An alternative clerkship model for ambulatory training: An interdisciplinary primary care experience

1993 ◽  
Vol 5 (4) ◽  
pp. 197-201 ◽  
Author(s):  
Barbara A. Fenton ◽  
Gail J. Povar
Keyword(s):  
Primary Care ◽  
Care Experience ◽  
Ambulatory Training

scholarly journals National Competencies for Registered Nurses in Primary Care: A Delphi Study

2020 ◽  
Vol 42 (12) ◽  
pp. 1078-1087
Author(s):  
Julia Lukewich ◽  
Michelle Allard ◽  
Lisa Ashley ◽  
Kris Aubrey-Bassler ◽  
Denise Bryant-Lukosius ◽  
...  
Keyword(s):  
Primary Care ◽  
Registered Nurses ◽  
Delphi Study ◽  
Delphi Consensus ◽  
Care Experience ◽  
Role Integration ◽  
Partnership Quality ◽  
Research Leadership ◽  
Team Functioning ◽  
Final Round

A Delphi (consensus) process was used to obtain national agreement on competencies for registered nurses (RNs) in primary care. A draft of competencies was developed by key informants. Following this, nurses with primary care experience/expertise completed a Delphi survey to rate the importance of competency statements on a six-point Likert scale. Statements not reaching consensus (agreement ≥80%) were modified and included in a second (final) round. The first survey was completed by 63% ( n = 86/137) of participants and 84% ( n = 72/86) of these participants completed the second survey. Most statements ( n = 45) achieved agreement after the first survey; one statement was dropped and two were combined following the second round. The final list of competencies consists of 47 statements across six domains (professionalism; clinical practice; communication; collaboration and partnership; quality assurance, evaluation, and research; leadership). National competencies will help strengthen the RN workforce within primary care, improve team functioning, and support role integration/optimization.

Establishment of Primary Care Continuity Experiences in Community Pediatricians' Offices: Nuts and Bolts

PEDIATRICS ◽  
1993 ◽  
Vol 91 (6) ◽  
pp. 1185-1189
Author(s):  
Janice R. Sargent ◽  
Lucy M. Osborn ◽  
Kenneth B. Roberts ◽  
Thomas G. DeWitt
Keyword(s):  
Primary Care ◽  
Medical Education ◽  
Professional Education ◽  
Primary Care Physicians ◽  
Clinical Training ◽  
Clinical Teaching ◽  
Tertiary Care ◽  
Ambulatory Training ◽  
Lengths Of Stay ◽  
Tertiary Care Centers

During the past 30 years, there has been an increasing awareness of the importance of ambulatory care training in medical education. The discrepancy between education and practice was pointed out in the General Professional Education Panel report that indicated training was based largely in hospital settings even though the vast majority of doctor-patient encounters do not result in hospitalization.1 Perkoff,2 noting changes in hospital care such as shorter lengths of stay, increased outpatient care, and the need for well-trained primary care physicians, stated that programs need to make a major effort to emphasize clinical teaching in outpatient settings. Recognizing the need for these changes, the Accreditation Council on Graduate Medical Education (ACGME) has increased dramatically the requirement in primary care specialties for clinical ambulatory training.3 For pediatrics, these requirements have progressed from the suggestion that clinical training should be obtained in outpatient clinics (1961) to requiring clinical training in primary care clinics weekly for 3 years (1985). The problems in providing good training in ambulatory settings have been well described.2-4 In comparison inpatient teaching, training students and residents in an outpatient clinic is inefficient and costly. One of the methods suggested to address these problems has been to move ambulatory training out of tertiary care centers to community sites.5-9 Many pediatric programs are now using community sites for at least a portion of resident education.10 Alpert et al10 and Greenberg et al,11 although encouraging the use of these sites to reduce the gap between pediatric education and the service delivery system, pointed out that there are no standards for use of community sites.

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

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.

scholarly journals Delivering on the Promise: Exploring Training Characteristics and Graduate Career Pursuits of Primary Care Internal Medicine Residency Programs and Tracks

2019 ◽  
Vol 11 (4) ◽  
pp. 447-453
Author(s):  
Robin Klein ◽  
Samantha Alonso ◽  
Caitlin Anderson ◽  
Akanksha Vaidya ◽  
Nour Chams ◽  
...  
Keyword(s):  
Internal Medicine ◽  
Primary Care ◽  
Clinical Experiences ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Training Time ◽  
Residency Programs ◽  
Primary Care Internal Medicine ◽  
Ambulatory Training ◽  
Curricular Content

ABSTRACT Background Specialized primary care internal medicine (PC IM) residency programs and tracks aim to provide dedicated PC training. How programs deliver this is unclear. Objective We explored how PC IM programs and tracks provide ambulatory training. Methods We conducted a cross-sectional survey from 2012 to 2013 of PC IM program and track leaders via a search of national databases and program websites. We reported PC IM curricular content, clinical experiences, and graduate career pursuits, and assessed correlation between career pursuits and curricular content and clinical experiences. Results Forty-five of 70 (64%) identified PC IM programs and tracks completed the survey. PC IM programs provide a breadth of curricular content and clinical experiences, including a mean 22.8 weeks ambulatory training and a mean 69.4 continuity clinics per year. Of PC IM graduates within 5 years, 55.8% pursue PC or general internal medicine (GIM) careers and 23.1% pursue traditional subspecialty fellowship training. Curricular content and clinical experiences correlate weakly with career choices. PC IM graduates pursuing PC or GIM careers correlated with ambulatory rotation in women's health (correlation coefficient [rho] = 0.36, P = .034) and mental health (rho = 0.38, P = .023) and curricular content in teaching and medical education (rho = 0.35, P = .035). PC IM graduates pursuing subspecialty fellowship negatively correlated with curricular content in leadership and teams (rho = -0.48, P = .003) and ambulatory training time (rho = -0.38, P = .024). Conclusions PC IM programs and tracks largely deliver on the promise to provide PC training and education and produce graduates engaged in PC and GIM.

