that goes beyond cancer survivorship care. Facilitated national conversations might help specialists and primary care develop knowledge translation platforms to support the prioritizing, integrating, and personalizing functions of primary care for patients with highly complicated issues requiring specialized knowledge.
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Affiliation(s)
- Benjamin F Crabtree
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey .,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | | | - Jenna Howard
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | | | - Jennifer Tsui
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Shawna V Hudson
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Denalee O'Malley
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Jeanne M Ferrante
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
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Sørensen M, Groven KS, Gjelsvik B, Almendingen K, Garnweidner-Holme L. The roles of healthcare professionals in diabetes care: a qualitative study in Norwegian general practice. Scand J Prim Health Care 2020; 38:12-23. [PMID: 31960746 PMCID: PMC7054922 DOI: 10.1080/02813432.2020.1714145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Objective: To explore the experiences of general practitioners (GPs), nurses and medical secretaries in providing multi-professional diabetes care and their perceptions of professional roles.Design, setting and subjects: Semi-structured interviews were conducted with six GPs, three nurses and two medical secretaries from five purposively sampled diabetes teams. Interviews were analysed thematically.Main outcome measures: Healthcare professionals' (HCPs') experiences of multi-professional diabetes care in general practice.Results: The involvement of nurses and medical secretaries (collaborating health care professionals) was mainly motivated by GPs' time pressure and their perception of diabetes care as easy to standardize. GPs reported that diabetes care had become more structured and continuous after the involvement of collaborating health care professionals (cHCPs). cHCPs defined their role differently from GPs, emphasizing that their approach included acknowledging patients' need for diabetes education, listening to their stories and meeting their need for emotional support. GPs appeared less involved in patients' emotional concerns and more focused on the biomedical aspects of illness. There was little emphasis on teamwork among GPs and cHCPs, and none of the practices used care plans to involve patients in decisions or unify treatment among professionals. Participants stated that institutional structures including a discriminatory remuneration system, lack of role descriptions and missing procedures for collaborative approaches were an obstacle to MPC.Conclusions: cHCPs worked independently under delegated leadership of the GPs. Although cHCPs had a complementary role, HCPs in general practice may not take full advantage of the potential of sharing patient responsibility and learning with, from and about each other. Contextual barriers for team-based care approaches should be addressed in future research.KEY POINTSIt has been suggested that multi-professional approaches improve quality of care in people with long-term conditions.In this study, nurses and medical secretaries perceived to have a complementary role to general practitioners (GPs) in diabetes care, focusing on patient education, building trusting relationships and providing patients with emotional support.As multi-professional collaboration was minimal, GPs, nurses and medical secretaries in the included practices may not take full advantage of the potential of sharing care responsibility and learning with, from and about each other.
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Affiliation(s)
- Monica Sørensen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University, Oslo, Norway;
- CONTACT Monica Sørensen Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University, St. Olavs Plass, P.O. Box 4, 0130, Oslo, Norway
| | - Karen Synne Groven
- Faculty of Health Sciences, Department of Physiotherapy, OsloMet University, Oslo, Norway;
| | - Bjørn Gjelsvik
- Department of General Practice, Institute for Health and Society, University of Oslo, Oslo, Norway;
| | - Kari Almendingen
- Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University, Oslo, Norway
| | - Lisa Garnweidner-Holme
- Faculty of Health Sciences, Department of Nursing and Health Promotion, OsloMet University, Oslo, Norway
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Saleh Stattin N, Kane K, Stenbäck M, Wajngot A, Seijboldt K. Improving the structure of diabetes care in primary care: A pilot study. Prim Care Diabetes 2020; 14:33-39. [PMID: 31176676 DOI: 10.1016/j.pcd.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 05/08/2019] [Accepted: 05/12/2019] [Indexed: 10/26/2022]
Abstract
AIM The aim of this pilot study was to determine whether glycemic control can be improved in patients with type 2 diabetes by implementing a workshop model to improve the structure of diabetes care at primary health care centers (PHCCs). METHODS The intervention consisted of 4 workshops at 12 PHCCs with HbA1c >70 mmol/mol (high HbA1c). Each PHCC could choose how many workshops they wished to attend and was to be represented by the manager, a diabetes nurse, and a GP. Participants analyzed the structure of diabetes care at their PHCC and developed an action plan to improve it. The percentage of patients with high HbA1c at baseline, 12, and 24 months was collected. Qualitative content analysis was also conducted. RESULTS All PHCCs reduced the percentage of patients with high HbA1c 12 months after the intervention, but not all maintained the reduction at 24 months. Participants experienced structuring diabetes care as central to reducing the percentage of patients with high HbA1c. Pillars of structured diabetes care included establishing routines, working in teams, and having and implementing an action plan. CONCLUSIONS Working with the structure of diabetes care improved care structure and had a positive impact on HbA1c. To sustain the positive impact, PHCCs had to set long-term goals and regularly evaluate performance.
