scholarly journals SP8.1.3 Primary care practitioners have a high level of satisfaction with the current breast referral pathway but the majority would support a change to patient self-referral

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Thomas Russell ◽  
Jemma Cooper ◽  
Mairead McIntyre ◽  
Sa'ed Ramzi
Keyword(s):  
Primary Care ◽  
Free Text ◽  
Referral Rates ◽  
Care Services ◽  
Primary Care Services ◽  
Level Of Satisfaction ◽  
And Gender ◽  
Primary Care Practitioners ◽  
High Level ◽  
The Impact

Abstract Aims Currently, patients must consult with a primary care practitioner (PCP) prior to being referred to specialist breast services. A change to patient self-referral would arguably reduce primary care workload, improve access for patients, and allow breast units to allocate resources more appropriately; no data currently supports this. This study aims to explore PCP’s views on breast referral, evaluate the community breast workload, and to investigate the impact of COVID-19 on referral rates. Methods An electronic survey was sent out to PCPs in South West England via two electronic newsletters. Participants were asked: their role and gender, their level of confidence surrounding breast care, details surrounding their breast workload, how they felt COVID-19 had affected their referral rates, their level of satisfaction with the current pathway, and their opinions on a potential change to patient self-referral. Results 79 responses were received. PCPs estimated that 7.0% (median) of their total consultations were regarding a breast-related issue and that COVID-19 had not had a significant impact on the rate of referral to breast units (P = 0.75). 84.8% of PCPs had a high level of satisfaction with the current referral pathway. Whilst 74.5% felt a change to patient self-referral would benefit patients and primary care services, their free text comments highlighted some of their reservations. Conclusions PCPs have a high level of satisfaction with the current breast referral pathway, but the majority would be open to a change to patient self-referral to specialist breast units.

scholarly journals 46 Primary Care Practitioners Have A High Level of Satisfaction with The Current Breast Referral Pathway but The Majority Would Support A Change to Patient Self-Referral

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Russell ◽  
J Cooper ◽  
M McIntyre ◽  
S Ramzi
Keyword(s):  
Primary Care ◽  
Free Text ◽  
Referral Rates ◽  
Care Services ◽  
Primary Care Services ◽  
Level Of Satisfaction ◽  
And Gender ◽  
Primary Care Practitioners ◽  
High Level ◽  
The Impact

Abstract Aim Currently, patients must consult with a primary care practitioner (PCP) prior to being referred to secondary care breast services. A change to patient self-referral would arguably reduce primary care workload, improve access for patients, and allow breast units to allocate resources more appropriately; no data currently supports this. This study aims to explore PCP's views on breast referral, evaluate the community breast workload, and to investigate the impact of COVID-19 on referral rates. Method An electronic survey was designed on SurveyMonkey.com which aimed to collect both quantitative and qualitative data. The weblink to the survey was sent out via two electronic newsletters. Participants were asked: their role and gender, their level of confidence surrounding breast care, details surrounding their breast workload, how they felt COVID-19 had affected their referral rates, their level of satisfaction with the current pathway, and their opinions on a potential change to patient self-referral. Results 79 responses were received. PCPs estimated that 7.0% (median) of their total consultations were regarding a breast-related issue and that COVID-19 had not had a significant impact on the rate of referral to breast units (P = 0.75). 84.8% of PCPs were satisfied with the current referral pathway. Whilst 74.5% felt a change to patient self-referral would benefit patients and primary care services, their free text comments highlighted some of their reservations. Conclusions PCPs have a high level of satisfaction with the current breast referral pathway, but the majority would be open to a change to patient self-referral to specialist breast units.

