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Hunter B, Davidson S, Lumsden N, Chima S, Gutierrez JM, Emery J, Nelson C, Manski-Nankervis JA. Optimising a clinical decision support tool to improve chronic kidney disease management in general practice. BMC PRIMARY CARE 2024; 25:220. [PMID: 38898462 PMCID: PMC11186183 DOI: 10.1186/s12875-024-02470-w] [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: 07/18/2023] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Early identification and treatment of chronic disease is associated with better clinical outcomes, lower costs, and reduced hospitalisation. Primary care is ideally placed to identify patients at risk of, or in the early stages of, chronic disease and to implement prevention and early intervention measures. This paper evaluates the implementation of a technological intervention called Future Health Today that integrates with general practice EMRs to (1) identify patients at-risk of, or with undiagnosed or untreated, chronic kidney disease (CKD), and (2) provide guideline concordant recommendations for patient care. The evaluation aimed to identify the barriers and facilitators to successful implementation. METHODS Future Health Today was implemented in 12 general practices in Victoria, Australia. Fifty-two interviews with 30 practice staff were undertaken between July 2020 and April 2021. Practice characteristics were collected directly from practices via survey. Data were analysed using inductive and deductive qualitative analysis strategies, using Clinical Performance - Feedback Intervention Theory (CP-FIT) for theoretical guidance. RESULTS Future Health Today was acceptable, user friendly and useful to general practice staff, and supported clinical performance improvement in the identification and management of chronic kidney disease. CP-FIT variables supporting use of FHT included the simplicity of design and delivery of actionable feedback via FHT, good fit within existing workflow, strong engagement with practices and positive attitudes toward FHT. Context variables provided the main barriers to use and were largely situated in the external context of practices (including pressures arising from the COVID-19 pandemic) and technical glitches impacting installation and early use. Participants primarily utilised the point of care prompt rather than the patient management dashboard due to its continued presence, and immediacy and relevance of the recommendations on the prompt, suggesting mechanisms of compatibility, complexity, actionability and credibility influenced use. Most practices continued using FHT after the evaluation phase was complete. CONCLUSIONS This study demonstrates that FHT is a useful and acceptable software platform that provides direct support to general practice in identifying and managing patients with CKD. Further research is underway to explore the effectiveness of FHT, and to expand the conditions on the platform.
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Affiliation(s)
- Barbara Hunter
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia.
| | - Sandra Davidson
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Natalie Lumsden
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
- Western Health Chronic Disease Alliance, Western Health Melbourne, Melbourne, Australia
| | - Sophie Chima
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
| | - Javiera Martinez Gutierrez
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- Family Medicine Department, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jon Emery
- Department of General Practice and Primary Care, University of Melbourne, Melbourne, Australia
- Centre for Cancer Research, University of Melbourne, Melbourne, Australia
- The Primary Care Unit, University of Cambridge, Cambridge, UK
| | - Craig Nelson
- Western Health Chronic Disease Alliance, Western Health Melbourne, Melbourne, Australia
- Department of Medicine - Western Health, University of Melbourne, Melbourne, Australia
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Sattler A, Phadke A, Mickelsen J, Seay-Morrison T, Filipowicz H, Chhoa D, Srinivasan M. Catalyzing System Change: 100 Quality Improvement Projects in 1000 Days. J Gen Intern Med 2024; 39:940-950. [PMID: 37985609 DOI: 10.1007/s11606-023-08431-w] [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: 03/11/2023] [Accepted: 09/14/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND Health system change requires quality improvement (QI) infrastructure that supports frontline staff implementing sustainable innovations. We created an 8-week rapid-cycle QI training program, Stanford Primary Care-Project Engagement Platform (PC-PEP), open to patient-facing primary care clinicians and staff. OBJECTIVE Examine the feasibility and outcomes of a scalable QI program for busy practicing providers and staff in an academic medical center. DESIGN Program evaluation. PARTICIPANTS A total of 172 PCPH team members: providers (n = 55), staff (n = 99), and medical learners (n = 18) in the Stanford Division of Primary Care and Population Health (PCPH) clinics, 2018-2021. MAIN MEASURES We categorized projects by the Institute for Healthcare Improvement's (IHI) Quintuple Aim (QA): better health, better patient experience, lower cost of care, better care team experience, and improved equity/inclusion. We assessed project progress with a modified version of The Ottawa Hospital Innovation Framework: step 1 (identified root causes), step 2 (designed/tested interventions), step 3 (assessed project outcome), step 4 (met project goal with target group), step 5A (intervention(s) spread within clinic), step 5B (intervention(s) spread to different setting). Participants rated post-participation QI self-efficacy. KEY RESULTS Within 1000 days, 172 unique participants completed 104 PC-PEP projects. Most projects aimed to improve patient health (55%) or care team experience (23%). Among projects, 9% reached step 1, 8% step 2, 16% step 3, 26% step 4, 21% step 5A, and 20% step 5B. Learner involvement increased likelihood of scholarly products (47% vs 10%). Forty-six of 47 (98%) survey respondents reported improved QI self-efficacy. Medical assistants, more so than physicians, reported feeling acknowledged by the health system for their QI efforts (100% vs 61%). CONCLUSIONS With appropriate QI infrastructure, scalable QI training models like Stanford PC-PEP can empower frontline workers to create meaningful changes across the IHI QA.
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Affiliation(s)
- Amelia Sattler
- Stanford University School of Medicine, Palo Alto, CA, USA.
| | | | | | | | | | - Davis Chhoa
- Stanford University School of Medicine, Palo Alto, CA, USA
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Birhane BM, Assefa Y, Belay DM, Nibret G, Munye Aytenew T, Liyeh TM, Gelaw KA, Tiruneh YM. Interventions to improve the quality of maternal care in Ethiopia: a scoping review. Front Glob Womens Health 2024; 5:1289835. [PMID: 38694232 PMCID: PMC11061455 DOI: 10.3389/fgwh.2024.1289835] [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: 09/19/2023] [Accepted: 03/25/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction Quality improvement interventions have been part of the national agenda aimed at reducing maternal and neonatal morbidities and mortality. Despite different interventions, neonatal mortality and morbidity rates remain steady. This review aimed to map and synthesize the evidence of maternal and newborn quality improvement interventions in Ethiopia. Methods A scoping review was reported based on the reporting items for systematic reviews and meta-analysis extensions for the scoping review checklist. Data extraction, collation, and organization were based on the Joanna Briggs Institute manual of the evidence synthesis framework for a scoping review. The maternal and neonatal care standards from the World Health Organization and the Donabedian quality of health framework were used to summarize the findings. Results Nineteen articles were included in this scoping review. The review found that the studies were conducted across various regions of Ethiopia, with the majority published after 2013. The reviewed studies mainly focused on three maternal care quality interventions: mobile and electronic health (eHealth), quality improvement standards, and human resource mobilization. Moreover, the reviewed studies explored various approaches to quality improvement, such as providing training to healthcare workers, health extension workers, traditional birth attendants, the community health development army, and mothers and supplying resources needed for maternal and newborn care. Conclusion In conclusion, quality improvement strategies encompass community involvement, health education, mHealth, data-driven approaches, and health system strengthening. Future research should focus on the impact of physical environment, culture, sustainability, cost-effectiveness, and long-term effects of interventions. Healthcare providers' knowledge, skills, attitudes, satisfaction, and adherence to guidelines should also be considered.
