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Bayoumi I, Glazier RH, Jaakkimainen L, Premji K, Kiran T, Frymire E, Khan S, Green ME. Trends in attachment to a primary care provider in Ontario, 2008-2018: an interrupted time-series analysis. CMAJ Open 2023; 11:E809-E819. [PMID: 37669813 PMCID: PMC10482493 DOI: 10.9778/cmajo.20220167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Attachment to a regular primary care provider is associated with better health outcomes, but 15% of people in Canada lack a consistent source of ongoing primary care. We sought to evaluate trends in attachment to a primary care provider in Ontario in 2008-2018, through an equity lens and in relation to policy changes in implementation of payment reforms and team-based care. METHODS Using linked, population-level administrative data, we conducted a retrospective observational study to calculate rates of patients attached to a regular primary care provider from Apr. 1, 2008, to Mar. 31, 2019. We evaluated the association of patient characteristics and attachment in 2018 using sex-stratified, adjusted, multivariable logistic regression models and used segmented piecewise regression to evaluate changing trends before and after implementation of a policy that restricted physician entry to alternate models. RESULTS Attachment increased from 80.5% (n = 10 352 385) in 2008 to 88.9% of the population (n = 12 537 172) in 2018, but was lower among people with low comorbidity, high residential instability, material deprivation, rural residence and recent immigrants. Inequities narrowed for recent immigrants, males and people with lower incomes over the study period, but disparities persisted for these groups. Attachment grew by 1.47% annually until 2014 (p < 0.0001), but was stagnant thereafter (annual percent change of 0.13, p = 0.16). INTERPRETATION Lack of sustained progress in attachment followed reduced levels of physician entry to alternate funding models. Although disparities narrowed for many groups over the study period, persistent gaps remained for immigrants and people with lower incomes; targeted interventions and policy changes are needed to address these persistent gaps.
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Affiliation(s)
- Imaan Bayoumi
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont.
| | - Richard H Glazier
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont
| | - Liisa Jaakkimainen
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont
| | - Kamila Premji
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont
| | - Tara Kiran
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont
| | - Eliot Frymire
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont
| | - Shahriar Khan
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont
| | - Michael E Green
- Department of Family Medicine (Bayoumi), Queen's University; ICES Queen's (Bayoumi, Frymire, Khan, Green), Kingston, Ont.; ICES Central (Glazier, Jaakkimainen, Premji, Kiran); Department of Family and Community Medicine (Glazier, Kiran), University of Toronto, Toronto, Ont.; Health Services and Policy Research Institute (Frymire, Khan, Green), Queen's University, Kingston, Ont
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de Bekker PJGM, de Weerdt V, Vink MDH, van der Kolk AB, Donker MH, van der Hijden EJE. 'Give me something meaningful': GPs perspectives on how to improve an audit and feedback report provided by health insurers - an exploratory qualitative study. BMJ Open Qual 2022; 11:bmjoq-2022-002006. [PMID: 36375859 PMCID: PMC9664288 DOI: 10.1136/bmjoq-2022-002006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Audit and feedback (A&F) is a valuable quality improvement strategy, which can contribute to de-implementation of low-value care. In the Netherlands, all health insurers collaboratively provide A&F to general practitioners (GPs), the 'Primary Care Practice Report' (PCPR). Unfortunately, the use of this report by GPs is limited. This study examined the thoughts of GPs on the usability of the PCPR and GPs recommendations for improving the PCPR. METHOD We used an interpretative qualitative design, with think-aloud tasks to uncover thoughts of GPs on the usability of the PCPR and semistructured interview questions to ask GPs' recommendations for improvement of the PCPR. Interviews were audiorecorded and transcribed ad verbatim. Data were analysed using thematic content analysis. RESULTS We identified two main themes: 'poor usability of the PCPR', and 'minimal motivation to change based on the PCPR'. The GPs found the usability of the PCPR poor due to the feedback not being clinically meaningful, the data not being recent, individual and reliable, the performance comparators offer insufficient guidance to assess clinical performance, the results are not discussed with peers and the definitions and visuals are unclear. The GPs recommended improving these issues. The GPs motivation to change based on the PCPR was minimal. CONCLUSIONS The GPs evaluated the PCPR as poorly usable and were minimally motivated to change. The PCPR seems developed from the perspective of the reports' commissioners, health insurers, and does not meet known criteria for effective A&F design and user-centred design. Importantly, the GPs did state that well-designed feedback could contribute to their motivation to improve clinical performance.Furthermore, the GPs stated that they receive a multitude of A&F reports, which they hardly use. Thus, we see a need for policy makers to invest in less, but more usable A&F reports.
