Day surgery: the impact on general practice-based primary care

Abstract Aims An updated Cochrane systematic review assessed effectiveness of screening and brief intervention to reduce hazardous or harmful alcohol consumption in general practice or emergency care settings. This paper summarises the implications of the review for clinicians. Methods Cochrane methods were followed. Reporting accords with PRISMA guidance. We searched multiple resources to September 2017, seeking randomised controlled trials of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. Brief intervention was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 min. Our primary outcome was alcohol consumption, measured as or convertible to grams per week. We conducted meta-analyses to assess change in consumption, and subgroup analyses to explore the impact of participant and intervention characteristics. Results We included 69 studies, of which 42 were added for this update. Most studies (88%) compared brief intervention to control. The primary meta-analysis included 34 studies and provided moderate-quality evidence that brief intervention reduced consumption compared to control after one year (mean difference −20 g/wk, 95% confidence interval −28 to −12). Subgroup analysis showed a similar effect for men and women. Conclusions Brief interventions can reduce harmful and hazardous alcohol consumption in men and women. Short, advice-based interventions may be as effective as extended, counselling-based interventions for patients with harmful levels of alcohol use who are presenting for the first time in a primary care setting.

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Child Health General Practice Hubs: a service evaluation

Archives of Disease in Childhood ◽

10.1136/archdischild-2015-308910 ◽

2015 ◽

Vol 101 (4) ◽

pp. 333-337 ◽

Cited By ~ 22

Author(s):

Sarah Montgomery-Taylor ◽

Mando Watson ◽

Robert Klaber

Keyword(s):

Primary Care ◽

General Practice ◽

Child Health ◽

Service Evaluation ◽

High Patient Satisfaction ◽

Patient Reported ◽

The Impact ◽

Lower Capacity ◽

Inside Out

ObjectiveTo evaluate the impact of an integrated child health system.DesignMixed methods service evaluation.Setting and patientsChildren, young people and their families registered in Child Health General Practitioner (GP) Hubs where groups of GP practices come together to form ‘hubs’.InterventionsHospital paediatricians and GPs participating in joint clinics and multidisciplinary team (MDT) meetings in GP practices, a component of an ‘Inside-Out’ change known as ‘Connecting Care For Children (CC4C)’.Main outcome measuresCases seen in clinic or discussed at MDT meetings and their follow-up needs. Hospital Episode data: outpatient and inpatient activity and A&E attendance. Patient-reported experience measures and professionals’ feedback.ResultsIn one hub, 39% of new patient hospital appointments were avoided altogether and a further 42% of appointments were shifted from hospital to GP practice. In addition, there was a 19% decrease in sub-specialty referrals, a 17% reduction in admissions and a 22% decrease in A&E attenders. Smaller hubs running at lower capacity in early stages of implementation had less impact on hospital activity. Patients preferred appointments at the GP practice, gained increased confidence in taking their child to the GP and all respondents said they would recommend the service to family and friends. Professionals valued the improvement in knowledge and learning and, most significantly, the development of trust and collaboration.ConclusionsChild Health GP Hubs increase the connections between secondary and primary care, reduce secondary care usage and receive high patient satisfaction ratings while providing learning for professionals.

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Advanced Access scheduling in general practice and use of primary care: a Danish population-based matched cohort study

BJGP Open ◽

10.3399/bjgpopen20x101091 ◽

2020 ◽

Vol 4 (5) ◽

pp. bjgpopen20X101091

Author(s):

Maria Bang ◽

Henrik Schou Pedersen ◽

Bodil Hammer Bech ◽

Claus Høstrup Vestergaard ◽

Jannik Falhof ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Cohort Study ◽