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Affiliation(s)
- Binyam Minuye Birhane
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Demeke Mesfin Belay
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Gedefaye Nibret
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Tewachew Muche Liyeh
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
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Khatri RB, Assefa Y. Drivers of the Australian Health System towards Health Care for All: A Scoping Review and Qualitative Synthesis. BIOMED RESEARCH INTERNATIONAL 2023; 2023:6648138. [PMID: 37901893 PMCID: PMC10611547 DOI: 10.1155/2023/6648138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Revised: 08/03/2023] [Accepted: 10/07/2023] [Indexed: 10/31/2023]
Abstract
Background Australia has made significant progress towards universal access to primary health care (PHC) services. However, disparities in the utilisation of health services and health status remain challenges in achieving the global target of universal health coverage (UHC). This scoping review aimed at synthesizing the drivers of PHC services towards UHC in Australia. Methods We conducted a scoping review of the literature published from 1 January 2010 to 30 July 2021 in three databases: PubMed, Scopus, and Embase. Search terms were identified under four themes: health services, Australia, UHC, and successes or challenges. Data were analysed using an inductive thematic analysis approach. Drivers (facilitators and barriers) of PHC services were explained by employing a multilevel framework that included the proximal level (at the level of users and providers), intermediate level (organisational and community level), and distal level (macrosystem or distal/structural level). Results A total of 114 studies were included in the review. Australia has recorded several successes in increased utilisation of PHC services, resulting in an overall improvement in health status. However, challenges remain in poor access and high unmet needs of health services among disadvantaged/priority populations (e.g., immigrants and Indigenous groups), those with chronic illnesses (multiple chronic conditions), and those living in rural and remote areas. Several drivers have contributed in access to and utilisation of health services (especially among priority populations)operating at multilevel health systems, such as proximal level drivers (health literacy, users' language, access to health facilities, providers' behaviours, quantity and competency of health workforce, and service provision at health facilities), intermediate drivers (community engagement, health programs, planning and monitoring, and funding), and distal (structural) drivers (socioeconomic disparities and discriminations). Conclusion Australia has had several successes towards UHC. However, access to health services poses significant challenges among specific priority populations and rural residents. To achieve universality and equity of health services, health system efforts (supply- and demand-side policies, programs and service interventions) are required to be implemented in multilevel health systems. Implementation of targeted health policy and program approaches are needed to provide comprehensive PHC and address the effects of structural disparities.
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Affiliation(s)
- Resham B. Khatri
- Health Social Science and Development Research Institute, Kathmandu, Nepal
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
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Hespe CM, Brown E, Rychetnik L. Learning from the implementation of a quality improvement intervention in Australian general practice: a qualitative analysis of participants views of a CVD preventive care project. BMC PRIMARY CARE 2022; 23:79. [PMID: 35421935 PMCID: PMC9011978 DOI: 10.1186/s12875-022-01692-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/04/2022] [Indexed: 11/23/2022]
Abstract
Background Quality improvement collaborative projects aim to reduce gaps in clinical care provided in the healthcare system. This study evaluated the experience of key participants from a Quality Improvement Program (QPulse) that focussed on cardiovascular disease assessment and management. The study goal was to identify critical barriers and factors enabling the implementation of a quality improvement framework in Australian general practice. Methods This qualitative study examined in-depth semi-structured interviews with nineteen purposively-selected participants of the QPulse project. Interviewees were from General Practices and the local supporting organisation, a Primary Health Network. Interviews were analysed thematically using the Complex Systems Improvement framework, focusing on five domains: strategy, culture, structure, workforce and technology. Results Despite reported engagement with QPulse objectives to improve cardiovascular preventive care, implementation barriers associated with this program were considerable for all interviewees. Adoption of the quality improvement process was reliant on designated leadership, aligned practice culture, organised systems for clear communication, tailored education and utilisation of clinical audit and review processes. Rather than practice size and location, practice culture and governance alignment to quality improvement predicted successful implementation. Financial incentives for both general practice and the Primary Health Network were also identified as prerequisites for systematised quality improvement projects in the future, along with individualised support and education for each general practice. Technology was both an enabler and a barrier, and the Primary Health Network was seen as key to assisting the successful utilisation of the available tools. Conclusions Implementation of Quality Improvement programs remains a potential tool for achieving better health outcomes in General Practice. However, enablers such as financial incentives, individualised education and support provided via a supporting organisation, and IT tools and support are crucial if the full potential of Quality Improvement programs are to be realised in the Australian healthcare setting. Trial registration ACTRN12615000108516, UTN U1111-1163–7995. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01692-0.
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Eide TB, Øyane N, Høye S. Promoters and inhibitors for quality improvement work in general practice: a qualitative analysis of 2715 free-text replies. BMJ Open Qual 2022; 11:bmjoq-2022-001880. [PMID: 36207051 PMCID: PMC9557324 DOI: 10.1136/bmjoq-2022-001880] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 09/27/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Continuous quality improvement (QI) is necessary to develop and maintain high quality general practice services. General Practitioners (GPs') motivation is an important factor in the success of QI initiatives. We aimed to identify factors that impair or promote GPs' motivation for and participation in QI projects. MATERIAL AND METHODS We analysed 2715 free-text survey replies from 2208 GPs participating in the QI intervention 'Correct Antibiotic Use in the Municipalities'. GPs received reports detailing their individual antibiotic prescriptions for a defined period, including a comparison with a corresponding previous period. The content was discussed in peer group meetings. Each GP individually answered work-sheets on three separate time-points, including free-text questions regarding their experiences with the intervention. Data were analysed using inductive thematic analysis. RESULTS We identified three overarching themes in the GPs' thoughts on inhibitors and promoters of QI work: (1) the desire to be a better doctor, (2) structural and organisational factors as both promoters and inhibitors and (3) properties related to different QI measures. The provision of individual prescription data was generally very well received. The participants stressed the importance of a safe peer group, like the Continuous Medical Education group, for discussions, and also underlined the motivating effect of working together with their practice as a whole. Lack of time was essential in GPs' motivation for QI work. QI tools should be easily available and directly relevant in clinical work. CONCLUSION The desire to be good doctor is a strong motivator for improvement, but the framework for general practice must allow for QI initiatives. QI tools must be easily obtainable and relevant for practice. Better tools for obtaining clinical data for individual GPs are needed.