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Affiliation(s)
- P J G M de Bekker
- Department of Health Economics & Talma Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands .,Zorgvuldig Advies, Utrecht, Netherlands
| | - V de Weerdt
- Department of Health Economics & Talma Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Amsterdam University Medical Centres, Holendrecht, Netherlands
| | - M D H Vink
- Department of Health Economics & Talma Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Gynaecology, Amsterdam Universitair Medische Centra, Duivendrecht, Netherlands
| | - A B van der Kolk
- Talma Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - M H Donker
- Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - E J E van der Hijden
- Department of Health Economics & Talma Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Zilveren Kruis Health Insurance, Zeist, Netherlands
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van Olmen J, Absetz P, Mayega RW, Timm L, Delobelle P, Alvesson HM, Naggayi G, Kasujja F, Hassen M, de Man J, Sidney Annerstedt K, Puoane T, Östenson CG, Tomson G, Guwatudde D, Daivadanam M. Process evaluation of a pragmatic implementation trial to support self-management for the prevention and management of type 2 diabetes in Uganda, South Africa and Sweden in the SMART2D project. BMJ Open Diabetes Res Care 2022; 10:e002902. [PMID: 36162865 PMCID: PMC9516210 DOI: 10.1136/bmjdrc-2022-002902] [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] [Received: 04/11/2022] [Accepted: 08/28/2022] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Type 2 diabetes (T2D) and its complications are increasing rapidly. Support for healthy lifestyle and self-management is paramount, but not adequately implemented in health systems. Process evaluations facilitate understanding why and how interventions work through analyzing the interaction between intervention theory, implementation and context. The Self-Management and Reciprocal Learning for Type 2 Diabetes project implemented and evaluated community-based interventions (peer support program; care companion; and link between facility care and community support) for persons at high risk of or having T2D in a rural community in Uganda, an urban township in South Africa, and socioeconomically disadvantaged urban communities in Sweden. RESEARCH DESIGN AND METHODS This paper reports implementation process outcomes across the three sites, guided by the Medical Research Council framework for complex intervention process evaluations. Data were collected through observations of peer support group meetings using a structured guide, and semistructured interviews with project managers, implementers, and participants. RESULTS The countries aligned implementation in accordance with the feasibility and relevance in the local context. In Uganda and Sweden, the implementation focused on peer support; in South Africa, it focused on the care companion part. The community-facility link received the least attention. Continuous capacity building received a lot of attention, but intervention reach, dose delivered, and fidelity varied substantially. Intervention-related and context-related barriers affected participation. CONCLUSIONS Identification of the key uncertainties and conditions facilitates focus and efficient use of resources in process evaluations, and context relevant findings. The use of an overarching framework allows to collect cross-contextual evidence and flexibility in evaluation design to adapt to the complex nature of the intervention. When designing interventions, it is crucial to consider aspects of the implementing organization or structure, its absorptive capacity, and to thoroughly assess and discuss implementation feasibility, capacity and organizational context with the implementation team and recipients. These recommendations are important for implementation and scale-up of complex interventions. TRIAL REGISTRATION NUMBER ISRCTN11913581.
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Affiliation(s)
- Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
| | - Pilvikki Absetz
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Roy William Mayega
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Linda Timm
- Department of Global Health, Karolinska Institute, Stockholm, Sweden
| | - Peter Delobelle
- Chronic Disease Initiative for Africa, University of Cape Town, Rondebosch, Western Cape, South Africa
- Mental Health & Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Glorai Naggayi
- School of Public Health, Makerere University Faculty of Medicine, Kampala, Uganda
| | - Francis Kasujja
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Mariam Hassen
- School of Public Health, University of the Western Cape, Bellville, South Africa
| | - Jeroen de Man
- Department of Family Medicine and Population Health, University of Antwerp, Antwerpen, Belgium
| | | | - Thandi Puoane
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Claes-Göran Östenson
- Department of Global Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Goran Tomson
- Department of Global Health, Centrum för arbets- och miljömedicin, Stockholm, Sweden
| | - David Guwatudde
- School of Public Health, Makerere School of Public Health, Kampala, Uganda
| | - Meena Daivadanam
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Uppsala Universitet, Uppsala, Sweden
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Marshall EG, Breton M, Green M, Edwards L, Ayn C, Smithman MA, Ryan Carson S, Ashcroft R, Bayoumi I, Burge F, Deslauriers V, Lawson B, Mathews M, McPherson C, Moritz LR, Nesto S, Stock D, Wong ST, Andrew M. CUP study: protocol for a comparative analysis of centralised waitlist effectiveness, policies and innovations for connecting unattached patients to primary care providers. BMJ Open 2022; 12:e049686. [PMID: 35256440 PMCID: PMC8905966 DOI: 10.1136/bmjopen-2021-049686] [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: 11/24/2022] Open
Abstract
INTRODUCTION Access to a primary care provider is a key component of high-functioning healthcare systems. In Canada, 15% of patients do not have a regular primary care provider and are classified as 'unattached'. In an effort to link unattached patients with a provider, seven Canadian provinces implemented centralised waitlists (CWLs). The effectiveness of CWLs in attaching patients to regular primary care providers is unknown. Factors influencing CWLs effectiveness, particularly across jurisdictional contexts, have yet to be confirmed. METHODS AND ANALYSIS A mixed methods case study will be conducted across three Canadian provinces: Ontario, Québec and Nova Scotia. Quantitatively, CWL data will be linked to administrative and provider billing data to assess the rates of patient attachment over time and delay of attachment, stratified by demographics and compared with select indicators of health service utilisation. Qualitative interviews will be conducted with policymakers, patients, and primary care providers to elicit narratives regarding the administration, use, and access of CWLs. An analysis of policy documents will be used to identify contextual factors affecting CWL effectiveness. Stakeholder dialogues will be facilitated to uncover causal pathways and identify strategies for improving patient attachment to primary care. ETHICS AND DISSEMINATION Approval to conduct this study has been granted in Ontario (Queens University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board, file number 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol number 40335), Québec (Centre intégré universitaire de santé et de services sociaux de l'Estrie, project number 2020-3446) and Nova Scotia (Nova Scotia Health Research Ethics Board, file number 1024979).