Population Based ◽

Matched Cohort ◽

Face To Face ◽

Matched Cohort Study ◽

Adjusted Incidence Rate ◽

Advanced Access ◽

The Impact

BackgroundAdvanced access scheduling (AAS) allows patients to receive care from their GP at the time chosen by the patient. AAS has shown to increase the accessibility to general practice, but little is known about how AAS implementation affects the use of in-hours and out-of-hours (OOH) services.AimTo describe the impact of AAS on the use of in-hours and OOH services in primary care.Design & settingA population-based matched cohort study using Danish register data.MethodA total of 161 901 patients listed in 33 general practices with AAS were matched with 287 837 reference patients listed in 66 reference practices without AAS. Outcomes of interest were use of daytime face-to-face consultations, and use of OOH face-to-face and phone consultations in a 2-year period preceding and following AAS implementation.ResultsNo significant differences were seen between AAS practices and reference practices. During the year following AAS implementation, the number of daytime face-to-face consultations was 3% (adjusted incidence rate ratio [aIRR] = 1.03; 95% confidence interval [CI] = 0.99 to 1.07) higher in the AAS practices compared with the number in the reference practices. Patients listed with an AAS practice had 2% (aIRR = 0.98; 95% CI = 0.92 to 1.04) fewer OOH phone consultations and 6% (aIRR = 0.94; 95% CI = 0.86 to 1.02) fewer OOH face-to-face consultations compared with patients listed with a reference practice.ConclusionThis study showed no significant differences following AAS implementation. However, a trend was seen towards slightly higher use of daytime primary care and lower use of OOH primary care.

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Improving the Management of Atrial Fibrillation in General Practice: Protocol for a Mixed Methods Study (Preprint)

10.2196/preprints.21259 ◽

2020 ◽

Author(s):

Simon de Lusignan ◽

F D Richard Hobbs ◽

Harshana Liyanage ◽

Filipa Ferreira ◽

Manasa Tripathy ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

General Practice ◽

Real World ◽

Early Recognition ◽

Phase 1 ◽

Second Phase ◽

National Guidelines ◽

Sentinel Network ◽

The Impact

BACKGROUND Atrial fibrillation (AF) is one of the commonest arrhythmias observed in general practice. The thromboembolic complications of AF include transient ischemic attack, stroke, and pulmonary embolism. Early recognition of AF can lead to early intervention with managing the risks of these complications. OBJECTIVE The primary aim of this study is to investigate if patients are managed in general practice according to current national guidelines. In addition, the study will evaluate the impact of direct oral anticoagulant use with respect to AF complications in a real-world dataset. The secondary aims of the study are to develop a dashboard that will allow monitoring the management of AF in general practice and evaluate the usability of the dashboard. METHODS The study was conducted in 2 phases. The initial phase was a quantitative analysis of routinely collected primary care data from the Oxford Royal College of General Practitioners Research and Surveillance Center (RCGP RSC) sentinel network database. AF cases from 2009 to 2019 were identified. The study investigated the impact of the use of anticoagulants on complications of AF over this time period. We used this dataset to examine how AF was managed in primary care during the last decade. The second phase involved development of an online dashboard for monitoring management of AF in general practice. We conducted a usability evaluation for the dashboard to identify usability issues and performed enhancements to improve usability. RESULTS We received funding for both phases in January 2019 and received approval from the RCGP RSC research committee in March 2019. We completed data extraction for phase 1 in May 2019 and completed analysis in December 2019. We completed building the AF dashboard in May 2019. We started recruiting participants for phase 1 in May 2019 and concluded data collection in July 2019. We completed data analysis for phase 2 in October 2019. The results are expected to be published in the second half of 2020. As of October 2020, the publications reporting the results are under review. CONCLUSIONS Results of this study will provide an insight into the current trends in management of AF using real-world data from the Oxford RCGP RSC database. We anticipate that the outcomes of this study will be used to guide the development and implementation of an audit-based intervention tool to assist practitioners in identifying and managing AF in primary care. INTERNATIONAL REGISTERED REPORT RR1-10.2196/21259

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Varicose veins are a risk factor for deep venous thrombosis in general practice patients

VASA ◽

10.1024/0301-1526/a000222 ◽

2012 ◽

Vol 41 (5) ◽

pp. 360-365 ◽

Cited By ~ 35

Author(s):

Müller-Bühl ◽

Leutgeb ◽

Engeser ◽

N. Achankeng ◽

Szecsenyi ◽

...