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Affiliation(s)
| | - Nicolas Øyane
- Centre for Quality Improvement in Medical Practices, Bergen, Norway,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Hordaland, Norway
| | - Sigurd Høye
- Department of General Practice, University of Oslo, Oslo, Norway
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Knight AW, Tam CWM, Dennis S, Fraser J, Pond D. The role of quality improvement collaboratives in general practice: a qualitative systematic review. BMJ Open Qual 2022; 11:bmjoq-2021-001800. [PMID: 35589275 PMCID: PMC9121486 DOI: 10.1136/bmjoq-2021-001800] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 04/26/2022] [Indexed: 11/25/2022] Open
Abstract
Background This systematic review used qualitative methodologies to examine the role of quality improvement collaboratives (QICs) in general practice. The aim was to inform implementers and participants about the utility of using or participating in QICs in general practice. Methods Included studies were published in English, used a QIC intervention, reported primary research, used qualitative or mixed methods, and were conducted in general practice. A Medline search between January 1995 and February 2020 was developed and extended to include Embase, CINAHL and PsycInfo databases. Articles were sought through chaining of references and grey literature searches. Qualitative outcome data were extracted using a framework analysis. Data were analysed using thematic synthesis. Articles were assessed for quality using a threshold approach based on the criteria described by Dixon-Woods. Results 15 qualitative and 18 mixed-methods studies of QICs in general practice were included. Data were grouped into four analytical themes which describe the role of a collaborative in general practice: improving the target topic, developing practices and providers, developing the health system and building quality improvement capacity. Discussion General practice collaboratives are reported to be useful for improving target topics. They can also develop knowledge and motivation in providers, build systems and team work in local practice organisations, and improve support at a system level. Collaboratives can build quality improvement capacity in the primary care system. These roles suggest that QICs are well matched to the improvement needs of general practice. General practice participants in collaboratives reported positive effects from effective peer interaction, high-quality local support, real engagement with data and well-designed training in quality improvement. Strengths of this study were an inclusive search and explicit qualitative methodology. It is possible some studies were missed. Qualitative studies of collaboratives may be affected by selection bias and confirmation bias. PROSPERO registration number CRD4202017512.
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Affiliation(s)
- Andrew Walter Knight
- The Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia .,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Chun Wah Michael Tam
- The Primary and Integrated Care Unit, South Western Sydney Local Health District, Liverpool, New South Wales, Australia.,School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Sarah Dennis
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Ingham Institute, Liverpool, New South Wales, Australia
| | - John Fraser
- School of Rural Medicine, University of New England, Armidale, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Dimity Pond
- The University of Newcastle, Callaghan, New South Wales, Australia
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Knight AW, Fraser J, Pond CD. It is time to reinvest in quality improvement collaboratives to support Australian general practice. Med J Aust 2022; 216:438-440. [PMID: 35441388 PMCID: PMC9325532 DOI: 10.5694/mja2.51502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Andrew W Knight
- South Western Sydney Local Health District Sydney NSW
- UNSW Sydney Sydney NSW
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Hespe CM, Giskes K, Harris MF, Peiris D. Findings and lessons learnt implementing a cardiovascular disease quality improvement program in Australian primary care: a mixed method evaluation. BMC Health Serv Res 2022; 22:108. [PMID: 35078460 PMCID: PMC8790896 DOI: 10.1186/s12913-021-07310-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are discrepancies between evidence-based guidelines for screening and management of cardiovascular disease (CVD) and implementation in Australian general practice. Quality-improvement (QI) initiatives aim to reduce these gaps. This study evaluated a QI program (QPulse) that focussed on CVD assessment and management. Methods This mixed-methods study explored the implementation of guidelines and adoption of a QI program with a CVD risk-reduction intervention in 34 general practices. CVD screening and management were measured pre- and post-intervention. Qualitative analyses examined participants’ Plan-Do-Study-Act (PDSA) goals and in-depth interviews with practice stakeholders focussed on barriers and enablers to the program and were analysed thematically using Normalisation Process Theory (NPT). Results Pre- and post-intervention data were available from 15 practices (n = 19,562 and n = 20,249, respectively) and in-depth interviews from seven practices. At baseline, 45.0% of patients had their BMI measured and 15.6% had their waist circumference recorded in the past 2 years and blood pressure, lipids and smoking status were measured in 72.5, 61.5 and 65.3% of patients, respectively. Most high-risk patients (57.5%) were not prescribed risk-reducing medications. After the intervention there were no changes in the documentation and prevalence of risk factors, attainment of BP and lipid targets or prescription of CVD risk-reducing medications. However, there was variation in performance across practices with some showing isolated improvements, such as recording waist circumference (0.7-32.2% pre-intervention to 18.5-69.8% post-intervention), BMI and smoking assessment. Challenges to the program included: lack of time, need for technical support, a perceived lack of value for quality improvement work, difficulty disseminating knowledge across the practice team, tensions between the team and clinical staff and a part-time workforce. Conclusion The barriers associated with this QI program was considerable in Australian GP practices. Findings highlighted they were not able to effectively operationalise the intervention due to numerous factors, ranging from lack of internal capacity and leadership to competing demands and insufficient external support. Trial registration Australian New Zealand Clinical Trials Reference Number (ACTRN12615000108516), registered 06/02/2015. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07310-6.
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Affiliation(s)
- C M Hespe
- School of Medicine, Sydney, University of Note Dame Australia, 160 Oxford St, Darlinghurst, Sydney, NSW, 2010, Australia.
| | - K Giskes
- School of Medicine, Sydney, University of Note Dame Australia, 160 Oxford St, Darlinghurst, Sydney, NSW, 2010, Australia.,Heart Research Institute, University of Sydney, Sydney, Australia
| | - M F Harris
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
| | - D Peiris
- The George Institute for Global Health, University of Sydney, Sydney, Australia
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Trankle SA, Metusela C, Reath J. Undertaking general practice quality improvement to improve cancer screening - a thematic analysis of provider experiences. BMC FAMILY PRACTICE 2021; 22:230. [PMID: 34789162 PMCID: PMC8597279 DOI: 10.1186/s12875-021-01581-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 11/08/2021] [Indexed: 12/01/2022]
Abstract
Background Cancer is a major cause of illness and death, and its incidence and mortality can be reduced through effective screening. In order to improve below target screening rates in one region of Australia, the local Primary Health Network supported local general practices to implement a range of quality improvement initiatives. Methods We used a qualitative approach and interviewed 18 general practice staff and five Primary Health Network staff and contractors to understand their experiences with these quality improvement initiatives. Results In a thematic analysis, we identified four key themes related to program set-up and implementation; patient and community education and promotion; engaging patients and communities in screening; and general practice enhancement. Program roles were clear and understood, and the program received strong oversight and support. Practice staff felt supported and motivated. Information Technology was a challenge for many practices often requiring tailored assistance. Education provided by practices facilitated patient empowerment but practice staff noted difficulties engaging patients in screening. Practices were enhanced though strong leadership and teamwork and practice learning activities. Conclusions The tailored evidence-based quality improvement initiatives were considered effective in supporting general practices to increase their cancer screening. Key facilitators reported by participants included use of Plan-Do-Study-Act cycles, enhanced data entry and audit capacity, effective recall and reminder systems and maintaining staff motivation. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01581-y.
