Care Seeking Pathway Of Depression In Children And Adolescents: Differences In The Need For Care Coordination Between Patients Managed By Primary Care Providers Or Psychiatrists

84 Background: To improve coordination of cancer care between cancer specialist hospitals and primary care providers (PCPs), the Japanese government accredited cancer specialist hospitals, so called “designated cancer care hospitals (DCCHs)” and introduced “Cancer care coordination instruction fee” which PCPs can receive if they share a cancer critical path (Japanese version of Survivorship Care Plans) of each cancer patient with DCCHs. We sought to assess the current status of coordination of cancer care in Japan and communication between DCCHs and PCPs from PCPs’ point of view. Methods: A cross-sectional mail survey was administered to randomly selected clinic-based PCPs (4,000 clinics) from a nation-wide database of medical institutions authorized by Ministry of Health, Labour and Welfare Japan to treat patients with health insurance (87,869 clinics). The survey evaluated how much PCPs provided cancer follow-up care and how well DCCHs coordinated care and communicated with PCPs in cancer survivorship. Results: 1,873 PCPs returned the questionnaire (response rate: 46.8%). 1,223 (65.3%) answered to provide cancer follow-up care in outpatient setting. Most of the PCPs which provided cancer follow-up care evaluated the care coordination and support by DCCHs were satisfactory (946, 77.4%) but the degree of good evaluation varied by region (highest: 91.3%, lowest: 45.8%). In regression analysis, provision of palliative care by PCPs (OR 1.52 95%CI 1.05-2.17) and use of cancer critical path (OR 2.10 95%CI 1.63-2.71) were significantly correlated with better evaluation of communication and care coordination. Conclusions: DCCHs communicated well with PCPs and PCPs were satisfied with the communication and care coordination by DCCHs. Provision of palliative care by PCPs and use of cancer critical path are likely to lead good care coordination in cancer care.

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Return to Activity After SARS-CoV-2 Infection: Cardiac Clearance for Children and Adolescents

Sports Health A Multidisciplinary Approach ◽

10.1177/19417381211039746 ◽

2021 ◽

pp. 194173812110397

Author(s):

Devyani Chowdhury ◽

Michael A. Fremed ◽

Peter Dean ◽

Julie S. Glickstein ◽

Jeff Robinson ◽

...

Keyword(s):

Primary Care ◽

Sudden Cardiac Death ◽

Children And Adolescents ◽

Cardiac Death ◽

Cardiac Injury ◽

Primary Care Providers ◽

Return To Play ◽

Return To Sports ◽

Care Providers ◽

Return To Activity

Context: Sedentary behavior and inability to participate in organized physical activity has negatively affected the physical and mental health of children and adolescents; however, cardiac injury and associated risk for sudden cardiac death with return to activity remains a major concern. Guidelines have been proposed for return to activities; however, these fail to address the needs of younger children and those participating in more casual activities. Guidance is needed for primary care providers to facilitate safe return to everyday activity and sports and to help direct appropriate laboratory, electrocardiographic, and anatomical assessment. Evidence Acquisition: Review of computerized databases of available literature on SARS-CoV-2 infection in children and postinfection sequelae, risk factors for sudden cardiac death, and previous return to play recommendations. Study Design: Clinical guidelines based on available evidence and expert consensus. Level of Evidence: Level 4. Results: In this report, we review the literature on return to activity after SARS-CoV-2 infection and propose recommendations for cardiac clearance for children and adolescents. Though severe disease and cardiac injury is less common in children than in adults, it can occur. Several diagnostic modalities such as electrocardiography, echocardiography, cardiac magnetic resonance imaging, and serologic testing may be useful in the cardiac evaluation of children after SARS-CoV-2 infection. Conclusion: Gradual return to activity is possible in most children and adolescents after SARS-CoV-2 infection and many of these patients can be cleared by their primary care providers. Providing education on surveillance for cardiopulmonary symptoms with return to sports can avoid unnecessary testing and delays in clearance.

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Effect of a Digital Precision Public Health Intervention for Care Coordination During Covid-19 Pandemic in Australia: A Real World Study

10.21203/rs.3.rs-882615/v1 ◽

2021 ◽

Author(s):

Andre Q Andrade ◽

Jean-Pierre Calabretto ◽

Nicole L Pratt ◽

Lisa M Kalisch-Ellett ◽

Vanessa T LeBlanc ◽

...