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Affiliation(s)
- Emily Gard Marshall
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
| | | | - Lynn Edwards
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Caitlyn Ayn
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mélanie Ann Smithman
- Centre de recherche Charles-LeMoyne, Université de Sherbrooke, Longueuil, Québec, Canada
| | | | | | | | - Frederick Burge
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Véronique Deslauriers
- Centre de recherche Charles-LeMoyne, Université de Sherbrooke, Longueuil, Québec, Canada
| | - Beverley Lawson
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Lauren R Moritz
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sue Nesto
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - David Stock
- Primary Care Research Unit, Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Melissa Andrew
- Division of Geriatric Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Alawadhi A, Palin V, van Staa T. Prevalence and factors associated with missed hospital appointments: a retrospective review of multiple clinics at Royal Hospital, Sultanate of Oman. BMJ Open 2021; 11:e046596. [PMID: 34408035 PMCID: PMC8375741 DOI: 10.1136/bmjopen-2020-046596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES Missed hospital appointments pose a major challenge for healthcare systems. There is a lack of information about drivers of missed hospital appointments in non-Western countries and extent of variability between different types of clinics. The aim was to evaluate the rate and predictors of missed hospital appointments and variability in drivers between multiple outpatient clinics. SETTING Outpatient clinics in the Royal hospital (tertiary referral hospital in Oman) between 2014 and 2018. PARTICIPANTS All patients with a scheduled outpatient clinic appointment (N=7 69 118). STUDY DESIGN Retrospective cross-sectional analysis. PRIMARY AND SECONDARY OUTCOME MEASURES A missed appointment was defined as a patient who did not show up for the scheduled hospital appointment without notifying or asking for the appointment to be cancelled or rescheduled. The outcomes were the rate and predictors of missed hospital appointments overall and variations by clinic. Conditional logistic regression compared patients who attended and those who missed their appointment. RESULTS The overall rate of missed hospital appointments was 22.3%, which varied between clinics (14.0% for Oncology and 30.3% for Urology). Important predictors were age, sex, service costs, patient's residence distance from hospital, waiting time and appointment day and season. Substantive variability between clinics in ORs for a missed appointment was present for predictors such as service costs and waiting time. Patients aged 81-90 in the Diabetes and Endocrine clinic had an adjusted OR of 0.53 for missed appointments (95% CI 0.37 to 0.74) while those in Obstetrics and Gynaecology had OR of 1.70 (95% CI 1.11 to 2.59). Adjusted ORs for longer waiting times (>120 days) were 2.22 (95% CI 2.10 to 2.34) in Urology but 1.26 (95% CI 1.18 to 1.36) in Oncology. CONCLUSION Predictors of a missed appointment varied between clinics in their effects. Interventions to reduce the rate of missed appointments should consider these factors and be tailored to clinic.
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Affiliation(s)
- Ahmed Alawadhi
- Health Informatics, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
| | - Victoria Palin
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Tjeerd van Staa
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Footman A, Dagama D, Smith CH, Van Der Pol B. A Systematic Review of New Approaches to Sexually Transmitted Infection Screening Framed in the Capability, Opportunity, Motivation, and Behavior Model of Implementation Science. Sex Transm Dis 2021; 48:S58-S65. [PMID: 33938515 PMCID: PMC8284379 DOI: 10.1097/olq.0000000000001461] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/28/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Chlamydia and gonorrhea are 2 of the most common bacterial sexually transmitted infections (STIs) worldwide. Rising chlamydia and gonorrhea rates along with increased closing of STI clinics has led many to seek STI testing in clinical settings such as urgent cares and walk-in clinics. However, with competing priorities, providing effective and efficient STI care can be difficult in these settings. This has left a growing need for the implementation of novel STI screening programs in other clinical settings. This review summarizes previous studies that have evaluated the clinical implementation of chlamydia and gonorrhea screening programs in these settings. Literature from January 2015 to February 2020 regarding the implementation or evaluation of STI screening programs in clinical settings was reviewed. Constructs from the Capability, Opportunity, Motivation, and Behavior model were used to organize results, as this model can aid in identifying specific strategies for behavior/process change interventions. We found that multiple STI screening programs have been implemented and evaluated in 5 different countries and multiple health care facilities including sexual health clinics, urgent cares, walk-in clinics, and university health clinics. When implementing new STI screening programs, sample-first, test-and-go services and molecular point-of-care (POC) testing approaches were found to be effective in increasing screening and reducing costs and time to treatment. At the health care systems level, these programs can help reduce STI screening costs and generate additional revenue for clinics. At the provider level, clear communication and guidance can help clinical and administrative staff in adopting new screening programs. Finally, at the patient level, new programs can reduce time to treatment and travel costs in visiting clinics multiple times for testing and treatment services.
