A classification of primary care streaming pathways in UK emergency departments: Findings from a multi-methods study comprising cross-sectional survey; site visits with observations, semi-structured and informal interviews

2021 ◽  
Vol 56 ◽  
pp. 101000
Author(s):  
Michelle Edwards ◽  
Alison Cooper ◽  
Thomas Hughes ◽  
Freya Davies ◽  
Rebecca Sherlock ◽  
...  
BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033188
Author(s):  
Marlene Karam ◽  
Anne-Sophie Lambert ◽  
Jean Macq

ObjectivesTo assess patients’ perceptions of continuity of care (COC) across primary care level and emergency departments (EDs) and to identify contextual and individual factors that influence this perception.DesignCross-sectional multicentre survey.SettingFive EDs in Brussels and Wallonia.Participants501 adult patients referred to the ED by their primary care physician (PCP). Patients with cognitive impairment or in critical condition were excluded.ResultsPatients perceived high levels of the three types of COC. On an individual level, older patients showed a perception of higher levels of continuity. Lower levels of informational and management continuity were observed among patients suffering from chronic diseases and patients with a high level of education. Patients also perceived a redundancy of medical exams, in parallel to a high degree of accessibility between care levels. On an organisational level, three structural factors were identified as barriers to COC, namely, ED workload, suboptimal sharing information system and the current fee-for-service payment system that encourages competition and hinders coordination between actors.ConclusionBelgian healthcare services seem satisfying for patients and easily accessible. However, efforts need to be directed towards improving their efficiency. A stronger primary care level is also needed to benefit the healthcare system by reducing overuse of emergency services. On the individual level, a more enhanced patient-centred approach could be beneficial in improving patients experience of care.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Jerrald Lau ◽  
David Hsien-Yung Tan ◽  
Gretel Jianlin Wong ◽  
Yii-Jen Lew ◽  
Ying-Xian Chua ◽  
...  

Abstract Background Primary care physicians (PCPs) are first points-of-contact between suspected cases and the healthcare system in the current COVID-19 pandemic. This study examines PCPs’ concerns, impact on personal lives and work, and level of pandemic preparedness in the context of COVID-19 in Singapore. We also examine factors and coping strategies that PCPs have used to manage stress during the outbreak. Methods Two hundred and sixteen PCPs actively practicing in either a public or private clinic were cluster sampled via email invitation from three primary care organizations in Singapore from 6th to 29th March 2020. Participants completed a cross-sectional online questionnaire consisting of items on work- and non-work-related concerns, impact on personal and work life, perceived pandemic preparedness, stress-reduction factors, and personal coping strategies related to COVID-19. Results A total of 158 questionnaires were usable for analyses. PCPs perceived themselves to be at high risk of COVID-19 infection (89.9%), and a source of risk (74.7%) and concern (71.5%) to loved ones. PCPs reported acceptance of these risks (91.1%) and the need to care for COVID-19 patients (85.4%). Overall perceived pandemic preparedness was extremely high (75.9 to 89.9%). PCPs prioritized availability of personal protective equipment, strict infection prevention guidelines, accessible information about COVID-19, and well-being of their colleagues and family as the most effective stress management factors. Conclusions PCPs continue to serve willingly on the frontlines of this pandemic despite the high perception of risk to themselves and loved ones. Healthcare organizations should continue to support PCPs by managing both their psychosocial (e.g. stress management) and professional (e.g. pandemic preparedness) needs.


CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S76-S76
Author(s):  
R. Schonnop ◽  
B. Stauffer ◽  
A. Gauri ◽  
D. Ha

Introduction: Procedural skills are a key component of an emergency physician's practice. The Edmonton Zone is a health region that comprises twelve tertiary, urban community and rural community emergency departments (EDs) and represents over three hundred emergency physicians. This study describes the current attitudes toward procedural skill competency, current procedural skill practices, and the role for educational skills training sessions among emergency medicine physicians within a geographical health region. Methods: Multicenter descriptive cross-sectional survey of all emergency medicine physicians working at 12 emergency departments within the Edmonton Zone in 2019 (n = 274). The survey underwent several phases of systematic review; including item generation and reduction, pilot testing, and clinical sensibility testing. Survey items addressed current procedural skill performance frequency, perceived importance and confidence, current methods to maintain competence, barriers and facilitating factors to participation in a curriculum, preferred teaching methods, and desired frequency of practice for each procedural skill. Results: Survey response rate was 53.6%. Variability in frequency of performed procedures was apparent across the type of hospital sites. For majority of skills, there was a significantly positive correlation between the frequency at which a skill was performed and the perceived confidence performing said skill. There was inconsistency and no significant correlation with perceived importance, perceived confidence, or frequency performing a given skill and the desired frequency of training for that skill. Course availability (76.2%) and time (72.8%) are the most common identified barriers to participation in procedural skills training. Conclusion: This study summarized the current emergency department procedural skill practices and attitudes toward procedural skill competency and an educational curriculum among emergency medicine physicians in Edmonton. This represents a step towards targeted continuing professional development in the growing realm of competency-based medical education.