Keyword(s):

Public Health ◽

Primary Care ◽

Continuity Of Care ◽

Care Coordination ◽

Real World ◽

Primary Care Providers ◽

Patient Specific ◽

Specific Information ◽

Care Providers ◽

Precision Public Health

Abstract Background: Emergencies disproportionally affect vulnerable populations. The COVID-19 pandemic affected older patients with co-morbidities both directly due to more severe infection and indirectly by affecting care provision. To promote continuity of care, public health professionals require tools to quickly and precisely coordinate with primary care providers. This study evaluated whether digital interventions powered by current existing infrastructure are more effective than conventional interventions in promoting primary care appointments during the COVID-19 pandemic. Methods: We developed a digital intervention delivered by secure messaging and compared it to a post delivered intervention to promote continuity of care for vulnerable veterans during COVID-19 in a real world, non-randomised, interventional study. The study was implemented as part of the Veterans’ MATES program, an Australian Government Department of Veterans’ Affairs program to promote improvements in health care for veterans. The intervention provided patient specific information to general practitioners (GPs) to support continuity of care, alongside mailed education to veterans. The intervention key messages were to maintain regular contact with care providers and to continue to adhere to health plans. The intervention took place in April 2020, during the first weeks of COVID-19 social distancing rules in Australia. The main outcome was time to first appointment with the primary general practitioner (GP) measured using a Cox proportional hazards model.Results: GPs received digital messaging for 51,052 veterans and post messaging for 26,859 veterans. The proportion of patients seeing their primary GP during the three months following intervention was higher in the digital group (77.8%) than the post group (61.5%) (p<0.01). Being in the digital group was associated with earlier appointments. Conclusion: Current infrastructure coupled with innovative solutions is effective in promoting care coordination at scale during national emergencies, opening up new perspectives for precision public health initiatives.

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Bicuspid Aortic Valve in Infants, Children, and Adolescents: A Review for Primary Care Providers

Pediatrics in Review ◽

10.1542/pir.2019-0307 ◽

2021 ◽

Vol 42 (5) ◽

pp. 233-244

Author(s):

Talha Niaz ◽

Jonathan N. Johnson ◽

Frank Cetta ◽

Timothy M. Olson ◽

Donald J. Hagler

Keyword(s):

Primary Care ◽

Aortic Valve ◽

Children And Adolescents ◽

Bicuspid Aortic Valve ◽

Primary Care Providers ◽

Care Providers

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Improving home-based providers’ communication to primary care providers to enhance care coordination

Aging & Mental Health ◽

10.1080/13607863.2014.977772 ◽

2014 ◽

Vol 19 (10) ◽

pp. 921-931 ◽

Cited By ~ 5

Author(s):

Amber M. Gum ◽

Natalie D. Dautovich ◽

Jennifer Greene ◽

Anne Hirsch ◽

Lawrence Schonfeld

Keyword(s):

Primary Care ◽

Care Coordination ◽

Primary Care Providers ◽

Care Providers ◽

Home Based

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Multisystem comorbidities in classic Rett syndrome: a scoping review

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000731 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000731

Author(s):

Cary Fu ◽

Dallas Armstrong ◽

Eric Marsh ◽

David Lieberman ◽

Kathleen Motil ◽

...

Keyword(s):

Primary Care ◽

Rett Syndrome ◽

Care Coordination ◽

Clinical Care ◽

Primary Care Providers ◽

Cardiac Conduction ◽

Care Providers ◽

Medical Comorbidities ◽

Medical Needs ◽

Organ Systems

BackgroundRett syndrome (RTT) is a severe, progressive neurodevelopmental disorder with multisystem comorbidities that evolve across a patient’s lifespan requiring attentive coordination of subspecialty care by primary care providers. A comprehensive, up-to-date synthesis of medical comorbidities in RTT would aid care coordination and anticipatory guidance efforts by healthcare providers. Our objective was to review and summarise published evidence regarding prevalence of RTT medical comorbidities across all relevant organ systems.MethodsSearch of PubMed from January 2000 to July 2019 was performed using the search terms (Rett and MECP2 AND patient) OR (Rett and MECP2 AND cohort). Articles reporting the prevalence of clinical findings in RTT were assessed with respect to the size and nature of the cohorts interrogated and their relevance to clinical care.ResultsAfter review of over 800 records, the multisystem comorbidities of RTT were summarised quantitatively from 18 records comprising both retrospective and prospective cohorts (31–983 subjects). Neurological comorbidities had the highest prevalence, occurring in nearly all individuals with gastrointestinal and orthopaedic concerns almost as prevalent as neurological. With the exception of low bone mineral content which was relatively common, endocrine comorbidities were seen in only around one-third of patients. Although more prevalent compared with the general population, cardiac conduction abnormalities were the least common comorbidity in RTT.ConclusionsEffective care coordination for RTT requires knowledge of and attention to multiple comorbidities across multiple unrelated organ systems. Many issues common to RTT can potentially be managed by a primary care provider but the need for sub-specialist referral can be anticipated. Since the median life expectancy extends into the sixth decade with evolving subspecialty requirements throughout this time, paediatric providers may be tasked with continued coordination of these comorbidities or transitioning to adult medicine and specialists with experience managing individuals with complex medical needs.