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Affiliation(s)
| | | | | | - Barbara Van Der Pol
- From the School of Public Health
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL
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Bohm V, Lacaille D, Spencer N, Barber CE. Scoping review of balanced scorecards for use in healthcare settings: development and implementation. BMJ Open Qual 2021; 10:e001293. [PMID: 34244173 PMCID: PMC8273481 DOI: 10.1136/bmjoq-2020-001293] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 06/28/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Balanced scorecards (BSCs) were developed in the early 1990s in corporate settings as a strategic performance management tool that emphasised measurement from multiple perspectives. Since their introduction, BSCs have been adapted for a variety of industries, including to healthcare settings. The aim of this scoping review was to describe the application of BSCs in healthcare. METHODS Medline, Embase and CINHAL databases were searched using keywords and medical subject headings for 'balanced scorecard' and related terms from 1992 to 17/04/2020. Title and abstract screening and full text review were conducted in duplicate by two reviewers. Studies describing the development and/or implementation of a BSC in a healthcare setting were included. Data were abstracted using pilot-tested forms and reviewed for key themes and findings. RESULTS 8129 records were identified and 841 underwent a full text review. 87 articles were included. Over 26 countries were represented and the majority of BSCs were applied at a local level (54%) in hospital settings (41%). While almost all discussed Kaplan and Norton's original BSC (97%), only 69% described alignment with a strategic plan. Patients/family members were rarely involved in development teams (3%) which typically were comprised of senior healthcare leaders/administrators. Only 21% of BSCs included perspectives using identical formatting to the original BSC description. Lessons learnt during development addressed three main themes: scorecard design, stakeholder engagement and feasibility. CONCLUSIONS BSC frameworks have been used in various healthcare settings but frequently undergo adaptation from the original description in order to suit a specific healthcare context. Future BSCs should aim to include patients/families to promote patient-centred healthcare systems. Considering the heterogeneity evident in development approaches, methodological guidance in this area is warranted.
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Affiliation(s)
- Victoria Bohm
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Richmond, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Nicole Spencer
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Claire Eh Barber
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Richmond, British Columbia, Canada
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Parmar PK, Rawashdah F, Al-Ali N, Abu Al Rub R, Fawad M, Al Amire K, Al-Maaitah R, Ratnayake R. Integrating community health volunteers into non-communicable disease management among Syrian refugees in Jordan: a causal loop analysis. BMJ Open 2021; 11:e045455. [PMID: 33879489 PMCID: PMC8061821 DOI: 10.1136/bmjopen-2020-045455] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Globally, there is emerging evidence on the use of community health workers and volunteers in low-income and middle-income settings for the management of non-communicable diseases (NCDs), provision of out-of-clinic screening, linkage with health services, promotion of adherence, and counselling on lifestyle and dietary changes. Little guidance exists on the role of this workforce in supporting NCD care for refugees who lack access to continuous care in their host country. The goals of this work were to evaluate the current roles of community health volunteers (CHVs) in the management of diabetes and hypertension (HTN) among Syrian refugees and to suggest improvements to the current primary care model using community health strategies. SETTING AND PARTICIPANTS A participatory, multistakeholder causal loop analysis workshop with representatives from the Ministry of Health of Jordan, non-governmental organisations, United Nations agencies, CHVs and refugee patients was conducted in June 2019 in Amman, Jordan. PRIMARY OUTCOME This causal loop analysis workshop was used to collaboratively develop a causal loop diagram and CHV strategies designed to improve the health of Syrian refugees with diabetes and HTN living in Jordan. RESULTS During the causal loop analysis workshop, participants collaboratively identified and mapped how CHVs might improve care among diagnosed patients. Possibilities identified included the following: providing psychosocial support and foundational education on their conditions, strengthening self-management of complications (eg, foot checks), and monitoring patients for adherence to medications and collection of basic health monitoring data. Elderly refugees with restricted mobility and/or uncontrolled disease were identified as a key population where CHVs could provide home-based blood glucose and blood pressure measurement and targeted health education to provide more precise monitoring. CONCLUSIONS CHV programmes were cited as a key strategy to implement secondary prevention of morbidity and mortality among Syrian refugees, particularly those at high risk of decompensation.
