Tailoring Communications for Primary Care Settings

1998 ◽  
Vol 37 (02) ◽  
pp. 171-178 ◽  
Author(s):  
B. Glassman ◽  
B. K. Rimer
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Contact Time ◽  
Behavioral Changes ◽  
Patient Specific ◽  
Specific Information ◽  
Medical Settings ◽  
Primary Care Settings ◽  
Professional Contact ◽  
Tailored Communications

AbstractIn more and more medical settings, physicians have less and less time to be effective communicators. To be effective, they need accurate, current information about their patients. Tailored health communications can facilitate positive patient-provider communications and foster behavioral changes conducive to health. Tailored communications (TCs) are produced for an individual based on information about that person. The focus of this report is on tailored print communications (TPCs). TPCs also enhance the process of evaluation, because they require a database and the collection of patient-specific information. We present a Tailoring Model for Primary Care that describes the steps involved in creating TPCs. We also provide examples from three ongoing studies in which TPCs are being used in order to illustrate the kinds of variables used for tailoring the products that are developed and how evaluation is conducted. TPCs offer opportunities to expand the reach of health professionals and to give personalized, individualized massages in an era of shrinking professional contact time.

scholarly journals The prognosis of depression in late life versus mid-life: implications for the treatment of older adults

2005 ◽  
Vol 17 (4) ◽  
pp. 533-538 ◽  
Author(s):  
Hari Subramaniam ◽  
Alex J. Mitchell
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Nursing Homes ◽  
Late Life ◽  
Clinical Excellence ◽  
Late Life Depression ◽  
Medical Settings ◽  
Nice Guidelines ◽  
Primary Care Settings

Depression in late life is extremely common. Of those aged 65 years or older, 2–5% have syndromal depression, but up to 20% of elderly people have depressive symptoms (Horwath et al., 2002). Both syndromal and subsyndromal depression carry a high risk of long-term complications and both are associated with elevated risks of morbidity and mortality (Penninx et al., 1999). Despite repeated alerts, depression is consistently under-recognized in acute medical settings, in nursing homes and in primary care (Volkers et al., 2004). For reasons that are inadequately understood, late-life depression seems to be under-treated to an even greater extent than depression in mid-life (Mackenzie et al., 1999). This issue is particularly important, given that effective and safe treatments for depression are available (Bartels et al., 2003), even though the evidence regarding maintenance therapies in older people is inconsistent (Geddes et al., 2003; Wilson et al., 2003). Recent evidence suggests that a package of care can improve the care of older depressed patients in primary care settings (Bruce et al., 2004) and in nursing homes (Ciechanowski et al., 2004). This has led to the development of several clinical guidelines specifically for late-life depression (Baldwin et al., 2003; Charney et al., 2003; Lebowitzet al., 1997). Yet, in the recent National Institute of Clinical Excellence (NICE) guidelines for the management of depression in primary and secondary care, no distinction was made between early, middle and late-life depression (Malone and Mitchell, 2005).

scholarly journals Clinicians' Values and Preferences for Medication Adherence and Cost Clinical Decision Support in Primary Care: A Qualitative Study

2020 ◽  
Vol 11 (03) ◽  
pp. 405-414
Author(s):  
Shubha Bhat ◽  
Catherine Grace Derington ◽  
Katy E. Trinkley
Keyword(s):  
Primary Care ◽  
Decision Support ◽  
Medication Adherence ◽  
Clinical Decision Support ◽  
Clinical Decision ◽  
Patient Specific ◽  
Specific Information ◽  
Impact Patient Care ◽  
Primary Care Clinicians ◽  
The Cost