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Affiliation(s)
- Steven A Trankle
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.24 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Christine Metusela
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.24 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Jennifer Reath
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.24 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
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Wan G, Wei X, Yin H, Qian Z, Wang T, Wang L. The trend in primary health care preference in China: a cohort study of 12,508 residents from 2012 to 2018. BMC Health Serv Res 2021; 21:768. [PMID: 34344362 PMCID: PMC8336283 DOI: 10.1186/s12913-021-06790-w] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Residents’ preference for primary health care (PHC) determined their utilization of PHC. This study aimed to assess the determinants of PHC service preference among the residents and the trend in PHC service preference over time in China. Methods We employed the nationally representative longitudinal data from 2012 to 2018 based on the China Family Panel Studies. The analysis framework was guided by the Andersen model of health service utilization. We included a total of 12,508 individuals who have been successfully followed up in the surveys of 2012, 2014, 2016, and 2018 without any missing data. Logistic regressions were performed to analyze potential predictors of PHC preference behavior. Results The results indicated that individuals’ socio-economic circumstances and their health status factors were statistically significant determinants of PHC preference. Notably, over time, the residents’ likelihood of choosing PHC service represented a decreasing trend. Compare to 2012, the likelihood of PHC service preference decreased by 18.6% (OR, 0.814; 95% CI, 0.764–0.867) in 2014, 30.0% (OR, 0.700; 95% CI, 0.657–0.745) in 2016, and 34.9% (OR, 0.651; 95% CI, 0.611–0.694) in 2018. The decrease was significantly associated with the changes in residents’ health status. Conclusions The residents’ likelihood of choosing PHC service represented a decreasing trend, which was contrary to the objective of China’s National Health Reform in 2009. We recommend that policymakers adjust the primary service items in PHC facilities and strengthen the coordination of service between PHC institutions and higher-level hospitals. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06790-w.
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Affiliation(s)
- Guangsheng Wan
- School of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China.
| | - Xiaolin Wei
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, M5T3M6, Canada.
| | - Hui Yin
- School of Health Management, Harbin Medical University, Harbin, 150081, Heilongjiang, China
| | - Zhiwang Qian
- School of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China
| | - Tingting Wang
- School of Nursing and Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China
| | - Lina Wang
- Foreign Language Faculty, Shanghai University of Medicine & Health Sciences, Shanghai, 201318, China
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Biezen R, Buising K, Monaghan T, Ball R, Thursky K, Cheah R, Clark M, Manski-Nankervis JA. Evaluating the Implementation of a Pilot Quality Improvement Program to Support Appropriate Antimicrobial Prescribing in General Practice. Antibiotics (Basel) 2021; 10:antibiotics10070867. [PMID: 34356788 PMCID: PMC8300821 DOI: 10.3390/antibiotics10070867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/05/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
Inappropriate antimicrobial prescribing contributes to increasing antimicrobial resistance. An antimicrobial stewardship (AMS) program in the form of quality improvement activities that included audit and feedback, clinical decision support and education was developed to help optimise prescribing in general practice. The aim of this study was to evaluate the implementation of this program (Guidance GP) in three general practices in Melbourne, Australia, between November 2019 and August 2020. Thirty-one general practitioners (GPs) participated in the program, with 11 GPs and three practice managers participating in follow-up focus groups and interviews to explore the acceptability and feasibility of the program. Our findings showed that the quality improvement activities were acceptable to GPs, if they accurately fit GPs' decision-making process and workflow. It was also important that they provided clinically meaningful information in the form of audit and feedback to GPs. The time needed to coordinate the program, and costs to implement the program were some of the potential barriers identified. Facilitators of success were a "whole of practice" approach with enthusiastic GPs and practice staff, and an identified practice champion. The findings of this research will inform implementation strategies for both the Guidance GP program and AMS programs more broadly in Australian general practice, which will be critical for general practice participation and engagement.
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Affiliation(s)
- Ruby Biezen
- Department of General Practice, The University of Melbourne, Melbourne 3004, Australia; (T.M.); (M.C.); (J.-A.M.-N.)
- Correspondence: ; Tel.: +61-3-9035-4886
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Melbourne 3004, Australia; (K.B.); (K.T.); (R.C.)
- The Guidance Group, Royal Melbourne Hospital, Melbourne 3050, Australia
| | - Tim Monaghan
- Department of General Practice, The University of Melbourne, Melbourne 3004, Australia; (T.M.); (M.C.); (J.-A.M.-N.)
| | - Rachael Ball
- North Western Melbourne Primary Health Network, Melbourne 3052, Australia;
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Melbourne 3004, Australia; (K.B.); (K.T.); (R.C.)
- The Guidance Group, Royal Melbourne Hospital, Melbourne 3050, Australia
| | - Ron Cheah
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Melbourne 3004, Australia; (K.B.); (K.T.); (R.C.)
- The Guidance Group, Royal Melbourne Hospital, Melbourne 3050, Australia
| | - Malcolm Clark
- Department of General Practice, The University of Melbourne, Melbourne 3004, Australia; (T.M.); (M.C.); (J.-A.M.-N.)
| | - Jo-Anne Manski-Nankervis
- Department of General Practice, The University of Melbourne, Melbourne 3004, Australia; (T.M.); (M.C.); (J.-A.M.-N.)
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Improving Care for Childhood Obesity: A Quality Improvement Initiative. Pediatr Qual Saf 2021; 6:e412. [PMID: 34046541 PMCID: PMC8143745 DOI: 10.1097/pq9.0000000000000412] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 12/04/2020] [Indexed: 11/29/2022] Open
Abstract
Obesity affected 13.7 million children in the United States in 2015. The American Academy of Pediatrics (AAP) offers an evidence-based approach to obesity management, but adherence to recommendations is suboptimal. Our objective was to improve provider adherence to the AAP recommendations for care of patients with obesity by making systematic changes in our practice for patients of ages > 2 and younger than 19 years with a BMI > 95th percentile.
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Evolution and Evaluation of a Quality and Patient Safety Fellowship for Practicing Health Professionals. Am J Med Qual 2021; 37:118-126. [PMID: 34050051 DOI: 10.1097/01.jmq.0000750800.92547.8a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Developing clinical quality champions is an important strategy for improving health care quality. The NorthShore Quality and Patient Safety Fellowship was a yearlong program for practicing physicians devoting 4 hours/wk to a didactic curriculum and quality practicum. Thirty-seven clinicians completed the Fellowship from 2011 to 2018. Sixty percent of graduates reported a significant impact on their quality-related career trajectory, with 44% of early graduates and 64% of recent graduates reporting a new quality role or responsibility as a result of the Fellowship. Fifty-four percent of practicum projects were adopted or adapted by the organization. The Fellowship has been an effective framework to identify and train future quality champions and has led to further quality leadership opportunities for many graduates. Evolution of the Fellowship aligned practicum projects with organizational quality priorities. This curricular framework may be useful for other organizations that seek to develop quality champions among practicing physicians.