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Affiliation(s)
- Parveen K Parmar
- Department of Emergency Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Nahla Al-Ali
- Department of Community and Mental Health Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Raeda Abu Al Rub
- Department of Community and Mental Health Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Rowaida Al-Maaitah
- Department of Community and Mental Health Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Ruwan Ratnayake
- International Rescue Committee, New York, New York, USA
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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Gong X, Wang X, Shi T, Shi J, Yu W, Zhou L, Chen N, Huang J, Wang Z. Disease composition and epidemiological characteristics of primary care visits in Pudong New Area, Shanghai: a longitudinal study, 2016-2018. BMJ Open 2020; 10:e040878. [PMID: 33203636 PMCID: PMC7674101 DOI: 10.1136/bmjopen-2020-040878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This study aims to analyse the disease composition of primary care visits rather than specialist visits, the former of which had scarcely been studied. We adopted specific disease classification (International Statistical Classification of Diseases and Related Health Problems, 10th Revision), disease system and communicable/non-communicable/injury disease classification, and variations of sex and age were also analysed. SETTING We extracted data from all community health service centres (CHSCs) and community health service stations in Pudong, Shanghai, from 2016 to 2018 using the electronic health record systems of the Pudong health information centre. PARTICIPANTS Our data included all 46 720 972 primary care visits from 2016 to 2018 in CHSCs in Pudong. RESULTS We found that the top five diseases in primary care visits continued to be primary hypertension, problems related to medical facilities, chronic ischaemic heart disease, unspecified diabetes mellitus and acute upper respiratory infection. Lipoprotein metabolism disorder visits continued to increase over the study years. The numbers and proportions of patients with hypertension and unspecified diabetes were higher among men than women, and other cerebrovascular diseases were higher among women than men. The top five disease systems were circulatory system diseases, respiratory system diseases, endocrine/nutritional/metabolic diseases, factors influencing health status and digestive system diseases. The rankings of respiratory system and endocrine/nutritional/metabolic diseases rose over time. Non-communicable diseases (NCDs) accounted for approximately 90% of the primary care visits-a much higher percentage than other causes. The top five NCDs in primary care visits were cardiovascular and circulatory diseases, musculoskeletal disorders, diabetes, digestive diseases and urogenital diseases. Compared with women, men suffered from cardiovascular diseases at an earlier age. CONCLUSIONS Different from specialist visits, common diseases, especially NCDs, were the main disease composition of current primary healthcare visits while the former focused on intractable diseases such as tumours, indicating that primary healthcare had played the role of gatekeeper of the healthcare system.
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Affiliation(s)
- Xin Gong
- Heart Failure Department, Shanghai East Hospital affiliated to Tongji University School of Medicine, Shanghai, China
| | - Xiaoli Wang
- Pudong Health Information Center, Pudong Institute for Health Development, Shanghai, China
| | - Tianxing Shi
- Pudong Health Information Center, Pudong Institute for Health Development, Shanghai, China
| | - Jianwei Shi
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenya Yu
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang Zhou
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ning Chen
- School of Medicine, Tongji University, Shanghai, China
| | - Jiaoling Huang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhaoxin Wang
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Paxton B, Mills K, Usher-Smith JA. Fidelity of the delivery of NHS Health Checks in general practice: an observational study. BJGP Open 2020; 4:bjgpopen20X101077. [PMID: 32967842 PMCID: PMC7606139 DOI: 10.3399/bjgpopen20x101077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 02/02/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The NHS Health Check programme aims to reduce the risk of common preventable diseases by providing risk information and behaviour change advice. Failure to deliver the consultation appropriately could undermine its efficacy. To date, to the authors' knowledge, there are no published data on the fidelity of delivery of NHS Health Checks. AIM To assess the fidelity of delivery of NHS Health Checks in general practice. DESIGN & SETTING Fidelity assessment of video and audio recordings of NHS Health Check consultations conducted in four GP practices across the East of England. METHOD A secondary analysis of 38 NHS Health Check consultations, which were video or audio recorded as part of a pilot study of introducing discussions of cancer risk into NHS Health Checks. Using a checklist based on the NHS Health Check Best Practice Guidance, fidelity of delivery was assessed as the proportion of key elements completed during the consultations. RESULTS The mean number of elements of the NHS Health Check completed across all consultations was 14.5/18 (80.6%), with a range of 10 to 17 (55.6% to 94.4%). The mean fidelity for risk assessment, risk communication, and risk management sections was 8.7/10 (87.0%), 4.1/5 (82.0%), and 1.7/3 (56.7%), respectively. Clinically appropriate lifestyle advice was given in 34/38 consultations. Elements with the lowest fidelity were ethnicity assessment (n = 12/38; 31.6%), family history of cardiovascular disease (CVD) assessment (n = 25/38; 65.8%), AUDIT-C communication (n = 13/38; 34.2%), and dementia risk management (n = 6/38; 15.8%). CONCLUSION Although fidelity of delivery was high overall, important elements of the NHS Health Check were being regularly omitted. Opportunities for behaviour change, particularly relating to alcohol consumption and dementia risk management, may be being missed.