Keyword(s):

Primary Care ◽

General Practice ◽

Risk Factor ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Potential Risk ◽

Varicose Veins ◽

Medical Attention ◽

Increased Risk ◽

The Impact

Background: The role of varicose veins (VV) as a risk factor for development of deep venous thrombosis (DVT) is still controversial. The aim of this study in primary care was to determine the impact of varicosity as a potential risk factor for developing DVT. Patients and methods: During the observation period between 01-Jan-2008 and 01-Jan-2011, all cases with VV (ICD code I83.9) and DVT (ICD codes I80.1 - I80.9) were identified out of the CONTENT primary care register (Heidelberg, Germany). The exposure of VV and DVT was based solely on ICD coding without regarding the accuracy of the diagnosis. The covariates age, gender, surgery, hospitalization, congestive heart failure, malignancy, pregnancy, hormonal therapy, and respiratory infection were extracted for each patient. Multivariate binary logistic regression was performed in order to assess potential risk factors for DVT. The SAS procedure PROC GENMOD (SAS version 9.2, 64-bit) was parameterised accordingly. A potential cluster effect (patients within practices) was regarded in the regression model. Results: There were 132 out of 2,357 (5.6 %) DVT episodes among patients with VV compared to 728 out of 80,588 (0.9 %) in the patient cohort without VV (p < 0.0001). An increased risk of DVT was associated with previous DVT (adjusted odds ratio (OR): 9.07, 95 % confidence interval (CI): 7.78 - 10.91), VV (OR 7.33 [CI 6.14 - 8.74]), hospitalization during the last 6 months (OR 1.69 [CI 1.29 - 2.22]), malignancy (OR 1.55 [CI 1.19 - 2.02]), and age (OR 1.02 [CI 1.01 - 1.03]). Conclusions: There are strong associations between VV and DVT in a general practice population with documented VV. Special medical attention is required for patients with VV, a history of previous venous thromboembolism, comorbid malignancy, and recent hospital discharge, particularly those with a combination of these factors.

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42 Measuring disruption of UK general practice by digital first primary care: a case study examining the impact of babylon GP at hand in London

10.1136/leader-2021-fmlm.42 ◽

2021 ◽

Author(s):

Saqib Zakaria Latif ◽

Jonathan Turnbull-Ross ◽

Hui Wang ◽

Sudip Chowdhury

Keyword(s):

Primary Care ◽

General Practice ◽

The Impact

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Improving the Management of Atrial Fibrillation in General Practice: Protocol for a Mixed Methods Study

JMIR Research Protocols ◽

10.2196/21259 ◽

2020 ◽

Vol 9 (11) ◽

pp. e21259

Author(s):

Simon de Lusignan ◽

F D Richard Hobbs ◽

Harshana Liyanage ◽

Filipa Ferreira ◽

Manasa Tripathy ◽

...

Keyword(s):

Atrial Fibrillation ◽

Primary Care ◽

General Practice ◽

Real World ◽

Early Recognition ◽

Phase 1 ◽

Second Phase ◽

National Guidelines ◽

Sentinel Network ◽

The Impact

Background Atrial fibrillation (AF) is one of the commonest arrhythmias observed in general practice. The thromboembolic complications of AF include transient ischemic attack, stroke, and pulmonary embolism. Early recognition of AF can lead to early intervention with managing the risks of these complications. Objective The primary aim of this study is to investigate if patients are managed in general practice according to current national guidelines. In addition, the study will evaluate the impact of direct oral anticoagulant use with respect to AF complications in a real-world dataset. The secondary aims of the study are to develop a dashboard that will allow monitoring the management of AF in general practice and evaluate the usability of the dashboard. Methods The study was conducted in 2 phases. The initial phase was a quantitative analysis of routinely collected primary care data from the Oxford Royal College of General Practitioners Research and Surveillance Center (RCGP RSC) sentinel network database. AF cases from 2009 to 2019 were identified. The study investigated the impact of the use of anticoagulants on complications of AF over this time period. We used this dataset to examine how AF was managed in primary care during the last decade. The second phase involved development of an online dashboard for monitoring management of AF in general practice. We conducted a usability evaluation for the dashboard to identify usability issues and performed enhancements to improve usability. Results We received funding for both phases in January 2019 and received approval from the RCGP RSC research committee in March 2019. We completed data extraction for phase 1 in May 2019 and completed analysis in December 2019. We completed building the AF dashboard in May 2019. We started recruiting participants for phase 1 in May 2019 and concluded data collection in July 2019. We completed data analysis for phase 2 in October 2019. The results are expected to be published in the second half of 2020. As of October 2020, the publications reporting the results are under review. Conclusions Results of this study will provide an insight into the current trends in management of AF using real-world data from the Oxford RCGP RSC database. We anticipate that the outcomes of this study will be used to guide the development and implementation of an audit-based intervention tool to assist practitioners in identifying and managing AF in primary care. International Registered Report Identifier (IRRID) RR1-10.2196/21259

