The Teamwork Study: enhancing the role of non-GP staff in chronic disease management in general practice

2013 ◽  
Vol 19 (3) ◽  
pp. 184 ◽  
Author(s):  
D. A. Black ◽  
J. Taggart ◽  
U. W. Jayasinghe ◽  
J. Proudfoot ◽  
P. Crookes ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Chronic Disease ◽  
Chronic Illness ◽  
Team Work ◽  
Chronic Illness Care ◽  
Patient Assessment ◽  
Significant Difference ◽  
The Impact

There is evidence for a team-based approach in the management of chronic disease in primary health care. However, the standard of care is variable, probably reflecting the limited organisational capacity of health services to provide the necessary structured and organised care for this group of patients. This study aimed to evaluate the impact of a structured intervention involving non-GP staff in GP practices on the quality of care for patients with diabetes or cardiovascular disease. A cluster randomised trial was undertaken across 60 GP practices. The intervention was implemented in 30 practices with staff and patients interviewed at baseline and at 12–15 months follow up. The change in team roles was evaluated using a questionnaire completed by practice staff. The quality of care was evaluated using the Patient Assessment of Chronic Illness Care questionnaire. We found that although the team roles of staff improved in the intervention practices and there were significant differences between practices, there was no significant difference between those in the intervention and control groups in patient-assessed quality of care after adjusting for baseline-level score and covariates at the 12-month follow up. Practice team roles were not significantly associated with change in Patient Assessment of Chronic Illness Care scores. Patients with multiple conditions were more likely to assess their quality of care to be better. Thus, although previous research has shown a cross-sectional association between team work and quality of care, we were unable to replicate these findings in the present study. These results may be indicative of insufficient time for organisational change to result in improved patient-assessed quality of care, or because non-GP staff roles were not sufficiently focussed on the aspects of care assessed. The findings provide important information for researchers when designing similar studies.

scholarly journals Exploring the impact of pharmacist comprehensive annual care plans on perceived quality of chronic illness care by patients in Alberta, Canada

2021 ◽  
pp. 171516352110203
Author(s):  
Candace Necyk ◽  
Jeffrey A. Johnson ◽  
Ross T. Tsuyuki ◽  
Dean T. Eurich
Keyword(s):  
Quality Of Care ◽  
Chronic Illness ◽  
Care Plan ◽  
Short Version ◽  
Chronic Illness Care ◽  
Online Questionnaire ◽  
Care Plans ◽  
Funding Program ◽  
The Impact

Background: In 2012, the Government of Alberta introduced a funding program to remunerate pharmacists to develop a comprehensive annual care plan (CACP) for patients with complex needs. The objective of this study is to explore patients’ perceptions of the care they received through the pharmacist CACP program in Alberta. Methods: We invited 3442 patients who received a pharmacist-billed CACP within the previous 3 months and 6888 matched controls across Alberta to complete an online questionnaire. The questionnaire consisted of the short version Patient Assessment of Chronic Illness Care (PACIC-11), with 3 additional pharmacy-specific assessment questions added. Additional questions related to health status and demographics were also included. Results: Overall, most patients indicated a low level of chronic illness care by pharmacists, with few differences noted between CACP patients and non-CACP controls. Of note, controls reported higher quality of care for 5 domains within the adapted PACIC-like tool compared with CACP patients ( p < 0.05 for all). Interestingly, only 79 (44%) of CACP patients reported that they had received a CACP, whereas only 192 (66%) of control patients reported that they did not receive a care plan. In a sensitivity analysis including only these respondents, individuals who received a CACP perceived a significantly higher quality of chronic illness care across all PACIC domains. Conclusion: Overall, chronic illness care incentivized by the pharmacist CACP program in Alberta is perceived to be moderate to low. When limited to respondents who explicitly recognized receiving the service or not, the perceptions of quality of care were more positive. This suggests that better implementation of CACP by pharmacists may be associated with improved quality of care and that some redesign is needed to engage patients more. Can Pharm J (Ott) 2021;154:xx-xx.