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Affiliation(s)
- Ben Paxton
- University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Katie Mills
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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11
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Brigham KS, Peer MJ, Ghoshhajra BB, Co JPT. Increasing Vaginal Chlamydia Trachomatis Testing in Adolescent and Young Adults. Pediatrics 2020; 146:peds.2019-3028. [PMID: 32636237 DOI: 10.1542/peds.2019-3028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/11/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The Centers for Disease Control and Prevention recommend testing for Chlamydia trachomatis in sexually active female patients <25 years old using nucleic-acid amplification tests (NAAT) from a vaginal swab. Our providers were typically testing using the less sensitive urine NAATs. We aimed to increase the percentage of urogenital C trachomatis NAATs performed by using vaginal swabs in adolescent female patients ages 10 through 20 years from 1.4% to 25%. METHODS We implemented 3 interventions at 3 pediatric practices over 12 months including education, process standardization, and cross-training. We used statistical process control to analyze the effect of interventions on our primary outcome: the percentage of urogenital C trachomatis tests performed with a vaginal swab. Our balance measure was the total number of urogenital C trachomatis tests. RESULTS There were 818 urogenital C trachomatis tests performed: 289 before and 529 after the first intervention. Of urogenital C trachomatis tests in the preintervention time period, 1.4% were performed by using vaginal swabs. We surpassed our aim of 25% 6 weeks after the first intervention. We noted sustained improvement after the second intervention, with an average of 68.3% of tests performed by using vaginal swabs for the remaining postintervention period. There was no difference in the overall number of urogenital C trachomatis tests pre- and postintervention. CONCLUSIONS Using quality improvement methodology and implementing easily replicable interventions, we significantly and sustainably increased use of vaginal swabs. The interventions standardizing processes were associated with a higher impact than the educational intervention.
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Affiliation(s)
- Kathryn S Brigham
- MassGeneral Hospital for Children, Boston, Massachusetts; and .,Division of Adolescent and Young Adult Medicine and
| | - Michael J Peer
- Quality and Safety.,MassGeneral Hospital for Children, Boston, Massachusetts; and
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - John Patrick T Co
- Quality and Safety, .,MassGeneral Hospital for Children, Boston, Massachusetts; and
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12
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Lefèvre H, Moro MR, Lachal J. Research in adolescent healthcare: The value of qualitative methods. Arch Pediatr 2019; 26:426-430. [PMID: 31611145 DOI: 10.1016/j.arcped.2019.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/22/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND The vast majority of publications about adolescent healthcare use a quantitative methodology that often involves long and expensive research protocols with results that do not always provide answers adequate to the complexity of the questions being asked. The qualitative method is sometimes a more effective alternative for exploring some of these. This method can be defined from its objective, which is to generate theoretical hypotheses, its mandatory consideration of the researcher's subjectivity, and the importance it ascribes to the context of the participants' experience. Among the many techniques of qualitative research, the use of phenomenological methods, in particular, interpretative phenomenological analysis (IPA), is highly developed in medical research. OBJECTIVES To define the qualitative method and describe the principal stages of a phenomenological qualitative study. RESULTS The three stages of a qualitative study are data collection (population and sampling, data collection methods), data analysis, and writing up the results. Purposive sampling makes it possible to include participants who can describe in detail, and as experts, their experience during semi-structured interviews. The analysis takes place in two stages, the first very descriptive, the second more interpretative. The results are written-up in a narrative form, including both direct quotations from the interviews and the researchers' interpretation. DISCUSSION The issues of health promotion and healthcare associated with the management of chronic symptoms or diseases in adolescents involve an extremely rich and complex context. Qualitative methods make it possible to approach these questions and to understand them better by generating hypotheses from a rigorous scientific procedure appropriate to the context and objectives. In addition to being used on their own, they can be used on an exploratory basis early in a quantitative study to help define it better, for explanatory purposes, to help understand complex quantitative results, or combined with a quantitative study. The qualitative and quantitative results will then be integrated.
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Affiliation(s)
- H Lefèvre
- Maison de Solenn, hôpital Cochin, AP-HP, 97, boulevard de Port Royal, 75014 Paris, France; UVSQ, Inserm, CESP, faculté de médecine, université Paris-Sud, université Paris-Saclay, 94805 Villejuif, France; French Clinical Research Group in Adolescent Medicine and Health, 75014 Paris, France.
