‘Real-world’ priority setting for service improvement in English primary care: a decentred approach

BackgroundPatient engagement in safety has shown positive effects in preventing or reducing adverse events and potential safety risks. Capturing and utilising patient-reported safety incident data can be used for service learning and improvement.ObjectiveThe aim of this study was to characterise the nature of patient-reported safety incidents in primary care.DesignSecondary analysis of two cross sectional studies.ParticipantsAdult patients from Australian and English primary care settings.MeasuresPatients’ self-reported experiences of safety incidents were captured using the validated Primary Care Patient Measure of Safety questionnaire. Qualitative responses to survey items were analysed and categorised using the Primary Care Patient Safety Classification System. The frequency and type of safety incidents, contributory factors, and patient and system level outcomes are presented.ResultsA total of 1329 patients (n=490, England; n=839, Australia) completed the questionnaire. Overall, 5.3% (n=69) of patients reported a safety incident over the preceding 12 months. The most common incident types were administration incidents (n=27, 31%) (mainly delays in accessing a physician) and incidents involving diagnosis and assessment (n=16, 18.4%). Organisation of care accounted for 27.6% (n=29) of the contributory factors identified in the safety incidents. Staff factors (n=13, 12.4%) was the second most commonly reported contributory factor. Where an outcome could be determined, patient inconvenience (n=24, 28.6%) and clinical harm (n=21, 25%) (psychological distress and unpleasant experience) were the most frequent.ConclusionsThe nature and outcomes of patient-reported incidents differ markedly from those identified in studies of staff-reported incidents. The findings from this study emphasise the importance of capturing patient-reported safety incidents in the primary care setting. The patient perspective can complement existing sources of safety intelligence with the potential for service improvement.

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Primary care patients’ attitudes to priority setting in Sweden

Scandinavian Journal of Primary Health Care ◽

10.1080/02813430902883901 ◽

2009 ◽

Vol 27 (2) ◽

pp. 123-128 ◽

Cited By ~ 7

Author(s):

Eva Arvidsson ◽

Malin André ◽

Lars Borgquist ◽

Kjell Lindström ◽

Per Carlsson

Keyword(s):

Primary Care ◽

Priority Setting ◽

Primary Care Patients

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LDL-cholesterol change and goal attainment following statin intensity titration among Asians in primary care: a retrospective cohort study

Lipids in Health and Disease ◽

10.1186/s12944-020-01427-z ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Hao Sen Andrew Fang ◽

Qiao Gao ◽

Mong Li Lee ◽

Wynne Hsu ◽

Ngiap Chuan Tan

Keyword(s):

Primary Care ◽

Clinical Trials ◽

Cohort Study ◽

Real World ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Goal Attainment ◽

Real World Data ◽

World Data ◽

Asian Patients

Abstract Background Clinical trials have demonstrated that either initiating or up-titrating a statin dose substantially reduce Low-Density Lipoprotein-Cholesterol (LDL-C) levels. However, statin adherence in actual practice tends to be suboptimal, leading to diminished effectiveness. This study aims to use real-world data to determine the effect on LDL-C levels and LDL-C goal attainment rates, when selected statins are titrated in Asian patients. Methods A retrospective cohort study over a 5-year period, from April 2014 to March 2019 was conducted on a cohort of multi-ethnic adult Asian patients with clinical diagnosis of Dyslipidaemia in a primary care clinic in Singapore. The statins were classified into low-intensity (LI), moderate-intensity (MI) and high-intensity (HI) groups according to the 2018 American College of Cardiology and American Heart Association (ACC/AHA) Blood Cholesterol Guidelines. Patients were grouped into “No statin”, “Non-titrators” and “Titrators” cohorts based on prescribing patterns. For the “Titrators” cohort, the mean percentage change in LDL-C and absolute change in LDL-C goal attainment rates were computed for each permutation of statin intensity titration. Results Among the cohort of 11,499 patients, with a total of 266,762 visits, there were 1962 pairs of LDL-C values associated with a statin titration. Initiation of LI, MI and HI statin resulted in a lowering of LDL-C by 21.6% (95%CI = 18.9–24.3%), 28.9% (95%CI = 25.0–32.7%) and 25.2% (95%CI = 12.8–37.7%) respectively. These were comparatively lower than results from clinical trials (30 to 63%). The change of LDL-C levels due to up-titration, down-titration, and discontinuation were − 12.4% to − 28.9%, + 13.2% to + 24.6%, and + 18.1% to + 32.1% respectively. The improvement in LDL-C goal attainment ranged from 26.5% to 47.1% when statin intensity was up-titrated. Conclusion In this study based on real-world data of Asian patients in primary care, it was shown that although statin titration substantially affected LDL-C levels and LDL-C goal attainment rates, the magnitude was lower than results reported from clinical trials. These results should be taken into consideration and provide further insight to clinicians when making statin adjustment recommendations in order to achieve LDL-C targets in clinical practice, particularly for Asian populations.

