OP08 Using Real World Data To Support National Postmarketing Surveillance

2018 ◽  
Vol 34 (S1) ◽  
pp. 3-3
Author(s):  
Yeqin Zuo ◽  
Bernie Mullen ◽  
Rachel Hayhurst ◽  
Karen Kaye ◽  
Renee Granger ◽  
...  
Keyword(s):  
Primary Care ◽  
Real World ◽  
National Level ◽  
Clinical Information ◽  
Health Priorities ◽  
Care Practice ◽  
Postmarketing Surveillance ◽  
Care Practices ◽  
Primary Care Practices ◽  
Tract Infections

Introduction:While medicines and medical tests are developed in a controlled clinical trial environment, postmarketing surveillance in the real world can be challenging. MedicineInsight—a database of longitudinal patient-level clinical information from primary care practices in Australia—is a novel program that collects primary care data to improve postmarketing surveillance at a national level.Methods:MedicineInsight collects de-identified clinical information from primary care practice information systems using data extraction tools. MedicineInsight currently includes 3.6 million regular patients of 3,300 family physicians (general practitioners) from 650 primary care practices across Australia. MedicineInsight data include longitudinal clinical information on diagnosis and medicines (dose, strength, route of administration, medication switches over time, adverse events, and allergies), and pathology testing data. A series of observational studies was developed for postmarketing surveillance of management of a range of health priorities including type 2 diabetes mellitus (T2DM), chronic obstructive pulmonary disease (COPD), depression, and antibiotics use.Results:Forty-four percent of patients with T2DM in the MedicineInsight database did not have a recorded hemoglobin A1c result and thirty-one percent did not have a recorded blood pressure reading in the previous 6 months. While guidelines recommend a stepwise approach to the initiation of COPD therapy, forty-nine percent of patients with COPD (with or without asthma) were prescribed dual therapy at initiation and a small number (4.5 percent) were prescribed triple therapy. Between 2011 and 2015, the annual rate of antidepressant prescribing per 1,000 family physician encounters increased by eight percent. High volumes of antibiotics were prescribed for respiratory tract infections in Australian primary care, notwithstanding guideline recommendations that antibiotics are not recommended in most cases.Conclusions:Large scale, real-world clinical data from primary care practices can play an important role in postmarketing surveillance at a national level.

scholarly journals Do statins reduce mortality in older people? Findings from a longitudinal study using primary care records

2021 ◽  
Vol 9 (2) ◽  
pp. e000780
Author(s):  
Lisanne Andra Gitsels ◽  
Ilyas Bakbergenuly ◽  
Nicholas Steel ◽  
Elena Kulinskaya
Keyword(s):  
Primary Care ◽  
Older People ◽  
Clinical Information ◽  
Cardiac Risk ◽  
Health Improvement ◽  
Network Database ◽  
Statin Prescription ◽  
The Health Improvement Network ◽  
Care Practices ◽  
Primary Care Practices

ObjectiveAssess whether statins reduce mortality in the general population aged 60 years and above.DesignRetrospective cohort study.SettingPrimary care practices contributing to The Health Improvement Network database, England and Wales, 1990–2017.ParticipantsCohort who turned age 60 between 1990 and 2000 with no previous cardiovascular disease or statin prescription and followed up until 2017.ResultsCurrent statin prescription was associated with a significant reduction in all-cause mortality from age 65 years onward, with greater reductions seen at older ages. The adjusted HRs of mortality associated with statin prescription at ages 65, 70, 75, 80 and 85 years were 0.76 (95% CI 0.71 to 0.81), 0.71 (95% CI 0.68 to 0.75), 0.68 (95% CI 0.65 to 0.72), 0.63 (95% CI 0.53 to 0.73) and 0.54 (95% CI 0.33 to 0.92), respectively. The adjusted HRs did not vary by sex or cardiac risk.ConclusionsUsing regularly updated clinical information on sequential treatment decisions in older people, mortality predictions were updated every 6 months until age 85 years in a combined primary and secondary prevention population. The consistent mortality reduction of statins from age 65 years onward supports their use where clinically indicated at age 75 and older, where there has been particular uncertainty of the benefits.