Effect of a Reduced Postpartum Length of Stay Program on Primary Care Services Use by Mothers and Infants

PEDIATRICS ◽  
2000 ◽  
Vol 106 (Supplement_3) ◽  
pp. 937-941
Author(s):  
Kenneth D. Mandl ◽  
Charles J. Homer ◽  
Oren Harary ◽  
Jonathan A. Finkelstein
Keyword(s):  
Primary Care ◽  
Length Of Stay ◽  
Early Discharge ◽  
Urgent Care ◽  
Care Utilization ◽  
Care Services ◽  
Primary Care Services ◽  
Ambulatory Services ◽  
The Impact ◽  
Services Use

Objective. To determine the impact of reduced postpartum length of stay (LOS) on primary care services use. Methods. Design: Retrospective quasiexperimental study, comparing 3 periods before and 1 period after introducing an intervention and adjusting for time trends.Setting: A managed care plan.Intervention: A reduced obstetrical LOS program (ROLOS), offering enhanced education and services.Participants: mother-infant dyads, delivered during 4 time periods: February through May 1992, 1993, and 1994, before ROLOS, and 1995, while ROLOS was in effect.Independent Measures: Pre-ROLOS or the post-ROLOS year.Outcome Measures: Telephone calls, visits, and urgent care events during the first 3 weeks postpartum summed as total utilization events. Results. Before ROLOS, LOS decreased gradually (from 51.6 to 44.3 hours) and after, sharply to 36.5 hours. Although primary care use did not increase before ROLOS, utilization for dyads increased during ROLOS. Before ROLOS, there were between 2.37 and 2.72 utilization events per dyad; after, there were 4.60. Well-child visits increased slightly to .98 visits per dyad, but urgent visits did not. Conclusion. This program resulted in shortened stays and more primary care use. There was no increase in infant urgent primary care utilization. Early discharge programs that incorporate and reimburse for enhanced ambulatory services may be safe for infants; these findings should not be extrapolated to mandatory reduced LOS initiatives without enhancement of care.

scholarly journals The impact of general practitioners working in or alongside emergency departments: a rapid realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e024501 ◽  
Author(s):  
Alison Cooper ◽  
Freya Davies ◽  
Michelle Edwards ◽  
Pippa Anderson ◽  
Andrew Carson-Stevens ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
General Practitioners ◽  
Patient Experience ◽  
Emergency Departments ◽  
Care Facility ◽  
Patient Choice ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact

ObjectivesWorldwide, emergency healthcare systems are under intense pressure from ever-increasing demand and evidence is urgently needed to understand how this can be safely managed. An estimated 10%–43% of emergency department patients could be treated by primary care services. In England, this has led to a policy proposal and £100 million of funding (US$130 million), for emergency departments to stream appropriate patients to a co-located primary care facility so they are ‘free to care for the sickest patients’. However, the research evidence to support this initiative is weak.DesignRapid realist literature review.SettingEmergency departments.Inclusion criteriaArticles describing general practitioners working in or alongside emergency departments.AimTo develop context-specific theories that explain how and why general practitioners working in or alongside emergency departments affect: patient flow; patient experience; patient safety and the wider healthcare system.ResultsNinety-six articles contributed data to theory development sourced from earlier systematic reviews, updated database searches (Medline, Embase, CINAHL, Cochrane DSR & CRCT, DARE, HTA Database, BSC, PsycINFO and SCOPUS) and citation tracking. We developed theories to explain: how staff interpret the streaming system; different roles general practitioners adopt in the emergency department setting (traditional, extended, gatekeeper or emergency clinician) and how these factors influence patient (experience and safety) and organisational (demand and cost-effectiveness) outcomes.ConclusionsMultiple factors influence the effectiveness of emergency department streaming to general practitioners; caution is needed in embedding the policy until further research and evaluation are available. Service models that encourage the traditional general practitioner approach may have shorter process times for non-urgent patients; however, there is little evidence that this frees up emergency department staff to care for the sickest patients. Distinct primary care services offering increased patient choice may result in provider-induced demand. Economic evaluation and safety requires further research.PROSPERO registration numberCRD42017069741.

scholarly journals Establishing Clinical Ethics Committees in Primary Care: A Study from Norwegian Municipal Care

