Quality and targeting of new referrals for ocular complications of diabetes from primary care to a public hospital ophthalmology service in Western Sydney, Australia

2020 ◽  
Vol 26 (4) ◽  
pp. 293 ◽  
Author(s):  
Belinda Ford ◽  
Lisa Keay ◽  
Blake Angell ◽  
Stephanie Hyams ◽  
Paul Mitchell ◽  
...  
Keyword(s):  
Primary Care ◽  
Wait Time ◽  
Public Hospitals ◽  
Cross Sectional ◽  
Primary Care Settings ◽  
South Wales ◽  
Diabetes Status ◽  
Westmead Hospital ◽  
Patients With Diabetes ◽  
Endothelial Growth Factor

Patients with diabetes require regular examination for eye disease, usually in primary care settings. Guidelines recommend patients with at least moderate non-proliferative diabetic retinopathy (NPDR) be referred to an ophthalmologist for treatment; however, poorly targeted referrals lead to access blocks. The quality of new referrals associated with diabetes to a public ophthalmology service in Sydney, New South Wales, Australia, were assessed for referral completeness and targeting. A cross-sectional audit of medical records for new patients referred to Westmead Hospital Eye Clinic in 2016 was completed. Completeness of medical and ophthalmic information in referrals and subsequent patient diagnosis and management in 2016–17 was recorded. Sub-analyses were conducted by primary care referrer type (GP or optometrist). In total, 151 new retinopathy referrals were received; 12% were sent directly to a treatment clinic. Information was incomplete for diabetes status (>60%), medical (>50%) and ophthalmic indicators (>70%), including visual acuity (>60%). GP referrals better recorded medical, and optometrists (37%) ophthalmic information, but information was still largely incomplete. Imaging was rarely included (retinal photos <1%; optical coherence tomography <3%). Median appointment wait-time was 124 days; 21% of patients received treatment (laser or anti-vascular endothelial growth factor) at this or the following encounter. Targeting referrals for ocular complication of diabetes to public hospitals needs improvement. Education, feedback and collaborative care mechanisms should be considered to improve screening and referral in primary care.

Personality and cardiovascular risk: Association between hypertension and affective temperaments—a cross-sectional observational study in primary care settings

2014 ◽  
Vol 20 (4) ◽  
pp. 247-252 ◽  
Author(s):  
Ajandek Eory ◽  
Xenia Gonda ◽  
Zsolt Lang ◽  
Peter Torzsa ◽  
Janos Kalman ◽  
...  
Keyword(s):  
Primary Care ◽  
Cardiovascular Risk ◽  
Observational Study ◽  
Cross Sectional ◽  
Affective Temperaments ◽  
Primary Care Settings ◽  
Risk Association

scholarly journals Hypoglycemia Prevention Practice and Associated Factors Among Patients with Diabetes Mellitus Following at Public Hospitals of Central Zone, Tigray, Ethiopia, 2018

2019 ◽  
Author(s):  
Gebrewahd Bezabh Gebremichael ◽  
Teklewoini Mariye Zemichael
Keyword(s):  
Diabetes Mellitus ◽  
Associated Factors ◽  
Central Zone ◽  
Public Hospitals ◽  
P Value ◽  
Diabetic Patients ◽  
Binary Logistic Regression Model ◽  
Cross Sectional ◽  
Patients With Diabetes ◽  
At Home

