1
|
Stavelin A, Sandberg S. Analytical performance specifications and quality assurance of point-of-care testing in primary healthcare. Crit Rev Clin Lab Sci 2024; 61:164-177. [PMID: 37779370 DOI: 10.1080/10408363.2023.2262029] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/19/2023] [Indexed: 10/03/2023]
Abstract
Point-of-care testing (POCT) is the fastest-growing segment of laboratory medicine. This review focuses on the essential aspects of setting analytical performance specifications (APS) and performing quality assurance for POCT in primary healthcare. In-vitro diagnostic medical devices for POCT are typically small and easy to operate. Users often have little to no laboratory experience and may not necessarily see the value of conducting quality assurance on their devices. Therefore, training, guidance, and motivation should be integral parts of the total quality management system, as they are vital for managing errors and ensuring reliable results. It is common to believe that the analytical quality of POCT should be comparable to that of laboratory testing, and as a result, APS should be the same. This paper challenges this concept. The APS for POCT can often be less stringent compared to those used in a central laboratory because the requester is closer to both the analytical and clinical situation. Point-of-care instruments should be selected based on clinical needs, the required analytical quality and user-friendliness in the intended usage setting.Quality assurance should include both internal quality control (IQC) and external quality assessment (EQA). It is recommended that IQC protocols should be dependent on the complexity of the POCT device. A scoring system to determine how frequent IQC should be analyzed in primary healthcare on different types of POCT devices has been suggested. The main challenge in EQA for POCT involves using suitable control materials that reflect instrument performance on patient samples. Obtaining commutable control materials for POCT is difficult since the matrix often is whole blood. An essential aspect of EQA for POCT is that feedback reports should be easily interpretable. Users should receive advice from the EQA organizer regarding the root causes of deviating results. Quality assurance for POCT is not an easy task and presents numerous challenges. However, there is evidence that quality assurance improves the quality of POCT measurements and, consequently, can enhance patient outcomes.
Collapse
Affiliation(s)
- Anne Stavelin
- The Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Diaconess Hospital, Bergen, Norway
| | - Sverre Sandberg
- The Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Diaconess Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| |
Collapse
|
2
|
Norful AA, Dierkes A, de Jacq K, Brewer KC. Construct Validity Testing of the Provider Co-Management Index to Measure Shared Care in Provider Dyads. Nurs Res 2024; 73:248-254. [PMID: 38329959 DOI: 10.1097/nnr.0000000000000719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
BACKGROUND Co-management encompasses the dyadic process between two healthcare providers. The Provider Co-Management Index (PCMI) was initially developed as a 20-item instrument across three theory-informed subscales. OBJECTIVE This study aimed to establish construct validity of the PCMI with a sample of primary care providers through exploratory and confirmatory factor analyses. METHODS We conducted a cross-sectional survey of primary care physicians, nurse practitioners, and physician assistants randomly selected from the IQVIA database across New York State. Mail surveys were used to acquire a minimum of 300 responses for split sample factor analyses. The first subsample (derivation sample) was used to explore factorial structure by conducting an exploratory factor analysis. A second (validation) sample was used to confirm the emerged factorial structure using confirmatory factor analysis. We performed iterative analysis and calculated good fit indices to determine the best-fit model. RESULTS There were 333 responses included in the analysis. Cronbach's alpha was high for a three-item per dimension scale within a one-factor model. The instrument was named PCMI-9 to indicate the shorter version length. DISCUSSION This study established the construct validity of an instrument that scales the co-management of patients by two providers. The final instrument includes nine items on a single factor using a 4-point, Likert-type scale. Additional research is needed to establish discriminant validity.
Collapse
|
3
|
Joint Committee on the Chinese Guidelines for Lipid Management. [Chinese guideline for lipid management (primary care version 2024)]. Zhonghua Xin Xue Guan Bing Za Zhi 2024; 52:330-7. [PMID: 38548600 DOI: 10.3760/cma.j.cn112148-20240102-00002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
|
4
|
Iezadi S, Gholipour K, Sherbafi J, Behpaie S, Soltani N, Pasha M, Farahishahgoli J. Service quality: perspective of people with type 2 diabetes mellitus and hypertension in rural and urban public primary healthcare centers in Iran. BMC Health Serv Res 2024; 24:517. [PMID: 38658925 DOI: 10.1186/s12913-024-10854-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/12/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE This study aimed to assess the service quality (SQ) for Type 2 diabetes mellitus (T2DM) and hypertension in primary healthcare settings from the perspective of service users in Iran. METHODS The Cross-sectional study was conducted from January to March 2020 in urban and rural public health centers in the East Azerbaijan province of Iran. A total of 561 individuals aged 18 or above with either or both conditions of T2DM and hypertension were eligible to participate in the study. The study employed a two-step stratified sampling method in East Azerbaijan province, Iran. A validated questionnaire assessed SQ. Data were analyzed using One-way ANOVA and multiple linear regression statistical models in STATA-17. RESULTS Among the 561 individuals who participated in the study 176 (31.3%) were individuals with hypertension, 165 (29.4%) with T2DM, and 220 (39.2%) with both hypertension and T2DM mutually. The participants' anthropometric indicators and biochemical characteristics showed that the mean Fasting Blood Glucose (FBG) in individuals with T2DM was 174.4 (Standard deviation (SD) = 73.57) in patients with T2DM without hypertension and 159.4 (SD = 65.46) in patients with both T2DM and hypertension. The total SQ scores were 82.37 (SD = 12.19), 82.48 (SD = 12.45), and 81.69 (SD = 11.75) for hypertension, T2DM, and both conditions, respectively. Among people with hypertension and without diabetes, those who had specific service providers had higher SQ scores (b = 7.03; p = 0.001) compared to their peers who did not have specific service providers. Those who resided in rural areas had lower SQ scores (b = -6.07; p = 0.020) compared to their counterparts in urban areas. In the group of patients with T2DM and without hypertension, those who were living in non-metropolitan cities reported greater SQ scores compared to patients in metropolitan areas (b = 5.09; p = 0.038). Additionally, a one-point increase in self-management total score was related with a 0.13-point decrease in SQ score (P = 0.018). In the group of people with both hypertension and T2DM, those who had specific service providers had higher SQ scores (b = 8.32; p < 0.001) compared to the group without specific service providers. CONCLUSION Study reveals gaps in T2DM and hypertension care quality despite routine check-ups. Higher SQ correlates with better self-care. Improving service quality in primary healthcare settings necessitates a comprehensive approach that prioritizes patient empowerment, continuity of care, and equitable access to services, particularly for vulnerable populations in rural areas.
Collapse
Affiliation(s)
- Shabnam Iezadi
- Tabriz Health Services Management Research Center, Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kamal Gholipour
- Tabriz Health Services Management Research Center, Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Jabraeil Sherbafi
- East Azerbaijan Provincial Health Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sama Behpaie
- Student Research Committee, Department of Health Policy and Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nazli Soltani
- East Azerbaijan Provincial Health Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohsen Pasha
- East Azerbaijan Provincial Health Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javad Farahishahgoli
- East Azerbaijan Provincial Health Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
5
|
Altarifi D, Harb T, Abualhasan M. Patient satisfaction with pharmaceutical services at primary healthcare centers under the Palestinian Ministry of Health. BMC Health Serv Res 2024; 24:514. [PMID: 38658951 DOI: 10.1186/s12913-024-10983-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The measurement of patient satisfaction is a vital metric that enhances stakeholders to take proactive steps in improving the quality of healthcare services within medical care systems. This study assessed patient satisfaction receiving pharmaceutical services from primary health care centers in the Palestinian Ministry of Health (PMoH) governorate directorates in the West Bank. METHODS A total of 938 patients, all aged 18 years or older, completed a self-administered questionnaire. The assessment of general satisfaction was based on selected questions. Analyses were conducted to explore demographic characteristics. Mean and standard deviation (S.D.) were reported. Likert method was used to average scale satisfaction. To examine statistically significant differences, Chi-square analysis and binary logistic analysis were employed. RESULTS 56.8% of the survey respondents were women, 57.2% were 40 years or older, and 63.2% had graduated from high school. The general satisfaction score averaged 4.10 ± 0.77 indicating good satisfaction. Patients were satisfied with interpersonal relationships, with a mean score of 4.19 ± 0.70. However, satisfaction with therapy management was lower, with a mean score of 3.99 ± 0.77 indicating moderate satisfaction. A significant factor can affect patient's satisfaction such as the location of the pharmacy (OR = 1.720, P = 0.012), the waiting area (OR = 1.671, P = 0.002) and the cleanness of pharmacy (OR = 2.307, P = 0.001). CONCLUSION This study underlines the main components of patient satisfaction who receive pharmaceutical services in PMoH. It is highly recommended that PMoH must address patient dissatisfaction points in a total quality management plan.
Collapse
Affiliation(s)
- Doaa Altarifi
- Ramallah & Al-Bireh Health Directorate, Ministry of Health, Ramallah, Palestine.
| | - Tahani Harb
- Pharmaceutical Registration Department, Ministry of Health, Ramallah, Palestine
| | - Murad Abualhasan
- Faculty of Medicine and Health Sciences, Department of Pharmacy, An-Najah National University, Nablus, Palestine.
| |
Collapse
|
6
|
Clark PW, Williams LT, Brickley B, Ball L. Minimum reporting standards for process and outcomes assessments for private practice dietitians working in Australian primary care: The Thought Leader Consensus study. Nutr Diet 2023; 80:284-296. [PMID: 36217703 PMCID: PMC10952596 DOI: 10.1111/1747-0080.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 07/18/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
Abstract
AIM To identify minimum reporting standards for assessing the processes and outcomes of Australian primary care dietetics practice. METHODS A sequential, mixed-method, exploratory process with peer-nominated Australian 'thought leaders'. A literature review was undertaken to identify possible standards, followed by semi-structured qualitative interviews with thought leaders. Content analysis was used to identify a comprehensive group of items that could inform evidence-based reporting standards. Two rounds of a modified Delphi survey were conducted with the same thought leaders to seek consensus on the most relevant items. Individual items were analysed for content validity, and those with a rating of excellent item-content validity (index >0.78) were included as evidenced-based standards for primary care practice. RESULTS Twenty-six thought leaders (response rate: 87%) from all mainland Australian states completed a qualitative interview and two rounds of modified-Delphi consensus surveys. Items were identified and categorised into three domains: business, clinical, and implementation. Content analysis identified 216 items published or used in practice by the thought leaders. After two rounds of consensus review, 97 items (45 business, 33 clinical, and 19 implementation) achieved excellent consensus ratings. Combining these items into a standardised tool, the scale-content validity index average was >0.90, which is considered excellent content validity. CONCLUSIONS This study has identified minimum reporting standards for evidence-based process and outcome assessments in primary care dietetics practice in Australia. Incorporating such standards into a standardised tool could enable benchmarking across the dietetics workforce and contribute to a broader understanding of the dietetic impact on public health.
