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 The impact of COVID-19 on chronic care according to providers: a qualitative study among primary care practices in Belgium

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Katrien Danhieux ◽  
Veerle Buffel ◽  
Anthony Pairon ◽  
Asma Benkheil ◽  
Roy Remmen ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Qualitative Study ◽  
Chronic Care ◽  
Self Management ◽  
Management Support ◽  
High Risk Patients ◽  
Risk Patients ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for next waves of the pandemic. Methods A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. Twenty-one people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM). Results Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care, and reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated. Conclusion Our findings show a disruption of the delivery of chronic care in the Belgium prim care context. In such contexts, the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during next waves of the epidemic.

Vaccine Hesitancy in Pediatric Primary Care Practices

2018 ◽  
Vol 28 (13) ◽  
pp. 2071-2080 ◽  
Author(s):  
Salini Mohanty ◽  
Amy Carroll-Scott ◽  
Marissa Wheeler ◽  
Cecilia Davis-Hayes ◽  
Renee Turchi ◽  
...  
Keyword(s):  
Primary Care ◽  
Vaccine Hesitancy ◽  
Structured Interviews ◽  
Vaccine Acceptance ◽  
Multiple Strategies ◽  
Efficiency And Effectiveness ◽  
Care Practices ◽  
Barriers And Challenges ◽  
Primary Care Practices

Understanding how pediatric practices handle parental vaccine hesitancy is important as it impacts the efficiency and effectiveness of pediatric practices. In total, 21 semi-structured interviews with pediatric practice staff within a primary care network were conducted between May 2012 and March 2013. Thematic analysis focused on the barriers and challenges of vaccine hesitancy and strategies to reduce the burden at the practice level. Barriers and challenges of vaccine hesitancy included time constraints, administrative challenges, financial challenges and strained patient-provider relationships. Strategies to minimize the burden of vaccine hesitancy included training for vaccine counseling, screening for vaccine hesitancy prior to immunization visits, tailored vaccine counseling, and primary care provider visits for follow-up immunization. Pediatric practices reported many challenges when caring for vaccine-hesitant families. Multiple strategies were identified to reduce the burden of vaccine hesitancy, which future studies should explore to determine how effective they are in increasing vaccine acceptance in pediatric practices.

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 Implementing Home Blood Glucose and Blood Pressure Telemonitoring in Primary Care Practices for Patients with Diabetes: Lessons Learned

2014 ◽  
Vol 20 (3) ◽  
pp. 253-260 ◽  
Author(s):  
Richelle J. Koopman ◽  
Bonnie J. Wakefield ◽  
Jennifer L. Johanning ◽  
Lynn E. Keplinger ◽  
Robin L. Kruse ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Blood Glucose ◽  
Lessons Learned ◽  
Patients With Diabetes ◽  
Care Practices ◽  
Primary Care Practices

scholarly journals The Impact of COVID-19 on Chronic Care: A Qualitative Study Among Primary Care Practices in Belgium

2020 ◽  
Author(s):  
Katrien Danhieux ◽  
Veerle Buffel ◽  
Anthony Pairon ◽  
Asma Benkheil ◽  
Roy Remmen ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Qualitative Study ◽  
Chronic Care ◽  
Self Management ◽  
Management Support ◽  
Risk Patients ◽  
Care Practices ◽  
Primary Care Practices ◽  
Second Wave

Abstract Background. The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for a second wave or flare-ups of the pandemic.Methods. A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. 21 people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM).Results. Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care, and reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated.Conclusion: Our findings show the delivery of chronic care as disrupted. It indicates that the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during a second wave or in flare-ups.

scholarly journals Lessons learned from the conduct of a multisite cluster randomized practical trial of decision aids in rural and suburban primary care practices

Trials ◽  
2013 ◽  
Vol 14 (1) ◽  
pp. 267 ◽  
Author(s):  
Kari L Ruud ◽  
Annie LeBlanc ◽  
Rebecca J Mullan ◽  
Laurie J Pencille ◽  
Kristina Tiedje ◽  
...  
Keyword(s):  
Primary Care ◽  
Decision Aids ◽  
Lessons Learned ◽  
Care Practices ◽  
Practical Trial ◽  
Cluster Randomized ◽  
Primary Care Practices

Aggregating Claims Data Across Payers: Approaches, Challenges, and Lessons Learned From the Comprehensive Primary Care Initiative

2019 ◽  
Vol 35 (1) ◽  
pp. 29-36
Author(s):  
Anne Mutti ◽  
Erin Fries Taylor ◽  
Deborah Peikes ◽  
Janel Jin ◽  
Kristie Liao ◽  
...  
Keyword(s):  
Primary Care ◽  
Performance Feedback ◽  
Claims Data ◽  
Lessons Learned ◽  
Potential Game ◽  
Practice Performance ◽  
Care Practices ◽  
Primary Care Practices ◽  
Incomplete Picture ◽  
Game Changer

The Comprehensive Primary Care (CPC) initiative fueled the emergence of new organizational alliances and financial commitments among payers and primary care practices to use data for performance improvement. In most regions of the country, practices received separate confidential feedback reports of claims-based measures from multiple payers, which varied in content and provided an incomplete picture of a practice’s patient panel. Over CPC’s last few years, participating payers in several regions resisted the tendency to guard data as a proprietary asset, instead working collaboratively to produce aggregated performance feedback for practices. Aggregating claims data across payers is a potential game changer in improving practice performance because doing so potentially makes the data more accessible, comprehensive, and useful. Understanding lessons learned and key challenges can help other initiatives that are aggregating claims or clinical data across payers for primary care practices or other types of providers.

scholarly journals Perceived Susceptibility to Chronic Kidney Disease among High-risk Patients Seen in Primary Care Practices

2009 ◽  
Vol 24 (10) ◽  
pp. 1123-1129 ◽  
Author(s):  
L. Ebony Boulware ◽  
Kathryn A. Carson ◽  
Misty U. Troll ◽  
Neil R. Powe ◽  
Lisa A. Cooper
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
High Risk ◽  
Kidney Disease ◽  
Perceived Susceptibility ◽  
High Risk Patients ◽  
Risk Patients ◽  
Care Practices ◽  
Primary Care Practices
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