Author(s):  
Peter P. Groenewegen ◽  
Wienke G. W. Boerma ◽  
Peter Spreeuwenberg ◽  
Bohumil Seifert ◽  
Willemijn Schäfer ◽  
...  

Abstract Aim: To describe variation in task shifting from general practitioners (GPs) to practice assistants/nurses in 34 countries, and to explain differences by analysing associations with characteristics of the GPs, their practices and features of the health care systems. Background: Redistribution of tasks and responsibilities in primary care are driven by changes in demand for care, such as the growing number of patients with chronic conditions, and workforce developments, including staff shortage. The need to manage an expanding range of services has led to adaptations in the skill mix of primary care teams. However, these developments are hampered by barriers between professional domains, which can be rigid as a result of strict regulation, traditional attitudes and lack of trust. Methods: Data were collected between 2011 and 2013 through a cross-sectional survey among approximately 7200 GPs in 34 countries. The dependent variable ‘task shifting’ is measured through a composite score of GPs’ self-reported shifting of tasks. Independent variables at GP and practice level are: innovativeness; part-time working; availability of staff; location and population of the practice. Country-level independent variables are: institutional development of primary care; demand for and supply of care; nurse prescribing as an indicator for professional boundaries; professionalisation of practice assistants/nurses (indicated by professional training, professional associations and journals). Multilevel analysis is used to account for the clustering of GPs in countries. Findings: Countries vary in the degree of task shifting by GPs. Regarding GP and practice characteristics, use of electronic health record applications (as an indicator for innovativeness) and age of the GPs are significantly related to task shifting. These variables explain only little variance at the level of GPs. Two country variables are positively related to task shifting: nurse prescribing and professionalisation of primary care nursing. Professionalisation has the strongest relationship, explaining 21% of the country variation.


BMJ Open ◽  
2017 ◽  
Vol 7 (7) ◽  
pp. e015145 ◽  
Author(s):  
William C W Wong ◽  
ShanZhu Zhu ◽  
Jason J Ong ◽  
MingHui Peng ◽  
Cindy L K Lam ◽  
...  

2020 ◽  
Author(s):  
Wichai Aekplakorn ◽  
Paibul Suriyawongpaisal ◽  
Samrit Srithamrongsaw ◽  
Phanuwich kaewkamjonchai

Abstract Background To improve care for patients with chronic diseases, a recent policy initiative in Thailand focuses on strengthening primary care including training of the team to deliver healthcare based on the concept of Chronic Care Model (CCM). This study aimed to assess the perception of patients on the health care services after the implementation. Methods We conducted a cross-sectional survey of 4,071 patients with hypertension and/or diabetes registered to 27 primary care units and 11 hospital Non-communicable diseases (NCDs) clinics in 11 provinces.The patients were interviewed at home using a validated questionnaire of the Patient Assessment of Chronic Illness Care (PACIC+). It contains 20 items from the original PACIC, which measure different parts of the CCM, and an additional 6 items assess the 5A Model including assess, advise, agree, assist, and arrange subscales. Upgraded primary care unit (PCUs) were ordinary PCUs with the multi-professional team including a physician. Trained upgraded PCUs were upgraded PCUs with the training input. Structural equation modeling was used to create subscale scores for CCM and 5 A model characteristics. Mixed effect models were employed to compare subscale of patient perception of the care quality between trained upgraded PCUs, upgraded PCUs, ordinary PCUs and NCD clinics.Results There was an independent association between every PACIC subscale (as a measure of CCM) and facility type with the maximum likelihood for patients of ordinary PCU reporting high to highest scores (ORs: 1.46-1.85; p<0.05) compared to hospital NCD clinics. This is also the case for patients: seeing the same doctor on repeated visits (ORs: 1.82-2.17; p<0.05) or having phone contacts of the providers (ORs:1.53-1.99; p<0.05). Similarly, across all of the 5A model subscales, ORs for patients attending ordinary PCU responded with high to highest scores were 1.48-2.10 times compared to those for patients attending hospital NCD clinics (p<0.05). Conclusions The training and allocation of family physician approach in PCU may not satisfy the patients’ perception on quality of chronic care. Further studies might focus on other factors such as mismatch between health workforce and workload as a key factor influencing the success of the policy implementation.


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