Collapse
Affiliation(s)
- Peter W. Clark
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
- Healthier You Pty. LtdPort MacquarieNew South WalesAustralia
| | - Lauren T. Williams
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
| | - Bryce Brickley
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
| | - Lauren Ball
- Griffith University School of Allied Health Sciences, Parklands DriveSouthport, Gold CoastQueenslandAustralia
- Griffith University, Menzies Health Institute QueenslandNathanQueenslandAustralia
| |
Collapse
|
7
|
O'Malley AS, Rich EC, Ghosh A, Palakal M, Rose T, Swankoski K, Peikes D, McCall N. Medicare beneficiaries with more comprehensive primary care physicians report better primary care. Health Serv Res 2023; 58:264-270. [PMID: 36527443 PMCID: PMC10012239 DOI: 10.1111/1475-6773.14119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To examine whether primary care physician (PCP) comprehensiveness is associated with Medicare beneficiaries' overall rating of care from their PCP and staff. DATA SOURCES We linked Medicare claims with survey data from Medicare beneficiaries attributed to Comprehensive Primary Care Plus (CPC+) physicians and practices. STUDY DESIGN We performed regression analyses of the associations between two claims-based measures of PCP comprehensiveness in 2017 and beneficiaries' rating of care from their PCP and practice staff in 2018. DATA COLLECTION/EXTRACTION METHODS The analytic sample included 6228 beneficiaries cared for by 3898 PCPs. Regressions controlled for beneficiary, physician, practice, and market characteristics. PRINCIPAL FINDINGS Beneficiaries with more comprehensive PCPs rated care from their PCP and practice staff higher than did those with less comprehensive PCPs. For each comprehensiveness measure, beneficiaries whose PCP was in the 75th percentile were more likely than beneficiaries whose PCP was in the 25th percentile to rate their care highly (2 percentage point difference, p = 0.02). CONCLUSIONS Medicare beneficiaries with more comprehensive PCPs rate overall care from their PCPs and staff higher than those with less comprehensive PCPs.
Collapse
|
8
|
Potter AJ, Wright B, Akiyama J, Stehlin GG, Trivedi AN, Wolinsky FD. Primary care patterns among dual eligibles with Alzheimer's disease and related dementias. J Am Geriatr Soc 2023; 71:1259-1266. [PMID: 36585893 PMCID: PMC10089966 DOI: 10.1111/jgs.18166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/26/2022] [Accepted: 11/20/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Primary care is essential for persons with Alzheimer's disease and related dementias (ADRD). Prior research suggests that the propensity to provide high-quality, continuous primary care varies by provider setting, but the settings used by Medicare-Medicaid dual-eligibles with ADRD have not been described at the population level. METHODS Using 2012-2018 Medicare data, we identified dual-eligibles with ADRD. For each person-year, we identified primary care visits occurring in six settings. We calculated descriptive statistics for beneficiaries with a majority of visits in each setting, and conducted a k-means cluster analysis to determine utilization patterns, using the standardized count of primary care visits in each setting. RESULTS Each year from 2012 to 2018, at least 45.6% of dual-eligibles with ADRD received a majority of their primary care in nursing facilities, while at least 25.2% did so in physician offices. Over time, the share relying on nursing facilities for primary care decreased by 5.2 percentage points, offset by growth in Federally Qualified Health Centers (FQHCs) and miscellaneous settings (2.3 percentage points each). Dual-eligibles relying on nursing facilities had more annual primary care visits (16.1) than those relying on other settings (range: 6.8-10.7 visits). Interpersonal care continuity was also higher in nursing facilities (97.0%) and physician offices (87.9%) than in FQHCs (54.2%), rural health clinics (RHCs, 46.6%), or hospital-based clinics (56.8%). Among dual-eligibles without care continuity, 82.7% were assigned to a cluster with few primary care visits. CONCLUSIONS A trend toward care in different settings likely reflects improved access to patient-centered primary care. Low rates of interpersonal care continuity in FQHCs, RHCs, and physician offices may warrant concern, unless providers in these settings function as a care team. Nonetheless, every healthcare system encounter presents an opportunity to designate a primary care provider for dual-eligibles with ADRD who use little or no primary care.
Collapse
Affiliation(s)
- Andrew J. Potter
- Department of Political Science & Criminal Justice, California State University, Chico
| | - Brad Wright
- Department of Family Medicine, UNC-Chapel Hill School of Medicine, Chapel Hill, NC
- Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, Chapel Hill, NC
| | - Jill Akiyama
- Department of Health Policy and Management, Gillings School of Public Health, UNC-Chapel Hill
| | - Grace G. Stehlin
- Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, Chapel Hill, NC
| | - Amal N. Trivedi
- Department of Health Services, Policy and Practice, School of Public Health, Brown University
| | - Fredric D. Wolinsky
- Department of Health Management and Policy, College of Public Health, University of Iowa
| |
Collapse
|
9
|
Bond AM, Schpero WL, Casalino LP, Zhang M, Khullar D. Association Between Individual Primary Care Physician Merit-based Incentive Payment System Score and Measures of Process and Patient Outcomes. JAMA 2022; 328:2136-2146. [PMID: 36472595 PMCID: PMC9856441 DOI: 10.1001/jama.2022.20619] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE The Medicare Merit-based Incentive Payment System (MIPS) influences reimbursement for hundreds of thousands of US physicians, but little is known about whether program performance accurately captures the quality of care they provide. OBJECTIVE To examine whether primary care physicians' MIPS scores are associated with performance on process and outcome measures. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of 80 246 US primary care physicians participating in the MIPS program in 2019. EXPOSURES MIPS score. MAIN OUTCOMES AND MEASURES The association between physician MIPS scores and performance on 5 unadjusted process measures, 6 adjusted outcome measures, and a composite outcome measure. RESULTS The study population included 3.4 million patients attributed to 80 246 primary care physicians, including 4773 physicians with low MIPS scores (≤30), 6151 physicians with medium MIPS scores (>30-75), and 69 322 physicians with high MIPS scores (>75). Compared with physicians with high MIPS scores, physicians with low MIPS scores had significantly worse mean performance on 3 of 5 process measures: diabetic eye examinations (56.1% vs 63.2%; difference, -7.1 percentage points [95% CI, -8.0 to -6.2]; P < .001), diabetic HbA1c screening (84.6% vs 89.4%; difference, -4.8 percentage points [95% CI, -5.4 to -4.2]; P < .001), and mammography screening (58.2% vs 70.4%; difference, -12.2 percentage points [95% CI, -13.1 to -11.4]; P < .001) but significantly better mean performance on rates of influenza vaccination (78.0% vs 76.8%; difference, 1.2 percentage points [95% CI, 0.0 to 2.5]; P = .045] and tobacco screening (95.0% vs 94.1%; difference, 0.9 percentage points [95% CI, 0.3 to 1.5]; P = .001). MIPS scores were inconsistently associated with risk-adjusted patient outcomes: compared with physicians with high MIPS scores, physicians with low MIPS scores had significantly better mean performance on 1 outcome (307.6 vs 316.4 emergency department visits per 1000 patients; difference, -8.9 [95% CI, -13.7 to -4.1]; P < .001), worse performance on 1 outcome (255.4 vs 225.2 all-cause hospitalizations per 1000 patients; difference, 30.2 [95% CI, 24.8 to 35.7]; P < .001), and did not have significantly different performance on 4 ambulatory care-sensitive admission outcomes. Nineteen percent of physicians with low MIPS scores had composite outcomes performance in the top quintile, while 21% of physicians with high MIPS scores had outcomes in the bottom quintile. Physicians with low MIPS scores but superior outcomes cared for more medically complex and socially vulnerable patients, compared with physicians with low MIPS scores and poor outcomes. CONCLUSIONS AND RELEVANCE Among US primary care physicians in 2019, MIPS scores were inconsistently associated with performance on process and outcome measures. These findings suggest that the MIPS program may be ineffective at measuring and incentivizing quality improvement among US physicians.
Collapse
Affiliation(s)
- Amelia M. Bond
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - William L. Schpero
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Lawrence P. Casalino
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Manyao Zhang
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Dhruv Khullar
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| |
Collapse
|
10
|
Koskela T, Liu V, Kaila M. How Does Triage by an Electronic Symptom Checker Match with Triage by a Nurse? Stud Health Technol Inform 2022; 294:571-572. [PMID: 35612149 DOI: 10.3233/shti220528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Omaolo© electronic symptom checkers (ESCs) have been developed to make triage for primary health care patients in Finland. Based on the analysis of the patient's responses to a set of questions, the ESC classifies him/her as emergent, urgent, not urgent, or advices on self-care. In this study the user answered the questions posed by the electronic symptom checker, after which a nurse assessed the urgency of the same user's symptom. The triage nurse was not allowed to know the result of the electronic symptom assessment until he or she had assessed the patient's condition. The level of triage was compared between ESC and nurse in each individual case. Findings from 825 individual cases were analyzed. The mean "exactly matched" for all symptom estimates was 52.6%. The mean "exactly matched" or "overconservative but suitable" for all symptom assessments was 66.6%. Safe assessments of electronic symptom checkers accounted for 98.6% of all assessments. A case was defined as "safe" if the recommendation for action given by the symptom assessment was at most one level less urgent than the nurse's triage assessment of the same case. The findings show that electronic symptom assessments are safe compared to the assessment of an experienced nurse.
Collapse
Affiliation(s)
| | | | - Minna Kaila
- The Finnish Medical Society Duodecim, Finland
| |
Collapse
|
11
|
de Oliveira CA, Weber B, dos Santos JLF, Zucoloto ML, de Camargo LL, Zanetti ACG, Rzewuska M, de Azevedo-Marques JM. Health complexity assessment in primary care: A validity and feasibility study of the INTERMED tool. PLoS One 2022; 17:e0263702. [PMID: 35180262 PMCID: PMC8856552 DOI: 10.1371/journal.pone.0263702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background Health complexity includes biological, psychological, social, and health systems. Having complex health needs is associated with poorer clinical outcomes and higher healthcare costs. Care management for people with health complexity is increasingly recommended in primary health care (PHC). The INTERMED complexity assessment grid showed adequate psychometric properties in specialized settings. This study aimed to evaluate INTERMED’s validity and feasibility to assess health complexity in an adult PHC population. Method The biopsychosocial health care needs of 230 consecutive adult patients from three Brazilian PHC services were assessed using the INTERMED interview. Participants with a total score >20 were classified as “complex”. Quality of life was measured using the World Health Organization Quality of Life BREF (WHOQOL-BREF); symptoms of anxiety and depression using the Hospital Anxiety and Depression Scale (HADS); social support using the Medical Outcomes Study—Social Support Survey (MOS-SSS); comorbidity levels using the Charlson Comorbidity Index (CCI). We developed two questionnaires to evaluate health services use, and patient perceived feasibility of INTERMED. Results 42 participants (18.3%) were classified as “complex”. A moderate correlation was found between the total INTERMED score and the total scores of WHOQOL-BREF (rho = - 0.59) and HADS (rho = 0.56), and between the social domains of INTERMED and MOS-SSS (rho = -0.44). After adjustment, the use of PHC (β = 2.12, t = 2.10, p < 0.05), any other health care services (β = 3.05, t = 3.97, p < 0.01), and any medication (β = 3.64, t = 4.16, p < 0.01) were associated with higher INTERMED scores. The INTERMED internal consistency was good (ω = 0.83), and the median application time was 7 min. Patients reported satisfaction with the questions, answers, and application time. Conclusion INTERMED displayed good psychometric values in a PHC population and proved promising for practical use in PHC.