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Toomey M, Gyawali R, Stapleton F, Ho KC, Keay L, Jalbert I. Facilitators and barriers to the delivery of eye care by optometrists: a systematic review using the theoretical domains framework. Ophthalmic Physiol Opt 2021; 41:782-797. [PMID: 33774856 DOI: 10.1111/opo.12801] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 01/21/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE Evidence-based practice is fundamental to providing quality care, patient satisfaction and judicious use of limited healthcare resources. However, variability in evidence-based eye care delivery has been reported. Given the important role of optometrists in delivering primary eye care, a better understanding of the barriers and facilitators to providing optometric care is required. This systematic review aimed to identify determinants (barriers and facilitators) of eye care delivery by optometrists and interventions that may improve eye care delivery. RECENT FINDINGS PubMed, MEDLINE, EMBASE, CINAHL, SCOPUS, PsychINFO, ProQuest and Web of Science were searched for studies reporting barriers and facilitators to eye care delivery published between 1999 and 2020. The Theoretical Domains Framework (TDF) was used to analyse data (quotations, interpretive summaries, survey result) with barriers and facilitators coded to one or more of the 14 domains, and used to identify the key behavioural domains influencing eye care delivery based on frequency of coding, elaboration and stated importance in the study. Influential domains were mapped to the Behaviour Change Wheel to identify potential interventions to improve eye care delivery. Of the 802 studies retrieved from the search, 30 were included. Frequently identified barriers were time constraints, resources and equipment issues, patient factors, lack of awareness, skill proficiency deficits and negative attitudes and beliefs. Frequently identified facilitators were adequate time, resources and equipment, education, skill proficiency and understanding the relevancy of the eye care provided. The key TDF domains influencing eye care delivery were 'environmental context and resources' (time, resources, equipment issues, patient factors), 'knowledge' (awareness issues), 'skills' (skills proficiency) and 'belief about consequences' (beliefs and relevancy). Intervention functions that may improve eye care delivery were education, training, restriction, environmental restructuring, enablement, persuasion and modelling. SUMMARY The barriers and facilitators identified in this review were diverse and located at both the practitioner and organisational levels. Four TDF domains were found to be influential determinants of eye care practice. Intervention functions identified in this study can be used to improve the appropriateness of primary eye care delivery.
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Affiliation(s)
- Melinda Toomey
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Rajendra Gyawali
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Fiona Stapleton
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Kam Chun Ho
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Lisa Keay
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.,The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Isabelle Jalbert
- School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
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Lai S, Lu L, Zhou Z, Shen C, Yang X, Zhao Y, Zhang X. The effects of family physician-contracted service on health-related quality of life and equity in health in China. Int J Equity Health 2021; 20:15. [PMID: 33407523 PMCID: PMC7788691 DOI: 10.1186/s12939-020-01348-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 12/09/2020] [Indexed: 02/07/2023] Open
Abstract
Background Family physician-contracted service (FPCs) has been recently implemented in Chinese primary care settings. This study was aimed at measuring the effects of FPCs on residents’ health-related quality of life (HRQoL) and equity in health among the Chinese population. Methods The study data was drawn from the 2018 household health survey (Shaanxi Province, China) using multistage, stratified cluster random sampling. We measured HRQoL using EQ-5D-3L based on the Chinese-specific time trade-off values set. Coarsened exact matching (CEM) technique was used to control for confounding factors between residents with and without a contracted family physician. The concentration index (C) was calculated to measure equity in health. Results Individuals with a contracted family physician had significantly higher HRQoL than those without, after data matching (0.9355 vs. 0.8995; P < 0.001). Additionally, the inequity in HRQoL among respondents with a contracted family physician was significantly lower than those without a contracted family physician (Cs of EQ-5D utility score: 0.0084 vs. 0.0263; p < 0.001). Conclusions This study highlights the positive effects of FPCs on HRQoL and socioeconomic-related equity in HRQoL. Future efforts should prioritize the economically and educationally disadvantaged groups, the expansion of service coverage, and the competency of family physician teams to further enhance health outcome and equity in health.
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Affiliation(s)
- Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, 710048, Shaanxi, China
| | - Li Lu
- Team IETO, Bordeaux Population Health Research Center, UMR U1219, INSERM, Université de Bordeaux, Bordeaux, France
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, 710048, Shaanxi, China.
| | - Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, 710048, Shaanxi, China
| | - Xiaowei Yang
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, 710048, Shaanxi, China.
| | - Yaxin Zhao
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, 710048, Shaanxi, China
| | - Xiaolong Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, No. 28 West Xianning Road, Xi'an, 710048, Shaanxi, China
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17
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Rose M, Maciejewski H, Nowack J, Stamm B, Liu G, Gowda C. Promoting Pediatric Preventive Visits Through Quality Improvement Initiatives in the Primary Care Setting. J Pediatr 2021; 228:220-227.e3. [PMID: 32890582 DOI: 10.1016/j.jpeds.2020.08.081] [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: 05/01/2020] [Revised: 07/13/2020] [Accepted: 08/27/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate whether quality improvement (QI) capacity-building in affiliated primary care practices could increase well care visit uptake. STUDY DESIGN Partners For Kids (PFK) is an accountable care organization caring for pediatric Medicaid beneficiaries in Ohio. PFK QI specialists recruited practices to develop QI projects around increasing well care visit rates (proportion of eligible children with well care visits during calendar year) for children aged 3-6 years and adolescents. The QI specialists supported practice teams in implementing interventions and collecting data through monthly or bimonthly practice visits. RESULTS Ten practices, serving more than 26 000 children, participated in QI projects for a median of 8.5 months (IQR 5.3-17.6). Well care visit rates in the QI-engaged practices significantly improved from 2016 to 2018 (P < .001 for both age groups). Over time, well care visit rates for 3- to 6-year-old children increased by 11.8% (95% CI 5.4%-18.2%) in QI-engaged practices, compared with 4.1% (95% CI 0.1%-7.4%) in non-engaged practices (P = .233). For adolescents, well care visit rates increased 14.3% (95% CI -2.6% to 31.2%) compared with 5.4% (95% CI 1.8%-9.0%) in QI-engaged vs non-engaged practices over the same period (P = .215). Although not statistically significant, QI-engaged practices had greater magnitudes of rate increases for both age groups. CONCLUSIONS Through practice facilitation, PFK helped a diverse group of community practices substantially improve preventive visit uptake over time. QI programs in primary care can reach patients early to promote preventive services that potentially avoid costly downstream care.
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Affiliation(s)
- Megan Rose
- Partners For Kids, The Ohio State University College of Medicine, Columbus, OH; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Heather Maciejewski
- Partners For Kids, The Ohio State University College of Medicine, Columbus, OH; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Joshua Nowack
- Partners For Kids, The Ohio State University College of Medicine, Columbus, OH; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Brad Stamm
- Partners For Kids, The Ohio State University College of Medicine, Columbus, OH; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
| | - Gilbert Liu
- Partners For Kids, The Ohio State University College of Medicine, Columbus, OH; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH
| | - Charitha Gowda
- Partners For Kids, The Ohio State University College of Medicine, Columbus, OH; Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH; Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.