scholarly journals The Evolving Role of Medical Assistants in Primary Care Practice: Divergent and Concordant Perspectives from MAs and Family Physicians

2020 ◽  
pp. 107755872096614
Author(s):  
Erin P. Fraher ◽  
Allison Cummings ◽  
Dana Neutze
Keyword(s):  
Primary Care ◽  
Patient Education ◽  
Population Health ◽  
Low Cost ◽  
Family Physicians ◽  
Direct Patient Care ◽  
Care Practice ◽  
Medical Assistants ◽  
Care Practices ◽  
Primary Care Practices

Medical assistants (MAs) are a flexible and low-cost resource for primary care practices and their roles are swiftly transforming. We surveyed MAs and family physicians in primary care practices in North Carolina to assess concordance in their perspectives about MA roles, training, and confidence in performing activities related to visit planning; direct patient care; documentation; patient education, coaching or counseling; quality improvement; population health and communication. For most activities, we did not find evidence of role confusion between MAs and physicians, physician resistance to delegate tasks to properly trained MAs, or MA reluctance to pursue training to take on new roles. Three areas emerged where the gap between the potential and actual implementation of MA role transformation could be narrowed—population health and panel management; patient education, coaching, and counseling; and scribing. Closing these gaps will become increasingly important as our health care system moves toward value-based models of care.

scholarly journals Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting

2016 ◽  
Vol 18 (01) ◽  
pp. 3-13 ◽  
Author(s):  
Bonnie M. Vest ◽  
Victoria M. Hall ◽  
Linda S. Kahn ◽  
Arvela R. Heider ◽  
Nancy Maloney ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Real World ◽  
Hospital Admissions ◽  
Lessons Learned ◽  
Diabetic Patients ◽  
Structured Interviews ◽  
Economic Context ◽  
Care Practices ◽  
Primary Care Practices

Aims The purpose of this qualitative evaluation was to explore the experience of implementing routine telemonitoring (TM) in real-world primary care settings from the perspective of those delivering the intervention; namely the TM staff, and report on lessons learned that could inform future projects of this type. Background Routine TM for high-risk patients within primary care practices may help improve chronic disease control and reduce complications, including unnecessary hospital admissions. However, little is known about how to integrate routine TM in busy primary care practices. A TM pilot for diabetic patients was attempted in six primary care practices as part of the Beacon Community in Western New York. Methods Semi-structured interviews were conducted with representatives of three TM agencies (n=8) participating in the pilot. Interviews were conducted over the phone or in person and lasted ~30 min. Interviews were audio-taped and transcribed. Analysis was conducted using immersion-crystallization to identify themes. Findings TM staff revealed several themes related to the experience of delivering TM in real-world primary care: (1) the nurse–patient relationship is central to a successful TM experience, (2) TM is a useful tool for understanding socio-economic context and its impact on patients’ health, (3) TM staff anecdotally report important potential impacts on patient health, and (4) integrating TM into primary care practices needs to be planned carefully. Conclusions This qualitative study identified challenges and unexpected benefits that might inform future efforts. Communication and integration between the TM agency and the practice, including the designation of a point person within the office to coordinate TM and help address the broader contextual needs of patients, are important considerations for future implementation. The role of the TM nurse in developing trust with patients and uncovering the social and economic context within which patients manage their diabetes was an unexpected benefit.

scholarly journals What is the carbon footprint of primary care practices? A retrospective life-cycle analysis in Switzerland