| | - M R Moro
- Maison de Solenn, hôpital Cochin, AP-HP, 97, boulevard de Port Royal, 75014 Paris, France; UVSQ, Inserm, CESP, faculté de médecine, université Paris-Sud, université Paris-Saclay, 94805 Villejuif, France; Université Paris-Descartes, Sorbonne-Paris-Cité, 75005 Paris, France
| | - J Lachal
- Maison de Solenn, hôpital Cochin, AP-HP, 97, boulevard de Port Royal, 75014 Paris, France; UVSQ, Inserm, CESP, faculté de médecine, université Paris-Sud, université Paris-Saclay, 94805 Villejuif, France; Université Paris-Descartes, Sorbonne-Paris-Cité, 75005 Paris, France
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13
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Thompson LH, Nugent Z, Wylie JL, Loeppky C, Van Caeseele P, Blanchard JF, Yu N. Laboratory Detection of First and Repeat Chlamydia Cases Influenced by Testing Patterns: A Population-Based Study. Microbiol Insights 2019; 12:1178636119827975. [PMID: 30833813 PMCID: PMC6393833 DOI: 10.1177/1178636119827975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 12/28/2018] [Indexed: 12/03/2022] Open
Abstract
Objectives: The purpose of this study was to describe and explore potential driving factors of trends in reported chlamydia infections over time in Manitoba, Canada. Methods: Surveillance and laboratory testing data from Manitoba Health, Seniors and Active Living were analysed using SAS v9.4. Kaplan-Meier plots of time from the first to second chlamydia infection were constructed, and Cox proportional hazards regression was used to estimate the risk of second repeat chlamydia infections in males and females. Results: Overall, the number of reported infections found mirrored the number of tests conducted. From 2008 to 2014, the number of first infections found among females decreased as the number of first tests conducted among females also decreased. Between 2008 and 2012, the number of repeat tests among females increased and was accompanied by an increase in the number of repeat positive results from 2009 to 2013. From 2008 to 2016, the number of repeat tests and repeat positive results increased steadily among males. Conclusions: Chlamydia infection rates consistently included a subset composed of repeat infections. The number of cases identified appears to mirror testing volumes, drawing into question incidence calculations that do not include testing volumes. Summary Box: 1) What is the current understanding of this subject? Chlamydia incidence is high in Manitoba, particularly among young women and in northern Manitoba. 2) What does this report add to the literature? This report suggests that incidence calculated using case-based surveillance data alone does not provide an accurate estimate of chlamydia incidence in Manitoba and is heavily influenced by testing patterns. 3) What are the implications for public health practice? In general, improving testing rates in clinical practices as well as through the provision of rapid services in non-clinical venues could result in higher screening and treatment rates. In turn, this could lead to a better understanding of true disease occurrence.
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Affiliation(s)
- Laura H Thompson
- Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | | | - John L Wylie
- Cadham Provincial Laboratory, Manitoba Health, Seniors and Active Living, Winnipeg, MB, Canada.,Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Carla Loeppky
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.,Epidemiology and Surveillance Unit, Public Health and Primary Health Care Division, Manitoba Health, Seniors and Active Living, Winnipeg, MB, Canada
| | - Paul Van Caeseele
- Cadham Provincial Laboratory, Manitoba Health, Seniors and Active Living, Winnipeg, MB, Canada
| | - James F Blanchard
- Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada
| | - Nancy Yu
- Centre for Global Public Health, University of Manitoba, Winnipeg, MB, Canada.,Epidemiology and Surveillance Unit, Public Health and Primary Health Care Division, Manitoba Health, Seniors and Active Living, Winnipeg, MB, Canada
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Application of the COM-B model to barriers and facilitators to chlamydia testing in general practice for young people and primary care practitioners: a systematic review. Implement Sci 2018; 13:130. [PMID: 30348165 PMCID: PMC6196559 DOI: 10.1186/s13012-018-0821-y] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 09/21/2018] [Indexed: 11/24/2022] Open
Abstract
Background Chlamydia is a major public health concern, with high economic and social costs. In 2016, there were over 200,000 chlamydia diagnoses made in England. The highest prevalence rates are found among young people. Although annual testing for sexually active young people is recommended, many do not receive testing. General practice is one ideal setting for testing, yet attempts to increase testing in this setting have been disappointing. The Capability, Opportunity, and Motivation Model of Behaviour (COM-B model) may help improve understanding of the underpinnings of chlamydia testing. The aim of this systematic review was to (1) identify barriers and facilitators to chlamydia testing for young people and primary care practitioners in general practice and (2) map facilitators and barriers onto the COM-B model. Methods Qualitative, quantitative, and mixed methods studies published after 2000 were included. Seven databases were searched to identify peer-reviewed publications which examined barriers and facilitators to chlamydia testing in general practice. The quality of included studies was assessed using the Critical Appraisal Skills Programme. Data (i.e., participant quotations, theme descriptions, and survey results) regarding study design and key findings were extracted. The data was first analysed using thematic analysis, following this, the resultant factors were mapped onto the COM-B model components. All findings are reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results Four hundred eleven papers were identified; 39 met the inclusion criteria. Barriers and facilitators were identified at the patient (e.g., knowledge), provider (e.g., time constraints), and service level (e.g., practice nurses). Factors were categorised into the subcomponents of the model: physical capability (e.g., practice nurse involvement), psychological capability (e.g.: lack of knowledge), reflective motivation (e.g., beliefs regarding perceived risk), automatic motivation (e.g., embarrassment and shame), physical opportunity (e.g., time constraints), social opportunity (e.g., stigma). Conclusions This systematic review provides a synthesis of the literature which acknowledges factors across multiple levels and components. The COM-B model provided the framework for understanding the complexity of chlamydia testing behaviour. While we cannot at this juncture state which component represents the most salient influence on chlamydia testing, across all three levels, multiple barriers and facilitators were identified relating psychological capability and physical and social opportunity. Implementation should focus on (1) normalisation, (2) communication, (3) infection-specific information, and (4) mode of testing. In order to increase chlamydia testing in general practice, a multifaceted theory- and evidence-based approach is needed. Trial registration PROSPERO CRD42016041786 Electronic supplementary material The online version of this article (10.1186/s13012-018-0821-y) contains supplementary material, which is available to authorized users.