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Affiliation(s)
- Nouha Saleh Stattin
- Academic Primary Healthcare Centre, Stockholm County Council, Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden; Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Allé 23 D2, 141 83 Huddinge, Sweden.
| | - Kimberly Kane
- Academic Primary Healthcare Centre, Stockholm County Council, Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden; Aging Research Center, Karolinska Institutet and Stockholm University, Tomtebodavägen 18 A, SE-171 77 Stockholm, Sweden
| | - Marina Stenbäck
- Academic Primary Healthcare Centre, Stockholm County Council, Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden
| | - Alexandre Wajngot
- Academic Primary Healthcare Centre, Stockholm County Council, Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden
| | - Kaija Seijboldt
- Academic Primary Healthcare Centre, Stockholm County Council, Solnavägen 1E (Torsplan), 113 65, Stockholm, Sweden
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Kósa K, Katona C, Papp M, Fürjes G, Sándor J, Bíró K, Ádány R. Health mediators as members of multidisciplinary group practice: lessons learned from a primary health care model programme in Hungary. BMC FAMILY PRACTICE 2020; 21:19. [PMID: 31992209 PMCID: PMC6988313 DOI: 10.1186/s12875-020-1092-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 01/23/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND A Model Programme of primary care group practices was implemented in Hungary between 2013 and 2017 - where virtually all GPs had worked in single practices - aiming to increase preventive service uptake and reduce inequalities based on a bilateral agreement between the Swiss and Hungarian governments. Group practices employed a wide variety of health professionals as well as support workers called health mediators. Employment of the latter was based on two decades of European experience of health mediators who specifically facilitate access to and use of health services in Roma minority groups. Health mediators had been recruited from local communities, received training on the job, and were tasked to increase uptake of new preventive services provided by the group practices by personal contacts in the local minority populace. The paper describes the contribution of the work of health mediators to the uptake of two new services provided by group practices. METHODS Quantitative analysis of depersonalized administrative data mandatorily reported to the Management of the Programme during 43 months of operation was carried out on the employment of health mediators and their contribution to the uptake of two new preventive services (health status assessment and community health promoting programmes). RESULTS 80% of all clients registered with the GPs participated at health status assessment by invitation that was 1.3-1.7 times higher than participation at the most successful national screening programmes in the past 15 years. Both the number of mediator work minutes per client and participation rate at health status assessment, as well as total work time of mediators and participants at community health events showed high correlation. Twice as many Roma minority patients were motivated for service use by health mediators compared to all patients. The very high participation rate reflects the wide impact of health mediators who probably reached not only Roma minority, but vulnerable population groups in general. CONCLUSION The future of general practices lays in multidisciplinary teams in which health mediators recruited from the serviced communities can be valuable members, especially in deprived areas.