Collapse
Affiliation(s)
- Camila Almeida de Oliveira
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
- * E-mail:
| | - Bernardete Weber
- Registered Nurse, Hospital do Coração (HCor), São Paulo City, Brazil
| | | | - Miriane Lucindo Zucoloto
- Public Health Postgraduate Program, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Lisa Laredo de Camargo
- Postgraduate Program in Psychiatric Nursing, Ribeirão Preto College of Nursing, University of São Paulo, São Paulo, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- Department of Psychiatric Nursing and Human Sciences, University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Centre for Nursing Research Development, São Paulo, Brazil
| | - Magdalena Rzewuska
- Health Services Research Unit, University of Aberdeen, Aberdeen, Scotland, United Kingdom
- Aberdeen Centre for Health Data Sciences, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | | |
Collapse
|
12
|
Grynin VM, Avetisyan AY, Reshetnikov VA. [The criterion mode of evaluating functioning of stomatologic polyclinic]. Probl Sotsialnoi Gig Zdravookhranenniiai Istor Med 2022; 30:288-291. [PMID: 35439391 DOI: 10.32687/0869-866x-2022-30-2-288-291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/26/2021] [Indexed: 06/14/2023]
Abstract
To improve quality and efficiency of primary health care and to strengthen its preventive directivity is possible through health care modernization including implementation of management technologies, development of database for evaluation and control. The purpose of the study is to develop method of evaluating activity of stomatologic clinic. The methodology was based on concepts of "functional systems" and "decision making". The listing of informative criteria was based on data analysis of functioning of stomatologic service of the Chechen Republic in 2002-2016 and results of sociological survey of stomatologists (n=181), health care administrators in stomatology (n=45), paramedics (n=220) and patients (n=359). The experts (n=13) developed required number of criteria and their gradation. The algorithm of evaluating activity of stomatologic clinic was developed using systematic approach. The listing of 52 criteria and their 10 blocks were established. The experts established coefficients of significance of criteria (0.0084-0.0781; ≥0.0224 - more significant, <0.0224 - less significant). Three levels were determined for each criterion (according principle of minimization) that became a basis for calculation of integrated indicator of efficiency of functioning of stomatologic polyclinic. The expanded methodological approaches ensure comparartivity of estimates of stomatologic polyclinic in various time periods. The health care authorities have opportunity to objectify analysis of functioning of a number of polyclinics in different periods.
Collapse
Affiliation(s)
- V M Grynin
- The Federal State Autonomous Educational Institution of Higher Education "The I. M. Sechenov First Moscow State Medical University" (Sechenov University) of Minzdrav of Russia, 119991, Moscow, Russia
| | - A Yu Avetisyan
- The Federal State Autonomous Educational Institution of Higher Education "The I. M. Sechenov First Moscow State Medical University" (Sechenov University) of Minzdrav of Russia, 119991, Moscow, Russia,
| | - V A Reshetnikov
- The Federal State Autonomous Educational Institution of Higher Education "The I. M. Sechenov First Moscow State Medical University" (Sechenov University) of Minzdrav of Russia, 119991, Moscow, Russia
| |
Collapse
|
13
|
Hysong SJ, SoRelle R, Hughes AM. Prevalence of Effective Audit-and-Feedback Practices in Primary Care Settings: A Qualitative Examination Within Veterans Health Administration. Hum Factors 2022; 64:99-108. [PMID: 33830786 DOI: 10.1177/00187208211005620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The purpose of this study is to uncover and catalog the various practices for delivering and disseminating clinical performance in various Veterans Affairs (VA) locations and to evaluate their quality against evidence-based models of effective feedback as reported in the literature. BACKGROUND Feedback can enhance clinical performance in subsequent performance episodes. However, evidence is clear that the way in which feedback is delivered determines whether performance is harmed or improved. METHOD We purposively sampled 16 geographically dispersed VA hospitals based on high, low, consistently moderate, and moderately average highly variable performance on a set of 17 outpatient clinical performance measures. We excluded four sites due to insufficient interview data. We interviewed four key personnel from each location (n = 48) to uncover effective and ineffective audit and feedback strategies. Interviews were transcribed and analyzed qualitatively using a framework-based content analysis approach to identify emergent themes. RESULTS We identified 102 unique strategies used to deliver feedback. Of these strategies, 64 (62.74%) have been found to be ineffective according to the audit-and-feedback research literature. Comparing features common to effective (e.g., individually tailored, computerized feedback reports) versus ineffective (e.g., large staff meetings) strategies, most ineffective strategies delivered feedback in meetings, whereas strategies receiving the highest effectiveness scores delivered feedback via visually understood reports that did not occur in a group setting. CONCLUSIONS Findings show that current practices are leveraging largely ineffective feedback strategies. Future research should seek to identify the longitudinal impact of current feedback and audit practices on clinical performance. APPLICATION Feedback in primary care has little standardization and does not follow available evidence for effective feedback design. Future research in this area is warranted.
Collapse
Affiliation(s)
- Sylvia J Hysong
- Michael E. DeBakey VA Medical Center, Texas, USA
- 3989 Baylor College of Medicine, Texas, USA
| | | | - Ashley M Hughes
- 5228 University of Illinois at Chicago, Champaign, USA
- 20116 Edward Hines JR VA Medical Center, Illinois, USA
| |
Collapse
|
14
|
Tomasi E, de Assis TM, Muller PG, da Silveira DS, Neves RG, Fantinel E, Thumé E, Facchini LA. Evolution of the quality of prenatal care in the primary network of Brazil from 2012 to 2018: What can (and should) improve? PLoS One 2022; 17:e0262217. [PMID: 35041716 PMCID: PMC8765636 DOI: 10.1371/journal.pone.0262217] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 12/20/2021] [Indexed: 11/19/2022] Open
Abstract
The article describes the temporal evolution of prenatal quality indicators in the primary health care network in Brazil and investigates regional differences. This study used data from the external evaluation of Brazil's National Program for Improving Primary Care Access and Quality (PMAQ) with health teams participating in Cycles I, II and III of the Program, carried out respectively in 2012, 2013/14 and 2017/18. The number of visits, physical examination procedures, guidelines and request for laboratory tests were investigated. There was a positive evolution for tests-HIV, syphilis, blood glucose and ultrasound, and for all tests, guidance on feeding and weight gain of the baby and examination of the oral cavity. The indicators that performed the worst were: performance of tetanus vaccine, six or more visits, receiving guidance on exclusive breastfeeding and care for the newborn, and the procedures-all, measurement of uterine height, gynecological exam and cervix cancer prevention. These changes had a varied behavior between the regions of the country.
Collapse
Affiliation(s)
- Elaine Tomasi
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
| | | | | | - Denise Silva da Silveira
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Everton Fantinel
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Elaine Thumé
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Luiz Augusto Facchini
- Department of Social Medicine–Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Epidemiology, Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Family Health (PROFSAÚDE), Universidade Federal de Pelotas, Pelotas, Brazil
- Postgraduate Programme in Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| |
Collapse
|
15
|
Affiliation(s)
- Ravikar Ralph
- Department of Internal Medicine, Christian Medical College, Vellore, Tamil Nadu, 632004, India
| | | | - Sanjib Kumar Sharma
- Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, 76500, Nepal
| | - Isabela Ribeiro
- Dynamic Portfolio, Drugs for Neglected Diseases initiative (DNDi), 15 Chemin Louis-Dunant, 1202, Geneva, Switzerland
| | - François Chappuis
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, Rue Gabrielle-Perret-Gentil 6, Geneva, CH 1211, Switzerland
| |
Collapse
|
16
|
Abstract
Unhealthy alcohol and drug use are among the top 10 causes of preventable death in the United States, but they are infrequently identified and addressed in medical settings. Guidelines recommend screening adult primary care patients for alcohol and drug use, and routine screening should be a component of high-quality clinical care. Brief, validated screening tools accurately detect unhealthy alcohol and drug use, and their thoughtful implementation can facilitate adoption and optimize the quality of screening results. Recommendations for implementation include patient self-administered screening tools, integration with electronic health records, and screening during routine primary care visits.
Collapse
Affiliation(s)
- Jennifer McNeely
- Section on Alcohol, Tobacco, and Drug Use, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 17th Floor, New York, NY 10016, USA; Department of Medicine, Division of General Internal Medicine and Clinical Innovation, NYU Grossman School of Medicine, New York, NY 10016, USA.
| | - Leah Hamilton
- Section on Alcohol, Tobacco, and Drug Use, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, 17th Floor, New York, NY 10016, USA; Kaiser Permanente Washington Health Research Institute, 1730 Minor Avenue, Seattle, WA 98101, USA
| |
Collapse
|
17
|
Gionfriddo MR, Duboski V, Middernacht A, Kern MS, Graham J, Wright EA. A mixed methods evaluation of medication reconciliation in the primary care setting. PLoS One 2021; 16:e0260882. [PMID: 34855888 PMCID: PMC8638945 DOI: 10.1371/journal.pone.0260882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 11/18/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To understand the extent to which behaviors consistent with high quality medication reconciliation occurred in primary care settings and explore barriers to high quality medication reconciliation. DESIGN Fully mixed sequential equal status design including ethnographic observations, semi-structured interviews, and surveys. SETTING Primary care practices within an integrated healthcare delivery system in the United States. PARTICIPANTS We conducted 170 observations of patient encounters across 15 primary care clinics, 48 semi-structured interviews with staff, and 10 semi-structured interviews with patients. We also sent out surveys to 2,541 eligible staff with 616 responses (24% response rate) and to 5,132 eligible patients with 577 responses (11% response rate). RESULTS Inconsistency emerged as a major barrier to effective medication reconciliation. This inconsistency was present across a variety of factors such as the lack of standardized workflows for conducting medication reconciliation, a lack of knowledge about medication and the process of medication reconciliation, varying levels of importance ascribed to medication reconciliation, and inadequate integration of medication reconciliation into clinical workflows. Findings were generally consistent across all data collection methods. CONCLUSION We have identified several barriers which impact the process of medication reconciliation in primary care settings. Our key finding is that the process of medication reconciliation is plagued by inconsistencies which contribute to inaccurate medication lists. These inconsistencies can be broken down into several categories (standardization, knowledge, importance, and inadequate integration) which can be targets for future studies and interventions.
Collapse
Affiliation(s)
- Michael R. Gionfriddo
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, United States of America
- * E-mail:
| | - Vanessa Duboski
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, United States of America
| | - Allison Middernacht
- Wilkes University School of Pharmacy, Wilkes-Barre, PA, United States of America
| | - Melissa S. Kern
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, United States of America
| | - Jove Graham
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, United States of America
| | - Eric A. Wright
- Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, United States of America
| |
Collapse
|
18
|
Morreel S, Philips H, De Graeve D, Monsieurs KG, Kampen JK, Meysman J, Lefevre E, Verhoeven V. Triaging and referring in adjacent general and emergency departments (the TRIAGE trial): A cluster randomised controlled trial. PLoS One 2021; 16:e0258561. [PMID: 34731198 PMCID: PMC8565772 DOI: 10.1371/journal.pone.0258561] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 09/13/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To determine whether a new triage system safely diverts a proportion of emergency department (ED) patients to a general practitioner cooperative (GPC). METHODS Unblinded randomised controlled trial with weekends serving as clusters (three intervention clusters for each control). The intervention was triage by a nurse using a new extension to the Manchester Triage System assigning low-risk patients to the GPC. During intervention weekends, patients were encouraged to follow this assignment; it was not communicated during control weekends (all patients remained at the ED). The primary outcome was the proportion of patients assigned to and handled by the GPC during intervention weekends. The trial was randomised for the secondary outcome: the proportion of patients assigned to the GPC. Additional outcomes were association of these outcomes with possible confounders (study tool parameters, nurse, and patient characteristics), proportion of patients referred back to the ED by the GPC, hospitalisations, and performance of the study tool to detect primary care patients (the opinion of the treating physician was the gold standard). RESULTS In the intervention group, 838/6294 patients (13.3%, 95% CI 12.5 to 14.2) were assigned to the GPC, in the control group this was 431/1744 (24.7%, 95% CI 22.7 to 26.8). In total, 599/6294 patients (9.5%, 95% CI 8.8 to 10.3) experienced the primary outcome which was influenced by the reason for encounter, age, and the nurse. 24/599 patients (4.0%, 95% CI 2.7 to 5.9) were referred back to the ED, three were hospitalised. Positive and negative predictive values of the studied tool during intervention weekends were 0.96 (95%CI 0.94 to 0.97) and 0.60 (95% CI 0.58 to 0.62). Out of the patients assigned to the GPC, 2.4% (95% CI 1.7 to 3.4) were hospitalised. CONCLUSIONS ED nurses using a new tool safely diverted 9.5% of the included patients to primary care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03793972.