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15
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Herbert S, Chung E. Clinical round-up. Sex Transm Infect 2018. [DOI: 10.1136/sextrans-2018-053566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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16
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Pillay K, Gardner M, Gould A, Otiti S, Mullineux J, Bärnighausen T, Matthews PM. Long term effect of primary health care training on HIV testing: A quasi-experimental evaluation of the Sexual Health in Practice (SHIP) intervention. PLoS One 2018; 13:e0199891. [PMID: 30067778 PMCID: PMC6070165 DOI: 10.1371/journal.pone.0199891] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 06/15/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To examine the effect of Sexual Health in Practice (SHIP) training for general practitioners (GPs) on HIV testing rates in Haringey, a deprived area of London, UK, with a population of over 250,000 and HIV prevalence of 0.7% (in 2014). SHIP is an educational intervention delivering peer-developed and peer-led face-to-face training to improve quality of sexual and reproductive health (SRH) care. METHODS We carried out a quasi-experimental study of intervention effects across 52 GP practices (2008-2016). We used time variation in SHIP intervention exposure for effect estimation, controlling for practice and calendar month fixed effects in panel analysis. From 2008-2010, baseline data were collected, and in the subsequent six-year period, 78 GPs in Haringey (approximately 40% of all GPs) were SHIP trained. 46 Haringey practices (of 52) had at least one trained doctor. Outcome measures were monthly HIV tests and results by practice (obtained from the hospital laboratories). RESULTS SHIP significantly increased HIV testing; for every GP trained, practice HIV testing rates increased by 16% (testing rate ratio (TRR) 1.16, 95% confidence interval (CI) 1.05-1.28, p value 0.004). This significant effect was demonstrated using an 8-year observation period, and was sustained over the post-intervention period. An average of 1.42% of HIV tests were positive. CONCLUSION SHIP training produces a significant and sustained increase in HIV testing for each GP trained. Compared with general population screening, HIV tests used in routine clinical care have a high probability of detecting a positive person. Unlike an RCT, this evaluation is a 'real life' measure of the effect that commissioners of SHIP could expect in comparable areas of the UK. The effectiveness of the SHIP training may be related to the programme components not included in interventions that did not demonstrate an effect, such as peer-led teaching, and use of approaches to communication and rapid risk assessment tailored to the setting.
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Affiliation(s)
| | - Melissa Gardner
- Sexual Health in Practice Community Interest Company, London, United Kingdom
- Killick Street Health Centre, London, United Kingdom
| | - Allon Gould
- Whipps Cross Hospital, London, United Kingdom
| | - Susan Otiti
- Public Health, London Borough of Haringey, London, United Kingdom
| | | | - Till Bärnighausen
- Africa Health Research Institute, Somkhele, South Africa
- Institute of Public Health, Heidelberg University, Heidelberg, Germany
- Infection and Population Health, University College London, London, United Kingdom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, United States of America
| | - Philippa Margaret Matthews
- Division of Infection and Immunity, University College London, London, United Kingdom
- Africa Health Research Institute, Somkhele, South Africa
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17
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Qualitative impact assessment of an educational workshop on primary care practitioner attitudes to NICE HIV testing guidelines. BJGP Open 2018; 2:bjgpopen18X101433. [PMID: 30564709 PMCID: PMC6181084 DOI: 10.3399/bjgpopen18x101433] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/21/2017] [Indexed: 11/23/2022] Open
Abstract
Background In 2013, Public Health England piloted the ‘3Cs (chlamydia, contraception, condoms) and HIV (human immunodeficiency virus)’ educational intervention in 460 GP surgeries. The educational HIV workshop aimed to improve the ability and confidence of staff to offer HIV testing in line with national guidelines. Aim To qualitatively assess the impact of an educational workshop on GP staff’s attitudes to NICE HIV testing guidelines. Design & setting Qualitative interviews with GP staff across England before and after an educational HIV workshop. Method Thirty-two GP staff (15 before and 17 after educational HIV workshop) participated in interviews exploring their views and current practice of HIV testing. Interview transcripts were thematically analysed and examined, using the components of the theory of planned behaviour (TPB) and normalisation process theory (NPT) as a framework. Results GPs reported that the educational HIV workshop resulted in increased knowledge of, and confidence to offer, HIV tests based on indicator conditions. However, overall participants felt they needed additional HIV training around clinical care pathways for offering tests, giving positive HIV results, and current treatments and outcomes. Participants did not see a place for point-of-care testing in general practice. Conclusion Implementation of national HIV guidelines will require multiple educational sessions, especially to implement testing guidelines for indicator conditions in areas of low HIV prevalence. Additional role-play or discussions around scripts suggesting how to offer an HIV test may improve participants’ confidence and facilitate increased testing. Healthcare assistants (HCAs) may need specific training to ensure that they are skilled in offering HIV testing within new patient checks.
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