scholarly journals 413 - Delivering tailored, holistic support to people living with dementia and their families: a new primary care intervention

2021 ◽  
Vol 33 (S1) ◽  
pp. 37-37
Author(s):  
Greta Brunskill ◽  
Claire Bamford ◽  
Jane Wilcock ◽  
Alison Wheatley ◽  
Louise Robinson
Keyword(s):  
Primary Care ◽  
Best Practice ◽  
Public Involvement ◽  
Relevant Literature ◽  
Dementia Care ◽  
Long Term Conditions ◽  
England And Wales ◽  
Care Community ◽  
Care And Support ◽  
Diagnostic Support

Background:Currently, post-diagnostic dementia care and support in England and Wales is highly variable, and often insufficient in meeting the needs of people living with dementia and their families.Objective:To develop and deliver a new primary care based intervention to enable people living with dementia and their carers to live as well as possible from the point of diagnosis to end of life.Method:We conducted a survey and interviews with managers and commissioners of dementia services, and in-depth qualitative studies of six different existing service models to understand current post-diagnostic support in England and Wales. We also reviewed relevant literature on the management of long-term conditions and models of post-diagnostic support. Using the findings, a new intervention has been produced through a co-development process involving stakeholder task groups, our patient and public involvement group (the Dementia Care Community), and the multidisciplinary programme management board.Results:Our findings highlighted key priorities from the perspective of people living with dementia, their carers, and professionals which focus on the need for personalised, proactive and holistic care. We also identified a number of challenges in the provision of good quality post-diagnostic support, and examples of how these could be overcome to deliver best practice. Importantly, we found that no one service model delivered all aspects of post-diagnostic dementia support well.The new intervention will focus on three main areas: developing systems for delivering evidence-based support; delivering tailored care and support; and building capacity and capability. A clinical dementia expert, a specialist nurse or similar professional with dementia expertise, will be based in primary care to lead and facilitate change across these three interlinked areas to develop systems and services that meet the needs of all older people living with dementia.Conclusion:Our new intervention will now be tested in practice in a feasibility and implementation study.

scholarly journals Is multidisciplinary teamwork the key? A qualitative study of the development of respiratory services in the UK

2009 ◽  
Vol 102 (9) ◽  
pp. 378-390 ◽  
Author(s):  
Hilary Pinnock ◽  
Guro Huby ◽  
Alison Tierney ◽  
Sonya Hamilton ◽  
Alison Powell ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Educational Needs ◽  
Service Development ◽  
Multidisciplinary Teams ◽  
Successful Implementation ◽  
Clinical Services ◽  
Long Term Conditions ◽  
England And Wales

Summary Objectives Using frameworks, such as the long-term conditions pyramid of healthcare, primary care organizations (PCOs) in England and Wales are exploring ways of developing services for people with long-term respiratory disease. We aimed to explore the current and planned respiratory services and the roles of people responsible for change. Setting A purposive sample of 30 PCOs in England and Wales. Design Semi-structured telephone interviews with the person responsible for driving the reconfiguration of respiratory services. Recorded interviews were transcribed and coded, and themes identified. The association of the composition of the team driving change with the breadth of services provided was explored using a matrix. Results All but two of the PCOs described clinical services developed to address the needs of people with respiratory conditions, usually with a focus on preventing admissions for chronic obstructive pulmonary disease (COPD). Although the majority identified the need to develop a strategic approach to service development and to meet educational needs of primary care professionals, relatively few described clearly developed plans for addressing these issues. Involvement of clinicians from both primary and secondary care was associated with a broad multifaceted approach to service development. Teamwork was often challenging, but could prove rewarding for participants and could result in a fruitful alignment of objectives. The imminent merger of PCOs and overriding financial constraints resulted in a ‘fluid’ context which challenged successful implementation of plans. Conclusions While the majority of PCOs are developing clinical services for people with complex needs (principally in order to reduce admissions), relatively few are addressing the broader strategic issues and providing for local educational needs. The presence of multidisciplinary teams, which integrated primary and secondary care clinicians with PCO management, was associated with more comprehensive service provision addressing the needs of all respiratory patients. Future research needs to provide insight into the structures, processes and inter-professional relationships that facilitate development of clinical, educational and policy initiatives which aim to enhance local delivery of respiratory care.

