Connecting tobacco users in the primary care setting to comprehensive tobacco treatment: a quality improvement initiative

Abstract Objectives Quality assurance/quality improvement projects are an important part of professional development in graduate medical education. The purpose of our quality improvement study was to evaluate whether (1) the Generalized Anxiety Disorder (GAD-7) scale questionnaire increases detection of anxiety and (2) the Quick Inventory for Depressive Symptomatology Self Report (QIDS-SR) increases detection of depression in a primary care setting. We also aimed to determine whether monitoring patients with depression or generalized anxiety using the QIDS-SR and GAD-7 scales influences treatment changes in the primary care setting. Methods Patients seen in a general internal medicine clinic between August 2008 and March 2009 were asked to fill out the QID-SR questionnaire and GAD-7 as part of a resident quality improvement project. We measured the prevalence of anxiety and depression during 6 months prior to the use of the GAD-7 and QIDS-SR instruments during the intervention period. We also compared the frequency of treatment changes initiated both 12 months prior to and during the intervention period. The aforementioned measures were performed with use of a retrospective chart review. Results The prevalence of anxiety was 15.2% in the pre-intervention period and 33.3% in the intervention period, and the prevalence of depression was 38.9% in the prescreening period and 54.8% during the screening period (P value for both was <0.001). The change in anxiety therapy was 21.6% in the prescreening period and 62.2% in the screening period (P = .028). The change in depression therapy was 23.2% in the pre-intervention period and 52.1% in the intervention period (P = .025). Conclusion Routine screening for depression and anxiety may help clinicians detect previously undiagnosed anxiety and depression and also may facilitate identification of needed treatment changes. Further work is needed to determine whether routine screening improves patient outcomes.

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Effectiveness of an audit programme for dyslipidaemia management in a primary care setting in Macau: a quality improvement study

Family Medicine and Community Health ◽

10.1136/fmch-2019-000222 ◽

2020 ◽

Vol 8 (1) ◽

pp. e000222 ◽

Cited By ~ 1

Author(s):

In Wong ◽

See Fai Tse ◽

Chau Sha Kwok

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Statin Therapy ◽

Health Center ◽

Care Setting ◽

Primary Care Setting ◽

Outcome Measure ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Patient Records

ObjectiveThe objective of this study was to test the effectiveness of an audit programme for dyslipidaemia management in a primary care setting in Macau.DesignA quality improvement study based on an evaluation of a before-after intervention trial was conducted in 2017–2018. Interventions comprising feedback from an audit, general practitioner (GP) training via interactive workshops and one-on-one case discussions were implemented. The primary outcome measure was the proportion of patients with reasonable management of dyslipidaemia, and the secondary outcome measure was the proportion of patients with low-density lipoprotein cholesterol (LDL-C) meeting the target recommended by the Adult Treatment Panel III guidelines.SettingThis study was conducted at the Sao Lourenco Health Center, one of the health centres in the Macau primary care system; this centre provides primary care services to one-tenth of the residents of Macau.ParticipantsAll GPs who worked in the Sao Lourenco Health Center participated in the study. We systematically reviewed 100 patient records from each participating physician’s patient list. In total, 1200 and 1100 patient records were reviewed before and after the intervention, respectively.ResultsAt baseline, 390 (43.5%) patients were eligible for statin therapy, while 411 (47.7%) patients were eligible for statin therapy in the reaudit group (p=0.08). After intervention, the proportion of patients with reasonable management of dyslipidaemia increased from 83.9% to 88.5% (p=0.005), and the proportion of eligible patients with LDL-C levels meeting the target increased from 55.1% to 65% (p=0.004).ConclusionsThe audits and feedback significantly improved dyslipidaemia management in the Macau primary care setting.

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