Constructing a framework for quality activity in primary care

2013 ◽  
Vol 37 (1) ◽  
pp. 98 ◽  
Author(s):  
G. A. Roshan Perera ◽  
Anthony C. Dowell ◽  
Caroline J. Morris
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
New Zealand ◽  
Clinical Care ◽  
Care Practice ◽  
Quality Improvement Activity ◽  
Practice Level ◽  
Theoretical Approaches ◽  
Primary Care Practitioners ◽  
Competing Priorities

Introduction. In 2009, the Royal New Zealand College of General Practitioners commissioned the development of a framework to facilitate quality-improvement activity in primary care settings. This paper outlines the development of the framework, which integrates concepts of quality with the reality of practice-based clinical care, and discusses its value for primary care quality improvement. Method. Framework development involved: (1) literature review of theoretical approaches to healthcare quality; (2) field work utilising a mixed methods approach to obtain empirical data; and (3) model design. Results. Primary care practitioners are juggling competing priorities. Models and tools that promote quality-related activity at practice level need to take into account, and incorporate by design, day-to-day clinical and practice functions. Conclusions. The quality framework identifies the components of primary care practice and locates this model within the concepts and activities necessary for quality improvement. It may be used by primary care organisations and practices to facilitate focussed quality-improvement activity and self-directed process review. The framework was developed for, and within a New Zealand primary care setting, and is applicable internationally and within other healthcare settings. What is known about the topic? Primary care practitioners are frequently juggling competing priorities while participating in an array of professional development, quality assurance, and improvement activities, some perceived to be of little relevance to day-to-day clinical care. What does this paper add? The framework integrates concepts of quality with the reality of practice-based clinical care. The function of the framework is to ensure all relevant aspects of practice are considered in a systematic and comprehensive manner to obtain quality improvement. What are the implications for practitioners? The framework is a practical tool that can guide practices and organisational stakeholders to continually deconstruct, examine and reassemble any practice-based clinical care activity. Practices wishing to undertake quality-improvement activity within the context of clinical care may use the framework to guide critical thinking at practice level.

scholarly journals Refugee-like migrants have similar health needs to refugees: a New Zealand post-settlement cohort study

BJGP Open ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. bjgpopen20X101013
Author(s):  
Jonathan Donald Kennedy ◽  
Serena Moran ◽  
Sue Garrett ◽  
James Stanley ◽  
Jenny Visser ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
New Zealand ◽  
Primary Care Practice ◽  
Social Care ◽  
Hospital Admissions ◽  
Outpatient Service ◽  
Care Practice ◽  
Care Needs ◽  
Health And Social Care

BackgroundRefugees and asylum seekers have specific health and social care needs on arrival in a resettlement country. A third group — migrants with a refugee-like background (refugee-like migrants) — are less well defined or understood.AimUsing routinely collected data, this study compared demographics, interpreter need, and healthcare utilisation for cohorts of refugee-like migrants and refugees.Design & settingA retrospective cohort study was undertaken in Wellington, New Zealand.MethodData were obtained for refugee-like migrants and refugees accepted under the national quota system (quota refugees), who enrolled in a New Zealand primary care practice between 2011 and 2015. Data from the primary care practice and nationally held hospital and outpatient service databases, were analysed. Age and sex standardisation adjusted for possible differences in cohort demographic profiles.ResultsThe cohorts were similar in age, sex, deprivation, and interpreter need. Refugee-like migrants were found to have similar, but not identical, health and social care utilisation to quota refugees. Primary care nurse utilisation was higher for refugee-like migrants. Clinical entries in the primary care patient record were similar in rate for the cohorts. Emergency department utilisation and hospital admissions were similar. Hospital outpatient utilisation was lower for refugee-like migrants.ConclusionThis research suggests that health, social care, and other resettlement services should be aligned for refugee-like migrants and quota refugees. This would mean that countries accepting quota refugees should plan for health and social care needs of subsequent refugee-like migrant family migration. Further research should investigate matched larger-scale national health and immigration datasets, and qualitatively explore factors influencing health-seeking behaviour of refugee-like migrants.