Collapse
Affiliation(s)
- Stefan Morreel
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Hilde Philips
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
| | - Diana De Graeve
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Koenraad G. Monsieurs
- Department ASTARC, University of Antwerp, Antwerp, Belgium
- Emergency Department, Antwerp University Hospital, Antwerp, Belgium
| | - Jarl K. Kampen
- Department of Epidemiology and Medical Statistics, Antwerp University Hospital, Antwerp, Belgium
| | - Jasmine Meysman
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Eva Lefevre
- Department of Economics, University of Antwerp, Antwerp, Belgium
| | - Veronique Verhoeven
- Department of Family and Population Health, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
19
|
Curtis HJ, MacKenna B, Walker AJ, Croker R, Mehrkar A, Morton C, Bacon S, Hickman G, Inglesby P, Bates C, Evans D, Ward T, Cockburn J, Davy S, Bhaskaran K, Schultze A, Rentsch CT, Williamson E, Hulme W, Tomlinson L, Mathur R, Drysdale H, Eggo RM, Wong AY, Forbes H, Parry J, Hester F, Harper S, Douglas I, Smeeth L, Goldacre B. OpenSAFELY: impact of national guidance on switching anticoagulant therapy during COVID-19 pandemic. Open Heart 2021; 8:e001784. [PMID: 34785588 PMCID: PMC8595296 DOI: 10.1136/openhrt-2021-001784] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/08/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Early in the COVID-19 pandemic, the National Health Service (NHS) recommended that appropriate patients anticoagulated with warfarin should be switched to direct-acting oral anticoagulants (DOACs), requiring less frequent blood testing. Subsequently, a national safety alert was issued regarding patients being inappropriately coprescribed two anticoagulants following a medication change and associated monitoring. OBJECTIVE To describe which people were switched from warfarin to DOACs; identify potentially unsafe coprescribing of anticoagulants; and assess whether abnormal clotting results have become more frequent during the pandemic. METHODS With the approval of NHS England, we conducted a cohort study using routine clinical data from 24 million NHS patients in England. RESULTS 20 000 of 164 000 warfarin patients (12.2%) switched to DOACs between March and May 2020, most commonly to edoxaban and apixaban. Factors associated with switching included: older age, recent renal function test, higher number of recent INR tests recorded, atrial fibrillation diagnosis and care home residency. There was a sharp rise in coprescribing of warfarin and DOACs from typically 50-100 per month to 246 in April 2020, 0.06% of all people receiving a DOAC or warfarin. International normalised ratio (INR) testing fell by 14% to 506.8 patients tested per 1000 warfarin patients each month. We observed a very small increase in elevated INRs (n=470) during April compared with January (n=420). CONCLUSIONS Increased switching of anticoagulants from warfarin to DOACs was observed at the outset of the COVID-19 pandemic in England following national guidance. There was a small but substantial number of people coprescribed warfarin and DOACs during this period. Despite a national safety alert on the issue, a widespread rise in elevated INR test results was not found. Primary care has responded rapidly to changes in patient care during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Helen J Curtis
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian MacKenna
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alex J Walker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard Croker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Amir Mehrkar
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Caroline Morton
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Seb Bacon
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - George Hickman
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Peter Inglesby
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - David Evans
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tom Ward
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Simon Davy
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Krishnan Bhaskaran
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Anna Schultze
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Christopher T Rentsch
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Elizabeth Williamson
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
| | - William Hulme
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Laurie Tomlinson
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Rohini Mathur
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Henry Drysdale
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rosalind M Eggo
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Angel Yun Wong
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Harriet Forbes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | | | | | - Ian Douglas
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Liam Smeeth
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Ben Goldacre
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
20
|
Botey AP, GermAnn K, Robson PJ, O'Neill BM, Stewart DA. Physician perspectives on delays in cancer diagnosis in Alberta: a qualitative study. CMAJ Open 2021; 9:E1120-E1127. [PMID: 34848553 PMCID: PMC8648351 DOI: 10.9778/cmajo.20210013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Delays in cancer diagnosis have been associated with reduced survival, decreased quality of life after treatment, and suboptimal patient experience. The objective of the study was to explore the perspectives of a group of family physicians and other specialists regarding potentially avoidable delays in diagnosing cancer, and approaches that may help expedite the process. METHODS We conducted a qualitative study using interviews with physicians practising in primary and outpatient care settings in Alberta between July and September 2019. We recruited family physicians and specialists who were in a position to discuss delays in cancer diagnosis by email via the Cancer Strategic Clinical Network and the Alberta Medical Association. We conducted semistructured interviews over the phone, and analyzed data using thematic analysis. RESULTS Eleven family physicians and 22 other specialists (including 7 surgeons or surgical oncologists, 3 pathologists, 3 radiologists, 2 emergency physicians and 2 hematologists) participated in interviews; 22 were male (66.7%). We identified 4 main themes describing 9 factors contributing to potentially avoidable delays in diagnosis, namely the nature of primary care, initial presentation, investigation, and specialist advice and referral. We also identified 1 theme describing 3 suggestions for improvement, including system integration, standardized care pathways and a centralized advice, triage and referral support service for family physicians. INTERPRETATION These findings suggest the need for enhanced support for family physicians, and better integration of primary and specialty care before cancer diagnosis. A multifaceted and coordinated approach to streamlining cancer diagnosis is required, with the goals of enhancing patient outcomes, reducing physician frustration and optimizing efficiency.
Collapse
Affiliation(s)
- Anna Pujadas Botey
- Cancer Strategic Clinical Network (Pujadas Botey, Stewart), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey), University of Alberta, Edmonton, Alta.; Independent health services researcher (GermAnn), Lacombe County, Alta.; Cancer Strategic Clinical Network (Robon, O'Neill), Alberta Health Services, Edmonton, Alta.; Cancer Care Alberta (Robson), Alberta Health Services, Edmonton, Alta.; Departments of Oncology and Medicine (Stewart), University of Calgary, Calgary, Alta.
| | - Kathy GermAnn
- Cancer Strategic Clinical Network (Pujadas Botey, Stewart), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey), University of Alberta, Edmonton, Alta.; Independent health services researcher (GermAnn), Lacombe County, Alta.; Cancer Strategic Clinical Network (Robon, O'Neill), Alberta Health Services, Edmonton, Alta.; Cancer Care Alberta (Robson), Alberta Health Services, Edmonton, Alta.; Departments of Oncology and Medicine (Stewart), University of Calgary, Calgary, Alta
| | - Paula J Robson
- Cancer Strategic Clinical Network (Pujadas Botey, Stewart), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey), University of Alberta, Edmonton, Alta.; Independent health services researcher (GermAnn), Lacombe County, Alta.; Cancer Strategic Clinical Network (Robon, O'Neill), Alberta Health Services, Edmonton, Alta.; Cancer Care Alberta (Robson), Alberta Health Services, Edmonton, Alta.; Departments of Oncology and Medicine (Stewart), University of Calgary, Calgary, Alta
| | - Barbara M O'Neill
- Cancer Strategic Clinical Network (Pujadas Botey, Stewart), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey), University of Alberta, Edmonton, Alta.; Independent health services researcher (GermAnn), Lacombe County, Alta.; Cancer Strategic Clinical Network (Robon, O'Neill), Alberta Health Services, Edmonton, Alta.; Cancer Care Alberta (Robson), Alberta Health Services, Edmonton, Alta.; Departments of Oncology and Medicine (Stewart), University of Calgary, Calgary, Alta
| | - Douglas A Stewart
- Cancer Strategic Clinical Network (Pujadas Botey, Stewart), Alberta Health Services, Calgary, Alta.; School of Public Health (Pujadas Botey), University of Alberta, Edmonton, Alta.; Independent health services researcher (GermAnn), Lacombe County, Alta.; Cancer Strategic Clinical Network (Robon, O'Neill), Alberta Health Services, Edmonton, Alta.; Cancer Care Alberta (Robson), Alberta Health Services, Edmonton, Alta.; Departments of Oncology and Medicine (Stewart), University of Calgary, Calgary, Alta
| |
Collapse
|
21
|
Savitz LA, Bayliss EA. Emerging models of care for individuals with multiple chronic conditions. Health Serv Res 2021; 56 Suppl 1:980-989. [PMID: 34387358 PMCID: PMC8515217 DOI: 10.1111/1475-6773.13774] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To characterize emerging and current practice models to more effectively treat and support patients with multiple chronic conditions (MCC). DATA SOURCES/STUDY SETTING We conducted a rapid literature scoping augmented by key informant interviews with clinicians knowledgeable about MCC care from a broad spectrum of US delivery systems and feedback from multidisciplinary experts at two virtual meetings. STUDY DESIGN Literature findings were triangulated with data from semi-structured interviews with clinical experts. Reflections on early results were obtained from policy, research, clinical, advocacy, and patient representatives at two virtual meetings sponsored by the Agency for Healthcare Research and Quality. Emergent themes addressed were as follows: (1) more timely strategies for MCC care; and (2) trends not previously represented in the peer-reviewed literature. DATA COLLECTION/EXTRACTION METHODS The rapid literature scoping relied on Ovid MEDLINE(R) and Epub Ahead of Print databases for the most recent 5-year period. Qualitative interviews were conducted by telephone. Virtual meetings provided oral and written (chat) captured inputs. PRINCIPAL FINDINGS Although the literature scoping did not identify a specific set of evidence-based care models, key informant discussions identified eight themes reflecting emerging approaches to population-based MCC care. For example, addressing the needs of individuals with MCC through a complexity lens by assessing and addressing social risk factors; extending the care continuum with home-based care; understanding how to address ongoing patient and caregiver supports outside of clinical encounters; and engaging available community resources. CONCLUSIONS Integrating care for MCC patient populations requires processes for determining different subpopulation needs in various settings and lived experiences. Innovation should be anchored at the nexus of payment systems, social risks, medical needs, and community-based resources. Our learnings suggest a need for an ongoing MCC care research agenda to inform new approaches to care delivery incorporating innovations in technology and home-based supports for patients and caregivers.
Collapse
Affiliation(s)
| | - Elizabeth A. Bayliss
- Institute for Health Research, Kaiser Permanente ColoradoAuroraColoradoUSA
- Department of Family MedicineUniversity of ColoradoAuroraColoradoUSA
| |
Collapse
|
22
|
Swaleh R, McGuckin T, Myroniuk TW, Manca D, Lee K, Sharma AM, Campbell-Scherer D, Yeung RO. Using the Edmonton Obesity Staging System in the real world: a feasibility study based on cross-sectional data. CMAJ Open 2021; 9:E1141-E1148. [PMID: 34876416 PMCID: PMC8673483 DOI: 10.9778/cmajo.20200231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The Edmonton Obesity Staging System (EOSS) combined with body mass index (BMI) enables improved functional and prognostic assessment for patients. To facilitate application of the EOSS in practice, we aimed to create tools for capturing comorbidity assessments in electronic medical records and for automating the calculation of a patient's EOSS stage. METHODS In this feasibility study, we used cross-sectional data to create a clinical dashboard to calculate and display the relation between BMI and EOSS and the prevalence of related comorbidities. We obtained data from the Northern Alberta Primary Care Research Network and the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). We included patients at least 18 years of age with BMI between 30 and 60 who visited a network clinic between July 2016 and July 2019. We calculated descriptive statistics and used stepwise ordinary least squares regression to assess the contributions of age, sex and BMI to EOSS variation. RESULTS We created a clinical dashboard using the CPCSSN data presentation tool. Of the total 31 496 patients included in the study, 23 460 had a BMI of at least 30; BMI was unavailable for 8036 patients. Within each EOSS disease severity stage, there were similar proportions of patients from each BMI class (e.g., patients with EOSS stage 2 included 51.8% of those with BMI class I, 55.3% of those with BMI class II and 58.8% of those with BMI class III). INTERPRETATION Using data from primary care electronic medical records, it was feasible to create a clinical dashboard for obesity that highlighted the severity and stage of obesity. Making this information easily accessible for individual clinical care and practice-level quality improvement may advance obesity care.
