A Clinical Care Algorithmic Toolkit for Promoting Screening and Next-Level Assessment of Pediatric Depression and Anxiety in Primary Care

2017 ◽  
Vol 31 (3) ◽  
pp. e15-e23 ◽  
Author(s):  
Lisa Honigfeld ◽  
Susan J. Macary ◽  
Damion J. Grasso
Keyword(s):  
Primary Care ◽  
Clinical Care ◽  
Depression And Anxiety ◽  
Pediatric Depression

scholarly journals Datasets collected in general practice: an international comparison using the example of obesity

2018 ◽  
Vol 42 (5) ◽  
pp. 563 ◽  
Author(s):  
Elizabeth Sturgiss ◽  
Kees van Boven
Keyword(s):  
Primary Care ◽  
General Practice ◽  
The Netherlands ◽  
Care Management ◽  
Clinical Care ◽  
International Comparisons ◽  
Health Condition ◽  
Practice Management ◽  
Number Of Patients ◽  
Primary Care Management

International datasets from general practice enable the comparison of how conditions are managed within consultations in different primary healthcare settings. The Australian Bettering the Evaluation and Care of Health (BEACH) and TransHIS from the Netherlands collect in-consultation general practice data that have been used extensively to inform local policy and practice. Obesity is a global health issue with different countries applying varying approaches to management. The objective of the present paper is to compare the primary care management of obesity in Australia and the Netherlands using data collected from consultations. Despite the different prevalence in obesity in the two countries, the number of patients per 1000 patient-years seen with obesity is similar. Patients in Australia with obesity are referred to allied health practitioners more often than Dutch patients. Without quality general practice data, primary care researchers will not have data about the management of conditions within consultations. We use obesity to highlight the strengths of these general practice data sources and to compare their differences. What is known about the topic? Australia had one of the longest-running consecutive datasets about general practice activity in the world, but it has recently lost government funding. The Netherlands has a longitudinal general practice dataset of information collected within consultations since 1985. What does this paper add? We discuss the benefits of general practice-collected data in two countries. Using obesity as a case example, we compare management in general practice between Australia and the Netherlands. This type of analysis should start all international collaborations of primary care management of any health condition. Having a national general practice dataset allows international comparisons of the management of conditions with primary care. Without a current, quality general practice dataset, primary care researchers will not be able to partake in these kinds of comparison studies. What are the implications for practitioners? Australian primary care researchers and clinicians will be at a disadvantage in any international collaboration if they are unable to accurately describe current general practice management. The Netherlands has developed an impressive dataset that requires within-consultation data collection. These datasets allow for person-centred, symptom-specific, longitudinal understanding of general practice management. The possibilities for the quasi-experimental questions that can be answered with such a dataset are limitless. It is only with the ability to answer clinically driven questions that are relevant to primary care that the clinical care of patients can be measured, developed and improved.

scholarly journals 146 Improving Outcomes in Aspiration Pneumonia: A Collaborative Approach

2021 ◽  
Vol 50 (Supplement_1) ◽  
pp. i12-i42
Author(s):  
S Richards-Taylor ◽  
R Kitchener ◽  
M Whiffen ◽  
D Tiwari
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Aspiration Pneumonia ◽  
Clinical Care ◽  
Collaborative Approach ◽  
Bed Elevation ◽  
Pdsa Cycle ◽  
Mouth Care ◽  
Referral Form ◽  
Expected Mortality

Abstract Introduction Aspiration pneumonia is a major cause of morbidity and mortality especially in older adults. Our Trust recorded higher than expected mortality ratios in this group of patients. Aim To investigate reasons behind higher than expected mortality and improve outcomes. Intervention We developed a collaborative approach of investigating mortality in aspiration pneumonia with joint input from Speech and Language (SALT) specialists. Method We conducted structured retrospective review of annual mortality in aspiration pneumonia in 3 PDSA (plan, do, study, and act) cycles in 2015/18/20. We collected data on clinical care, diagnostic accuracy, SALT referral/input, feeding at risk discussion, communication with primary care. We monitored mortality ratios on national systems. Results We improved clinical and nursing care by auditing mouth care, bed elevation and safe feeding. We also developed electronic-SALT referral form to improve timings for the reviews (first PDSA cycle). SALT team developed “feeding at risk proforma” to formalise risk feeding where safe swallow plan was not possible (second PDSA cycle). We modified discharge summaries and made this a multidisciplinary document in the Trust so that SALT can communicate feeding plans to primary care (third PDSA cycle). Mortality ratios improved significantly in this period from Relative risk of 152 (higher than expected range) in 14/15 to 86 (within expected range) in 19/20. Conclusion We have demonstrated significant improvement in hospital mortality ratios from aspiration pneumonia and therefore improved care by collaboratively working with SALT team and bringing changes in stepwise manner. Multidisciplinary mortality reviews are key to improving outcomes for our patients.

scholarly journals Genomic Risk Profiling: Attitudes and Use in Personal and Clinical Care of Primary Care Physicians Who Offer Risk Profiling

2011 ◽  
Vol 26 (8) ◽  
pp. 834-840 ◽  
Author(s):  
Susanne B. Haga ◽  
Madeline M. Carrig ◽  
Julianne M. O’Daniel ◽  
Lori A. Orlando ◽  
Ley A. Killeya-Jones ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Clinical Care ◽  
Risk Profiling ◽  
Genomic Risk