Abstract Background Medication nonadherence and unaffordability are prevalent, burdensome issues in primary care. In response, technology companies are capitalizing on clinical decision support (CDS) to deliver patient-specific information regarding medication adherence and costs to clinicians using electronic health records (EHRs). To maximize adoption and usability, these CDS tools should be designed with consideration of end users' values and preferences. Objective This article evaluates primary care clinicians' values and preferences for a medication adherence and cost CDS. Methods We conducted semistructured interviews with primary care clinicians with prescribing privileges and EHR access to identify clinicians' perceptions of and approaches to assessing medication adherence and costs, and to determine perceived values and preferences for medication adherence and cost CDS. Interviews were conducted until saturation of responses was reached. ATLAS.ti was used for thematic analysis. Results Among 26 clinicians interviewed, themes identified included a high value, but moderate need for a medication adherence CDS and high value and need for cost CDS. Clinicians expressed the cost CDS would provide actionable solutions and greatly impact patient care. Another theme identified was a desire for medication adherence and cost CDS to be separate tools yet integrated into workflow. The majority of clinicians preferred a medication adherence CDS that integrated claims data and actively displayed data using color-coded adherence categories within patients' medication lists in the EHR. For the cost CDS, clinicians preferred medication out-of-pocket costs and a list of cheaper or payor-preferred alternatives to display within the order queue of the EHR. Conclusion We identified valuable insights regarding clinician values and preferences for medication adherence and cost CDS. Overall, primary care clinicians feel CDS for medication adherence and cost are valuable and prefer them to be separate. These insights should be used to inform the design, implementation, and EHR integration of future medication and cost CDS tools.

Weight Communication: How Do Health Professionals Communicate about Weight with Their Patients in Primary Care Settings?

2020 ◽  
pp. 1-7
Author(s):  
Stephanie Aboueid ◽  
Rukhsana Ahmed ◽  
Monika Jasinska ◽  
Catherine Pouliot ◽  
Billie Jane Hermosura ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Primary Care Settings

scholarly journals Patient Safety Culture Assessment in Primary Care Settings in Greece

Healthcare ◽  
2021 ◽  
Vol 9 (7) ◽  
pp. 880
Author(s):  
Ioannis Antonakos ◽  
Kyriakos Souliotis ◽  
Theodora Psaltopoulou ◽  
Yannis Tountas ◽  
Maria Kantzanou
Keyword(s):  
Primary Care ◽  
Patient Safety ◽  
Safety Culture ◽  
Health Professionals ◽  
Improve Patient Safety ◽  
Patient Safety Culture ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Survey Tool ◽  
Primary Care Settings

Introduction: A positive safety culture is considered a pillar of safety in health organizations and the first crucial step for quality health services. In this context, the aim of this study was to set a reference evaluation for the patient safety culture in the primary health sector in Greece, based on health professionals’ perceptions. Methods: We used a cross-sectional survey with a 62% response rate (n = 459), conducted in primary care settings in Greece (February to May 2020). We utilized the “Medical Office Survey on Patient Safety Culture” survey tool from the Agency for Healthcare Research and Quality (AHRQ). The study participants were health professionals who interacted with patients from 12 primary care settings in Greece. Results: The most highly ranked domains were: “Teamwork” (82%), “Patient Care Tracking/Follow-up” (80% of positive scores), and “Organizational Learning” (80%); meanwhile, the lowest-ranked ones were: “Leadership Support for Patient Safety” (62%) and “Work Pressure and Pace” (46%). The other domains, such as “Overall Perceptions of Patient Safety and Quality” (77%), “Staff Training“ (70%), “Communication about Error” (70%), “Office Processes and Standardization” (67%), and “Communication Openness” (64%), ranked somewhere in between. Conclusions: A positive safety culture was identified in primary care settings in Greece, although weak areas concerning the safety culture should be addressed in order to improve patient safety.

scholarly journals ‘Just asking the question’: a qualitative study of health professionals’ experiences and perceptions of recording torture in vulnerable migrants in primary care settings

