Patients’ experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care

Abstract Funding Acknowledgements Type of funding sources: None. Background Heart failure (HF) requires follow-up over time and by several different health services. The positive effects of follow-up care in secondary care services is well known. However, there is a lack of knowledge in how HF patients experience continuity of care a through various health care services in secondary and primary care. Purpose To explore how HF patients experience continuity of care through secondary and primary health care services. Methods The study used an inductive design by performing four semi-structured focus group interviews. Overall, 17 patients, mean age of 71 years (range 42-95), 11 men and 6 women, All patients were receiving regular and individual follow-up by cardiac nurses in primary care after hospital discharge The interviews were analysed through qualitative content analysis. Results Gaps in continuity of care were described as challenging. Information about HF at the time of discharge from hospital were not always fully comprehended. Patients experienced physical strain of being lost and abandoned after discharge from hospital. They did not know whom to contact for follow-up. Appointments with the GP was not agreed or scheduled weeks ahead. Patients appreciated home visit by a cardiac nurse in primary care who provided the patients with knowledge in self-care administration. When experiencing deterioration they could call the cardiac nurse, who could facilitate fast track to the hospital. Self-care was difficult to comprehend, especially for those experiencing comorbidities. Patients also described the importance of sharing knowledge and experience of living with HF with other patients in a secondary care setting, organized by specialised cardiac nurses. Conclusions There are gaps in continuity in patients’ pathways, throughout both secondary and primary healthcare. Even though patients receive information at discharge from hospital, they felt insecure when returning home. Health care services in the primary care provided the patients with both knowledge and confidence as they regularly met the patients, both at home and in organized primary care meetings.

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Continuity of care and delivery of diabetes and hypertensive care among regular users of primary care services in Chile: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-027830 ◽

2019 ◽

Vol 9 (10) ◽

pp. e027830

Author(s):

Javiera Leniz ◽

Martin C Gulliford

Keyword(s):

Primary Care ◽

Continuity Of Care ◽

Cross Sectional Study ◽

Self Report ◽

Secondary Outcome ◽

Diabetic Patients ◽

Sectional Study ◽

Cross Sectional ◽

Care Services ◽

Primary Care Services

ObjectivesExplore factors related to continuity of care and its association with diabetes and hypertensive care, and disease control.DesignCross-sectional study.SettingData from the Chilean Health National Survey 2009–2010.ParticipantsRegular users of primary care services aged 15 or older.Primary and secondary outcome measuresProportion of hypertensive and diabetic patients with a blood pressure <140/90 mm Hg and HbA1c<7.0% respectively, self-report of diagnosis, treatment and recent foot and ophthalmological exams. Associations between continuity of care, sociodemographic characteristics, and primary and secondary outcomes were explored using logistic regression.Results3887 primary care service users were included. 14.7% recognised a usual GP, 82.3% of them knew their name. Continuity of care was positively associated with age >65 years (OR 4.81, 95% CI 3.16 to 7.32), being female (OR 1.66, 95% CI 1.34 to 2.05), retired (OR 2.22, 95% CI 1.75 to 2.83), obese (OR 1.66, 95% CI 1.29 to 2.14), high cardiovascular risk (OR 2.98, 95% CI 2.13 to 4.17) and widowed (OR 1.50, 95% CI 1.13 to 1.99), and negatively associated with educational level (8–12 vs <8 years OR 0.79, 95% CI 0.64 to 0.97), smoking (OR 0.65, 95% CI 0.52 to 0.82) and physical activity (OR 0.76, 95% CI 0.61 to 0.95). Continuity of care was associated with diagnosis awareness (OR 2.83, 95% CI 1.21 to 6.63), pharmacological treatment (OR 2.04, 95% CI 1.15 to 3.63) and a recent foot (OR 3.17, 95% CI 1.84 to 5.45) and ophthalmological exam (OR 3.20, 95% CI 1.66 to 6.18) in diabetic but not in hypertensive patients.ConclusionsContinuity of care was associated with higher odds of having a recent foot and ophthalmological exam in patients with diabetes, but not with better diseases control. Findings suggest patients with chronic conditions have better continuity of care access.