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Inequalities in general practice remote consultations: A systematic review

BJGP Open ◽

10.3399/bjgpo.2021.0040 ◽

2021 ◽

pp. BJGPO.2021.0040

Author(s):

Ruth Parker ◽

Emma Figures ◽

Charlotte Paddison ◽

James Matheson ◽

David Blane ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

General Practice ◽

Quality Of Care ◽

Clinical Outcomes ◽

The Elderly ◽

Face To Face ◽

The Impact ◽

Remote Consultations

BackgroundCOVID-19 has led to rapid and widespread use of remote consultations in general practice, but the health inequalities impact remains unknown.AimTo explore the impact of remote consultations in general practice compared to face-to-face consultations on utilisation and clinical outcomes across socio-economic and disadvantaged groups.Design & settingSystematic reviewMethodWe undertook an electronic search of MEDLINE, EMBASE and Web of Science from inception to June 2020. We included studies which compared remote consultations to face-to-face consultations in primary care and reported outcomes by PROGRESS Plus criteria. Risk of bias was assessed using ROBINS-I. Data was synthesised narratively.ResultsBased on 13 studies, exploring telephone and internet-based consultations, we found that telephone consultations were used by younger working age people, the very old and non-immigrants, with internet-based consultations more likely to be used by younger people. Women consistently used more remote forms of consulting than men. Socio-economic and ethnicity findings were mixed, with weak evidence that patients from more affluent areas were more likely to use internet-based communication. Remote consultations appeared to help patients with opioid dependence remain engaged with primary care. No studies reported on the impact on quality of care or clinical outcomes.ConclusionRemote consultations in general practice are likely to be used more by younger working people, non-immigrants, the elderly and women, with internet-based consultations more by younger, affluent and educated groups. Wide-spread use of remote consultations should be treated with caution until the inequalities impact on clinical outcomes and quality of care is known.

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Reducing missed appointments in general practice: evaluation of a quality improvement programme in East London

British Journal of General Practice ◽

10.3399/bjgp20x713909 ◽

2020 ◽

Vol 71 (702) ◽

pp. e31-e38

Author(s):

Tom Margham ◽

Crystal Williams ◽

Jack Steadman ◽

Sally Hull

Keyword(s):

Primary Care ◽

General Practice ◽

Quality Improvement ◽

Effective Practice ◽

Missed Appointments ◽

Post Intervention ◽

Primary Care Sector ◽

Appointment System ◽

Times Series Analysis ◽

The Impact

BackgroundMissed appointments are common in primary care, contributing to reduced clinical capacity. NHS England has estimated that there are 7.2 million missed general practice appointments annually, at a cost of £216 million. Reducing these numbers is important for an efficient primary care sector.AimTo evaluate the impact of a system-wide quality improvement (QI) programme on the rates of missed GP appointments, and to identify effective practice interventions.Design and settingPractices within a clinical commissioning group (CCG) in East London, with an ethnically diverse and socially deprived population.MethodStudy practices engaged in a generic QI programme, which included sharing data on appointment systems and Did Not Attend (DNA) rates. Fourteen out of 25 practices implemented DNA reduction projects, supported by practice-based coaching. Appointment data were collected from practice electronic health records. Evaluation included comparisons of DNA rates pre- and post-intervention using interrupted times series analysis.ResultsIn total, 25 out of 32 practices engaged with the programme. The mean DNA rate at baseline was 7% (range 2–12%); 2 years later the generic intervention DNA rates were 5.2%. This equates to a reduction of 4030 missed appointments. The most effective practice intervention was to reduce the forward booking time to 1 day. The practice that made this change reduced its mean DNA rate from 7.8% to 3.9%.ConclusionForward booking time in days is the best predictor of practice DNA rates. Sharing appointment data produced a significant reduction in missed appointments, and behaviour change interventions with patients had a modest additional impact; in contrast, introducing structural change to the appointment system effectively reduced DNA rates. To reduce non-attendance, it appears that the appointment system needs to change, not the patient.

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