scholarly journals First-episode psychosis: primary care experience and implications for service development

2009 ◽  
Vol 33 (5) ◽  
pp. 165-168 ◽  
Author(s):  
Mamdouh El-Adl ◽  
John Burke ◽  
Karen Little
Keyword(s):  
Primary Care ◽  
Early Intervention ◽  
General Practitioners ◽  
Psychiatric Service ◽  
First Episode Psychosis ◽  
Health Clinic ◽  
First Episode ◽  
Care Experience ◽  
Episode Psychosis ◽  
Early Intervention In Psychosis

Aim and MethodsTo capture the local primary care experience of first-episode psychosis before developing a local early intervention in psychosis service. A survey of Northamptonshire general practitioners (GPs) using a confidential questionnaire was carried out.ResultsOut of 284 GPs, 123 (43%) responded. General practitioners are unlikely to start treatment before referring to a specialist service: 63 GPs (51% of responders) start treatment in 10% or less of individuals with first-episode psychosis and 19 (15.5%) GPs start treatment in 75% or more before referring them to psychiatric service; 42 GPs (34%) refer those who request/accept a referral and 66 GPs (53%) refer all even if they refuse. Overall, 92 GPs (74%) agreed that an early intervention in psychosis service is needed and 77 (63%) GPs welcome having a mental health clinic in their surgery.Clinical ImplicationsIndividuals are more likely to accept referral to a psychiatric service if offered than to ask for it. People disengaging, stigma, the service being difficult to access/inappropriate and carers' lack of knowledge about mental illness are the likely causes for delayed referral.

Integrated Pediatric Health Care in Pennsylvania: A Survey of Primary Care and Behavioral Health Providers

2018 ◽  
Vol 58 (2) ◽  
pp. 213-225 ◽  
Author(s):  
David J. Kolko ◽  
Eunice Torres ◽  
Kevin Rumbarger ◽  
Everette James ◽  
Renee Turchi ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Behavioral Health ◽  
Integrated Care ◽  
Primary Care Physicians ◽  
Empirical Literature ◽  
Health Providers ◽  
Pediatric Health ◽  
Care Experience ◽  
Pediatric Health Care

This study reports on a statewide survey of medical and behavioral health professionals to advance the knowledge base on the benefits and obstacles to delivering integrated pediatric health care. Surveys distributed in 3 statewide provider networks were completed by 110 behavioral health specialists (BHSs) and 111 primary care physicians (PCPs). Survey content documented their perceptions about key services, benefits, barriers, and needed opportunities related to integrated care. Factor analyses identified 8 factors, and other items were examined individually. We compared responses by specialty group (BHS vs PCP) and integrated care experience (no vs yes). The findings revealed differences across domains by specialty subgroup. In several cases, BHS (vs PCP) respondents, especially those with integrated care experience, reported lower benefits, higher barriers, and fewer resource requests. The implications of these results for enhancing care integration development, delivery, training, and research are discussed along with the study’s limitations and empirical literature.

Optimizing the management of depression: primary care experience

2014 ◽  
Vol 220 ◽  
pp. S45-S57 ◽  
Author(s):  
Catherine Cameron ◽  
Jeff Habert ◽  
Leena Anand ◽  
Melissa Furtado
Keyword(s):  
Primary Care ◽  
Care Experience

scholarly journals Does the Primary Care Experience Influence the Cancer Diagnostic Process?

2015 ◽  
Vol 2015 ◽  
pp. 1-12 ◽  
Author(s):  
Sylvie Provost ◽  
Raynald Pineault ◽  
Pierre Tousignant ◽  
Danièle Roberge ◽  
Dominique Tremblay ◽  
...  
Keyword(s):  
Primary Care ◽  
Metastatic Cancer ◽  
Diagnostic Process ◽  
Process Time ◽  
Care Experience ◽  
Usual Source ◽  
Point Of Entry ◽  
Experience Of Care ◽  
Time To Diagnosis ◽  
The Impact

Objective. To analyze the impact of patients’ experience of care at their usual source of primary care on their choice of point of entry into cancer investigation process, time to diagnosis, and presence of metastatic cancer at time of diagnosis. Method. A questionnaire was administered to 438 patients with cancer (breast, lung, and colorectal) between 2011 and 2013 in four oncology clinics of Quebec (Canada). Multiple regression analyses (logistic and Cox models) were conducted. Results. Among patients with symptoms leading to investigation of cancer (n=307), 47% used their usual source of primary care as the point of entry for investigation. Greater comprehensiveness of care was associated with the decision to use this source as point of entry (OR = 1.25; CI 90% = 1.06–1.46), as well as with shorter times between first symptoms and investigation (HR = 1.11; p=0.05), while greater accessibility was associated with shorter times between investigation and diagnosis (HR = 1.13; p<0.01).  Conclusion. Experience of care at the usual source of primary care has a slight influence on the choice of point of entry for cancer investigation and on time to diagnosis. This influence appears to be more related to patients’ perceptions of the accessibility and comprehensiveness of their usual source of primary care.

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