Qua pote quisque, in ea conterat arte diem: COVID-19 and Australian and New Zealand intensive care

2020 ◽  
Vol 22 (2) ◽  
pp. 103-104
Author(s):  
Andrew Udy ◽  
◽  
Keyword(s):  
Public Health ◽  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
New Zealand ◽  
Severe Acute Respiratory Syndrome ◽  
Clinical Care ◽  
Public Health Emergency ◽  
Care Practice ◽  
Health Care Practice

The current global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has thrust intensive care medicine to the forefront of health care practice in Australia and New Zealand. Indeed, reports from other countries and jurisdictions convey highly confronting statistics about the scale of this public health emergency, particularly in terms of the demand on intensive care unit (ICU)services. Whether this occurs here remains to be seen, although if such a scenario does eventuate, it will represent an unprecedented challenge to our community. In parallel, these events offer the opportunity for greater coordination, improved communication, and innovation in clinical care, which are principles that in many ways define our specialty.

scholarly journals Survival analysis of 219 dogs with hyperadrenocorticism attending primary care practice in England

2019 ◽  
Vol 186 (11) ◽  
pp. 348-348 ◽  
Author(s):  
Imogen Schofield ◽  
David C Brodbelt ◽  
Anna R L Wilson ◽  
Stijn Niessen ◽  
David Church ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Multivariable Analysis ◽  
Care Practice ◽  
Electronic Patient Records ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Cox Proportional Hazard Regression ◽  
Primary Care Practitioners ◽  
Primary Care Practices

BackgroundHyperadrenocorticism is an endocrine disease routinely encountered within primary care practice; however, few studies evaluating survival beyond diagnosis have studied this population.MethodsThis retrospective cohort study analysed the electronic patient records of 219 cases of hyperadrenocorticism from a sample of dogs attending primary care practices in England. Kaplan-Meier plots examined the cumulative survival and Cox proportional hazard regression modelling identified factors associated with the hazard of all-cause mortality.ResultsIn the analysis, 179/219 (81.7 per cent) hyperadrenocorticism cases died during the study period with a median survival time from first diagnosis of 510 days (95% CI 412 to 618 days). Trilostane was used in 94.1 per cent of cases and differentiation between pituitary-dependent and adrenal-dependent disease was made in 20.1 per cent of cases. In the multivariable analysis, dogs weighing greater than or equal to 15 kg (HR 1.51, 95% CI 1.06 to 2.15, P=0.023) and those diagnosed greater than or equal to 13 years of age (HR 3.74, 95% CI 2.29 to 6.09, P<0.001) had increased hazards of all-cause mortality. Dogs that had their initial trilostane dose increased had a favourable prognosis (HR 0.49, 95% CI 0.32 to 0.76, P=0.015).ConclusionThis study shows that survival from diagnosis of hyperadrenocorticism appears fair for many dogs and provides primary care practitioners with relatable benchmark prognostic figures.

scholarly journals GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patients

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Leah Palapar ◽  
Laura Wilkinson-Meyers ◽  
Thomas Lumley ◽  
Ngaire Kerse
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Older People ◽  
Home Visiting ◽  
Controlled Trial ◽  
Community Dwelling ◽  
Trial Registration ◽  
Primary Care Redesign ◽  
Practice Level ◽  
Practice Characteristics

Abstract Background Reducing ambulatory sensitive hospitalisations (ASHs) is a strategy to control spending on hospital care and to improve quality of primary health care. This research investigated whether ASH rates in older people varied by GP and practice characteristics. Methods We identified ASHs from the national dataset of hospital events for 3755 community-dwelling participants aged 75+ enrolled in a cluster randomised controlled trial involving 60 randomly selected general practices in three regions in New Zealand. Poisson mixed models of 36-month ASH rates were fitted for the entire sample, for complex participants, and non-complex participants. We examined variation in ASH rates according to GP- and practice-level characteristics after adjusting for patient-level predictors of ASH. Results Lower rates of ASHs were observed in female GPs (IRR 0.83, CI 0.71 to 0.98). In non-complex participants, but not complex participants, practices in more deprived areas had lower ASH rates (4% lower per deprivation decile higher, IRR 0.96, CI 0.92 to 1.00), whereas main urban centre practices had higher rates (IRR 1.84, CI 1.15 to 2.96). Variance explained by these significant factors was small (0.4% of total variance for GP sex, 0.2% for deprivation, and 0.5% for area type). None of the modifiable practice-level characteristics such as home visiting and systematically contacting patients were significantly associated with ASH rates. Conclusions Only a few GP and non-modifiable practice characteristics were associated with variation in ASH rates in 60 New Zealand practices interested in a trial about care of older people. Where there were significant associations, the contribution to overall variance was minimal. It also remains unclear whether lower ASH rates in older people represents underservicing or less overuse of hospital services, particularly for the relatively well patient attending practices in less central, more disadvantaged communities. Thus, reducing ASHs through primary care redesign for older people should be approached carefully. Trial registration Australian and New Zealand Clinical Trials Register ACTRN12609000648224.