Collapse
Affiliation(s)
- Rukia Swaleh
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Taylor McGuckin
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Tyler W Myroniuk
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Donna Manca
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Karen Lee
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Arya M Sharma
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Denise Campbell-Scherer
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| | - Roseanne O Yeung
- Division of Endocrinology and Metabolism, Department of Medicine (Swaleh, Yeung), Edmonton Physician Learning Program (McGuckin, Myroniuk, Manca, Campbell-Scherer, Yeung), Department of Family Medicine (Manca, Campbell-Scherer), Division of Preventive Medicine, Department of Medicine (Lee), and Department of Medicine (Sharma), Faculty of Medicine and Dentistry; School of Public Health (Lee); School of Urban and Regional Planning (Lee); and Alberta Diabetes Institute (Sharma, Campbell-Scherer, Yeung), University of Alberta, Edmonton, Alta.; and Department of Public Health (Myroniuk), University of Missouri-Columbia, Columbia, Mo
| |
Collapse
|
23
|
Abstract
BACKGROUND During the COVID-19 pandemic, telemedicine use rapidly and dramatically increased for management of diabetes mellitus. It is unknown whether access to telemedicine care has been equitable during this time. This study aimed to identify patient-level factors associated with adoption of telemedicine for subspecialty diabetes care during the pandemic. METHODS We conducted an explanatory sequential mixed-methods study using data from a single academic medical center. We used multivariate logistic regression to explore associations between telemedicine use and demographic factors for patients receiving subspecialty diabetes care between March 19 and June 30, 2020. We then surveyed a sample of patients who received in-person care to understand why these patients did not use telemedicine. RESULTS Among 1292 patients who received subspecialty diabetes care during the study period, those over age 65 were less likely to use telemedicine (OR: 0.34, 95% CI: 0.22-0.52, P < .001), as were patients with a primary language other than English (OR: 0.53, 95% CI: 0.31-0.91, P = .02), and patients with public insurance (OR: 0.64, 95% CI: 0.49-0.84, P = .001). Perceived quality of care and technological barriers were the most common reasons cited for choosing in-person care during the pandemic. CONCLUSIONS Our findings suggest that, amidst the COVID-19 pandemic, there have been disparities in telemedicine use by age, language, and insurance for patients with diabetes mellitus. We anticipate telemedicine will continue to be an important care modality for chronic conditions in the years ahead. Significant work must therefore be done to ensure that telemedicine services do not introduce or widen population health disparities.
Collapse
Affiliation(s)
- Sarah C. Haynes
- Department of Pediatrics, University of
California, Davis, CA, USA
- Center for Health and Technology,
University of California, Davis, CA, USA
| | - Tejaswi Kompala
- Department of Medicine, University of
California, San Francisco, CA, USA
| | - Aaron Neinstein
- Department of Medicine, University of
California, San Francisco, CA, USA
- Center for Digital Health Innovation,
University of California, San Francisco, CA, USA
| | - Jennifer Rosenthal
- Department of Pediatrics, University of
California, Davis, CA, USA
- Center for Health and Technology,
University of California, Davis, CA, USA
| | - Stephanie Crossen
- Department of Pediatrics, University of
California, Davis, CA, USA
- Center for Health and Technology,
University of California, Davis, CA, USA
- Stephanie Crossen, MD, MPH, Division of
Pediatric Endocrinology, University of California, Davis, 2516 Stockton Blvd,
Sacramento, CA 95817, USA.
| |
Collapse
|
24
|
Abstract
BACKGROUND Quantifying health care quality has long presented a challenge to identifying the relationship between provider level quality and cost. However, growing focus on quality improvement has led to greater interest in organizational performance, prompting payers to collect various indicators of quality that can be combined at the provider level. OBJECTIVE To explore the relationship between quality and average cost of medical visits provided in US Community Health Centers (CHCs) using composite measures of quality. RESEARCH DESIGN Using the Uniform Data System collected by the Bureau of Primary Care, we constructed composite measures by combining 9 process and 2 outcome indicators of primary care quality provided in 1331 US CHCs during 2015-2018. We explored different weighting schemes and different combinations of individual quality indicators constructed at the intermediate domain levels of chronic condition control, screening, and medication management. We used generalized linear modeling to regress average cost of a medical visit on composite quality measures, controlling for patient and health center factors. We examined the sensitivity of results to different weighting schemes and to combining individual quality indicators at the overall level compared with the intermediate domain level. RESULTS Both overall and domain level composites performed well in the estimations. Average cost of a medical visit was negatively associated with quality, although the magnitude of the effect varied across weighting schemes. CONCLUSION Efforts toward improvement of primary health care quality delivered in CHCs need not involve greater cost.
Collapse
Affiliation(s)
| | - Qian Luo
- Milken Institute School of Public Health, George Washington University, Washington, DC
| | - Avi Dor
- Milken Institute School of Public Health, George Washington University, Washington, DC
| |
Collapse
|
25
|
Loffredo AJ, Chan GK, Wang DH, Goett R, Isaacs ED, Pearl R, Rosenberg M, Aberger K, Lamba S. United States Best Practice Guidelines for Primary Palliative Care in the Emergency Department. Ann Emerg Med 2021; 78:658-669. [PMID: 34353647 DOI: 10.1016/j.annemergmed.2021.05.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 05/15/2021] [Accepted: 05/21/2021] [Indexed: 11/18/2022]
Abstract
The growing palliative care needs of emergency department (ED) patients in the United States have motivated the development of ED primary palliative care principles. An expert panel convened to develop best practice guidelines for ED primary palliative care to help guide frontline ED clinicians based on available evidence and consensus opinion of the panel. Results include recommendations for screening and assessment of palliative care needs, ED management of palliative care needs, goals of care conversations, ED palliative care and hospice consults, and transitions of care.
Collapse
Affiliation(s)
- Anthony J Loffredo
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
| | - Garrett K Chan
- Department of Physiologic Nursing, University of California, San Francisco, CA
| | - David H Wang
- Division of Palliative Medicine, Scripps Health, San Diego, CA
| | - Rebecca Goett
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ
| | - Eric D Isaacs
- Department of Emergency Medicine, Zuckerberg San Francisco General Hospital, University of California San Francisco, San Francisco, CA
| | - Rachel Pearl
- Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Mark Rosenberg
- Department of Emergency Medicine, St Joseph's Health, Paterson and Wayne, NJ
| | - Kate Aberger
- Division of Palliative Medicine and Geriatrics, St Joseph's Health, Paterson, NJ; Department of Emergency Medicine, Robert Wood Johnson University Hospital Somerset, Somerville, NJ
| | - Sangeeta Lamba
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ
| |
Collapse
|
26
|
Stewart AD. Prioritizing Primary Care Can Save the U.S. Health Care System. Fam Pract Manag 2021; 28:6-7. [PMID: 34254763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
|
27
|
Rurik I, Nánási A, Jancsó Z, Kalabay L, Lánczi LI, Móczár C, Semanova C, Schmidt P, Torzsa P, Ungvári T, Kolozsvári LR. Evaluation of primary care services in Hungary: a comprehensive description of provision, professional competences, cooperation, financing, and infrastructure, based on the findings of the Hungarian-arm of the QUALICOPC study. Prim Health Care Res Dev 2021; 22:e36. [PMID: 34193332 PMCID: PMC8278788 DOI: 10.1017/s1463423621000438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/03/2020] [Accepted: 04/19/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Primary health care provision in terms of quality, equity, and costs are different by countries. The Quality and Costs of Primary Care (QUALICOPC) study evaluated these domains and parameters in 35 countries, using uniformized method with validated questionnaires filled out by family physicians/general practitioners (GPs).This paper aims to provide data of the Hungarian-arm of the QUALICOPC study and to give an overview about the recent Hungarian primary care (PC) system. METHODS The questionnaires were completed in 222 Hungarian GP practices, delivered by fieldworkers, in a geographically representative distribution. Descriptive analysis was performed on the data. FINDINGS Financing is based mostly on capitation, with additional compensatory elements and minor financial incentives. The gate-keeping function is weak. The communication between GPs and specialists is often insufficient. The number of available devices and equipment are appropriate. Single-handed practices are predominant. Appointment instead of queuing is a new option and is becoming more popular, mainly among better-educated and urban patients. GPs are involved in the management of almost all chronic condition of all generations. Despite the burden of administrative tasks, half of the GPs estimate their job as still interesting, burn-out symptoms were rarely found. Among the evaluated process indicators, access, continuity, comprehensiveness, and coordination were rated as satisfactory, together with equity among health outcome indicators. Financing is insufficient; therefore, many GPs are involved in additional income-generating activities. The old age of the GPs and the lack of the younger GPs generation contributes to a shortage in manpower. Cooperation and communication between different levels of health care provision should be improved, focusing better on community orientation and on preventive services. Financing needs continuous improvement and appropriate incentives should be implemented. There is a need for specific PC-oriented guidelines to define properly the tasks and competences of GPs.
Collapse
Affiliation(s)
- Imre Rurik
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Anna Nánási
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Zoltán Jancsó
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Kalabay
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | | | - Csaba Móczár
- Irinyi Primary Care Health Center, Kecskemét, Hungary
| | - Csilla Semanova
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Péter Schmidt
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Tímea Ungvári
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - László Róbert Kolozsvári
- Department of Family and Occupational Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| |
Collapse
|
28
|
Tang KL, Kelly J, Sharma N, Ghali WA. Patient navigation programs in Alberta, Canada: an environmental scan. CMAJ Open 2021; 9:E841-E847. [PMID: 34493550 PMCID: PMC8428899 DOI: 10.9778/cmajo.20210004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Patient navigation is a complex intervention that has garnered substantial interest and investment across Canada. We conducted an environmental scan to understand the landscape of patient navigation programs within the health care system in Alberta, Canada. METHODS We included patient navigation programs within Alberta Health Services (AHS) and Alberta's Primary Care Networks (PCNs). Key informants were asked in October 2016 to identify existing programs and their corresponding program contacts. These program contacts were invited to complete a telephone-based survey from October 2016 to July 2017, to provide program descriptions and eligibility criteria, and to identify gaps in navigation. Programs were included if they engaged patients on an individual basis, and either facilitated continuity of care or promoted patient and family empowerment. We tabulated results and calculated summary statistics for program characteristics. RESULTS Ninety-five potentially eligible programs were identified by key informants. The response rate to the study survey was 73% (n = 69). After excluding programs not meeting inclusion criteria, we included a total of 58 programs in the study: 43 AHS programs and 15 PCN programs. Nearly all programs (93%, n = 54) delivered navigation via an individual acting as a navigator. A minority of programs also included nonnavigator components, such as Web-based resources (7%, n = 4) and process or structural changes to facilitate navigation (22%, n = 13). Certain patient subgroups were particularly well-served by patient navigation; these included patients with cancer, substance use disorders or mental health concerns, and pediatric patients. Gaps identified in navigation fell under 4 domains: awareness, resources, geographic distribution and integration. INTERPRETATION Patient navigation programs are common and have extended beyond cancer care, from which the construct originated; however, gaps include a lack of awareness and inequitable access to the programs. These findings will be of interest to those developing and implementing patient navigation interventions in Alberta and other jurisdictions.