Abstract Background Hypoglycemia is an acute medical situation that occurs when blood sugar falls below the recommended level. Even though, hypoglycemia prevention practice in the management of diabetes mellitus is one cornerstone in controlling the effect of hypoglycemia, hypoglycemia prevention practice among patients with diabetes mellitus is insufficiently studied. Moreover, the existed scarce literature in Ethiopia revealed hypoglycemia prevention practice is inadequate. Thus, this study tried to assess hypoglycemia prevention practices and associated factors among diabetic patients. Methods Hospital-based, cross-sectional study design was employed from April one to March one 2018 in Central Zone of Tigray Regional state of Ethiopia. A total of 272 diabetes mellitus patients were selected by systematic random sampling method from study area. The collected data was checked for its completeness and then entered into Epi data version 3.1 then cleaned and analyzed using SPSS version 23. Binary logistic regression model (AOR, 95% CI and p-value < 0.05) was used to determine the predictors of hypoglycemia prevention practice. Results the mean age of respondents was 52.19 years and about 100 (63.2%) had good hypoglycemia prevention practice. Knowledge regarding hypoglycemia [AOR = 10.34; 95% CI [5.41, 19.89]], having a glucometer at home [AOR=3. 02; 95% CI [1.12, 8.12]], attitude regarding diabetes mellitus [AOR = 2.36 CI [1.26, 4.39]], being governmental employee [AOR=5. 19, 95% CI [1.63, 16.58]] and being divorced [AOR = 0.13, 95% CI [0.32, 0.53]] were found significantly associated with good hypoglycemia prevention practice. Conclusion Around two third of the study participants were found to have good hypoglycemia prevention practice. Good knowledge and favorable attitude toward diabetes mellitus, having glucometer at home, being governmental employee and divorced were found to be the predictors of good hypoglycemia prevention practice.

scholarly journals Therapeutic inertia in proteinuria management among type 2 diabetes (T2DM) patients in primary care settings: prevalence and associated risk factors

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
FU Leung Chan ◽  
Yim Chu Li ◽  
Xiao Rui Catherine Chen
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Clinical Practice ◽  
Stepwise Logistic Regression ◽  
Continuous Variables ◽  
Cross Sectional ◽  
Case Register ◽  
Negatively Associated ◽  
Therapeutic Inertia ◽  
Primary Care Settings

Abstract Background Therapeutic inertia (TI), defined as physicians’ failure to increase therapy when treatment goals are unmet, is an impediment to chronic disease management. This study aimed to identify the prevalence of TI in proteinuria management among T2DM patients managed in primary care settings and to explore possible associating factors. Methods This was a cross-sectional study. T2DM patients with proteinuria (either microalbuminuria or macroalbuminuria) and had been followed up in 7 public primary care clinics of the Hospital Authority of Hong Kong from 1 Jan, 2014 to 31 Dec, 2015 were included. The prevalence of TI in proteinuria management and its association with patients’ demographic and clinical parameters and the working profile of the attending doctors were explored. Student’s t test and analysis of variance were used for analyzing continuous variables and Chi square test was used for categorical data. Multivariate stepwise logistic regression was used to determine the association between TI and the significant variables from patients' and doctors' characteristics. Results Among the 22,644 T2DM patients identified in the case register, 5163 (26.4%) patients were found to have proteinuria. Among the sampled 385 T2DM patients with proteinuria, TI was identified in 155 cases, with a prevalence rate of 40.3%. Male doctor, doctor with longer duration of clinical practice and have never received any form of Family Medicine training were found to have a higher TI. Patients with microalbuminuria range and lower systolic and diastolic blood pressure (BP) were also found to have higher TI. Logistic regression study revealed that patients’ systolic BP level and microalbuminuria range of proteinuria were negatively associated with the presence of TI, whereas doctor’s year of clinical practice being over 20 years and patients being treated with submaximal dose of medication were positively associated with the presence of TI. Conclusions TI is commonly present in proteinuria management among T2DM patients, with a prevalence of 40.3% in primary care. Systolic BP and microalbuminuria range of urine ACR were negatively associated with the presence of TI, whereas submaximal ACEI/ARB dose and doctors practicing over 20 years were positively associated with the presence of TI. Further studies exploring the strategies to combat TI are needed to improve the clinical outcome of T2DM patients.

scholarly journals Assessing a national policy on strengthening chronic care in primary care settings of a low-resource country using patients' perspectives.