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
John Nicolet ◽  
Yolanda Mueller ◽  
Paola Paruta ◽  
Julien Boucher ◽  
Nicolas Senn
Keyword(s):  
Primary Care ◽  
Life Cycle ◽  
Carbon Footprint ◽  
Carbon Emissions ◽  
Life Cycle Analysis ◽  
Care Practice ◽  
Worst Case ◽  
Patient Transport ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background The medical field causes significant environmental impact. Reduction of the primary care practice carbon footprint could contribute to decreasing global carbon emissions. This study aims to quantify the average carbon footprint of a primary care consultation, describe differences between primary care practices (best, worst and average performing) in western Switzerland and identify opportunities for mitigation. Methods We conducted a retrospective carbon footprint analysis of ten private practices over the year 2018. We used life-cycle analysis to estimate carbon emissions of each sector, from manufacture to disposal, expressing results as CO2 equivalents per average consultation and practice. We then modelled an average and theoretical best- case and worst-case practices. Collected data included invoices, medical and furniture inventories, heating and power supply, staff and patient transport, laboratory analyses (in/out-house) waste quantities and management costs. Results An average medical consultation generated 4.8 kg of CO2eq and overall, an average practice produced 30 tons of CO2eq per year, with 45.7% for staff and patient transport and 29.8% for heating. Medical consumables produced 5.5% of CO2eq emissions, while in-house laboratory and X-rays contributed less than 1% each. Emergency analyses requiring courier transport caused 5.8% of all emissions. Support activities generated 82.6% of the total CO2eq. Simulation of best- and worst-case scenarios resulted in a ten-fold variation in CO2eq emissions. Conclusion Optimizing structural and organisational aspects of practice work could have a major impact on the carbon footprint of primary care practices without large-scale changes in medical activities.

scholarly journals A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Briana S. Last ◽  
Alison M. Buttenheim ◽  
Anne C. Futterer ◽  
Cecilia Livesey ◽  
Jeffrey Jaeger ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Depression Screening ◽  
Care Practice ◽  
Participatory Methods ◽  
Patient Support ◽  
Medical Assistants ◽  
Care Practices ◽  
Primary Care Practices ◽  
Innovation Tournament

Abstract Background Most individuals with depression go unidentified and untreated. In 2016 the US Preventive Services Task Force released guidelines recommending universal screening in primary care to identify patients with depression and to link them to treatment. Feasible, acceptable, and effective strategies to implement these guidelines are needed. Methods This three-phased study employed rapid participatory methods to design and test strategies to increase depression screening at Penn Medicine, a large health system with 90 primary care practices. First, researchers solicited ideas and barriers from stakeholders to increase screening using an innovation tournament—a crowdsourcing method that invites stakeholders to submit ideas to address a workplace challenge. Second, a panel of stakeholders and scientists deliberated over and ranked the tournament ideas. An instant runoff election was held to select the winning idea. Third, the research team piloted the winning idea in a primary care practice using rapid prototyping, an approach that quickly refines and iterates strategy designs. Results The innovation tournament yielded 31 ideas and 32 barriers from diverse stakeholders (12 primary care physicians, 10 medical assistants, 4 nurse practitioners, 2 practice managers, and 4 patient support assistants). A panel of 6 stakeholders and scientists deliberated on the ideas and voted for patient self-report (i.e., through tablet computers, text message, or an online patient portal) as the winning idea. The research team rapid prototyped tablets in one primary care practice with one physician over 5 five-hour shifts to examine the feasibility, acceptability, and effectiveness of the strategy. Most patients, the physician, and medical assistants found the tablets acceptable and feasible. However, patient support assistants struggled to incorporate them in their workflow and expressed concerns about scaling up the process. Depression screening rates were higher using tablets compared to usual care; follow-up was comparable between tablets and usual care. Conclusions Rapid participatory methods engaged and amplified the voices of diverse stakeholders in primary care. These methods helped design an acceptable and feasible implementation strategy that showed promise for increasing depression screening in a primary care setting. The next step is to evaluate the strategy in a randomized controlled trial across primary care practices.

Collaborative Care in Primary Care: The Influence of Practice Interior Architecture on Informal Face-to-Face Communication—An Observational Study

2020 ◽  
pp. 193758672093966
Author(s):  
Sonya Morgan ◽  
Susan Pullon ◽  
Eileen McKinlay ◽  
Susan Garrett ◽  
Jonathan Kennedy ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Care Staff ◽  
Care Practice ◽  
Interior Architecture ◽  
Face To Face ◽  
Shared Spaces ◽  
Care Practices ◽  
Primary Care Practices ◽  
Primary Care Staff