HEC Forum ◽  
2021 ◽  
Author(s):  
Morten Magelssen ◽  
Heidi Karlsen ◽  
Lisbeth Thoresen
Keyword(s):  
Primary Care ◽  
Clinical Ethics ◽  
Ethics Committees ◽  
Time Frame ◽  
Next Of Kin ◽  
Care Services ◽  
Clinical Ethics Committee ◽  
Primary Care Services ◽  
Moral Problems ◽  
High Level

AbstractWould primary care services benefit from the aid of a clinical ethics committee (CEC)? The implementation of CECs in primary care in four Norwegian municipalities was supported and their activities followed for 2.5 years. In this study, the CECs’ structure and activities are described, with special emphasis on what characterizes the cases they have discussed. In total, the four CECs discussed 54 cases from primary care services, with the four most common topics being patient autonomy, competence and coercion; professionalism; cooperation and disagreement with next of kin; and priority setting, resource use and quality. Nursing homes and home care were the primary care services most often involved. Next of kin were present in 10 case deliberations, whereas patients were never present. The investigation indicates that it might be feasible for new CECs to attain a high level of activity including case deliberations within the time frame. It also confirms that significant, characteristic and complex moral problems arise in primary care services.

scholarly journals Exploring the Experiences of Changes to Support Access to Primary Health Care Services and the Impact on the Quality and Safety of Care for Homeless People During the COVID-19 Pandemic: A Study Protocol for A Qualitative Mixed Methods Approach.

2020 ◽  
Author(s):  
Kelly Howells ◽  
Martin Burrows ◽  
Mat Amp ◽  
Rachel Brennan ◽  
Wan-Ley Yeung ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Lived Experience ◽  
Health Care Services ◽  
Homeless People ◽  
Health Care Need ◽  
Seek Health Care ◽  
Care Services ◽  
High Level ◽  
The Impact

Abstract Background: Despite high level of health care need amongst people experiencing homelessness, poor access is a major concern. This is sometimes due to organisational and bureaucratic barriers, but also because they often feel stigmatised and treated badly when they do seek health care. The COVID-19 pandemic and the required social distancing measures have caused unprecedented disruption and change for the organisation of primary care, particularly for people experiencing homelessness. Against this back drop, there are many questions to address regarding whether the recent changes required to deliver services to people experiencing homelessness in the context of COVID-19 will help to address or compound problems in accessing care and inequalities in health outcomes. Methods: An action led and participatory research methodology will be employed to address the study objectives. Interviews with people experiencing homelessness were will be conducted by a researcher with lived experience of homelessness. Researchers with lived experience are able to engage with vulnerable communities in an empathetic, non-judgemental way as their shared experience promotes a sense of trust and integrity, which in turn encourages participation in research and may help people speak more openly about their experience. Interviews with health professionals and stakeholders exploring their experiences of delivering and facilitating care for homeless people during the pandemic will also be explored.Discussion: It is important to explore whether recent changes to the delivery of primary care in in response to the COVID-19 pandemic compromise the safety of homeless people and exacerbate existing health inequalities. This could have implications for how primary healthcare is delivered to those experiencing homelessness not only for the duration of the pandemic but in the future.

scholarly journals Development of a Research Tool to Document Self-Reported Chronic Conditions in Primary Care

2017 ◽  
Vol 7 (1) ◽  
pp. 117-123 ◽  
Author(s):  
Martin Fortin ◽  
José Almirall ◽  
Kathryn Nicholson
Keyword(s):  
Primary Care ◽  
Scoping Review ◽  
Chronic Conditions ◽  
Operational Definition ◽  
Research Tool ◽  
The Self ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact ◽  
Research Studies