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Family-Oriented Primary Care in the Real World

Family-Oriented Primary Care ◽

10.1007/978-1-4757-2096-9_20 ◽

1990 ◽

pp. 311-326

Author(s):

Susan H. McDaniel ◽

Thomas L. Campbell ◽

David B. Seaburn

Keyword(s):

Primary Care ◽

Real World ◽

The Real

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Cost-effectiveness of an Evidence-Based Childhood Asthma Intervention in Real-World Primary Care Settings

Journal of Ambulatory Care Management ◽

10.1097/jac.0000000000000231 ◽

2018 ◽

Vol 41 (3) ◽

pp. 213-224 ◽

Cited By ~ 3

Author(s):

Avi Dor ◽

Qian Luo ◽

Maya Tuchman Gerstein ◽

Floyd Malveaux ◽

Herman Mitchell ◽

...

Keyword(s):

Primary Care ◽

Cost Effectiveness ◽

Real World ◽

Childhood Asthma ◽

Evidence Based ◽

Primary Care Settings ◽

Asthma Intervention

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Are patients with COPD more adherent to single-inhaler compared with multiple-inhaler triple therapy in a real-world UK primary care treated population?

10.1183/13993003.congress-2021.oa2947 ◽

2021 ◽

Author(s):

Kieran Rothnie ◽

Alexandrosz Czira ◽

Chris Compton ◽

Vicky Banks ◽

Robert Wood ◽

...

Keyword(s):

Primary Care ◽

Triple Therapy ◽

Real World

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Real-World Budget Impact of the Adoption of Insulin Glargine Biosimilars in Primary Care in England (2015–2018)

Diabetes Care ◽

10.2337/dc19-2395 ◽

2020 ◽

Vol 43 (8) ◽

pp. 1767-1773 ◽

Cited By ~ 1

Author(s):

Ion Agirrezabal ◽

Eduardo Sánchez-Iriso ◽

Kiran Mandar ◽

Juan M. Cabasés

Keyword(s):

Primary Care ◽

Insulin Glargine ◽

Real World ◽

Budget Impact

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What matters most to patients about primary healthcare: mixed-methods patient priority setting exercises within the PREFeR (PRioritiEs For Research) project

BMJ Open ◽

10.1136/bmjopen-2018-025954 ◽

2019 ◽

Vol 9 (7) ◽

pp. e025954 ◽

Cited By ~ 1

Author(s):

Louisa Edwards ◽

Melody Monro ◽

Yaron Butterfield ◽

Ravin Johl ◽

Kent Cadogan Loftsgard ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Mixed Methods ◽

Priority Setting ◽

Primary Healthcare ◽

Health Resources ◽

Primary Care Providers ◽

Care Providers ◽

Online Surveys ◽

Care Research

ObjectivesTo identify patient-generated priority topics for future primary care research in British Columbia (BC), Canada within a diverse patient population.DesignMixed-methods priority setting exercises framed by the dialogue model, using the nominal group technique (rank-ordered scoring) and province-wide online surveys capturing importance ratings of the top 10 primary healthcare topics from patients and primary care providers.SettingBC, Canada.ParticipantsTopic identification was completed by 10 patient partners (7 female, 3 male) from the BC Primary Health Care Research Network Patient Advisory; online surveys were completed by 464 patients and 173 primary care providers.ResultsThe 10 members recruited to the patient advisory provided over 80 experiences of what stood out for them in BC primary care, which were grouped thematically into 18 topics, 10 of which were retained in province-wide surveys. Top-rated survey topics for both patients (n=464) and providers (n=173) included being unable to find a regular family doctor/other primary healthcare provider, support for living with chronic conditions, mental health resources and information sharing, including electronic medical records. However, all 10 topics were rated important, on average, by both groups.ConclusionsThe current project activities demonstrate the feasibility of including patients in priority setting exercises for primary healthcare in general, rather than focusing on a condition-specific population or disease area. There was considerable overlap between patient-generated topics and topics previously identified by other stakeholders, but patients identified two additional topics (mental health resources, improve and strengthen patient–provider communication). More similarities than differences in topic importance between patients and providers emerged in the online surveys. The project activities that follow (rapid literature reviews, multistakeholder dialogue) will highlight under-researched topics and inform the development of specific research questions.

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