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X702929
Author(s):  
Gemma Whyatt ◽  
Max Cooper
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Care Setting ◽  
Research Study ◽  
Political Factors ◽  
Factors Affecting ◽  
Qualitative Research Study ◽  
Primary Care Settings ◽  
Targeted Screening ◽  
Survivors Of Torture

BackgroundA large proportion of vulnerable migrants may be survivors of torture, with complex health needs as a result; yet there is a lack of guidance or understanding of how to identify and record signs of torture. Clinical professionals in primary care are in a unique position to care for and support this patient population.AimThe primary aim of this study was to explore the primary care context of how signs of torture could be better recorded to support patients and meet their needs.MethodThis was a qualitative research study conducted through remote interviews with health professionals from a range of clinical backgrounds and experience of working with survivors of torture.ResultsTwelve health professionals participated in the study, with results analysed using applied thematic analysis. Seven themes were identified, ranging from the barriers to asking about and disclosing torture, the underlying purpose of doing so, political factors affecting this issue and various ways to potentially improve recording torture.ConclusionBefore clinical professionals can record torture, they must first ask the patient about it as survivors are unlikely to raise the topic themselves. Many clinical professionals lack the awareness or confidence to do this, thereby warranting further discussion on strategies to educate clinical professionals about torture. Accessible guidance and a simple, systematic method to identify survivors of torture which is suitable for a primary care setting is necessary, with suggestions for further research including routine enquiry and targeted screening.

scholarly journals Effect of a Digital Precision Public Health Intervention for Care Coordination During Covid-19 Pandemic in Australia: A Real World Study

2021 ◽  
Author(s):  
Andre Q Andrade ◽  
Jean-Pierre Calabretto ◽  
Nicole L Pratt ◽  
Lisa M Kalisch-Ellett ◽  
Vanessa T LeBlanc ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Continuity Of Care ◽  
Care Coordination ◽  
Real World ◽  
Primary Care Providers ◽  
Patient Specific ◽  
Specific Information ◽  
Care Providers ◽  
Precision Public Health

Abstract Background: Emergencies disproportionally affect vulnerable populations. The COVID-19 pandemic affected older patients with co-morbidities both directly due to more severe infection and indirectly by affecting care provision. To promote continuity of care, public health professionals require tools to quickly and precisely coordinate with primary care providers. This study evaluated whether digital interventions powered by current existing infrastructure are more effective than conventional interventions in promoting primary care appointments during the COVID-19 pandemic. Methods: We developed a digital intervention delivered by secure messaging and compared it to a post delivered intervention to promote continuity of care for vulnerable veterans during COVID-19 in a real world, non-randomised, interventional study. The study was implemented as part of the Veterans’ MATES program, an Australian Government Department of Veterans’ Affairs program to promote improvements in health care for veterans. The intervention provided patient specific information to general practitioners (GPs) to support continuity of care, alongside mailed education to veterans. The intervention key messages were to maintain regular contact with care providers and to continue to adhere to health plans. The intervention took place in April 2020, during the first weeks of COVID-19 social distancing rules in Australia. The main outcome was time to first appointment with the primary general practitioner (GP) measured using a Cox proportional hazards model.Results: GPs received digital messaging for 51,052 veterans and post messaging for 26,859 veterans. The proportion of patients seeing their primary GP during the three months following intervention was higher in the digital group (77.8%) than the post group (61.5%) (p<0.01). Being in the digital group was associated with earlier appointments. Conclusion: Current infrastructure coupled with innovative solutions is effective in promoting care coordination at scale during national emergencies, opening up new perspectives for precision public health initiatives.

scholarly journals Using Consolidated Framework for Implementation Research to investigate facilitators and barriers of implementing alcohol screening and brief intervention among primary care health professionals: a systematic review

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Paul Shing-fong Chan ◽  
Yuan Fang ◽  
Martin Chi-sang Wong ◽  
Junjie Huang ◽  
Zixin Wang ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Brief Intervention ◽  
Implementation Research ◽  
Health Professionals ◽  
Alcohol Screening ◽  
Screening And Brief Intervention ◽  
Primary Care Settings ◽  
Facilitators And Barriers ◽  
Inner Setting