Collapse
Affiliation(s)
- Karen L Tang
- Department of Medicine (Tang); Department of Community Health Sciences (Tang, Sharma); O' Brien Institute for Public Health (Tang, Ghali); W21C Research and Innovation Centre, Cumming School of Medicine (Kelly, Sharma); Office of the Vice-President (Research) (Ghali), University of Calgary, Calgary, Alta.
| | - Jenny Kelly
- Department of Medicine (Tang); Department of Community Health Sciences (Tang, Sharma); O' Brien Institute for Public Health (Tang, Ghali); W21C Research and Innovation Centre, Cumming School of Medicine (Kelly, Sharma); Office of the Vice-President (Research) (Ghali), University of Calgary, Calgary, Alta
| | - Nishan Sharma
- Department of Medicine (Tang); Department of Community Health Sciences (Tang, Sharma); O' Brien Institute for Public Health (Tang, Ghali); W21C Research and Innovation Centre, Cumming School of Medicine (Kelly, Sharma); Office of the Vice-President (Research) (Ghali), University of Calgary, Calgary, Alta
| | - William A Ghali
- Department of Medicine (Tang); Department of Community Health Sciences (Tang, Sharma); O' Brien Institute for Public Health (Tang, Ghali); W21C Research and Innovation Centre, Cumming School of Medicine (Kelly, Sharma); Office of the Vice-President (Research) (Ghali), University of Calgary, Calgary, Alta
| |
Collapse
|
29
|
Affiliation(s)
- Robert L Phillips
- The Center for Professionalism & Value in Health Care, American Board of Family Medicine Foundation, Washington, DC
| | - Linda A McCauley
- Neil Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | | |
Collapse
|
30
|
Lazris A, Roth AR, Haskell H, James J. Poor Physician-Patient Communication and Medical Error. Am Fam Physician 2021; 103:757-759. [PMID: 34128617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
| | - Alan R Roth
- Jamaica Hospital Medical Center, Jamaica, NY, USA
| | | | | |
Collapse
|
31
|
Ross EL, Zuromski KL, Reis BY, Nock MK, Kessler RC, Smoller JW. Accuracy Requirements for Cost-effective Suicide Risk Prediction Among Primary Care Patients in the US. JAMA Psychiatry 2021; 78:642-650. [PMID: 33729432 PMCID: PMC7970389 DOI: 10.1001/jamapsychiatry.2021.0089] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 01/17/2021] [Indexed: 12/30/2022]
Abstract
Importance Several statistical models for predicting suicide risk have been developed, but how accurate such models must be to warrant implementation in clinical practice is not known. Objective To identify threshold values of sensitivity, specificity, and positive predictive value that a suicide risk prediction method must attain to cost-effectively target a suicide risk reduction intervention to high-risk individuals. Design, Setting, and Participants This economic evaluation incorporated published data on suicide epidemiology, the health care and societal costs of suicide, and the costs and efficacy of suicide risk reduction interventions into a novel decision analytic model. The model projected suicide-related health economic outcomes over a lifetime horizon among a population of US adults with a primary care physician. Data analysis was performed from September 19, 2019, to July 5, 2020. Interventions Two possible interventions were delivered to individuals at high predicted risk: active contact and follow-up (ACF; relative risk of suicide attempt, 0.83; annual health care cost, $96) and cognitive behavioral therapy (CBT; relative risk of suicide attempt, 0.47; annual health care cost, $1088). Main Outcomes and Measures Fatal and nonfatal suicide attempts, quality-adjusted life-years (QALYs), health care sector costs and societal costs (in 2016 US dollars), and incremental cost-effectiveness ratios (ICERs) (with ICERs ≤$150 000 per QALY designated cost-effective). Results With a specificity of 95% and a sensitivity of 25%, primary care-based suicide risk prediction could reduce suicide death rates by 0.5 per 100 000 person-years (if used to target ACF) or 1.6 per 100 000 person-years (if used to target CBT) from a baseline of 15.3 per 100 000 person-years. To be cost-effective from a health care sector perspective at a specificity of 95%, a risk prediction method would need to have a sensitivity of 17.0% or greater (95% CI, 7.4%-37.3%) if used to target ACF and 35.7% or greater (95% CI, 23.1%-60.3%) if used to target CBT. To achieve cost-effectiveness, ACF required positive predictive values of 0.8% for predicting suicide attempt and 0.07% for predicting suicide death; CBT required values of 1.7% for suicide attempt and 0.2% for suicide death. Conclusions and Relevance These findings suggest that with sufficient accuracy, statistical suicide risk prediction models can provide good health economic value in the US. Several existing suicide risk prediction models exceed the accuracy thresholds identified in this analysis and thus may warrant pilot implementation in US health care systems.
Collapse
Affiliation(s)
- Eric L. Ross
- Department of Psychiatry, McLean Hospital, Belmont, Massachusetts
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Kelly L. Zuromski
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Ben Y. Reis
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Matthew K. Nock
- Department of Psychology, Harvard University, Cambridge, Massachusetts
| | - Ronald C. Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
| | - Jordan W. Smoller
- Department of Psychiatry, Massachusetts General Hospital, Boston
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Boston
| |
Collapse
|
32
|
McNeely J, Adam A, Rotrosen J, Wakeman SE, Wilens TE, Kannry J, Rosenthal RN, Wahle A, Pitts S, Farkas S, Rosa C, Peccoralo L, Waite E, Vega A, Kent J, Craven CK, Kaminski TA, Firmin E, Isenberg B, Harris M, Kushniruk A, Hamilton L. Comparison of Methods for Alcohol and Drug Screening in Primary Care Clinics. JAMA Netw Open 2021; 4:e2110721. [PMID: 34014326 PMCID: PMC8138691 DOI: 10.1001/jamanetworkopen.2021.10721] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Guidelines recommend that adult patients receive screening for alcohol and drug use during primary care visits, but the adoption of screening in routine practice remains low. Clinics frequently struggle to choose a screening approach that is best suited to their resources, workflows, and patient populations. OBJECTIVE To evaluate how to best implement electronic health record (EHR)-integrated screening for substance use by comparing commonly used screening methods and examining their association with implementation outcomes. DESIGN, SETTING, AND PARTICIPANTS This article presents the outcomes of phases 3 and 4 of a 4-phase quality improvement, implementation feasibility study in which researchers worked with stakeholders at 6 primary care clinics in 2 large urban academic health care systems to define and implement their optimal screening approach. Site A was located in New York City and comprised 2 clinics, and site B was located in Boston, Massachusetts, and comprised 4 clinics. Clinics initiated screening between January 2017 and October 2018, and 93 114 patients were eligible for screening for alcohol and drug use. Data used in the analysis were collected between January 2017 and October 2019, and analysis was performed from July 13, 2018, to March 23, 2021. INTERVENTIONS Clinics integrated validated screening questions and a brief counseling script into the EHR, with implementation supported by the use of clinical champions (ie, clinicians who advocate for change, motivate others, and use their expertise to facilitate the adoption of an intervention) and the training of clinic staff. Clinics varied in their screening approaches, including the type of visit targeted for screening (any visit vs annual examinations only), the mode of administration (staff-administered vs self-administered by the patient), and the extent to which they used practice facilitation and EHR usability testing. MAIN OUTCOMES AND MEASURES Data from the EHRs were extracted quarterly for 12 months to measure implementation outcomes. The primary outcome was screening rate for alcohol and drug use. Secondary outcomes were the prevalence of unhealthy alcohol and drug use detected via screening, and clinician adoption of a brief counseling script. RESULTS Patients of the 6 clinics had a mean (SD) age ranging from 48.9 (17.3) years at clinic B2 to 59.1 (16.7) years at clinic B3, were predominantly female (52.4% at clinic A1 to 64.6% at clinic A2), and were English speaking. Racial diversity varied by location. Of the 93,114 patients with primary care visits, 71.8% received screening for alcohol use, and 70.5% received screening for drug use. Screening at any visit (implemented at site A) in comparison with screening at annual examinations only (implemented at site B) was associated with higher screening rates for alcohol use (90.3%-94.7% vs 24.2%-72.0%, respectively) and drug use (89.6%-93.9% vs 24.6%-69.8%). The 5 clinics that used a self-administered screening approach had a higher detection rate for moderate- to high-risk alcohol use (14.7%-36.6%) compared with the 1 clinic that used a staff-administered screening approach (1.6%). The detection of moderate- to high-risk drug use was low across all clinics (0.5%-1.0%). Clinics with more robust practice facilitation and EHR usability testing had somewhat greater adoption of the counseling script for patients with moderate-high risk alcohol or drug use (1.4%-12.5% vs 0.1%-1.1%). CONCLUSIONS AND RELEVANCE In this quality improvement study, EHR-integrated screening was feasible to implement in all clinics and unhealthy alcohol use was detected more frequently when self-administered screening was used at any primary care visit. The detection of drug use was low at all clinics, as was clinician adoption of counseling. These findings can be used to inform the decision-making of health care systems that are seeking to implement screening for substance use. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02963948.
Collapse
Affiliation(s)
- Jennifer McNeely
- Department of Population Health, New York University Grossman School of Medicine, New York
- Department of Medicine, Division of General Internal Medicine, New York University Grossman School of Medicine, New York
| | - Angéline Adam
- Department of Psychiatry, University Hospital Lausanne, Lausanne, Switzerland
| | - John Rotrosen
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Sarah E. Wakeman
- Department of Medicine, Harvard Medical School, Massachusetts General Hospital, Boston
| | | | - Joseph Kannry
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | | | - Sarah Farkas
- Department of Psychiatry, New York University Grossman School of Medicine, New York
| | - Carmen Rosa
- National Institute on Drug Abuse, Bethesda, Maryland
| | - Lauren Peccoralo
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Eva Waite
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Aida Vega
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jennifer Kent
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catherine K. Craven
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Elizabeth Firmin
- Department of Psychiatry, Massachusetts General Hospital, Boston
| | | | - Melanie Harris
- Department of Population Health, New York University Grossman School of Medicine, New York
| | - Andre Kushniruk
- School of Health Information Science, University of Victoria, Victoria, British Columbia, Canada
| | - Leah Hamilton
- Department of Population Health, New York University Grossman School of Medicine, New York
| |
Collapse
|
33
|
Abstract
Atrial fibrillation is a common chronic disease seen in primary care offices, emergency departments, inpatient hospital services, and many subspecialty practices. Atrial fibrillation care is complicated and multifaceted, and, at various points, clinicians may see it as a consequence and cause of multi-morbidity, as a silent driver of stroke risk, as a bellwether of an acute medical illness, or as a primary rhythm disturbance that requires targeted treatment. Primary care physicians in particular must navigate these priorities, perspectives, and resources to meet the needs of individual patients. This includes judicious use of diagnostic testing, thoughtful use of novel therapeutic agents and procedures, and providing access to subspecialty expertise. This review explores the epidemiology, screening, and risk assessment of atrial fibrillation, as well as management of its symptoms (rate and various rhythm control options) and stroke risk (anticoagulation and other treatments), and offers a model for the integration of the components of atrial fibrillation care.