Background: Quality patient care in primary care settings, especially for patients with complex long-term health needs, is improved by interprofessional collaborative practice. Effective collaboration is achieved in large part by frequent informal face-to-face “on-the-fly” communication between team members. Research undertaken in hospitals shows that interior architecture influences informal communication and collaboration between staff. However, little is known about how the interior architecture of primary care practices might facilitate or hinder informal communication and collaboration among primary care staff. Objectives: This research explores the influence of primary care practice interior architecture on face-to-face on-the-fly communication for collaborative care. Methods: An observational study was undertaken to compare face-to-face informal interactions between staff in three primary care practices of differing interior architecture. Data collected from practices included: direct observations floor plans, photographs, interviews, and surveys. Results: Most primary care staff engaged in frequent, brief face-to-face interactions, which appeared to be key to the delivery of effective collaboration. Features of primary care practice designs that were associated with increased frequency of staff interaction included shared spaces, staff proximity/visibility, and the presence of convenient circulatory and transitional spaces where staff were able to easily engage in timely on-the-fly communication with colleagues. Conclusions: The interior architecture of primary care practices has an important impact on staff collaboration. Although more research is needed to investigate further details in more practices, close attention should nevertheless be paid to maximizing opportunities for brief face-to-face communication in well-designed shared spaces in primary care practices.

scholarly journals A Pilot Study of Participatory and Rapid Implementation Approaches to Increase Depression Screening in Primary Care

2021 ◽  
Author(s):  
Briana S. Last ◽  
Alison M. Buttenheim ◽  
Anne C. Futterer ◽  
Cecilia Livesey ◽  
Jeffrey Jaeger ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Depression Screening ◽  
Care Practice ◽  
Participatory Methods ◽  
Patient Support ◽  
Medical Assistants ◽  
Care Practices ◽  
Primary Care Practices ◽  
Innovation Tournament

Abstract Background: Most individuals with depression go unidentified and untreated. In 2016 the US Preventive Services Task Force released guidelines recommending universal screening in primary care to identify patients with depression and to link them to treatment. Feasible, acceptable, and effective strategies to implement these guidelines are needed. Methods: This three-phased study employed rapid participatory methods to design and test strategies to increase depression screening at Penn Medicine, a large health system with 90 primary care practices. First, researchers solicited ideas and barriers from stakeholders to increase screening using an innovation tournament—a crowdsourcing method that invites stakeholders to submit ideas to address a workplace challenge. Second, a panel of stakeholders and scientists deliberated over and ranked the tournament ideas. An instant runoff election was held to select the winning idea. Third, the research team piloted the winning idea in a primary care practice using rapid prototyping, an approach that quickly refines and iterates strategy designs. Results: The innovation tournament yielded 31 ideas and 32 barriers from diverse stakeholders (12 primary care physicians, 10 medical assistants, 4 nurse practitioners, 2 practice managers, and 4 patient support assistants). A panel of 6 stakeholders and scientists deliberated on the ideas and voted for patient self-report (i.e., through tablet computers, text message, or an online patient portal) as the winning idea. The research team rapid prototyped tablets in one primary care practice with one physician over 5 five-hour shifts to examine the feasibility, acceptability, and effectiveness of the strategy. Most patients, the physician, and medical assistants found the tablets acceptable and feasible. However, patient support assistants struggled to incorporate them in their workflow and expressed concerns about scaling up the process. Depression screening rates were higher using tablets compared to usual care; follow-up was comparable between tablets and usual care. Conclusions: Rapid participatory methods engaged and amplified the voices of diverse stakeholders in primary care. These methods helped design an acceptable and feasible implementation strategy that showed promise for increasing depression screening in a primary care setting. The next step is to evaluate the strategy in a randomized controlled trial across primary care practices.

scholarly journals Pharmacists as Personalized Medicine Experts (PRIME): Experiences Implementing Pharmacist-Led Pharmacogenomic Testing in Primary Care Practices

Pharmacy ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. 201
Author(s):  
Miles J. Luke ◽  
Nina Krupetsky ◽  
Helen Liu ◽  
Clara Korenvain ◽  
Natalie Crown ◽  
...  
Keyword(s):  
Primary Care ◽  
Personalized Medicine ◽  
Behavioural Change ◽  
Theoretical Domains Framework ◽  
Structured Interview ◽  
Care Practice ◽  
Community Pharmacies ◽  
Internal Factors ◽  
Care Practices ◽  
Primary Care Practices