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Mental health and satisfaction with primary care services in older adults: a study from the patient perspective on four dimensions of care

Family Practice ◽

10.1093/fampra/cmaa019 ◽

2020 ◽

Vol 37 (4) ◽

pp. 459-464

Author(s):

Isabelle Pitrou ◽

Djamal Berbiche ◽

Helen-Maria Vasiliadis

Keyword(s):

Mental Health ◽

Older Adults ◽

Primary Care ◽

Psychological Distress ◽

Continuity Of Care ◽

Care Provider ◽

Four Dimensions ◽

Care Services ◽

Patient Interactions ◽

Primary Care Services

Abstract Background Few studies have examined the association between mental health and satisfaction with primary care services in community-dwelling older adults. Objective To examine the association between mental health in older adults and low satisfaction with primary care services within four dimensions of care. Methods This secondary data analysis included 1624 older adults participating in the ‘Étude sur la Santé des Aînés Services’ (ESA-Services study) and recruited in primary care practices between 2011 and 2013 in the province of Quebec. Patient satisfaction and experience with care were assessed during face-to-face interviews with questions adapted from the Primary Care Assessment Survey. Self-reported mental health indicators included depression, anxiety, suicidal ideation, psychological distress and cognition. We conducted four logistic regressions to examine the associations between mental health and low satisfaction in the following dimensions of care: continuity of care, provider–patient interactions, adequacy of care and physical environment. Results Nearly half of participants (48.5%) reported low satisfaction in at least one dimension of care examined. High psychological distress was associated with low satisfaction with provider–patient interactions [odds ratio (OR) = 1.02; 95% confidence interval (CI) = 1.00–1.04] and adequacy of care (OR = 1.04; 95% CI = 1.01–1.06). The presence of an anxiety disorder was associated with low satisfaction in adequacy of care (OR = 1.64; 95% CI = 1.00–2.72). Worse cognitive functioning was associated with low satisfaction in continuity of care, provider–patient interaction and adequacy of care. Conclusions Mental health was consistently associated with low satisfaction within dimensions of care. Results support the need for increased attention when delivering care to older adults with mental health problems.

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Continuity of Care and the Control of High Blood Pressure at Colombian Primary Care Services

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/00469580211047043 ◽

2021 ◽

Vol 58 ◽

pp. 004695802110470

Author(s):

Lena Barrera ◽

Diana Oviedo ◽

Alvaro Silva ◽

Diego Tovar ◽

Fabián Méndez

Keyword(s):

Blood Pressure ◽

Primary Care ◽

High Blood Pressure ◽

Continuity Of Care ◽

Median Income ◽

Logistic Regression Models ◽

Care Services ◽

Longitudinal Observational Study ◽

Primary Care Services ◽

Clinical Records

Continuity of care (COC) has been associated with lower mortality and hospitalizations and higher high blood pressure (HBP) control rates. This evidence mainly came from high income countries. We aimed to identify conditions associated with controlled HBP, particularly COC, in primary care services (PCSs) affiliated to two health insurances in Colombia, a low-median income country. A longitudinal observational study was carried out using clinical records of hypertensive adults >18 years with ≥4 clinic visits attending a contributive and a subsidized PCS in Cali (Colombia) between 2013 and 2014. Subsidized PCSs were for unemployment people and those at low socio-economic position and contributive for formal workers. COC was measured using the Bice and Boxerman index. Logistic regression models were performed to quantify the relation between COC and controlled HBP (blood pressure <140/90 mmHg). Between 2013 and 2014, among 8797 hypertensive people identified, 1358 were included: 935 (68.8%) and 423 (31.1%) from the contributive and subsidized PCSs, respectively. 856 (62.3%) were women and had a mean age of 67.7 years (SD 11.7). All people were on antihypertensive treatment. Over the study period, 522 (38.4%) people had controlled HBP, 410 (43.9%) in the contributive and 112 (26.5%) in subsidized PCSs. An increase in 1 unit of the COC index is associated with a 161% higher probability of having HBP controlled (OR, 2.61; 95% CI, 1.25–5.44). The odds of having controlled HBP increased as the number of visits rose; for example, people at the fourth visit had a 34% (OR, 1.34; 95% CI, 1.08–1.66) higher probability of reaching the target. Continuity of care was positively associated with controlled HBP. The strengthening of COC can improve the observed low HBP control rates and reduce health inequalities.

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