scholarly journals Patients’ Assessment of Care for Type 2 Diabetes: Results of the Patient Assessment of Chronic Illness Care Scale in A Danish Population

2020 ◽  
Author(s):  
Anne Frølich ◽  
Ann Nielsen ◽  
Charlotte Glümer ◽  
Hanne Birke ◽  
Christian U Eriksen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Chronic Illness ◽  
Diabetes Care ◽  
Emergency Department Visits ◽  
Descriptive Statistics ◽  
Chronic Illness Care ◽  
Patient Assessment

Abstract Background: The Patient Assessment of Chronic Illness Care (PACIC) scale is the most appropriate for assessing self-reported experience in chronic care. However, it has yet to be validated in a Danish diabetes population. We aimed to validate the PACIC, assess the quality of care for Danish patients with type 2 diabetes, and identify factors associated with quality of care. Methods: A survey of 7,745 individuals randomly selected from the National Diabetes Registry. Descriptive statistics inter-item and item-rest correlations and factor analysis assessed the PACIC properties. Quality of care was analysed with descriptive statistics; linear and multiple regression assessed the effect of forty-nine covariates on total and subscale scores. Results: In total, 2,696 individuals with type 2 diabetes completed ≥ 50% of items. The floor effect for individual items was 8.5-74.5%; the ceiling effect was 4.1- 47.8 %. Cronbach’s alpha was 0.73-0.86 for the five subscales. The comparative fit index (CFI) and the Tucker–Lewis index (TLI) were 0,87, and 0,84, respectively. Mean PACIC score was 2.44 (± 0.04). Respondents receiving rehabilitation and reporting primary of diabetes care had higher total mean scores; those 70 years or older had lower mean total and subscale scores. A higher number of diabetes visits were associated with higher total scores; higher number of emergency department visits were associated with lower total scores. The effect of healthcare utilisation on subscale scores varied. Conclusions: Floor effects suggest a need for further evaluation of the PACIC questionnaire in Danish settings. Total PACIC scores were lower than in other healthcare systems, possibly being a result of different contexts and cultures, and of a need for improving diabetes care in Denmark.

scholarly journals Patients' assessment of care for type 2 diabetes: Results of the Patient Assessment of Chronic Illness Care scale in a Danish population

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Anne Frølich ◽  
Ann Nielsen ◽  
Charlotte Glümer ◽  
Christian U Eriksen ◽  
Helle Terkildsen Maindal ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Chronic Illness ◽  
Diabetes Care ◽  
Descriptive Statistics ◽  
Chronic Illness Care ◽  
Patient Assessment ◽  
Danish Population

Abstract Background The Patient Assessment of Chronic Illness Care (PACIC) scale is the most appropriate for assessing self-reported experience in chronic care. We aimed to validate the PACIC questionnaire by (1) assess patients’ perception of the quality of care for Danish patients with type 2 diabetes, (2) identify which factors are most important to the quality of care designated by the five subscales in PACIC, and (3) the validity of the questionnaire. Methods A survey of 7,745 individuals randomly selected from the National Diabetes Registry. Descriptive statistics inter-item and item-rest correlations and factor analysis assessed the PACIC properties. Quality of care was analysed with descriptive statistics; linear and multiple regression assessed the effect of forty-nine covariates on total and subscale scores. Results In total, 2,696 individuals with type 2 diabetes completed ≥ 50 % of items. The floor effect for individual items was 8.5–74.5 %; the ceiling effect was 4.1–47.8 %. Cronbach’s alpha was 0.73–0.86 for the five subscales. The comparative fit index (CFI) and the Tucker–Lewis index (TLI) were 0,87, and 0,84, respectively. Mean PACIC score was 2.44 (± 0.04). Respondents, who receive diabetes care primarily at general practice and outpatient clinics had higher scores compared to those receiving care at a private specialist. Receiving rehabilitation was followed by higher scores in all subscales. Those 70 years or older had lower mean total and subscale scores compared to younger patient groups. A higher number of diabetes visits were associated with higher total scores; a higher number of emergency department visits were associated with lower total scores. The effects of healthcare utilisation on subscale scores varied. Conclusions These results provide insight into variations in the quality of provided care and can be used for targeting initiatives towards improving diabetes care. Factors important to the quality of perceived care are having a GP or hospital outpatient clinic as the primary organization. Also having a higher number of visits to the two organizations are perceived as higher quality of care as well as participating in a rehabilitation program. Floor and ceiling effects were comparable to an evaluation of the PACIC questionnaire in a Danish population. Yet, floor effects suggest a need for further evaluation and possible improvement of the PACIC questionnaire in a Danish setting. Total PACIC scores were lower than in other healthcare systems, possible being a result of different contexts and cultures, and of a need for improving diabetes care in Denmark.

