Primary Care, Prevention, and Coordination of Care

2016 ◽  
pp. 95-114
Author(s):  
Keisa Fallin-Bennett ◽  
Shelly L. Henderson ◽  
Giang T. Nguyen ◽  
Abbas Hyderi
Keyword(s):  
Primary Care ◽  
Coordination Of Care

scholarly journals Communication between health professionals and their influence on the coordination of care

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M F M Mendes ◽  
I C Samico ◽  
Z M A Hartz
Keyword(s):  
Primary Care ◽  
Primary Care Physician ◽  
Primary Care Physicians ◽  
Diagnostic Errors ◽  
Care Physician ◽  
Primary Role ◽  
Coordination Of Care ◽  
Levels Of Care ◽  
Specialized Care

Abstract Background Problems linked to the coordination of care may represent a lack of communication between levels of care and reflect diagnostic errors, duplication of tests and unnecessary hospitalizations. This study aims to understand the role of communicational relationships between professionals and their influence on coordination between levels of care. Methods An evaluative and qualitative nature research. 24 interviews were carried out, with primary care physicians and specialists, institutional supporters and managers of a public health network in Pernambuco, Brazil. The content thematic analysis worked out sought to identify synergies and contradictions in the relationships between the actors. Results Knowledge about the role of primary care was incomplete, not being understood its primary role as a care provider. The primary care physician was not recognized as the responsible physician by most professionals. The specialists considered the references poorly filled out and showed a lack of confidence in the primary care physician, who in turn revealed that he did not receive any counter-reference and difficulty in contacting a specialist. Few articulation mechanisms have been reported between levels and the use of informal communication mechanisms. The managers acknowledged the existence of problems, but highlighted the commitment of management in the actions for organizing the network. The “goodwill” of the professionals was considered an articulation facilitator, but not a sufficient practice. Conclusions The results allowed to deepen the look at the complexity of the relationships between the actors and how they can influence coordination. Since is perceived the communicational tensions and weaknesses, it is urgent to think of strategies that establish institutionalized spaces for meetings and dialogues that allow articulation among professionals. Key messages The study analyzes communicational relationships between primary and specialized care professionals and their influence on the coordination of care. Strategies for mutual collaboration are mandatory.

Older Patients’ Perspectives on Quality of Serious Illness Care in Primary Care

2018 ◽  
Vol 35 (10) ◽  
pp. 1330-1336 ◽  
Author(s):  
Nebras. Abu Al Hamayel ◽  
Sarina R. Isenberg ◽  
Susan M. Hannum ◽  
Joshua Sixon ◽  
Katherine Clegg. Smith ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Making ◽  
Quality Improvement ◽  
Access To Care ◽  
Shared Decision Making ◽  
Older Patients ◽  
Shared Decision ◽  
Coordination Of Care ◽  
Serious Illness

Background: Despite increased focus on measuring and improving quality of serious illness care, there has been little emphasis on the primary care context or incorporation of the patient perspective. Objective: To explore older patients’ perspectives on the quality of serious illness care in primary care. Design: Qualitative interview study. Participants: Twenty patients aged 60 or older who were at risk for or living with serious illness and who had participated in the clinic’s quality improvement initiative. Methods: We used a semistructured, open-ended guide focusing on how older patients perceived quality of serious illness care, particularly in primary care. We transcribed interviews verbatim and inductively identified codes. We identified emergent themes using a thematic and constant comparative method. Results: We identified 5 key themes: (1) the importance of patient-centered communication, (2) coordination of care, (3) the shared decision-making process, (4) clinician competence, and (5) access to care. Communication was an overarching theme that facilitated coordination of care between patients and their clinicians, empowered patients for shared decision-making, related to clinicians’ perceived competence, and enabled access to primary and specialty care. Although access to care is not traditionally considered an aspect of quality, patients considered this integral to the quality of care they received. Patients perceived serious illness care as a key aspect of quality in primary care. Conclusions: Efforts to improve quality measurement and implementation of quality improvement initiatives in serious illness care should consider these aspects of care that patients deem important, particularly communication as an overarching priority.