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Challenges and insights in implementing coordinated care between oncology and primary care providers: a Canadian perspective

Current Oncology ◽

10.3747/co.24.3426 ◽

2017 ◽

Vol 24 (2) ◽

pp. 120 ◽

Cited By ~ 6

Author(s):

J.R. Tomasone ◽

M. Vukmirovic ◽

M.C. Brouwers ◽

E. Grunfeld ◽

R. Urquhart ◽

...

Keyword(s):

Primary Care ◽

Care Coordination ◽

Cancer Care ◽

Program Planning ◽

Primary Care Providers ◽

Models Of Care ◽

Future Research ◽

Care Providers ◽

Coordinated Care ◽

Program Support

We report here on the current state of cancer care coordination in Canada and discuss challenges and insights with respect to the implementation of collaborative models of care. We also make recommendations for future research. This work is based on the findings of the Canadian Team to Improve Community-Based Cancer Care Along the Continuum (canimpact) casebook project. The casebook project identified models of collaborative cancer care by systematically documenting and analyzing Canadian initiatives that aim to improve or enhance care coordination between primary care providers and oncology specialists. The casebook profiles 24 initiatives, most of which focus on breast or colorectal cancer and target survivorship or follow-up care.Current key challenges in cancer care coordination are associated with establishing program support, engaging primary care providers in the provision of care, clearly defining provider roles and responsibilities, and establishing effective project or program planning and evaluation. Researchers studying coordinated models of cancer care should focus on designing knowledge translation strategies with updated and refined governance and on establishing appropriate protocols for both implementation and evaluation.

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Pandemic response in pluralistic health systems: a cross-sectional study of COVID-19 knowledge and practices among informal and formal primary care providers in Bihar, India

BMJ Open ◽

10.1136/bmjopen-2020-047334 ◽

2021 ◽

Vol 11 (4) ◽

pp. e047334

Author(s):

Krishna D Rao ◽

Japneet Kaur ◽

Michael A Peters ◽

Navneet Kumar ◽

Priya Nanda

Keyword(s):

Primary Care ◽

Health Systems ◽

Management Practices ◽

Primary Care Providers ◽

Cross Sectional Study ◽

Contact Tracing ◽

Care Seeking ◽

Care Providers ◽

Sectional Study ◽

Cross Sectional

ObjectivesResponding to pandemics is challenging in pluralistic health systems. This study assesses COVID-19 knowledge and case management of informal providers (IPs), trained practitioners of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) and Bachelor of Medicine, Bachelor of Surgery (MBBS) medical doctors providing primary care services in rural Bihar, India.DesignThis was a cross-sectional study of primary care providers conducted via telephone between 1 and 15 July 2020.SettingPrimary care providers from 224 villages in 34 districts across Bihar, India.Participants452 IPs, 57 AYUSH practitioners and 38 doctors (including 23 government doctors) were interviewed from a census of 1138 primary care providers used by community members that could be reached by telephone.Primary outcome measure(s)Providers were interviewed using a structured questionnaire with choice-based answers to gather information on (1) change in patient care seeking, (2) source of COVID-19 information, (3) knowledge on COVID-19 spread, symptoms and methods for prevention and (4) clinical management of COVID-19.ResultsDuring the early days of the COVID-19 pandemic, 72% of providers reported a decrease in patient visits. Most IPs and other private primary care providers reported receiving no COVID-19 related engagement with government or civil society agencies. For them, the principal source of COVID-19 information was television and newspapers. IPs had reasonably good knowledge of typical COVID-19 symptoms and prevention, and at levels similar to doctors. However, there was low stated compliance among IPs (16%) and qualified primary care providers (15% of MBBS doctors and 12% of AYUSH practitioners) with all WHO recommended management practices for suspect COVID-19 cases. Nearly half of IPs and other providers intended to treat COVID-19 suspects without referral.ConclusionsPoor management practices of COVID-19 suspects by rural primary care providers weakens government pandemic control efforts. Government action of providing information to IPs, as well as engaging them in contact tracing or public health messaging can strengthen pandemic control efforts.

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