Introduction to genomics in primary care

2020 ◽  
pp. 175573802097405
Author(s):  
Alexandra Whiter ◽  
Eamonn Sheridan ◽  
Judith Hayward ◽  
Imran Rafi
Keyword(s):  
Primary Care ◽  
Clinical Care ◽  
Genomic Medicine ◽  
Genomic Testing ◽  
Routine Clinical Care ◽  
Genomic Test ◽  
Medicine Service ◽  
Recent Developments ◽  
Primary Care Practitioners ◽  
Test Result

Advances in genomic technology and the launch of the NHS Genomic Medicine Service (GMS) in 2018 have firmly embedded genomic testing within routine clinical care. As the gateway to the NHS, primary care practitioners will be managing increasing numbers of patients who are eligible for genomic testing, or who present with their own, or a family member’s genomic test result. This article provides an overview of recent developments in the field of genomics, explains key concepts and terminology, and details the current organisation of the genomics services under the GMS. It also discusses some common presentations within primary care to highlight the relevance of genomics to frontline GPs.

scholarly journals A qualitative study of urban hospital transitional care

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Joe Feinglass ◽  
Samuel Wein ◽  
Caroline Teter ◽  
Christine Schaeffer ◽  
Angela Rogers
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Quality Improvement ◽  
Transitional Care ◽  
Behavioral Health Care ◽  
Care Quality ◽  
Care Staff ◽  
Internal Quality ◽  
Care Practice

This study is part of a mixed methods evaluation of a large urban medical center transitional care practice (NMG-TC). The NMG-TC provides integrated physical and behavioral health care for high need patients referred from the hospital emergency department or inpatient units and who lack a usual source of primary care. The study was designed for internal quality improvement and sought to evaluate staff perceptions of successful transitions for their medically and socially complex patients, and alternatively, the obstacles most likely to negatively impact patient outcomes. All 16 NMG-TC patient care staff were interviewed in a collaborative effort to produce empowered testimony that might go beyond expected clinical narratives. The interview schedule included questions on risk stratification, integrated mental health care, provider to provider handoffs, and how staff deal with key social determinates of patients’ health. The constant comparative method was used to deductively derive themes reflecting key domains of transitional care practice. Seven themes emerged: i) the need to quickly assess patient complexity; ii) emphasizing caring for major mental health and substance use issues; iii) obstacles to care for uninsured, often undocumented patients; iv) the intractability of homelessness; v) expertise in advancing patients’ health literacy, engagement and activation; vi) fragmented handoffs from hospital care and vii) to primary care in the community. Respondent stories emphasized methods of nurturing patients’ self-efficacy in a very challenging urban health environment. Findings will be used to conceptualize pragmatic, potentially high-impact transitional care quality improvement initiatives capable of better addressing frequent hospital use.

scholarly journals How to use interpreters in general practice: the development of a New Zealand toolkit

2012 ◽  
Vol 4 (1) ◽  
pp. 52 ◽  
Author(s):  
Ben Gray ◽  
Jo Hilder ◽  
Maria Stubbe
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
New Zealand ◽  
Limited English Proficiency ◽  
Ethical Behaviour ◽  
Patient Relations ◽  
Primary Care Practitioners ◽  
The Cost ◽  
Patient Resistance

BACKGROUND AND CONTEXT: New Zealand is becoming more ethnically diverse, with more limited English proficiency (LEP) people. Consequently there are more primary care consultations where patients have insufficient English to communicate adequately. Because effective communication is essential for good care, interpreters are needed in such cases. ASSESSMENT OF PROBLEM: The literature on the use of interpreters in health care includes the benefits of using both trained interpreters (accuracy, confidentiality, ethical behaviour) and untrained interpreters (continuity, trust, patient resistance to interpreter). There is little research on the actual pattern of use of interpreters. RESULTS: Our research documented a low use of trained interpreters, despite knowledge of the risks of untrained interpreters and a significant use of untrained interpreters where clinicians felt that the communication was acceptable. A review of currently available guidelines and toolkits showed that most insist on always using a trained interpreter, without addressing the cost or availability. None were suitable for direct use in New Zealand general practice. STRATEGIES FOR IMPROVEMENT: We produced a toolkit consisting of flowcharts, scenarios and information boxes to guide New Zealand practices through the structure, processes and outcomes of their practice to improve communication with LEP patients. This paper describes this toolkit and the links to the evidence, and argues that every consultation with LEP patients requires clinical judgement as to the type of interpreting needed. LESSONS: Primary care practitioners need understanding about when trained interpreters are required. KEYWORDS: Communication barriers; primary health care; New Zealand; quality of health care; professional–patient relations; cultural competency

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