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Pitts MA, Sashidhar S, Hudak P, Blood-Siegfried J. Early Peanut Protein Introduction in Clinical Practice. J Pediatr Nurs 2020; 55:95-99. [PMID: 32721769 DOI: 10.1016/j.pedn.2020.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/08/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE New multiple agency recommendations have encouraged the early introduction of peanut protein (PP) in high-risk children to decrease peanut allergies. However, many providers are hesitant to use these recommendations. Our objective was to increase the recommendation of new guidelines by providers during routine infant care and evaluate caregiver acceptance of early PP introduction. DESIGN AND METHODS This QI project focused on changing providers' knowledge and attitudes as a means to change practice using the "Plan-Do-Study-Act" model. Following provider educational sessions in 4 clinical sites providers and caregivers were questioned about instruction on the introduction of PP. Pre and post educational intervention data were collected from providers using chart audit and caregivers' report through the modified Promoting Healthy Development Survey (PHDS). RESULTS The educational intervention was effective in increasing provider knowledge (p < .05), providers' dissemination of knowledge to caregivers through provider report (p < .001) and caregiver report (p < .05). CONCLUSIONS Education increased providers' knowledge about the safety and importance of early introductions of PP, and allayed fears about initiating an allergic reaction. The increased provider recommendation to caregivers was validated by both provider and caregiver report. Caregivers felt comfortable initiating peanut protein. PRACTICE IMPLICATIONS Provider education led to increased recommendation to caregivers on early introduction of PP and increased caregiver comfort introducing PP.
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Affiliation(s)
- Melanie Ann Pitts
- Kids First Pediatrics of Fayetteville, NC, United States of America; Kids First Pediatrics of Fayetteville at Village One, NC, United States of America; Kids First Pediatrics of Raeford, NC, United States of America; Legacy Pediatrics, NC, United States of America; Duke University School of Nursing, NC, United States of America.
| | - Sreelekha Sashidhar
- Kids First Pediatrics of Fayetteville, NC, United States of America; Kids First Pediatrics of Fayetteville at Village One, NC, United States of America; Kids First Pediatrics of Raeford, NC, United States of America; Legacy Pediatrics, NC, United States of America
| | - Priscilla Hudak
- Kids First Pediatrics of Fayetteville, NC, United States of America; Kids First Pediatrics of Fayetteville at Village One, NC, United States of America; Kids First Pediatrics of Raeford, NC, United States of America; Legacy Pediatrics, NC, United States of America
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Feng S, Cheng A, Luo Z, Xiao Y, Zhang L. Effect of family doctor contract services on patient perceived quality of primary care in southern China. BMC FAMILY PRACTICE 2020; 21:218. [PMID: 33099322 PMCID: PMC7585687 DOI: 10.1186/s12875-020-01287-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 10/15/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Family doctor contract service is an important service item in China's primary care reform. This research was designed to evaluate the impact of the provision of family doctor contract services on the patient-perceived quality of primary care, and therefore give evidence-based policy suggestions. METHODS This cross-sectional study of family doctor contract service policy was conducted in three pilot cities in the Pearl River Delta, South China, using a multistage stratified sampling method. The validated Primary Care Assessment Tool-Adult Edition (PCAT-AS) was used to measure the quality of primary care services. PCAT-AS assesses each of the unique characteristics of primary care including first contact, continuity, comprehensiveness, coordination, family-centeredness, community orientation, culture orientation. Data was collected through face-to-face interviews held from July to November, 2015. Covariate analysis and multivariate Linear Regression were adopted to explore the effect of contract on the quality of primary care by controlling for the socio-demographic status and health care service utilization factors. RESULTS A total of 828 valid questionnaires were collected. Among the interviewees, 453 patients signed the contract (54.7%) and 375 did not (45.3%). Multivariate linear regression showed that contracted patients reported higher scores in dimensions of PCAT total score (β = - 8.98, P < 0.000), first contact-utilization(β = - 0.71,P < 0.001), first contact-accessibility(β = - 1.49, P < 0.001), continuity (β = 1.27, P < 0.001), coordination (referral) (β = - 1.42, P < 0.001), comprehensiveness (utilization) (β = - 1.70, P < 0.001), comprehensiveness (provision) (β = - 0.99, P < 0.001),family-centeredness(β = - 0.52, P < 0.01), community orientation(β = - 1.78, P < 0.001), than un- contracted after controlling socio-demographic and service utilization factors. There were no statistically significant differences in the dimensions of coordination (information system) (β = - 0.25, P = 0.137) and culture orientation (β = - 0.264, P = 0.056) between the two both groups. CONCLUSIONS This study demonstrates that the pilot implementation of family doctor contract services has significantly improved patients' perceived primary care quality in the pilot cities, and could help solve the quality problem of primary care. It needs further promotion across the province.
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Affiliation(s)
- Shanshan Feng
- School of Health Management, Guangzhou Medical University, Xinzao Town, Panyu District, Guangzhou, 5111436, Guangdong, People's Republic of China.
| | - Aiyun Cheng
- School of Health Management, Guangzhou Medical University, Xinzao Town, Panyu District, Guangzhou, 5111436, Guangdong, People's Republic of China
| | - Zhenni Luo
- School of Health Management, Guangzhou Medical University, Xinzao Town, Panyu District, Guangzhou, 5111436, Guangdong, People's Republic of China
| | - Yao Xiao
- School of Health Management, Guangzhou Medical University, Xinzao Town, Panyu District, Guangzhou, 5111436, Guangdong, People's Republic of China
| | - Luwen Zhang
- School of Health Management, Southern Medical University, No. 1023-1063, South Shatai Road, Baiyun District, Guangzhou, 510515, Guangdong Province, People's Republic of China
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20
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Qazi A, Armour C, Saini B. Perspectives of general practitioners about a collaborative asthma care model in primary care. J Asthma 2020; 58:1648-1660. [PMID: 32921189 DOI: 10.1080/02770903.2020.1823408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Asthma affects 2.7 million people in Australia and is predominantly managed by general practitioners (GPs) within primary care. Despite national focus on this condition, asthma control in the population is suboptimal, with many preventable hospitalizations. In the light of robust evidence supporting the role of pharmacists in the management of chronic diseases including asthma, the Australian Medical Association (AMA) proposed a General Practice Pharmacist (GPP) model in 2015. In this proposal, a non-dispensing pharmacist, co-located within the primary care setting and collaborating with GPs and allied health professionals, can make a positive impact on patients' health and minimize costs due to medication misadventure. The aim of this study was to obtain the views of GPs regarding the GPP model for better management of asthma in a qualitative study. METHODS Semi-structured interviews were conducted with 23 GPs, audio-recorded, transcribed verbatim, and later analyzed for emergent themes. The GPs support the idea of a GPP as time and task pressures restrict them in adhering to asthma management guidelines. RESULTS Support from another health professional in such a pressured environment can positively impact patient's health. Funding, clear role delineation within general practice, training of pharmacists working as GPPs, and effective communication systems were described as the potential catalysts for the success of the model. CONCLUSION Sustainable funding and the willingness of practice owners/managers were described as the barriers. The GPs agreed that pharmacists can make a positive difference in patient's asthma management once the barriers were effectively addressed.