Research exploring the integration of pharmacogenomics (PGx) testing by pharmacists into their primary care practices (including community pharmacies) has focused on the “external” factors that impact practice implementation. In this study, additional “internal” factors, related to the capabilities, opportunities, and motivations of pharmacists that influence their ability to implement PGx testing, were analyzed. Semi-structured interview data from the Pharmacists as Personalized Medicine Experts (PRIME) study, which examined the barriers and facilitators to implementing PGx testing by pharmacists into primary care practice, were analyzed. Through thematic analysis, using the theoretical domains framework (TDF) domains as deductive codes, the authors identified the most relevant TDF domains and applied the behavioural change wheel (BCW) to generate intervention types to aid in the implementation of PGx testing. Pharmacists described how their professional identities, practice environments, self-confidence, and beliefs in the benefits of PGx impacted their ability to provide a PGx-testing service. Potential interventions to improve the implementation of the PGx service included preparing pharmacists for managing an increased patient load, helping pharmacists navigate the software and technology requirements associated with the PGx service, and streamlining workflows and documentation requirements. As interest in the wide-scale implementation of PGx testing through community pharmacies grows, additional strategies need to address the “internal” factors that influence the ability of pharmacists to integrate testing into their practices.

scholarly journals Building managed primary care practice networks to deliver better clinical care: a qualitative semi-structured interview study

2017 ◽  
Vol 67 (664) ◽  
pp. e764-e774 ◽  
Author(s):  
Jasmine Pawa ◽  
John Robson ◽  
Sally Hull
Keyword(s):  
Primary Care ◽  
Clinical Care ◽  
Structured Interview ◽  
Care Practice ◽  
Structured Interviews ◽  
London Borough ◽  
Practice Performance ◽  
Care Practices ◽  
Primary Care Practices

BackgroundPrimary care practices are increasingly working in larger groups. In 2009, all 36 primary care practices in the London borough of Tower Hamlets were grouped geographically into eight managed practice networks to improve the quality of care they delivered. Quantitative evaluation has shown improved clinical outcomes.AimTo provide insight into the process of network implementation, including the aims, facilitating factors, and barriers, from both the clinical and managerial perspectives.Design and settingA qualitative study of network implementation in the London borough of Tower Hamlets, which serves a socially disadvantaged and ethnically diverse population.MethodNineteen semi-structured interviews were carried out with doctors, nurses, and managers, and were informed by existing literature on integrated care and GP networks. Interviews were recorded and transcribed, and thematic analysis used to analyse emerging themes.ResultsInterviewees agreed that networks improved clinical care and reduced variation in practice performance. Network implementation was facilitated by the balance struck between ‘a given structure’ and network autonomy to adopt local solutions. Improved use of data, including patient recall and peer performance indicators, were viewed as critical key factors. Targeted investment provided the necessary resources to achieve this. Barriers to implementing networks included differences in practice culture, a reluctance to share data, and increased workload.ConclusionCommissioners and providers were positive about the implementation of GP networks as a way to improve the quality of clinical care in Tower Hamlets. The issues that arose may be of relevance to other areas implementing similar quality improvement programmes at scale.

scholarly journals Utilizing the Learning Health System Adaptation to guide Family Medicine Practice to COVID-19 response

2020 ◽  
Vol 11 ◽  
pp. 215013272096640
Author(s):  
Niharika Khanna ◽  
Elena N. Klyushnenkova ◽  
Alexander Kaysin ◽  
David L. Stewart
Keyword(s):  
Primary Care ◽  
Health System ◽  
Primary Care Practice ◽  
Care Practice ◽  
Learning Health System ◽  
System Adaptation ◽  
Care Practices ◽  
Effectiveness And Efficiency ◽  
Current Guidance ◽  
Primary Care Practices

COVID-19 supportive quarantine care in the community is managed by primary care practices. There is no current guidance on how a primary care practice with high volumes of patients screened for COVID-19 can re-configure itself to become responsive to the pandemic. We examined Learning Health System guidance from the National Academies of Science, Engineering and Medicine and adapted it to our primary care practice to create an efficient, effective, adaptive response to the COVID-19 pandemic. We suggest evaluating this response in the future for effectiveness and efficiency.

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