2020 ◽  
Author(s):  
Paibul Suriyawongpaisal ◽  
Wichai Aekplakorn ◽  
Samrit Srithamrongsaw ◽  
Phanuwich Kaewkamjonchai
Keyword(s):  
Primary Care ◽  
Chronic Care ◽  
Care Quality ◽  
Local Health ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Mixed Effect ◽  
Multiprofessional Team ◽  
Primary Care Settings ◽  
Healthcare Needs

Abstract Background To improve care for patients with chronic diseases, a recent policy initiative in Thailand focuses on strengthening primary care including training of the team to deliver healthcare based on the concept of Chronic Care Model(CCM). This study conducted a cross-sectional survey of 4,071 patients with hypertension and/or diabetes registered to 25 primary care units and 16 hospital NCD clinics in 11 provinces (76 in total) to examine the effects of provider training and local health systems settings on patients’ perception of the chronic care quality.Methods A home-based interview with questionnaire was conducted on the patients in primary care settings. The questionnaire was adopted from the Thai version of the Patient Assessment of Chronic Illness Care (PACIC+) developed by the MacColl Institute for Healthcare Innovation. The questionnaire contains 20 items from the original PACIC, which measure different parts of the CCM, and an additional 6 items assess the 5A Model.Mixed effect models were employed to compare subscale of patient perception of the care quality between trained upgraded PCUs, upgraded PCUs, ordinary PCUs and NCD clinics. Upgraded PCUs were ordinary PCUs with the multiprofessional team including a physician. Trained upgraded PCUs were upgraded PCUs with the training input.Results Mixed effect models depicted an independent association between every PACIC subscale (as a measure of CCM) and facility type with the maximum likelihood for patients of ordinary PCU reporting high to highest scores (ORs: 1.52-1.76; p<0.05) compared to hospital NCD clinics. This is also the case for patients: seeing the same doctor on repeated visits (ORs: 1.66-1.87; p<0.05) or having phone contacts of the providers (ORs:1.42-1.63; p<0.05). Similarly, across all of the 5A model subscales, ORs for patients attending ordinary PCU responded with high to highest scores were 1.4-2.0 times compared to those for patients attending hospital NCD clinics(p<0.05). Conclusions We could not find evidence to support effectiveness of the training approach. The training failure might indicate a need to address mismatch between health workforce and workload. It also indicates a need to incorporate fidelity check into any training program for chronic care addressing the complex healthcare needs.

scholarly journals Parental Activation and Obesity-Related Health Behaviors Among a Racially and Ethnically Diverse Population of Low-Income Pediatric Patients: Protocol for a Cross-Sectional Survey Study (Preprint)

2017 ◽  
Author(s):  
Nakiya N Showell ◽  
Corinna Koebnick ◽  
Lisa R DeCamp ◽  
Margo Sidell ◽  
Tatiahna Rivera Rodriguez ◽  
...  
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Health Care ◽  
Health Behaviors ◽  
Health Systems ◽  
Low Income ◽  
Screen Time ◽  
Aged Patients ◽  
Cross Sectional ◽  
Primary Care Settings

BACKGROUND Despite a recent decline in the obesity prevalence among preschool-aged children, obesity remains disproportionately high among children from low-income racial or ethnic minority families. Promoting healthy lifestyles (eg, obesity-preventative behaviors) in primary care settings is particularly important for young children, given the frequency of preventative health visits and parent-provider interactions. Higher adoption of specific health behaviors is correlated with increased patient activation (ie, skill, confidence, and knowledge to manage their health care) among adults. However, no published study, to date, has examined the relationship between parental activation and obesity-related health behaviors among young children. OBJECTIVE The goal of this study is to measure parental activation in low-income parents of preschoolers in 2 large health systems and to examine the association with diet, screen-time, and physical activity behaviors. METHODS We will conduct a cross-sectional study of parents of preschool-aged patients (2-5 years) receiving primary care at multiple clinic sites within 2 large health care systems. Study participants, low-income black, Hispanic, and white parents of preschool-aged patients, are being recruited across both health systems to complete orally administered surveys. RESULTS Recruitment began in December 2017 and is expected to end in May 2018. A total of 267 low-income parents of preschool-aged children have been enrolled across both clinic sites. We are enrolling an additional 33 parents to reach our goal sample size of 300 across both health systems. The data analysis will be completed in June 2018. CONCLUSIONS This protocol outlines the first study to fully examine parental activation and its relationship with parent-reported diet, physical activity, and screen-time behaviors among low-income preschool-aged patients. It involves recruitment across 2 geographically distinct areas and resulting from a partnership between researchers at 2 different health systems with multiple clinical sites. This study will provide new knowledge about how parental activation can potentially be incorporated as a strategy to address childhood obesity disparities in primary care settings. INTERNATIONAL REGISTERED REPOR RR1-10.2196/9688

scholarly journals Development of a Brief Patient-Administered Screening Tool for Prescription Opioid Dependence for Primary Care Settings