Collapse
Affiliation(s)
- Shiva P Ponamgi
- Division of Hospital Internal Medicine, Mayo Clinic Health System, Austin, MN, USA
| | | | - David R Rushlow
- Department of Family Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Victor Montori
- Division of Endocrinology, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Peter A Noseworthy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
34
|
Vijh R, Wong ST, Grandy M, Peterson S, Ezzat AM, Gibb AG, Hawkins NM. Identifying heart failure in patients with chronic obstructive lung disease through the Canadian Primary Care Sentinel Surveillance Network in British Columbia: a case derivation study. CMAJ Open 2021; 9:E376-E383. [PMID: 33863795 PMCID: PMC8084551 DOI: 10.9778/cmajo.20200183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Heart failure (HF) poses a substantial global health burden, particularly in patients with chronic obstructive pulmonary disease (COPD). The objective of this study was to validate an electronic medical record-based definition of HF in patients with COPD in primary care practices in the province of British Columbia, Canada. METHODS We conducted a cross-sectional retrospective chart review from Sept. 1, 2018, to Dec. 31, 2018, for a cohort of patients from primary care practices in BC whose physicians were recruited through the BC node of the Canadian Primary Care Sentinel Surveillance Network. Heart failure case definitions were developed by combining diagnostic codes, medication information and laboratory values available in primary care electronic medical records. These were compared with HF diagnoses identified through detailed chart review as the gold standard. Sensitivity, specificity, negative (NPV) and positive predictive values (PPV) were calculated for each definition. RESULTS Charts of 311 patients with COPD were reviewed, of whom 72 (23.2%) had HF. Five categories of definitions were constructed, all of which had appropriate sensitivity, specificity and NPV. The optimal case definition consisted of 1 HF billing code or a specific combination of medications for HF. This definition had an excellent specificity (93.3%, 95% confidence interval [CI] 89.4%-96.1%), sensitivity (90.3%, 95% CI 81.0%-96.0%), PPV (80.2%, 95% CI 69.9%-88.3%) and NPV (97.0%, 95% CI 93.8%-98.8%). INTERPRETATION This comprehensive case definition improves upon previous primary care HF definitions to include medication codes and laboratory data, along with previously used billing codes. A case definition for HF was derived and validated and can be used with data from electronic medical records to identify HF in patients with COPD in primary care accurately.
Collapse
Affiliation(s)
- Rohit Vijh
- School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
| | - Sabrina T Wong
- School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
| | - Matthew Grandy
- School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
| | - Sandra Peterson
- School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
| | - Allison M Ezzat
- School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
| | - Andrew G Gibb
- School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
| | - Nathaniel M Hawkins
- School of Population and Public Health (Vijh), Centre for Health Services and Policy Research (Wong, Peterson, Ezzat, Gibb) and School of Nursing (Wong, Ezzat), University of British Columbia, Vancouver, BC; Primary Care Research Unit (Grandy) and Department of Family Medicine (Grandy), Dalhousie University, Halifax, NS; Division of Cardiology (Hawkins), University of British Columbia, Vancouver, BC
| |
Collapse
|
35
|
Strzelecka A, Stachura M, Wójcik T, Kordyzon M, Chmielewski JP, Florek-Łuszczki M, Nowak-Starz G. Determinants of primary healthcare patients' dissatisfaction with the quality of provided medical services. Ann Agric Environ Med 2021; 28:142-148. [PMID: 33775080 DOI: 10.26444/aaem/132783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION The quality of medical services and health care are complex problems with a number of various definitions, conceptual approaches, measurement tools and techniques. The most important influence on quality in primary health care has the (immaterial) human factor, the relationship between patient and doctor, medical personnel and the primary health care institution, and the skill to use new technologies to improve quality in health care. OBJECTIVE The aim of the study is to discover the determinants of primary health care patients' dissatisfaction with the quality of medical services. MATERIAL AND METHODS Patients with medical appointments on the day of the survey and gave their consent to participate were included in the study. A total of 901 patients of primary health care institutions [591 (65.59%) women and 310 (34.41%) men] in the Świętokrzyskie Province took part. The diagnostic poll method based on a questionnaire examining the patients' satisfaction with the quality of health services was used. Logistic regression identified the determinants of dissatisfaction of the patients. RESULTS The determinants that mostly affected the patients' dissatisfaction with medical services were: rudeness of the doctor (p=0.0001), rudeness of the rest of medical staff (p=0.0001), non-comprehensibility of information about health by the patient (p=0.004), no clear identification of the patient in the health care system (p=0.01), and difficult access to information regarding the health condition (medical documentation) (p=0.018). CONCLUSIONS Primary health care patients who participated in the study pointed to the attitude of the doctor towards a patient during a visit, and the attitude of the remaining medical personnel among the determinants of dissatisfaction with medical services.
Collapse
Affiliation(s)
- Agnieszka Strzelecka
- Collegium Medicum, Institute of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Michał Stachura
- Department of Economics and Finance, Faculty of Law and Social Sciences, Jan Kochanowski University, Kielce, Poland
| | - Tomasz Wójcik
- Collegium Medicum, Institute of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Marta Kordyzon
- Collegium Medicum, Institute of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | | | | | - Grażyna Nowak-Starz
- Collegium Medicum, Institute of Health Sciences, Jan Kochanowski University, Kielce, Poland
| |
Collapse
|
36
|
Hamzehgardeshi Z, Omidvar S, Amoli AA, Firouzbakht M. Pregnancy-related anxiety and its associated factors during COVID-19 pandemic in Iranian pregnant women: a web-based cross-sectional study. BMC Pregnancy Childbirth 2021; 21:208. [PMID: 33722198 PMCID: PMC7957463 DOI: 10.1186/s12884-021-03694-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 03/03/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pregnancy is a risk factor for coronavirus disease 2019 (COVID-19). Pregnant women suffer from varying levels of pregnancy-related anxiety (PRA) which can negatively affect pregnancy outcomes. The aim of this study was to assess PRA and its associated factors during the COVID-19 pandemic. METHODS This web-based cross-sectional study was conducted in 2020 on 318 pregnant women purposively recruited from primary healthcare centers in Sari and Amol, Iran. Data were collected using questionnaires (PRAQ, Edinburg, KAP of COVID-19, CDA-Q and Demographic questionnaire), which were provided to participants through the social media or were completed for them over telephone. Data were analyzed with the linear regression and the logistic regression analysis, at the significance level of 0.05 using the SPSS software (v. 21). RESULTS Around 21% of participants had PRA, 42.1% had depression, and 4.4% had COVID-19 anxiety. The significant predictors of PRA were number of pregnancies (P = 0.008), practice regarding COVID-19 (P < 0.001), COVID-19 anxiety (P < 0.001), depression (P < 0.001), and social support (P = 0.025) which explained 19% of the total variance. Depression and COVID-19 anxiety increased the odds of PRA by respectively four times and 13%, while good practice regarding COVID-19 decreased the odds by 62%. CONCLUSION Around 21% of pregnant women suffer from PRA during the COVID-19 pandemic and the significant predictors of PRA during the pandemic include number of pregnancies, practice regarding COVID-19, COVID-19 anxiety, depression, and social support. These findings can be used to develop appropriate strategies for the management of mental health problems during pregnancy in the COVID-19 pandemic.
Collapse
Affiliation(s)
- Zeinab Hamzehgardeshi
- Department of Reproductive Health and Midwifery, Sexual and Reproductive Health Research Center, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shabnam Omidvar
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Arman Asadi Amoli
- Commette Student Research, Babol University of Medical Sciences, Babol, Iran
| | - Mojgan Firouzbakht
- Department of Nursing- Midwifery, Comprehensive Health Research Center, Babol Branch, Isalamic Azad University, Babol, Iran.
| |
Collapse
|
37
|
Stewart J, Stadeli KM, Ásbjörnsdóttir KH, Green ML, Davidson GH, Weiner BJ, Dhanireddy S. Use of a Community Center Primary Care Clinic and Subsequent Emergency Department Visits Among Unhoused Women. JAMA Netw Open 2021; 4:e213134. [PMID: 33764421 PMCID: PMC7994947 DOI: 10.1001/jamanetworkopen.2021.3134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This cohort study evaluates the association between use of a community center primary care clinic and subsequent nonemergent emergency department (ED) visits by unhoused women who exchange sex and inject drugs.
Collapse
Affiliation(s)
- Jenell Stewart
- Department of Global Health, University of Washington, Seattle
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle
| | | | | | - Margaret L. Green
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle
| | | | - Bryan J. Weiner
- Department of Global Health, University of Washington, Seattle
| | - Shireesha Dhanireddy
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle
| |
Collapse
|
38
|
Cheng S, Hu Y, Pfaff H, Lu C, Fu Q, Wang L, Li D, Xia S. The Patient Safety Culture Scale for Chinese Primary Health Care Institutions: Development, Validity and Reliability. J Patient Saf 2021; 17:114-121. [PMID: 32404850 PMCID: PMC7908859 DOI: 10.1097/pts.0000000000000733] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Existing patient safety culture assessment tools are mostly developed in western countries and may not be suitable for Chinese primary health care institutions. Primary care plays an important role in China's medical system, and a targeted tool for its patient safety culture is urgently needed. OBJECTIVE The aim of the study was to develop a dependable instrument to assess the patient safety culture in Chinese primary health care institutions. METHODS Three phases were undertaken to develop the scale. The first phase developed a pilot scale by literature review, focus groups, and 2-round Delphi expert consultation. The second phase conducted a pilot survey. The third phase carried out a formal survey to test reliability and validity, involving 369 participants from 9 primary health care institutions. RESULTS The final scale included 32 items under 7 dimensions. For reliability, the Cronbach α coefficients among dimensions varied from 0.754 to 0.926, and the Cronbach α for the scale was 0.940. For content validity, the corrected item-level content validity varied between 0.64 and 1, the scale-level content validity index/universal agreement was 0.625, and the scale-level content validity index/average was 0.93. For construct validity, the Spearman correlations of dimension-total score varied between 0.129 and 0.851, all Spearman correlations of the dimension-total score were greater than that of interdimensions and the Spearman correlations of item-total score ranged from 0.042 to 0.775. The results of the confirmatory factor analysis indicated that the model fitted well. CONCLUSIONS The Patient Safety Culture Scale for Chinese primary health care institutions demonstrated good reliability and acceptable validity; thus, it can be used as an assessment instrument for patient safety culture in Chinese primary health care institutions.
Collapse
Affiliation(s)
- Siyu Cheng
- From the School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Yinhuan Hu
- From the School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Holger Pfaff
- Center for Health Services Research Cologne, University of Cologne, Cologne, Germany
| | - Chuntao Lu
- Jingmen No. 2 People's Hospital, Jingmen, Hubei, PR China
| | - Qiang Fu
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, Saint Louis, Missouri
| | - Liuming Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Dehe Li
- From the School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| | - Shixiao Xia
- From the School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, PR China
| |
Collapse
|
39
|
Garattini L, Badinella Martini M, Mannucci PM. Improving primary care in Europe beyond COVID-19: from telemedicine to organizational reforms. Intern Emerg Med 2021; 16:255-258. [PMID: 33196973 PMCID: PMC7668282 DOI: 10.1007/s11739-020-02559-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 12/04/2022]
Abstract
The COVID-19 pandemic has put under pressure all the health national systems in Europe and telemedicine (TM) has been an almost unavoidable answer for primary care (PC) services to constrain the contagion. PC includes all the healthcare services that are the first level of contact for individuals. General practitioners (GPs) are the pivotal providers of PC throughout Europe. Although GP costs are mainly covered by public services or social insurances in Europe, they are still self-employed physicians everywhere, differently from their colleagues in hospitals who are traditionally employees. TM is a very general term open to various interpretations and definitions. TM can now be practiced by means of modern audio-visual devices and is an alternative to the traditional face-to-face consultation in general practice. Although the adoption of TM seems to be compelling in our era, its practical dissemination in PC has been quite slow so far, and many different concerns have been raised on it. On the whole, TM widespread adoption in PC seems to be more a matter of labor organization and health care funding than of technology and ethics. Larger-scale organizations comprising a wide range of health professionals have become a pressing priority for a modern PC, because working together is crucial to provide high-quality care to patients, and co-location should boost teamwork and facilitate the management of information technology. A national network of large organizations in PC could be rationally managed through local budgets and should increase efficiency by adopting tools such as TM.