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Affiliation(s)
- Anila Qazi
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Carol Armour
- The Woolcock Institute of Medical Research, Glebe, NSW, Australia
| | - Bandana Saini
- Sydney Pharmacy School, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia.,The Woolcock Institute of Medical Research, Glebe, NSW, Australia
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Comparison of Patients' Perceived Quality of Primary Care Between Urban and Rural Community Health Centers in Guangdong, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134898. [PMID: 32646063 PMCID: PMC7369941 DOI: 10.3390/ijerph17134898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/28/2020] [Accepted: 07/03/2020] [Indexed: 12/18/2022]
Abstract
Background: A series of reforms were implemented to improve the quality of primary care services in China. This study aims to assess patients’ perceived quality of primary healthcare between rural and urban community health centers in Guangdong. Methods: A cross-sectional survey was conducted from July to December 2015 in Guangdong. We surveyed 1010 respondents who visited either community health centers/stations (CHCs/CHSs) in urban areas or township health centers/rural health stations (THCs/RHSs) in rural areas. A validated Chinese version of the Primary Care Assessment Tool-Adult Short Version (PCAT-AS), representing ten primary care domains, was used to collect information on patients’ primary care experiences. A t-test was used for comparison on domain scores and total scores between patients from CHCs/CHSs and THCs/RHSs. An analysis of covariance was employed to compare the adjusted PCAT domain scores and total scores. Multilevel models were used to explore factors associated with PCAT total scores. Results: Overall, patients reported a lower level of experience of community orientation and family centeredness compared to other primary care domains. Patients from THCs/RHSs settings in the rural area reported better primary care experience in four domains, including first contact, accessibility, ongoing care, and community orientation. Higher education background and those with a chronic disease were associated with better primary care experience, after controlling for confounding factors. Patients who preferred primary care institutions when getting sick or used health services more frequently reported better primary care experiences. Conclusion: Continued efforts are needed to strengthen primary care performances, particularly in a community orientation and family centeredness. Primary care delivery in CHCs/CHSs settings should be improved in four domains, including first contact, accessibility, ongoing care, and community orientation.
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Baatiema L, de‐Graft Aikins A, Sarfo FS, Abimbola S, Ganle JK, Somerset S. Improving the quality of care for people who had a stroke in a low-/middle-income country: A qualitative analysis of health-care professionals' perspectives. Health Expect 2020; 23:450-460. [PMID: 31967387 PMCID: PMC7104640 DOI: 10.1111/hex.13027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 12/06/2019] [Accepted: 12/27/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Efforts to improve the adoption of evidence-based interventions for optimal patient outcomes in low-/middle-income countries (LMICs) are persistently hampered by a plethora of barriers. Yet, little is known about strategies to address such barriers to improve quality stroke care. This study seeks to explore health professionals' views on strategies to improve quality stroke care for people who had a stroke in a LMIC. METHODS A qualitative interview study design was adopted. A semi-structured interview guide was used to conduct in-depth interviews among forty stroke care providers in major referral centres in Ghana. Participants were from nursing, medical, specialist and allied health professional groups. A purposive sample was recruited to share their views on practical strategies to improve quality stroke care in clinical settings. A thematic analysis approach was utilized to inductively analyse the data. RESULTS A number of overarching themes of strategies to improve quality stroke care were identified: computerization and digitization of medical practice, allocation of adequate resources, increase the human resource capacity to deliver stroke care, development of clinical guideline/treatment protocols, institutionalization of multidisciplinary care and professional development opportunities. These strategies were however differentially prioritized among different categories of stroke care providers. CONCLUSION Closing the gap between existing knowledge on how to improve quality of stroke care in LMICs has the potential to be successful if unique and context-specific measures from the views of stroke care providers are considered in developing quality improvement strategies and health systems and policy reforms. However, for optimal outcomes, further research into the effectiveness and feasibility of the proposed strategies by stroke care providers is needed.
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Affiliation(s)
- Leonard Baatiema
- Noguchi Memorial Institute for Medical ResearchUniversity of GhanaLegonGhana
| | | | - Fred S. Sarfo
- Kwame Nkrumah University of Science & TechnologyKumasiGhana
- Department of MedicineKomfo Anokye Teaching HospitalKumasiGhana
| | - Seye Abimbola
- School of Public HealthUniversity of SydneySydneyNSWAustralia
| | - John K. Ganle
- School of Public HealthUniversity of GhanaLegonGhana
| | - Shawn Somerset
- Faculty of HealthUniversity of CanberraCanberraACTAustralia
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Uptake of a primary care atrial fibrillation screening program (AF-SMART): a realist evaluation of implementation in metropolitan and rural general practice. BMC FAMILY PRACTICE 2019; 20:170. [PMID: 31810441 PMCID: PMC6896363 DOI: 10.1186/s12875-019-1058-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/22/2019] [Indexed: 11/17/2022]
Abstract
Background Screening for atrial fibrillation (AF) in people aged ≥65 years is recommended by international guidelines. The Atrial Fibrillation Screen, Management And guideline-Recommended Therapy (AF-SMART) studies of opportunistic AF screening in 16 metropolitan and rural general practices were conducted from November 2016–June 2019. These studies trialled custom-designed eHealth tools to support all stages of AF screening in general practice. Methods A realist evaluation of the AF-SMART studies, which aimed to explain the circumstances in which the program worked (or not) to increase the proportion of people screened for AF. The initial program theory was based on our previous research, policy documents and screening studies. To test this, we conducted 45 semi-structured interviews with general practitioners (GPs), nurses and practice managers across all participating practices, and collected observational and quantitative screening data. These data were analysed and interpreted to refine the program theory. Results GPs/nurses liked the eHealth tools, although technical problems sometimes disrupted screening. Time was the main barrier to screening for GPs/nurses, so systems need to be very efficient. Practices with leadership from a senior GP ‘screening champion’ had broader uptake, especially from the nursing team. Providing regular feedback on screening data was beneficial for quality improvement and motivation. Clear protocols for follow-up of abnormal results were required for successful nurse-led screening in a hierarchical system. Participation in the program had broader benefits of improving AF knowledge and raising the profile of cardiovascular health in the practice. Screening for a shorter, more intense period (eg during influenza vaccination) worked well for practices where sufficient staff time was allocated. Conclusions Introducing an AF screening program is likely to be successful in contexts where there is a senior GP ‘screening champion’, a clear protocol exists for abnormal results, and there is regular data reporting to staff. These contexts link to mechanisms around motivation, leadership, empowerment of nurses, and efficient screening systems. The contexts and mechanisms contribute to the longer-term outcomes of increasing the proportion of people screened and treated for AF, which is recommended by guidelines as a key strategy for the prevention of AF-related stroke. Trial registrations AF SMART (metropolitan): ACTRN12616000850471 (Australia New Zealand Clinical Trials Registry). AF SMART II (rural): ACTRN12618000004268 (Australia New Zealand Clinical Trials Registry).