THE IMPLEMENTATION OF PRINCIPLES OF PRIMARY CARE IN PRACTICE AT COMMUNE HEALTH CENTERS OF THUA THIEN HUE PROVINCE

2016 ◽  
pp. 103-109
Author(s):  
Minh Tam Nguyen ◽  
Thi Hoa Nguyen ◽  
Derese Anselme ◽  
Markuns Jeffrey
Keyword(s):  
Primary Care ◽  
Health Center ◽  
Assessment Tools ◽  
Health Centers ◽  
Coordination Of Care ◽  
Care Services ◽  
Primary Care Services ◽  
Quality Of Primary Care ◽  
Care Assessment ◽  
Total Average

Background: Evidences around the world in the recent time have affirmed the key role in Disease prevention and mortality rate decreasing.WHO in 2008 recommended contries should improve the primary care system and use primary care as a model to achieve the effectiveness and equity in Health. Evaluation of the quality of primary care services at commune health centers has been very crucial. Objectives: To assess the practice of the principles of primary care at commune health centers of Thua Thien Hue province.Subjects and Methods:Cross-sectional descriptive study of 860 adult people used the healh care services at commune health center at 4 districts in Thua Thien Hue province: Phu Loc, Nam Dong, Huong Thuy and Hue. The study used the Primary Care Assessment tools PCAT from John Hopkins University. Results:First Contact - Utilization was the highest score (3.25 ± 0.93), Affiliation (3.17 ± 0.90), Ongoing care (2.87 ± 0.50), Comprehensiveness – services available (2.75 ± 0.52);The low scores included Coordination of care (2.47 ± 0.97), Culture - based access (2.37 ± 1.17), Community - based orientation (2.35 ± 0.82), Comprehensiveness – services provided (2.22 ± 0.84), Coordination of care - Information system (2.03 ± 0.79 );Total average of primary care was 19.00 ± 3.46, and the total average of expanded primary care was 25.75 ± 5.42. Key words: primary care, principles of primary care, commune health center

scholarly journals Enhanced coordination of care to reduce medication risks in older home care clients in primary care: a randomized controlled trial

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Terhi Toivo ◽  
Marja Airaksinen ◽  
Maarit Dimitrow ◽  
Eeva Savela ◽  
Katariina Pelkonen ◽  
...  
Keyword(s):  
Primary Care ◽  
Randomized Controlled Trial ◽  
Home Care ◽  
Care Coordination ◽  
Controlled Trial ◽  
Potentially Inappropriate Medications ◽  
Coordination Of Care ◽  
Randomized Controlled ◽  
The Impact ◽  
Medication Changes

Abstract Background As populations are aging, a growing number of home care clients are frail and use multiple, complex medications. Combined with the lack of coordination of care this may pose uncontrolled polypharmacy and potential patient safety risks. The aim of this study was to assess the impact of a care coordination intervention on medication risks identified in drug regimens of older home care clients over a one-year period. Methods Two-arm, parallel, cluster randomized controlled trial with baseline and follow-up assessment at 12 months. The study was conducted in Primary Care in Lohja, Finland: all 5 home care units, the public healthcare center, and a private community pharmacy. Participants: All consented home care clients aged > 65 years, using at least one prescription medicine who were assessed at baseline and at 12 months. Intervention: Practical nurses were trained to make the preliminary medication risk assessment during home visits and report findings to the coordinating pharmacist. The coordinating pharmacist prepared the cases for the triage meeting with the physician and home care nurse to decide on further actions. Each patient’s physician made the final decisions on medication changes needed. Outcomes were measured as changes in medication risks: use of potentially inappropriate medications and psychotropics; anticholinergic and serotonergic load; drug-drug interactions. Results Participants (n = 129) characteristics: mean age 82.8 years, female 69.8%, mean number of prescription medicines in use 13.1. The intervention did not show an impact on the medication risks between the original intervention group and the control group in the intention to treat analysis, but the per protocol analysis indicated tendency for effectiveness, particularly in optimizing central nervous system medication use. Half (50.0%) of the participants with a potential need for medication changes, agreed on in the triage meeting, had none of the medication changes actually implemented. Conclusion The care coordination intervention used in this study indicated tendency for effectiveness when implemented as planned. Even though the outcome of the intervention was not optimal, the value of this paper is in discussing the real world experiences and challenges of implementing new practices in home care. Trial registration ClinicalTrials.gov (NCT02545257). Registered September 9 2015.

Differences in primary care providers’ and oncologists’ views on communication and coordination of care during active treatment of patients with cancer and comorbidities

2019 ◽  
Vol 22 (2) ◽  
pp. 51-57 ◽  
Author(s):  
Julia P Brockway ◽  
Keerti Murari ◽  
Alexandra Rosenberg ◽  
Orit Saigh ◽  
Matthew J Press ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Treatment ◽  
Active Treatment ◽  
Primary Care Providers ◽  
Attitudes And Beliefs ◽  
Coordination Of Care ◽  
Care Providers ◽  
Patients With Cancer ◽  
Medical Oncologists ◽  
Mount Sinai