Efficacy of a Behavioral Activation Teletherapy Intervention to Treat Depression and Anxiety in Primary Care VitalSign6 Program

2017 ◽  
Vol 19 (5) ◽  
Author(s):  
Joseph M. Trombello ◽  
Charles South ◽  
Audrey Cecil ◽  
Katherine E. Sánchez ◽  
Alma Christina Sánchez ◽  
...  
Keyword(s):  
Primary Care ◽  
Behavioral Activation ◽  
Depression And Anxiety

scholarly journals First line drug treatment for hypertension and reductions in blood pressure according to age and ethnicity: cohort study in UK primary care

BMJ ◽  
2020 ◽  
pp. m4080
Author(s):  
Sarah-Jo Sinnott ◽  
Ian J Douglas ◽  
Liam Smeeth ◽  
Elizabeth Williamson ◽  
Laurie A Tomlinson
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Cohort Study ◽  
Systolic Blood Pressure ◽  
Black People ◽  
Angiotensin Receptor Blockers ◽  
Clinical Care ◽  
Treatment Recommendations ◽  
First Line

Abstract Objective To study whether treatment recommendations based on age and ethnicity according to United Kingdom (UK) clinical guidelines for hypertension translate to blood pressure reductions in current routine clinical care. Design Observational cohort study. Setting UK primary care, from 1 January 2007 to 31 December 2017. Participants New users of angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), calcium channel blockers (CCB), and thiazides. Main outcome measures Change in systolic blood pressure in new users of ACEI/ARB versus CCB, stratified by age (< v ≥55) and ethnicity (black v non-black), from baseline to 12, 26, and 52 week follow-up. Secondary analyses included comparisons of new users of CCB with those of thiazides. A negative outcome (herpes zoster) was used to detect residual confounding and a series of positive outcomes (expected drug effects) was used to determine whether the study design could identify expected associations. Results During one year of follow-up, 87 440 new users of ACEI/ARB, 67 274 new users of CCB, and 22 040 new users of thiazides were included (median 4 (interquartile range 2-6) blood pressure measurements per user). For non-black people who did not have diabetes and who were younger than 55, CCB use was associated with a larger reduction in systolic blood pressure of 1.69 mm Hg (99% confidence interval −2.52 to −0.86) relative to ACEI/ARB use at 12 weeks, and a reduction of 0.40 mm Hg (−0.98 to 0.18) in those aged 55 and older. In subgroup analyses using six finer age categories of non-black people who did not have diabetes, CCB use versus ACEI/ARB use was associated with a larger reduction in systolic blood pressure only in people aged 75 and older. Among people who did not have diabetes, systolic blood pressure decreased more with CCB use than with ACEI/ARB use in black people (reduction difference 2.15 mm Hg (−6.17 to 1.87)); the corresponding reduction difference was 0.98 mm Hg (−1.49 to −0.47) in non-black people. Conclusions Similar reductions in blood pressure were found to be associated with new use of CCB as with new use of ACEI/ARB in non-black people who did not have diabetes, both in those who were aged younger than 55 and those aged 55 and older. For black people without diabetes, CCB new use was associated with numerically greater reductions in blood pressure than ACEI/ARB compared with non-black people without diabetes, but the confidence intervals were overlapping for the two groups. These results suggest that the current UK algorithmic approach to first line antihypertensive treatment might not lead to greater reductions in blood pressure. Specific indications could be considered in treatment recommendations.

scholarly journals The Practical Approach to Care Kit (PACK) training programme: scaling up and sustaining support for health workers to improve primary care

2018 ◽  
Vol 3 (Suppl 5) ◽  
pp. e001124 ◽  
Author(s):  
Makhosazana Lungile Simelane ◽  
Daniella Georgeu-Pepper ◽  
Christy-Joy Ras ◽  
Lauren Anderson ◽  
Michelle Pascoe ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Low Income ◽  
User Satisfaction ◽  
Health Workers ◽  
Clinical Care ◽  
Practical Approach ◽  
Educational Outreach ◽  
Care Programme ◽  
Training Strategy

There is an urgent need to depart from in-service training that relies on distance and/or intensive off-site training leading to limited staff coverage at clinical sites. This traditional approach fails to meet the challenge of improving clinical practice, especially in low-income and middle-income countries where resources are limited and disease burden high. South Africa’s University of Cape Town Lung Institute Knowledge Translation Unit has developed a facility-based training strategy for implementation of its Practical Approach to Care Kit (PACK) primary care programme. The training has been taken to scale in primary care facilities throughout South Africa and has shown improvements in quality of care indicators and health outcomes along with end-user satisfaction. PACK training uses a unique approach to address the needs of frontline health workers and the health system by embedding a health intervention into everyday clinical practice at facility level. This paper describes the features of the PACK training strategy: PACK training is scaled up using a cascade model of training using educational outreach to deliver PACK to clinical teams in their health facilities in short, regular sessions. Drawing on adult education principles, PACK training empowers clinicians by using experiential and interactive learning methodologies to draw on existing clinical knowledge and experience. Learning is alternated with practice to improve the likelihood of embedding the programme into everyday clinical care delivery.

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