Motivators and barriers for paediatricians discharging patients

The aim of this study was to identify motivators and barriers that paediatricians face when discharging patients from outpatient specialty care. A questionnaire was administered to outpatient care paediatricians in Victoria working in one of five speciality public hospital clinics. Questions focused on how important various motivators and barriers were in respondents’ decision to discharge a patient from their clinic. Nearly all (91%, n=74) paediatricians invited to participate provided responses. The factor influencing the greatest proportion of paediatricians in their decision to discharge patients back to primary care was the potential that patients may not receive the required care from a GP. The next most highly rated barrier was that it is too complicated to arrange discharge; rated as a very important influence by one-third of paediatricians (33%, n=24). Improvements to the discharge process may encourage more paediatricians to discharge patients back to their GP, therefore freeing up appointment slots. This in turn could reduce waiting times for paediatric outpatient clinics in Victoria. The concern from paediatricians that patients may not receive the required care from a GP warrants attention and should be further investigated.

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Use of Outpatient Care in Veterans Health Administration and Medicare among Veterans Receiving Primary Care in Community-Based and Hospital Outpatient Clinics

Health Services Research ◽

10.1111/j.1475-6773.2010.01123.x ◽

2010 ◽

Vol 45 (5p1) ◽

pp. 1268-1286 ◽

Cited By ~ 57

Author(s):

Chuan-Fen Liu ◽

Michael Chapko ◽

Chris L. Bryson ◽

James F. Burgess ◽

John C. Fortney ◽

...

Keyword(s):

Primary Care ◽

Outpatient Care ◽

Veterans Health Administration ◽

Outpatient Clinics ◽

Veterans Health ◽

Health Administration ◽

Community Based ◽

Hospital Outpatient

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Improving Access to Oral Surgery Services in Primary Care

Primary Dental Care ◽

10.1308/135576109789389540 ◽

2009 ◽

Vol os16 (4) ◽

pp. 137-142 ◽

Cited By ~ 20

Author(s):

Nick Kendall

Keyword(s):

Primary Care ◽

Oral Surgery ◽

Waiting Times ◽

Primary Care Trust ◽

Hospital Setting ◽

Substantial Improvement ◽

Dental Services ◽

Collaborative Working ◽

World Class ◽

Further Development

This paper describes the innovative use of National Health Service (NHS) dental commissioning powers to develop specialist primary care based oral surgery services. The outcomes, after one full year of the scheme, have been substantial improvement in access and reduced waiting times for patients, further development of NHS primary care dental services through commissioning processes, increased use and engagement of oral surgery specialists outside of a hospital setting, and considerable ongoing savings to the NHS. Collaborative working between hospital consultants and managers, Primary Care Trust dental commissioners, general dental practice providers, specialist oral surgeons and a dental public health consultant has resulted in sustainable benefits to patients and the NHS within the World Class Commissioning framework.

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Evaluation of Emergency Health-Care Initiatives to Reduce Overcrowding in a Referral Medical Complex, Jeddah, Saudi Arabia

Saudi Journal of Health Systems Research ◽

10.1159/000517487 ◽

2021 ◽

pp. 1-6

Author(s):

Khalid Alabbasi ◽

Estie Kruger ◽

Marc Tennant

Keyword(s):

Health Care ◽

Primary Health Care ◽

Public Hospital ◽

Waiting Times ◽

Care Centre ◽

Health Care Centre ◽

Transfer Policy ◽

Primary Health ◽

Before And After ◽

Ed Visits

Purpose: Excessive delays and emergency department (ED) overcrowding have become an increasingly major problem for public health worldwide. This study was to assess the key strategies adopted by an ED, at a public hospital in Jeddah, to reduce delays and streamline patient flow. Materials and Methods: This study was a service evaluation for a Saudi patient population of all age-groups who attended the ED of a public hospital for the period between June 2016 and July 2019. The Saudi initiative to reduce the ED visits at the King Abdullah Medical Complex hospital has started on August 7, 2018. The initiative was to apply an urgency transfer policy which outlines the procedures to follow when patients arrive to the ED where they are reviewed based on the Canadian Triage and Acuity Scale (CTAS). Patients with less-urgent conditions (category 4 and 5) are referred to a primary health-care practice (where a family medicine consultant is available). Patients with urgent conditions (category 1–3) are referred to a specialized health-care centre if the service is not currently provided. To test the effectiveness of ED initiative on reducing the overcrowd, data were categorized into before and after the initiative. The bivariate analysis χ2 tests and 2 sample t-tests were run to explore the relationship of gender and age with dependent variable emergency. Results: A total of 233,998 patients were included in this study, 61.8% of them were males and the average age of ED patients were 35.5 ± 18.6 years. The majority of cases were those classified as “less urgent” (CTAS 4), which accounted for 65.4%. Number of ED visits before and after the initiative was 67 and 33%, respectively. ED waiting times after the initiative have statistically significantly decreased across all acuity levels compared to ED waiting times before the initiative. Conclusion and Implication: The findings suggest that the majority of patients arrive to the ED with less-urgent conditions and arrived by walking-in. The number of cases attending the ED significantly decreased following the introduction of the urgency transfer policy. Referral for less-urgent patients to primary health-care centre may be an important front-end operational strategy to relieve congestion.