Collapse
Affiliation(s)
- Livio Garattini
- Institute for Pharmacological Research Mario Negri IRCCS, Ranica, BG, Italy.
| | | | | |
Collapse
|
40
|
|
41
|
Kazi F, Mushtaq A. Primary care of patients with HIV. Lancet Infect Dis 2021; 21:31. [PMID: 33271066 DOI: 10.1016/s1473-3099(20)30925-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
|
42
|
Abstract
Objectives. To reexamine the time required to provide the US Preventive Services Task Force (USPSTF)-recommended preventive services to a nationally representative adult patient panel of 2500.Methods. We determined the required time for a single physician to deliver the USPSTF preventive services by multiplying the eligible population, annual frequency, and patient-contact time required for each recommendation, all calculated by using data from the recommendations themselves and literature. We modeled a representative panel of 2500 adults based on the 2010 US Census Bureau data.Results. To deliver the USPSTF recommended preventive services across a 2500 adult patient panel would require 8.6 hours per working day, accounting for 131% of available physician time. Compared with 2003, there are fewer recommendations in 2020, but they require 1.2 more physician patient-contact hours per working day.Conclusions. The time required to deliver recommended preventive care places unrealistic expectations on already overwhelmed providers and leaves patients at risk. This is a systems problem, not a time-management problem. The USPSTF provides a set of recommendations with strong evidence of positive impact. It is imperative that our health care system is designed to deliver.
Collapse
Affiliation(s)
- Natalie Privett
- At the time the study was conducted, both authors were with the Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY. Natalie Privett was also with the Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai
| | - Shanice Guerrier
- At the time the study was conducted, both authors were with the Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY. Natalie Privett was also with the Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai
| |
Collapse
|
43
|
Affiliation(s)
- Jack Ende
- Department of Medicine, Perelman School of Medicine of the University of Pennsylvania, 5033 W. Gates Pavilion, 3400 Spruce Street, Philadelphia, PA 19104, USA.
| |
Collapse
|
44
|
Jester DJ, Hyer K, Guerra L, Robinson BE, Andel R. Beliefs regarding geriatrics primary care topics among medical students and internal medicine residents. Gerontol Geriatr Educ 2021; 42:46-58. [PMID: 31476132 DOI: 10.1080/02701960.2019.1661841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study evaluated beliefs regarding 25 content areas essential to the primary care of older adults and attitudes toward aging held by first-yearmedical students and Internal Medicine residents. A survey of 136 medical students and 61 Internal Medicine residents was conducted at an academic health-center. Beliefs were assessed by the 25-item Geriatrics Clinician-Educator Survey. Gap scores reflecting the difference in ratings between self-rated importance and knowledge were calculated. Attitudes toward aging was assessed by the Images of Aging Scale. Students and residents expressed similar beliefs about the importance of content areas, but students provided lower ratings in knowledge. Students reported larger gap scores in areas that reflected general primary care (e.g., chronic conditions, medications), whereas residents reported larger gap scores in areas that reflected specialists' expertise (e.g., driving risk, cognition, psychiatric symptoms). Attitudes toward aging did not differ appreciably between students and residents. Our findings suggest that primary care topics applicable for any age demographic were rated as most important by first-year medical students and Internal Medicine residents. Topics relevant to older populations--particularly those requiring specialists' knowledge of or requiring sensitive discussion with older adults-were rated as less important and were less well-mastered.
Collapse
Affiliation(s)
- Dylan J Jester
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Kathryn Hyer
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Lucy Guerra
- Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Bruce E Robinson
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
- Department of Geriatrics, Sarasota Memorial Hospital, Sarasota, FL, USA
| | - Ross Andel
- Florida Policy Exchange Center on Aging, School of Aging Studies, University of South Florida, Tampa, FL, USA
- Department of Neurology, 2nd Medical Faculty, Charles University, Prague, Czech Republic
| |
Collapse
|
45
|
Haralson DM, Hodgson JL, Brimhall AS, Baugh EJ, Knight SM. A comparison of primary care parenting programs for Latinx families. Fam Syst Health 2020; 38:428-438. [PMID: 32853002 DOI: 10.1037/fsh0000534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Introduction: Primary care agencies remain an ideal setting for implementing parenting programs that meet the needs of Latinx parents. However, little to no research has been done on how well adapted primary care parenting programs (PCPPs) are to the beliefs, values, and practices of many Latinx families. Method: Using 5 inclusion criteria, 8 PCPPs were selected and compared across 8 domains: focus, age of child, composition, sequence, duration, training length, estimated start-up costs, and number of cultural adaptations. Results: PCPPs vary widely across all 8 domains, with some PCPPs being relatively brief and low cost and others more all encompassing and expensive. Only 4 of the 8 programs demonstrated cultural adaptations outside Spanish translation. Conclusion: This comparison demonstrates that there is a lack of cultural consideration among researchers who develop PCPPs. Recommendations for providing culturally attuned parenting services for Latinx families within a primary care environment are given. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Jennifer L Hodgson
- Department of Human Development and Family Science, East Carolina University
| | - Andrew S Brimhall
- Department of Human Development and Family Science, East Carolina University
| | - Eboni J Baugh
- Department of Human Development and Family Science, East Carolina University
| | | |
Collapse
|
46
|
Affiliation(s)
- Glenn Duns
- MDCM, FRACGP, MPH; medical editor at Australian Journal of General Practice and general practitioner in Melbourne, Vic
| |
Collapse
|
47
|
Grad R, Ebell MH. Top POEMs of 2019 Consistent with the Principles of the Choosing Wisely Campaign. Am Fam Physician 2020; 102:673-678. [PMID: 33252912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In this article, we discuss the POEMs (patient-oriented evidence that matters) of 2019 judged to be most consistent with the principles of Choosing Wisely, an international campaign to reduce unnecessary testing and treatments. We selected these POEMs through a crowdsourcing strategy of the daily POEMs information service for the Canadian Medical Association's physician members. We present recommendations from these top POEMs of primary research or meta-analysis that identify interventions to encourage or consider avoiding in practice. The recommendations cover musculoskeletal conditions (e.g., do not recommend platelet-rich plasma injections for rotator cuff disease or knee osteoarthritis), respiratory disease (e.g., in clinically stable patients with community-acquired pneumonia, antibiotics can be stopped after five days), screening or preventive care (e.g., patients who take their blood pressure at home or in a pharmacy should know what to do when they have an elevated reading), and miscellaneous topics (e.g., in healthy adults treated for dermatophyte infection, do not obtain baseline or follow-up alanine transaminase level, aspartate transaminase level, or complete blood count). These POEMs describe interventions whose benefits are not superior to other options, are sometimes more expensive, or put patients at increased risk of harm. Knowing more about these POEMs and their connection with the Choosing Wisely campaign will help clinicians and patients engage in conversations better informed by high-quality evidence.
Collapse
|
48
|
Jonas WB. A new model of care to return holism to family medicine. J Fam Pract 2020; 69:493-498. [PMID: 33348344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Family medicine's leadership in primary care is slipping as it loses its vision of whole-person care. This model of care can help us better manage and combat chronic disease.
Collapse
Affiliation(s)
- Wayne B Jonas
- Samueli Integrative Health Programs, Corona Del Mar, CA; Georgetown University School of Medicine, Washington, DC; Uniformed Services University, Bethesda, MD, USA.
| |
Collapse
|
49
|
Goldstein E, Benton SF, Barrett B. Health Risk Behaviors and Resilience Among Low-Income, Black Primary Care Patients: Qualitative Findings From a Trauma-Informed Primary Care Intervention Study. Fam Community Health 2020; 43:187-199. [PMID: 32324650 PMCID: PMC7988480 DOI: 10.1097/fch.0000000000000260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
This study describes an intervention with low-income, Black primary care patients and their experience in changing a health risk behavior. Participant themes, including behavioral coping, personal values, accomplishments and strengths, barriers and strategies, and social support, are understood in relationship to health behavior theories. Two structured interviews were conducted 1 month apart. Content analysis was used to analyze responses from 40 participants. Participants were well equipped with resilience-based coping, self-efficacies, and informal social networks despite economic and social disadvantages. Findings from this study have the potential to improve behavioral health coping and reduce racial inequities in health prevalent for this population.
Collapse
Affiliation(s)
- Ellen Goldstein
- Department of Family Medicine and Community Health, University of Wisconsin-Madison
| | | | | |
Collapse
|
50
|
Baines R, Tredinnick-Rowe J, Jones R, Chatterjee A. Barriers and Enablers in Implementing Electronic Consultations in Primary Care: Scoping Review. J Med Internet Res 2020; 22:e19375. [PMID: 33035177 PMCID: PMC7674136 DOI: 10.2196/19375] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 06/26/2020] [Accepted: 07/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Often promoted as a way to address increasing demands, improve patient accessibility, and improve overall efficiency, electronic consultations are becoming increasingly common in primary care, particularly in light of the current COVID-19 pandemic. However, despite their increasing use, a theoretically informed understanding of the factors that support and inhibit their effective implementation is severely limited. OBJECTIVE With this scoping review, we sought to identify the factors that support and inhibit the implementation of electronic consultations in primary care. METHODS In total, 5 electronic databases (PubMed, Medline, Embase, CINAHL, and PsycINFO) were systematically searched for studies published in 2009-2019 that explored the impact and/or implementation of electronic consultations in primary care. Database searches were supplemented by reference list and grey literature searches. Data were analyzed using inductive thematic analysis and synthesized using Normalization Process Theory (NPT). RESULTS In total, 227 articles were initially identified and 13 were included in this review. The main factors found to hinder implementation included awareness and expectations; low levels of engagement; perceived suitability for all patient groups, conditions, and demographics; cost; and other contextual factors. Reports of information technology reliability and clinical workload duplication (as opposed to reduction) also appeared detrimental. Conversely, the development of protocols and guidance; patient and staff education; strategic marketing; and patient and public involvement were all identified as beneficial in facilitating electronic consultation implementation. CONCLUSIONS This review highlights the need for proactive engagement with patients and staff to facilitate understanding and awareness, process optimization, and delivery of coherent training and education that maximizes impact and success. Although the necessity to use online methods during the COVID-19 pandemic may have accelerated awareness, concerns over workload duplication and inequality of access may remain. Future research should explore health inequalities in electronic consultations and their economic impacts from multiple perspectives (eg, patient, professional, and commissioner) to determine their potential value. Further work to identify the role of meaningful patient involvement in digital innovation, implementation, and evaluation is also required following the rapid digitization of health and social care.
Collapse
Affiliation(s)
| | | | - Ray Jones
- University of Plymouth, Plymouth, United Kingdom
| | | |
Collapse
|