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De Leo A, Bayes S, Geraghty S, Butt J. Midwives' use of best available evidence in practice: An integrative review. J Clin Nurs 2019; 28:4225-4235. [PMID: 31410929 PMCID: PMC7328778 DOI: 10.1111/jocn.15027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/02/2019] [Accepted: 08/04/2019] [Indexed: 12/16/2022]
Abstract
AIMS AND OBJECTIVES To synthesise international research that relates to midwives' use of best available evidence in practice settings and identify key issues relating to the translation of latest evidence into everyday maternity care. BACKGROUND Midwifery is a research-informed profession. However, a gap persists in the translation of best available evidence into practice settings, compromising gold standard maternity care and delaying the translation of new knowledge into everyday practice. DESIGN A five-step integrative review approach, based on a series of articles published by the Joanna Briggs Institute (JBI) for conducting systematic reviews, was used to facilitate development of a search strategy, selection criteria and quality appraisal process, and the extraction and synthesis of data to inform an integrative review. METHODS The databases CINAHL, MEDLINE, Web of Science, Implementation Science Journal and Scopus were searched for relevant articles. The screening and quality appraisal process complied with the PRISMA 2009 checklist. Narrative analysis was used to develop sub-categories and dimensions from the data, which were then synthesised to form two major categories that together answer the review question. RESULTS The six articles reviewed report on midwives' use of best available evidence in Australia, the UK and Asia. Two major categories emerged that confirm that although midwifery values evidence-based practice (EBP), evidence-informed maternity care is not always employed in clinical settings. Additionally, closure of the evidence-to-practice gap in maternity care requires a multidimensional approach. CONCLUSION Collaborative partnerships between midwives and researchers are necessary to initiate strategies that support midwives' efforts to facilitate the timely movement of best available evidence into practice. RELEVANCE TO CLINICAL PRACTICE Understanding midwives' use of best available evidence in practice will direct future efforts towards the development of mechanisms that facilitate the timely uptake of latest evidence by all maternity care providers working in clinical settings.
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Affiliation(s)
| | | | | | - Janice Butt
- King Edward Memorial HospitalPerthWAAustralia
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Chen A, Feng S, Tang W, Zhang L. Satisfaction with service coverage and drug list may influence patients' acceptance of general practitioner contract service: a cross-sectional study in Guangdong, China. BMC Health Serv Res 2019; 19:251. [PMID: 31018859 PMCID: PMC6480488 DOI: 10.1186/s12913-019-4053-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 03/31/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND General practitioner (GP) system is proved to be effective in over 50 countries worldwide. Guangdong province, as a reform pilot in China, initiated its patient-GP contract service reform in 2014. This study is designed to assess the patients' acceptance of General Practitioners Contract (GPC) reform and explore its influencing factors. METHODS This survey interviewed 1010 participants from 16 primary health centers (PHCs) chosen from 4 pilot cities in Guangdong during July and December in 2015. Data were collected through face-to-face interviews. The questionnaire was developed to discover the acceptance of GPC and covered three parts: respondents' socio-demographic characteristics, health service utilization, and the patients' assessment of primary health care centers. A binary logistic regression model was used to measure the influencing factors of respondents' acceptance of GPC policy. RESULTS A total of 611(60.5%) participants accepted GPC policy. Compared to patients visited PHCs over 7 times in the previous year, those visited PHCs fewer times reported lower acceptance of GPC policy (OR:0.68, 95% CI:0.49-0.96 for visits ≤3 times and OR:0.57, 95% CI:0.38-0.84 for visits = 4-6 times). Patients' satisfaction with medical service coverage was positively associated with patients' acceptance of GPC (OR: 1.72, 95% CI:1.01-3.98 for the satisfied versus the dissatisfied; OR: 1.38, 95% CI:0.92-3.30 for neutral versus the dissatisfied), and the satisfaction with drug list also positively influenced patients' acceptance of GPC policy (OR: 1.44, 95% CI:1.26-2.73 for the satisfied versus the dissatisfied; OR:1.61, 95% CI:1.36-2.99 for neutral versus the dissatisfied). Meanwhile, age and education had positive impacts on the acceptance of the GPC policy. CONCLUSION This study finds out that patients' satisfaction with medical service coverage and drug list are the influencing factors for the acceptance of GPC policy. Therefore, improvement of medical service accessibility such as better follow-up of patients with chronic diseases and enhanced referral service, as well as the expansion of drug list, will improve patients' acceptance of GPC policy. It also finds that patients using more primary health service are inclined to accept GPC policy, so more attractive and high-quality service should be provided in PHCs.
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Affiliation(s)
- Aiyun Chen
- Research Centre of Rural Healthcare Services, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, No.13 Hangkong Road, Wuhan, 430030, Hubei, People's Republic of China.,School of Health Management, Guangzhou Medical University, Xinzao Town, Panyu District, Guangzhou, 511436, Guangdong, People's Republic of China
| | - Shanshan Feng
- School of Health Management, Guangzhou Medical University, Xinzao Town, Panyu District, Guangzhou, 511436, Guangdong, People's Republic of China
| | - Wenxi Tang
- School of International pharmaceutical Business, China Pharmaceutical University, No.639 Longmian Str, Jiangning District, Nanjing, 211198, Jiangsu, People's Republic of China
| | - Liang Zhang
- Research Centre of Rural Healthcare Services, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science & Technology, No.13 Hangkong Road, Wuhan, 430030, Hubei, People's Republic of China.
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Gardner K, Olney S, Dickinson H. Getting smarter with data: understanding tensions in the use of data in assurance and improvement-oriented performance management systems to improve their implementation. Health Res Policy Syst 2018; 16:125. [PMID: 30577854 PMCID: PMC6303867 DOI: 10.1186/s12961-018-0401-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/05/2018] [Indexed: 11/10/2022] Open
Abstract
Background A better understanding of the conditions under which performance indicators can be used to improve accountability for outcomes and promote quality improvement could help policy-makers develop more effective performance management systems. One problem is the lack of conceptual models and empirical data that describe the processes through which different approaches use data together with other incentives to influence motivation. Discussion Drawing on the performance governance and quality improvement literature, we developed a framework that distinguishes between the practice of using information to verify levels of performance in market-oriented performance management approaches and using indicators to monitor and promote improvement through building capacity for using data in service and professional networks. The framework explores how performance indicators are deployed and used in the different approaches to enact accountability or stimulate motivation for improvement and articulates the types of system architecture and processes needed to advance implementation. Summary The framework encourages a critical appraisal of the motivations, reward systems and techniques that underpin different performance management approaches. Understanding how and for what purpose performance information is used in everyday practice will advance theory and help inform decision-makers in designing the conditions that effectively contribute to performance accountability and improvements.
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Affiliation(s)
- Karen Gardner
- Public Service Research Group, School of Business, UNSW Canberra, PO Box 7196, Canberra BC, 2610, Australia.
| | - Sue Olney
- Public Service Research Group, School of Business, UNSW Canberra, PO Box 7196, Canberra BC, 2610, Australia
| | - Helen Dickinson
- Public Service Research Group, School of Business, UNSW Canberra, PO Box 7196, Canberra BC, 2610, Australia
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