Hospital cost differences and payment by results

2007 ◽  
Vol 2 (4) ◽  
pp. 429-433 ◽  
Author(s):  
JAMES M. MALCOMSON
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Average Cost ◽  
Best Practice ◽  
Community Services ◽  
Total Expenditure ◽  
Long Term Conditions ◽  
Care Requirements ◽  
Cost Differences

Street and Maynard (2007) argue the case for refining the system of payment by results currently being introduced for English hospitals. On the basis of international experience, they recommend, among other things, moving away from setting prices equal to average cost towards setting them equal to best practice costs, adjusting them for quality and using them to signal what activities are desirable. They also discuss how to control total expenditure for primary care trusts (PCTs) under payment by results and question the merits of extending payment by results to mental health services, ambulances, community services, and long-term conditions, ‘where it is difficult to describe patient care requirements and cost variations may be high’ (p. 9).

scholarly journals Barriers and facilitators to implementation of shared medical appointments in primary care for the management of long-term conditions: a systematic review and synthesis of qualitative studies

BMJ Open ◽  
2021 ◽  
Vol 11 (8) ◽  
pp. e046842
Author(s):  
Fiona Graham ◽  
Mei Yee Tang ◽  
Katherine Jackson ◽  
Helen Martin ◽  
Amy O'Donnell ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Best Practice ◽  
Medical Condition ◽  
Patient Characteristics ◽  
Qualitative Studies ◽  
Long Term Conditions ◽  
Shared Medical Appointments ◽  
Critical Appraisal Skills

ObjectiveTo synthesise the published literature on practitioner, patient and carer views and experiences of shared medical appointments (SMAs) for the management of long-term conditions in primary care.DesignSystematic review of qualitative primary studies.MethodsA systematic search was conducted using MEDLINE (Ovid), PsycINFO (Ovid), CINAHL (EBSCOhost), Web of Science, Social Science Premium Collection (Proquest) and Scopus (SciVerse) from database starting dates to June 2019. Practitioner, patient and carer perspectives were coded separately. Deductive coding using a framework approach was followed by thematic analysis and narrative synthesis. Quality assessment was conducted using the Critical Appraisal Skills Programme for qualitative studies.ResultsWe identified 18 unique studies that reported practitioner (n=11), patient (n=14) and/or carer perspectivs(n=3). Practitioners reported benefits of SMAs including scope for comprehensive patient-led care, peer support, less repetition and improved efficiency compared with 1:1 care. Barriers included administrative challenges and resistance from patients and colleagues, largely due to uncertainties and unclear expectations. Skilled facilitators, tailoring of SMAs to patient groups, leadership support and teamwork were reported to be important for successful delivery. Patients’ reported experiences were largely positive with the SMAs considered a supportive environment in which to share and learn about self-care, though the need for good facilitation was recognised. Reports of carer experience were limited but included improved communication between carer and patient.ConclusionThere is insufficient evidence to indicate whether views and experiences vary between staff, medical condition and/or patient characteristics. Participant experiences may be subject to reporting bias. Policies and guidance regarding best practice need to be developed with consideration given to resource requirements. Further research is needed to capture views about wider and co-occurring conditions, to hear from those without SMA experience and to understand which groups of patients and practitioners should be brought together in an SMA for best effect.PROSPERO registration numberCRD42019141893.

scholarly journals Integrating Healthcare Education for Best Practice – A Question of which Health Professionals Between Paediatric and adult Chronic Kidney Disease (CKD) Patients – Topic Tagging and what is ‘Deemed’ Clinically Relevant Context – A Qualitative Perspective

2021 ◽  
pp. 1-17
Author(s):  
Muhammad SN ◽  
◽  
Orzechowska K ◽  
Gardener J ◽  
Gardner V ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Support Groups ◽  
Health Professionals ◽  
Best Practice ◽  
Qualitative Data ◽  
Public Involvement ◽  
Patient And Public Involvement ◽  
Long Term Conditions ◽  
Educational Gaps

Education and information seeking is pinnacle for patients with Long-Term Conditions (LTCs) like Chronic Kidney Disease (CKD) to take ownership of health and disease and navigate healthcare between health sectors. Patient and Public Involvement (PPI) are key to help understand gaps in health education. Aims/ Objectives: 1) Involving patients between two support groups to help understand which topics and subjects are pertinent to CKD patients; 2) Involving patients to understand whether, retrospectively there has been an educational neglect in healthcare; and 3) To understand how healthcare and education for CKD patients could be more integrated. Methods: Two PPI workshops were implemented (May and June 2019) after reviewing NIHR INVOLVE best practice guidelines. Fourteen (14) topic tags were applied over 1-month (March and April 2020) between the Renal Patient Support Group (RPSG) (est.2009) and the Kidney Disease and Renal Support (KDARs) (est.2014) for Kids platforms. Ethics: Group disclaimers encouraged informed consent. GDPR (2018) guidelines were implemented to ensure best practice surrounding confidentiality and data protection. Results: Thematic Analysis was used to highlight findings, according to over-arching themes having used Nvivo-12 software to code and help understand where there are healthcare educational inefficiencies. Five themes were identified through this study including 1) Using Different Mediums to Collect Qualitative Data and Understanding Healthcare; 2) Reliability and Validity of using the Internet to Collect Data; 3) Healthcare, Patient and Public Involvement and Maintaining Confidentiality through Online Methods to collect Qualitative Data; 4) Advantages, Disadvantages and Limitations to Online Data Collection and Peer Support Groups and 5) Using Qualitative Methodology to Understand Educational Needs for CKD Patients. Discussion: Wider Allied Health Professionals (AHPs) could increasingly find themselves taking on roles, particularly where involvement is increasingly dependent bridging educational gaps and ‘alleviating misinformation’ through technology and ‘online spaces’. Conclusion: This is the first UK retrospective study that examines educational gaps between online paediatric and adult CKD patients close to two decades (16 years), and highlights where further PPI-focused research would help understand where healthcare requires investment