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493 Evaluation of Patient Waiting Times for Plain Radiographs Whilst Attending Outpatient Clinics in A Tertiary Orthopaedic Centre

British Journal of Surgery ◽

10.1093/bjs/znab134.435 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

Z Hayat ◽

E Kinene ◽

S Molloy

Keyword(s):

Waiting Time ◽

Waiting Times ◽

Time Frame ◽

Outpatient Clinics ◽

Contributing Factors ◽

Time Data ◽

Work Related ◽

Mean Waiting Time ◽

Appointment Time ◽

Related Stress

Abstract Introduction Reduction of waiting times is key to delivering high quality, efficient health care. Delays experienced by patients requiring radiographs in orthopaedic outpatient clinics are well recognised. Method To establish current patient and staff satisfaction, questionnaires were circulated over a two-week period. Waiting time data was retrospectively collected including appointment time, arrival time and the time at which radiographs were taken. Results 84% (n = 16) of radiographers believed patients would be dissatisfied. However, of the 296 patients questioned, 56% (n = 165) were satisfied. Most patients (89%) felt the waiting time should be under 30 minutes. Only 36% were seen in this time frame. There was moderate negative correlation (R=-0.5); higher waiting times led to increased dissatisfaction. Mean waiting time was 00:37 and the maximum 02:48. Key contributing factors included volume of patients, staff shortages (73.7%), equipment shortages (57.9%) and incorrectly filled request forms. Eight (42.1%) had felt unwell from work related stress. Conclusions A concerted effort is needed to improve staff and patient opinion. There is scope for change post COVID. Additional training and exploring ways to avoid overburdening the department would benefit. Numerous patients were open to different days or alternative sites. Funding requirements make updating equipment, expanding the department and recruiting more staff challenging.

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The effectiveness of different patient referral systems to shorten waiting times for elective surgeries: systematic review

BMC Health Services Research ◽

10.1186/s12913-021-06140-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Dimuthu Rathnayake ◽

Mike Clarke

Keyword(s):

Primary Care ◽

Health Systems ◽

Elective Surgery ◽

Waiting Times ◽

Surgical Care ◽

High Income ◽

Surgical Patients ◽

Timely Access ◽

Referral Systems

Abstract Background Long waiting times for elective surgery are common to many publicly funded health systems. Inefficiencies in referral systems in high-income countries are more pronounced than lower and middle-income countries. Primary care practitioners play a major role in determining which patients are referred to surgeon and might represent an opportunity to improve this situation. With conventional methods of referrals, surgery clinics are often overcrowded with non-surgical referrals and surgical patients experience longer waiting times as a consequence. Improving the quality of referral communications should lead to more timely access and better cost-effectiveness for elective surgical care. This review summarises the research evidence for effective interventions within the scope of primary-care referral methods in the surgical care pathway that might shorten waiting time for elective surgeries. Methods We searched PubMed, EMBASE, SCOPUS, Web of Science and Cochrane Library databases in December-2019 to January-2020, for articles published after 2013. Eligibility criteria included major elective surgery lists of adult patients, excluding cancer related surgeries. Both randomised and non-randomised controlled studies were eligible. The quality of evidence was assessed using ROBINS-I, AMSTAR 2 and CASP, as appropriate to the study method used. The review presentation was limited to a narrative synthesis because of heterogeneity. The PROSPERO registration number is CRD42019158455. Results The electronic search yielded 7543 records. Finally, nine articles were considered as eligible after deduplication and full article screening. The eligible research varied widely in design, scope, reported outcomes and overall quality, with one randomised trial, two quasi-experimental studies, two longitudinal follow up studies, three systematic reviews and one observational study. All the six original articles were based on referral methods in high-income countries. The included research showed that patient triage and prioritisation at the referral stage improved timely access and increased the number of consultations of surgical patients in clinics. Conclusions The available studies included a variety of interventions and were of medium to high quality researches. Managing patient referrals with proper triaging and prioritisation using structured referral formats is likely to be effective in health systems to shorten the waiting times for elective surgeries, specifically in high-income countries.