Pain Medicine ◽  
2019 ◽  
Author(s):  
Suzanne Nielsen ◽  
Louisa Picco ◽  
Gabrielle Campbell ◽  
Nicholas Lintzeris ◽  
Briony Larance ◽  
...  
Keyword(s):  
Primary Care ◽  
Opioid Dependence ◽  
Goodness Of Fit ◽  
Screening Tool ◽  
Prescription Opioid ◽  
Underlying Structure ◽  
Global Public Health ◽  
Cross Sectional ◽  
Chronic Noncancer Pain ◽  
Primary Care Settings

Abstract Objective To develop a short, patient-administered screening tool that will allow for earlier assessment of prescription opioid dependence (often referred to as addiction) in primary care settings. Design and Setting Cross-sectional analysis (N = 1,134) from the two-year time point of the Pain and Opioids IN Treatment (POINT) cohort was used in the scale development. Subjects Participants who completed two-year interviews in the POINT study, a prospective cohort study that followed people with chronic noncancer pain over a five-year period, and who were prescribed strong opioids for a minimum of six weeks at baseline. Methods An advisory committee provided advice on wording and content for screening in primary care settings. Univariate logistic regression identified individual items that were significantly associated with meeting ICD-11 criteria for prescription opioid dependence. Exploratory and confirmatory factor analysis (EFA and CFA) were conducted, and items were reduced to identify a small item set that were discriminative and shared a simple underlying structure. Results Sixty-four variables associated with ICD-11 criteria for prescription opioid dependence were initially identified. Four rounds of EFA were performed, resulting in five items remaining. CFA identified two possible four-item combinations, with the final combination chosen based on greater item endorsement and the results of goodness-of-fit indices. Conclusions Addressing prescription opioid dependence is an important part of the global public health challenge surrounding rising opioid-related harm. This study addresses an important initial requisite step to develop a brief screening tool. Further studies are required to validate the tool in clinical settings.

scholarly journals P084: Waiting makes me sick: is it time for formal triage in primary care?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S106-S106
Author(s):  
J. MacKay ◽  
P.R. Atkinson ◽  
M. Howlett ◽  
E. Palmer ◽  
J. Fraser ◽  
...  
Keyword(s):  
Primary Care ◽  
Wait Time ◽  
Patient Survey ◽  
Wait Times ◽  
Cross Sectional ◽  
Triage System ◽  
Care Appointment ◽  
Open Scheduling ◽  
Primary Care Practices ◽  
Advanced Access

Introduction: Patient morbidity and mortality are influenced by delay in access to care and lack of continuity of care. Patients frequently present to the emergency department (ED) for care despite being registered with a primary care (PC) provider. Advanced access is an open scheduling system promoted by the College of Family Physicians of Canada that triages primary care (PC) patients to be seen within 24 hours, reducing care delay. We wished to determine the prevalence of formal triage systems in PC appointment allocation. Methods: We performed linked cross sectional surveys to quantify the number of ambulatory patients presenting to a tertiary urban ED (with an annual census of 56,000 visits) who felt unable to access primary care. PC practices were also surveyed to assess use of formal triage methods and measure access using the metric of time to third next available appointment. Descriptive statistics were calculated. Results: In the patient survey, 381 of 580 patients consented to participate. Of those, 324 patients reported reasons for their ED visit. Perception that wait time for PC was “too long” was reported in 73/324 (23%); 86% reported wait times of greater than 48 hours. The PC practice response rate was 63.8% (46/ 72). The mean time to third next available appointment was 7.7 (95% CI 4.9-10.5) days (median 5 days, range 0-50 days). No PC practice reported utilizing a formal triage system when booking appointments. Conclusion: No primary care practices in the surveyed region used a formal triage system to allocate appointments, despite a range of wait times that extended up to 50 days. The safety of primary care appointment allocation may be improved with introduction of a formal triage system, especially if overall wait times cannot be reduced.

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