Background Researchers interested in multimorbidity often find themselves in the dilemma of identifying or creating an operational definition in order to generate data. Our team was invited to propose a tool for documenting the presence of chronic conditions in participants recruited for different research studies. Objective To describe the development of such a tool. Design A scoping review in which we identified relevant studies, selected studies, charted the data, and collated and summarized the results. The criteria considered for selecting chronic conditions were: (1) their relevance to primary care services; (2) the impact on affected patients; (3) their prevalence among the primary care users; and (4) how often the conditions were present among the lists retrieved from the scoping review. Results Taking into account the predefined criteria, we developed a list of 20 chronic conditions/categories of conditions that could be self-reported. A questionnaire was built using simple instructions and a table including the list of chronic conditions/categories of conditions. Conclusions We developed a questionnaire to document 20 self-reported chronic conditions/categories of conditions intended to be used for research purposes in primary care. Guided by previous literature, the purpose of this questionnaire is to evaluate the self-reported burden of multimorbidity by participants and to encourage comparability among research studies using the same measurement.

scholarly journals Barriers to self-management of chronic pain in primary care: a qualitative focus group study

2016 ◽  
Vol 67 (656) ◽  
pp. e209-e217 ◽  
Author(s):  
Katy Gordon ◽  
Helen Rice ◽  
Nick Allcock ◽  
Pamela Bell ◽  
Martin Dunbar ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Focus Groups ◽  
Treatment Options ◽  
Self Management ◽  
Emotional Impact ◽  
Focus Group Study ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact

BackgroundSupported self-management is a recommended intervention for chronic pain. Effective self-management should enable an individual to reduce the impact of pain on their everyday life. Clinical guidelines suggest primary care services have a role to play in supporting self-management of chronic pain.AimTo examine the opinions of primary care healthcare professionals (HCPs) and people with chronic pain and their carers, in order to identify possible barriers to the facilitation and adoption of self-management.Design and settingA qualitative study using focus groups in locations throughout Scotland.MethodEighteen focus groups were held with patients and HCPs. Fifty-four patients, nine carers, and 38 HCPs attended the groups.ResultsFour categories of barriers were found. 1) Patient–HCP consultation: some patients felt a discussion about self-management came too late or not at all. Communication and building positive relations were sometimes challenging. 2) Patient experience: the emotional impact of pain was difficult and patients often felt unsupported by HCPs. 3) Limited treatment options: some participants felt there was a tendency for overmedicalisation. 4) Organisational constraints: short appointment times, long waiting lists, and a compartmentalised NHS created challenges.ConclusionThis study illustrates some of the barriers faced by HCPs and patients in the facilitation and adoption of self-management of chronic pain. If self-management is to be an important approach to chronic pain, primary care services need to be designed to address the barriers identified.

scholarly journals Enhanced Primary Care improves GP service regularity in older patients without impacting on service frequency

2012 ◽  
Vol 18 (4) ◽  
pp. 295 ◽  
Author(s):  
David A. J. Gibson ◽  
Rachael E. Moorin ◽  
David Preen ◽  
Jon Emery ◽  
C. D'Arcy J. Holman
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Multinomial Logistic Regression ◽  
Care Service ◽  
Primary Care Service ◽  
Service Utilisation ◽  
Relative Likelihood ◽  
Care Services ◽  
Primary Care Services ◽  
The Impact

The objective of this study was to assess the impact of Enhanced Primary Care service utilisation on subsequent GP service regularity and frequency. The study involved a retrospective population-based longitudinal cohort using linked administrative health records of hospital and primary care services for people over the age of 65 years. Multinomial logistic regression modelling was used to evaluate changes in the relative likelihood of increased primary care service regularity and frequency in exposed and unexposed individuals adjusting for age, sex and recent chronic disease hospitalisation history. Enhanced Primary Care services significantly and substantially increased the relative likelihood of increased regularity with no corresponding higher likelihood of increased frequency of GP contact. Increased regularity was more likely with increasing age except for the oldest age group (90+ years). Some chronic disease histories (e.g. diabetes) showed a higher likelihood of improved regularity while others were less likely to produce an increased regularity (e.g. hypertension). The study suggests a capacity for modification of physician and patient behaviour using incentivised services within the current fee-for-service system in Australia.

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