Intensive multidisciplinary care programme for frail patients

2014 ◽  
Vol 2 (3) ◽  
pp. 274
Author(s):  
I Urreta ◽  
P Aranegi ◽  
J Artetxe ◽  
X Zubeldia ◽  
I Huerta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Multidisciplinary Care ◽  
Perceived Quality ◽  
Easy Access ◽  
Care Programme ◽  
Perceived Quality Of Care ◽  
The Impact

Rationale and Objectives: Patients with chronic diseases re-admitted for acute events are associated with a high use of hospital resources and represent a challenge for healthcare systems. In such cases, follow-up interventions at discharge can be effective. The widespread adoption of follow-up procedures not involving telemonitoring may greatly decrease re-admissions rates without the costs associated with telemedicine. To assess the impact of a structured follow-up programme on patient-perceived healthcare quality, treatment adherence, re-admissions and Emergency Department attendances.Methods: This was a before and after study of 242 patients at risk of re-admission for chronic obstructive pulmonary disease (COPD) or heart failure (HF), recruited between 1st July 2009 and 30th June 2010 at Donostia Tertiary University Hospital (Gipuzkoa, Spain). The follow-up ended on 30th December 2010. The intervention involved identifying independent re-admitted patients, providing personalised information and a direct number to call in the event of clinical worsening, assigning specialists and liaison nurses, structured follow-up by telephone and appointments and contact with general practitioners. Patient perceived quality of care estimated was analyzed using a focus group technique. To assess the number of re-admissions and the Emergency Department attendances we estimated the relative risk reduction as a percentage and corresponding 95% confidence intervals.Results: In terms of perceived quality of care, the most valued elements were related to having an assigned doctor/nurse and easy access in the event of worsening. Overall, 97.9% of patients reported full adherence to treatment (95% CI: 95.4-98.83).Hospital bed days and Emergency Department attendances decreased by 60.7% (95% CI: 58.7-62.7) and 77% (95% CI: 73.2-80.3), respectively.Conclusions: The intensive multidisciplinary care programme can reduce Emergency Department attendances and improve perceived quality of care in patients with HF and COPD.

scholarly journals Patient-assessed quality of care in type 2 diabetes in a German nationwide health survey 2017

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Baumert ◽  
G L Schmid ◽  
Y Du ◽  
R Paprott ◽  
S Carmienke ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Quality Of Care ◽  
Chronic Illness ◽  
Information Needs ◽  
Population Based ◽  
Short Version ◽  
Chronic Illness Care ◽  
Related Factors