Medical Education’s Role in Primary Care/Community Health: A Model from Kumasi, Ghana

1986 ◽  
Vol 2 (5) ◽  
pp. 273-277 ◽  
Author(s):  
G. Smilkstein ◽  
H.A. Addy ◽  
E.A. Gyebi-Ofosu ◽  
E.H.O. Parry
Keyword(s):  
Primary Care ◽  
Community Health ◽  
Care Community

scholarly journals Household medication safety practices during the COVID-19 pandemic: a descriptive qualitative study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e044441
Author(s):  
Tamasine C Grimes ◽  
Sara Garfield ◽  
Dervla Kelly ◽  
Joan Cahill ◽  
Sam Cromie ◽  
...  
Keyword(s):  
Social Media ◽  
Qualitative Study ◽  
Medication Safety ◽  
Best Practice ◽  
Public Involvement ◽  
Comparative Method ◽  
Patient And Public Involvement ◽  
Safety Practices ◽  
Trinity College Dublin ◽  
Descriptive Qualitative

IntroductionThose who are staying at home and reducing contact with other people during the COVID-19 pandemic are likely to be at greater risk of medication-related problems than the general population. This study aims to explore household medication practices by and for this population, identify practices that benefit or jeopardise medication safety and develop best practice guidance about household medication safety practices during a pandemic, grounded in individual experiences.Methods and analysisThis is a descriptive qualitative study using semistructured interviews, by telephone or video call. People who have been advised to ‘cocoon’/‘shield’ and/or are aged 70 years or over and using at least one long-term medication, or their caregivers, will be eligible for inclusion. We will recruit 100 patient/carer participants: 50 from the UK and 50 from Ireland. Recruitment will be supported by our patient and public involvement (PPI) partners, personal networks and social media. Individual participant consent will be sought, and interviews audio/video recorded and/or detailed notes made. A constructivist interpretivist approach to data analysis will involve use of the constant comparative method to organise the data, along with inductive analysis. From this, we will iteratively develop best practice guidance about household medication safety practices during a pandemic from the patient’s/carer’s perspective.Ethics and disseminationThis study has Trinity College Dublin, University of Limerick and University College London ethics approvals. We plan to disseminate our findings via presentations at relevant patient/public, professional, academic and scientific meetings, and for publication in peer-reviewed journals. We will create a list of helpful strategies that participants have reported and share this with participants, PPI partners and on social media.

scholarly journals Conversations about FGM in primary care: a realist review on how, why and under what circumstances FGM is discussed in general practice consultations

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e039809
Author(s):  
Sharon Dixon ◽  
Claire Duddy ◽  
Gabrielle Harrison ◽  
Chrysanthi Papoutsi ◽  
Sue Ziebland ◽  
...  
Keyword(s):  
Primary Care ◽  
Grey Literature ◽  
Relevant Literature ◽  
Theory Development ◽  
Realist Review ◽  
Primary Outcome Measure ◽  
Mandatory Reporting ◽  
Programme Theory ◽  
Genital Mutilation ◽  
The Impact

ObjectivesLittle is known about the management of female genital mutilation (FGM) in primary care. There have been significant recent statutory changes relevant to general practitioners (GPs) in England, including a mandatory reporting duty. We undertook a realist synthesis to explore what influences how and when GPs discuss FGM with their patients.SettingPrimary care in England.Data sourcesRealist literature synthesis searching 10 databases with terms: GPs, primary care, obstetrics, gynaecology, midwifery and FGM (UK and worldwide). Citation chasing was used, and relevant grey literature was included, including searching FGM advocacy organisation websites for relevant data. Other potentially relevant literature fields were searched for evidence to inform programme theory development. We included all study designs and papers that presented evidence about factors potentially relevant to considering how, why and in what circumstances GPs feel able to discuss FGM with their patients.Primary outcome measureThis realist review developed programme theory, tested against existing evidence, on what influences GPs actions and reactions to FGM in primary care consultations and where, when and why these influences are activated.Results124 documents were included in the synthesis. Our analysis found that GPs need knowledge and training to help them support their patients with FGM, including who may be affected, what needs they may have and how to talk sensitively about FGM. Access to specialist services and guidance may help them with this role. Reporting requirements may complicate these conversations.ConclusionsThere is a pressing need to develop (and evaluate) training to help GPs meet FGM-affected communities’ health needs and to promote the accessibility of primary care. Education and resources should be developed in partnership with community members. The impact of the mandatory reporting requirement and the Enhanced Dataset on healthcare interactions in primary care warrants evaluation.PROSPERO registration numberCRD42018091996.

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