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Online Ratings of Primary Care Physicians: Comparison of Gender, Training, and Specialty

Journal of Patient Experience ◽

10.1177/23743735211007700 ◽

2021 ◽

Vol 8 ◽

pp. 237437352110077

Author(s):

Daliah Wachs ◽

Victoria Lorah ◽

Allison Boynton ◽

Amanda Hertzler ◽

Brandon Nichols ◽

...

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Waiting Times ◽

Wait Time ◽

Primary Care Providers ◽

Wait Times ◽

Care Providers ◽

Female Physicians ◽

Online Ratings ◽

And Gender

The purpose of this study was to explore patient perceptions of primary care providers and their offices relative to their physician’s philosophy (medical degree [MD] vs doctorate in osteopathic medicine [DO]), specialty (internal medicine vs family medicine), US region, and gender (male vs female). Using the Healthgrades website, the average satisfaction rating for the physician, office parameters, and wait time were collected and analyzed for 1267 physicians. We found female doctors tended to have lower ratings in the Midwest, and staff friendliness of female physicians were rated lower in the northwest. In the northeast, male and female MDs were rated more highly than DOs. Wait times varied regionally, with northeast and northwest regions having the shortest wait times. Overall satisfaction was generally high for most physicians. Regional differences in perception of a physician based on gender or degree may have roots in local culture, including proximity to a DO school, comfort with female physicians, and expectations for waiting times.

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Entry-Level Competencies Required of Primary Care Nurse Practitioners Providing HIV Specialty Care: A National Practice Validation Study

Journal of the Association of Nurses in AIDS Care ◽

10.1016/j.jana.2015.12.004 ◽

2016 ◽

Vol 27 (3) ◽

pp. 203-213 ◽

Cited By ~ 5

Author(s):

Michael V. Relf ◽

James L. Harmon

Keyword(s):

Primary Care ◽

Nurse Practitioners ◽

Validation Study ◽

Specialty Care ◽

Care Nurse ◽

Entry Level ◽

Primary Care Nurse ◽

National Practice

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Hospital – primary care articulation in care transition: both sides of the process

Revista da Escola de Enfermagem da USP ◽

10.1590/1980-220x-reeusp-2021-0145 ◽

2021 ◽

Vol 55 ◽

Author(s):

Adriéli Donati Mauro ◽

Danielle Fabiana Cucolo ◽

Marcia Galan Perroca

Keyword(s):

Primary Care ◽

Health Care ◽

Continuity Of Care ◽

Discharge Planning ◽

Patient Discharge ◽

Team Work ◽

Discharge Process ◽

Care Experience ◽

Integration Of Services ◽

Communication And Coordination

ABSTRACT Objective: To analyze how the articulation between hospital and primary health care related to patient discharge and continuity of care after hospitalization takes place. Method: Qualitative study, using the focus group technique to explore the experience of 21 nurses in hospitals (n = 10) and at primary care (n = 11) in a municipality in the northwest area of the State of São Paulo. Data collection took place between December 2019 and April 2020. Four focus groups were carried out (two in the hospital and two in the health units) and the findings underwent thematic analysis. Results: The categories identified were: Patient inclusion flow in the responsible discharge planning, Patient/family member/caregiver participation, Care planning, Communication between services, and Challenges in the discharge process. According to reports, the discharge process is centered on bureaucratic aspects with gaps in communication and coordination of care. Conclusion: This research allowed understanding how nurses from different points of health care experience the discharge and (dis)articulation of the team work. The findings can equip managers in the (re)agreement of practices and integration of services to promote continuity of care.

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Career Regret Among Physician Assistants: A Comparative Survey of Primary and Specialty Care Careers

Internet Journal of Allied Health Sciences and Practice ◽

10.46743/1540-580x/2019.1787 ◽

2019 ◽

Author(s):

Talia Sierra ◽

Jennifer Forbes ◽

Michael Nelson

Keyword(s):

Primary Care ◽

Statistical Significance ◽

Career Path ◽

Physician Assistants ◽

Student Loan ◽

Care Physician ◽

Specialty Care ◽

Care Group ◽

Care Groups ◽

Comparative Survey

Purpose: This study investigated if career regret varies among physician assistants (PAs) practicing in primary and specialty care fields. This information may assist practicing and aspiring physician assistants when selecting or changing their career path. Methods: A survey was emailed to 5,000 primary and specialty care physician assistants. Items indicating career regret were compared between primary and specialty care groups. Results: Eight hundred and thrity-four (16.7%) completed surveys were received back. Career regret is similar between primary and specialty care physician assistants, with low reports from both groups. No statistical significance was found between primary care and specialty care groups with regards to career regret or student loan debt. The primary care group noted a less sustainable work/ life balance and higher perceived burnout. Specialty care physician assistants reported higher annual gross income. Regret and disappointment correlated highly with burnout. Conclusions: Physician assistants and prospective physician assistants should carefully consider their career path as regret and disappointment correlated highly with burnout.

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