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Affiliation(s)
- Karolina Kósa
- Institute of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Móricz Zs. krt. 22, Debrecen, 4032, Hungary.
| | - Cintia Katona
- Institute of Behavioural Sciences, Faculty of Public Health, University of Debrecen, Móricz Zs. krt. 22, Debrecen, 4032, Hungary
| | - Magor Papp
- Semmelweis Health Promotion Centre, Budapest, Hungary
| | - Gergely Fürjes
- Institute of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - János Sándor
- Institute of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Klára Bíró
- Department of Health Management, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- Institute of Preventive Medicine, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
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Abstract
Primary care transformation will usher in a new era of advanced team-based care with extensive roles beyond the physician to build authentic healing relationships with patients. Smart technology will support these relationships, empower and engage patients, and build confidence that their health care team will take excellent care of them. Investments need to shift from catastrophic hospital-based care to proactive prevention and wellness, pushing us to think of health beyond health care. Systems need to build a culture of continuous improvement, supported by data-driven improvement science, and keep a sharp focus on the patient experience of care.
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Affiliation(s)
- Gregory Sawin
- Tufts University Family Medicine Residency, Malden Family Medicine Center, Cambridge Health Alliance, Tufts University School of Medicine, Harvard University Faculty of Medicine, 195 Canal Street, Malden, MA 02148, USA.
| | - Nicole O'Connor
- Practice Improvement Team, Patient Advisory Council, Tufts University Family Medicine Residency, Malden Family Medicine Center, Cambridge Health Alliance, Tufts University School of Medicine, 195 Canal Street, Malden, MA 02148, USA
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50
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Kung A, Cheung T, Knox M, Willard-Grace R, Halpern J, Olayiwola JN, Gottlieb L. Capacity to Address Social Needs Affects Primary Care Clinician Burnout. Ann Fam Med 2019; 17:487-494. [PMID: 31712286 PMCID: PMC6846269 DOI: 10.1370/afm.2470] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 05/10/2019] [Accepted: 05/30/2019] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Primary care clinicians disproportionately report symptoms of burnout, threatening workforce sustainability and quality of care. Recent surveys report that these symptoms are greater when clinicians perceive fewer clinic resources to address patients' social needs. We undertook this study to better understand the relationship between burnout and clinic capacity to address social needs. METHODS We completed semistructured, in-person interviews and brief surveys with 29 primary care clinicians serving low-income populations. Interview and survey topics included burnout and clinic capacity to address social needs. We analyzed interviews using a modified grounded theory approach to qualitative research and used survey responses to contextualize our qualitative findings. RESULTS Four key themes emerged from the interview analyses: (1) burnout can affect how clinicians evaluate their clinic's resources to address social needs, with clinicians reporting high emotional exhaustion perceiving low efficacy even in when such resources are available; (2) unmet social needs affect practice by influencing clinic flow, treatment planning, and clinician emotional wellness; (3) social services embedded in primary care clinics buffer against burnout by increasing efficiency, restoring clinicians' medical roles, and improving morale; and (4) clinicians view clinic-level interventions to address patients' social needs as a necessary but insufficient strategy to address burnout. CONCLUSIONS Primary care clinicians described multiple pathways whereby increased clinic capacity to address patients' social needs mitigates burnout symptoms. These findings may inform burnout prevention strategies that strengthen the capacity to address patients' social needs in primary care clinical settings.
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Affiliation(s)
- Alina Kung
- University of California Berkeley-UCSF Joint Medical Program, Berkeley, California
| | | | - Margae Knox
- University of California San Francisco, Center for Excellence in Primary Care, San Francisco, California
| | - Rachel Willard-Grace
- University of California San Francisco, Center for Excellence in Primary Care, San Francisco, California
| | - Jodi Halpern
- University of California Berkeley-UCSF Joint Medical Program, Berkeley, California.,University of California Berkeley, School of Public Health, Berkeley, California
| | - J Nwando Olayiwola
- Department of Family Medicine, Ohio State University College of Medicine, Columbus, Ohio
| | - Laura Gottlieb
- University of California San Francisco, Department of Family and Community Medicine, San Francisco, California.,Social Interventions Research and Evaluation Network, San Francisco, California
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