Abstract Background Patient-assessed quality of chronic illness care is important to guide medical care for patients with diabetes and other complex chronic diseases, but information from epidemiological studies is scarce. Thus, we examined self-assessed quality of care among adults with type 2 diabetes (T2D) based on a population-based design. Methods The study population was drawn from a nationwide survey on diabetes-related knowledge and information needs conducted in Germany in 2017 and included participants aged ≥18 years with known type 2 diabetes (T2D) in the last 12 months (n = 1,328). A German short version of the “Patient assessment of chronic illness care (PACIC-DSF)” consisting of 9 items based on 5-point Likert scale was applied to assess self-reported quality of care in diabetes which was operationalized by a standardized PACIC sum score ranging from 1 to 5. Linear regression with different stages of adjustment was applied to assess the association of basic characteristics and diabetes-related factors with the PACIC score. Results Quality of care was assessed less favorably by women than by men (PACIC score: 2.38 vs. 2.47) overall and decreased along with age. The PACIC score significantly increased in participants with insulin use (β = 0.16, p = 0.024), ever participating in a diabetes education program (β = 0.33, p &lt; 0.001), following a diet plan at least once a week (β = 0.33, p &lt; =0.001) as well as performing daily self-examination of feet (β = 0.14, p = 0.023), self-control of blood glucose (β = 0.34, p &lt; 0.001), and being physically active for at least 30 min (β = 0.21, p &lt; 0.001) compared to participants without the respective trait. Conclusions Self-assessed quality of care by adults with known T2D from this population-based study is moderate and seems lower compared to findings from clinical studies. Key messages An active involvement of people with type 2 diabetes into the implementation of care is essential and may contribute to improved self-perceived quality of care. To identify and overcome obstacles in diabetes care based on the patient’s perspective remains a public health challenge.

Quality improvement in chronic care by self-audit, benchmarking and networking in general practices in South Tyrol, Italy: results from an interventional study

2020 ◽  
Author(s):  
Giuliano Piccoliori ◽  
Angelika Mahlknecht ◽  
Muna E Abuzahra ◽  
Adolf Engl ◽  
Vera Breitenberger ◽  
...  
Keyword(s):  
General Practice ◽  
Quality Of Care ◽  
Quality Indicators ◽  
Quality Score ◽  
Interventional Study ◽  
South Tyrol ◽  
Electronic Health ◽  
The Impact

Abstract Background Systematic strategies promoting quality of care in general practice are yet under-represented in several European countries. Objective This interventional study assessed whether a combined intervention (self-audit, benchmarking, quality circles) improved quality of care in Salzburg, Austria and South Tyrol, Italy. The present publication reports the Italian results. Methods We developed quality indicators for general practice in a consensus process based on pre-existing quality programmes. The indicators addressed diagnosis and treatment regarding eight common chronic conditions. A quality score comprising 91 indicators was calculated (0–5 points per indicator depending on fulfilment, maximum 455 points). We collected anonymous data from the electronic health records of the participating physicians in 2012, 2013 and 2014. Wilcoxon signed-rank tests were used for pre-post analysis. Results Thirty-six GPs participated in the study. The median quality score increased significantly from 177.0 points at baseline to 272.0 points at the second follow-up (P = 0.000). Improvements concerned process and intermediate outcome indicators particularly between baseline and the first follow-up. Conclusion Performance was relatively low at baseline and improved considerably, mainly in the first study period. The intervention investigated in this study can serve as a model for future quality programmes. A customized electronic health record for the implementation of this intervention as well as standardized and consistent documentation by GPs is a prerequisite. Use of a limited set of quality indicators (QIs) and regular QI modification is probably advisable to increase the benefits. Long-term prospective studies should investigate the impact of QI-based interventions on end-result outcomes.

scholarly journals Health Related Quality of Life in Patients with Chronic Disease in Lebanese Community Setting

2020 ◽  
Author(s):  
Hani Dimassi ◽  
Soumana C Nasser ◽  
Aline Issa ◽  
Sandrine Sarine Adrian ◽  
Bassima Hazimeh
Keyword(s):  
Quality Of Life ◽  
Socioeconomic Status ◽  
Chronic Disease ◽  
Utility Score ◽  
Health Related Quality ◽  
Significant Difference ◽  
Related Quality ◽  
Health Related ◽  
The Impact