Abstract Background Alcohol screening and brief intervention (SBI) is recommended to be implemented in primary care settings to intervene against hazardous/harmful drinking. However, studies showed that the uptake rate was low in many regions/countries. This systematic review presented current findings on the facilitators and barriers of SBI implemented by health professionals in primary care settings using the Consolidated Framework for Implementation Research (CFIR). Methods We included qualitative, quantitative, and mixed-method studies identified through four electronic databases (PubMed, MEDLINE, PsycInfo, and Web of Science) from inception to June 2020. Included articles had to address barriers and facilitators of SBI implementation and provide sufficient details that the CFIR domains could be identified and data were abstracted using a standardized extraction form. Results A total of 74 studies published from 1985 to 2019 were finally analysed and summarized. The most common facilitators were knowledge and positive beliefs about SBI (characteristics of the individuals) and available resources (inner setting). In contrast, the most common barriers were cost related to implementing SBI (intervention characteristics), negative beliefs about SBI (characteristics of the individuals), and lack of self-efficacy in implementing SBI (characteristics of the individuals). It could be observed that factors related to the inner setting and characteristics of individuals were extensively studied whilst the process received the least attention. Conclusions Most of the facilitators and barriers are modifiable. Additionally, most literature focused on various kinds of available assets to implement SBI. To promote the spread of SBI implementation, more high-quality studies on the implementation process are needed. This systematic review could serve as a reference framework for health authorities to devise strategies for improving the implementation of SBI in primary care settings. Trial registration This systematic review was registered in PROSPERO (CRD42021258833).

Clinical Judgment and the Influence of Screening on Decision Making

2009 ◽  
Author(s):  
Howard N. Garb
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Clinical Practice ◽  
Mental Health Professionals ◽  
Health Professionals ◽  
Clinical Judgment ◽  
Structured Interviews ◽  
Primary Care Settings ◽  
Broad Array ◽  
Clinically Depressed

How do clinicians arrive at diagnostic decisions? In most cases the decision is not made following formal criteria, but by intuition. In addition, routine interviews are often narrow and the feedback gleaned from patients is inadequate. Yet it is not clear if screening helps or hinders clinical judgment. It might be that only clinicians who have low confidence and interviewing and diagnostic skills are open to the use of and actually helped by diagnostic tools. To provide a theoretical framework for understanding why it is difficult for physicians to detect depression in primary care settings, a broad array of research in the mental health fields can be described. For example, more than 1,000 studies have been conducted on clinical judgment in the area of mental health practice, and the results from these studies can be used to illuminate the challenges physicians face in judging whether a patient is clinically depressed and can benefit from treatment. In this chapter, results on clinical judgment will be described. A second topic will also be briefly discussed. Results from research on clinical judgment would seem to indicate that screening should be of value. Yet, as noted in Chapter 7, stand-alone screening programs have added little or nothing to outcomes. Reasons for this unexpected result will be explored. Three topics will be discussed: (1) narrowness of interviews, (2) nature of patient feedback, and (3) the cognitive processes of clinicians. Depression goes undetected because in many cases physicians do not ask patients if they have symptoms of a depressive mood disorder.3 To place this in context, it can be noted that mental health professionals also often do not ask patients about important symptoms and behaviors. Failure to inquire about depression in primary care settings can be viewed in the broader context of failure to inquire about important symptoms and events in mental health settings. Research on clinical judgment has demonstrated that lack of comprehensiveness is often a problem for interviews made in clinical practice. For example, in one study,4 mental health professionals saw patients in routine clinical practice, and afterwards research investigators conducted semi-structured interviews with the patients. Remarkably, the mental health professionals had evaluated only about 50% of the symptoms that were recorded using the semi-structured interviews.

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