Introduction Management of comorbid diseases in patients with cancer is often unclear. The purpose of our study was to identify differences and similarities between primary care providers and oncologists’ knowledge, attitudes, and beliefs regarding coordination of care and comorbid disease management for patients undergoing active cancer treatment. Methods We conducted a cross-sectional study using an anonymous self-administered survey which was available to approximately 600 providers in primary care and medical oncology practicing in both outpatient and inpatient settings from March to December 2014 at three academic hospitals in New York City (Mount Sinai Hospital, Mount Sinai Beth Israel, and Weill Cornell). Our survey instrument assessed physician knowledge, attitudes, and beliefs using a clinical vignette of a cancer patient undergoing active treatment. Descriptive statistics were used to summarize the demographic and practice details of survey responses, and univariate analyses were used to assess differences in responses between primary care providers and oncologists. Results The survey was completed by 203 providers, including 127 primary care providers (62.5%), 32 medical oncologists (15.8%), 11 palliative care physicians (5.4%), and 33 nurse practitioners or physician assistants (16.3%). Medical oncologists admitted more uncertainty regarding who should manage preventive care as compared to primary care providers (34.4% vs. 16.5%, p = 0.02), whereas primary care providers were more concerned about duplicated care (22.8% vs. 6.3%, p = 0.03). Both primary care providers and medical oncologists agreed that diabetes should be actively managed during cancer treatment. More primary care providers felt less strict glycemic control was allowable (56.8% vs. 37.5%, p = 0.05) and that it is allowable for patients to miss some diabetes-related visits (80.6% vs. 56.3%, p = 0.01). Discussion Primary care providers and medical oncologists differ in their knowledge, attitudes, and beliefs regarding coordination of care and management of comorbid conditions in patients undergoing cancer treatment. These differences reflect systemic challenges to provision of care to cancer patients and the need for a model of care coordination.

scholarly journals Investigating the effect of the Vula Mobile app on coordination of care and capacity building in district health services, Cape Town: Convergent mixed methods study

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Patrick Gloster ◽  
Robert Mash ◽  
Steve Swartz
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Health Services ◽  
Capacity Building ◽  
District Hospital ◽  
Mobile App ◽  
Coordination Of Care ◽  
District Health ◽  
Number Of Patients ◽  
Care Facilities

Background: Coordinating care is a defining characteristic of high quality primary care. Currently, very little is known about coordination of care in South Africa’s primary care setting. The Vula Mobile app was introduced in 2018 to assist with referring patients from primary care facilities to the Eerste River District Hospital (ERDH) emergency centre. The aim of this study was to evaluate the use of the app and its effect on coordination of care and capacity building of staff.Methods: Convergent mixed methods were used with quantitative data collected from hospital records and the Vula Mobile database, and with qualitative data collected from health professionals in primary care and the district hospital.Results: Out of 13 321 patients seen in the emergency centre of the district hospital over the 6-month study period, only 1932 (14.5%) of the patients were referred with Vula. Most of these referrals were accepted (85.5%). Sometimes, advice was given to (35.0%) or additional information was requested (27.4%) from the referring doctor. There was little use of Vula in providing other feedback (0.6%). The introduction of the Vula app led to a decrease in the number of inappropriately referred patients (6.7% to 4.2%, p = 0.004). Doctors using the Vula app perceived that it improved care coordination and had the potential for useful feedback.Conclusion: Vula improved coordination of patients referred from primary care facilities in the Metro Health Services to the district hospital, but missed the opportunity to support continuing professional development and learning. Utilisation of the Vula app should be increased and its potential to provide feedback should be enhanced. Attention should be given to reducing the number of patients self-referred or referred without using the Vula app.

Pediatrician's Role in Primary Health Care

PEDIATRICS ◽  
1983 ◽  
Vol 71 (3) ◽  
pp. 441-442
Author(s):  
JAMES E. STRAIN
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Pediatric Care ◽  
Coordination Of Care ◽  
Care Model ◽  
Primary Health ◽  
Primary Care Model

The article by Starfield1 highlights important aspects of primary pediatric care. She points to some of the deficiencies of the pediatric primary care model as they relate to accessibility, comprehensiveness of care and coordination of care. She then poses several provocative questions about the pediatrician's role in the delivery of primary health care to children. Pediatrics, internal medicine, and family practice have traditionally been considered primary care specialties. The truth of the matter is that general pediatrics is a mix of primary and secondary care and in some cases tertiary care. It is the mundane and the esoteric, the assessment of growth and development and the treatment of acute and chronic diseases, the management of psychosocial and biomedical disorders and the care provided in the ambulatory as well as the hospital setting that make pediatrics interesting and exciting.

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