Abstract Background: The impact of chronic diseases on patient quality of life are becoming of high priority in healthcare system. There is an increased need of such data in Middle Eastern countries. Objective: To measure health related quality of life (HRQOL) in patients with chronic disease to associate this information with demographic data, socioeconomic status, and health satisfaction.Setting: Six community pharmacies in Beirut region.Method: A prospective cross-sectional study was conducted to gather information on socioeconomic status, health condition and quality of life of participants during their visit to their local pharmacy. Main outcome measure: Health related quality of life using the EQ5D instrumentResults: Participants (n=103) gave an average of 6.8, and 7.4 over ten for their current health and for their satisfaction with their treatment, respectively. The mean utility score was 0.762 (SD 0.202). The number of prescribed medications per respondent indicated a significant impact on HRQOL (p = 0.002); with diuretic agents having a significant difference in utility scores (p<0.001). On average, participants 75 years or older, hospitalized in the past 12 months, diagnosed with hypertension, had a lower utility score of 0.15 (p<0.001), 0.111 (p=0.001), and 0.065 (p=0.035), respectively. For every unit increase in treatment satisfaction, the quality of life score increased by 0.036 unit (p= 0.001)Conclusion: HRQOL as measured by the EQ5D in this study was affected in patients with cardiac disease or diabetes. Male gender, advanced age, low socioeconomic status, frequent hospital and doctor visits were important risk factors for a poor HRQOL.

scholarly journals The impact of the COVID-19 pandemic on the management and outcomes of STEMI patients in Switzerland

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
S Fournier ◽  
T Mahendiran ◽  
D Radovanovic ◽  
G Pedrazzini ◽  
F Eberli ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Quality Of Care ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
First Year ◽  
Significant Difference ◽  
All Cause Mortality ◽  
Door To Balloon ◽  
The Impact

Abstract Introduction The COVID-19 pandemic has placed unprecedented strain on healthcare systems around the world, with potential repercussions on the quality of care of patients with other diseases. From a cardiological perspective, there have been concerns that the pandemic may have impacted the management of the most acute cardiovascular conditions. Purpose We evaluated the impact of the COVID-19 pandemic on the management of ST-elevation myocardial infarction (STEMI) in Switzerland by assessing a range of quality-of-care metrics during the first year of the pandemic, as compared with the preceding year. Methods Data on STEMI patients hospitalised in Switzerland from 1st January 2019 to 31st December 2020 were obtained from the Acute Myocardial Infarction in Switzerland (AMIS) registry. Symptom-to-first-medical-contact (symptom-to-FMC) time, symptom-to-door time, and door-to-balloon (DTB) time were compared between 2020 and 2019 in an analysis by year and by month. Additionally, rates of in-hospital all-cause mortality and in-hospital major adverse cardiovascular events (MACE: all-cause mortality, MI, stroke) were compared. Results Data on 2192 STEMI patients were available. Compared with the preceding 12 months, the first year of the pandemic was not associated with a significant change in median symptom-to-FMC time (2020: 90 minutes vs 2019: 95 minutes, p=0.32) or median symptom-to-door time (2020: 145 min vs 2019: 157 min, p=0.51). In 2020, February (start of the pandemic) and March (start of national lockdown) were associated with increased DTB times as compared with the same months of 2019 (+7 minutes, +10 minutes, respectively). However, overall median door-to-balloon times remained stable (2020: 40 min vs 2019: 39 min, p=0.06). Furthermore, there was no significant difference in the proportion of patients undergoing percutaneous coronary intervention (2020: 95.6% vs 2019: 95.1%, p=0.54). Finally, there were no significant differences in median length of stay (2020: 4 days vs 2019: 157 min, p=0.51), in-hospital all-cause mortality (2020: 4.9% vs. 2019: 4.2%, p=0.41) or MACE (2020: 6.2% vs. 2019: 5.6%, p=0.52). Conclusions Although there are some limitations associated with the present study inherent to its retrospective observational design (for instance, a potentially important number of late comers may not have been included in the registry), the data suggest that despite the impact of COVID-19 on the healthcare system in Switzerland in 2020, STEMI management as defined by a range of quality-of-care metrics remained effective and efficient. FUNDunding Acknowledgement Type of funding sources: None.

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