Palpitation referrals from primary care to a secondary care cardiology outpatient clinic: assessing adherence to guidelines

2020 ◽  
Author(s):  
Susil Pallikadavath ◽  
Roshan Patel ◽  
Rishi Sarania ◽  
Talal Ahmad ◽  
Zakariyya Vali ◽  
...  
Keyword(s):  
Primary Care ◽  
Outpatient Clinic ◽  
Secondary Care ◽  
Resonance Imaging ◽  
Adherence To Guidelines ◽  
Common Presentation ◽  
Care Services ◽  
Early Evidence ◽  
Number Of Patients ◽  
Care Guidelines

Abstract Background and aims Palpitations are a common presentation in primary care. Guidelines have been developed to identify patients with palpitations who require further assessment by a cardiologist in secondary care. However, patients that do not meet guideline thresholds for referrals are still referred to secondary care services. This audit evaluated the adherence to referral guidelines at our trust and assessed the characteristics of patients who were referred appropriately versus those referred without meeting guideline referral thresholds (inappropriate referral). Results Palpitation referrals to a single cardiology outpatient clinic were assessed (n = 66). Half the patients referred for palpitations were referred inappropriately (n = 34, 51.5%). Patients referred inappropriately were more likely to have a benign diagnosis after assessment (91.2%). These patients also had significantly fewer investigations [mean difference of 1.1 (confidence interval: 0.6–1.6)]. Specialist investigations, such as cardiac event recorders (P < 0.05) and cardiac magnetic resonance imaging (P < 0.05) were less likely to be used in inappropriately referred patients. Conclusions The results from this audit provide early evidence that there are a significant number of patients who are being referred that could be managed in primary care. Further studies are needed to confirm our findings in larger cohorts and to establish the underlying reasons for inappropriate referrals.

scholarly journals Referrals to Urgent Dental Centres During the COVID-19 Pandemic: A Multi-Site Analysis Research Project

2021 ◽  
Vol 10 (1) ◽  
pp. 40-45
Author(s):  
Adam Shathur ◽  
Samuel Reeves ◽  
Faizal Sameja ◽  
Vishal Patel ◽  
Allan Jones
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Easy Access ◽  
Dental Services ◽  
Care Services ◽  
Dental Practitioners ◽  
Consultation And Referral ◽  
Care Systems ◽  
Access To Primary Care ◽  
The Uk

Introduction: The COVID-19 pandemic enforced the cessation of routine dentistry and the creation of local urgent dental care systems in the UK. General dental practices are obligated by NHS guidance to remain open and provide remote consultation and referral where appropriate to patients having pain or problems. Aims: To compare two urgent dental centres with different triage and referral systems with regard to quality and appropriateness of referrals, and patient management outcomes. Methods: 110 consecutive referrals received by a primary care urgent dental centre and a secondary care urgent dental centre were assessed. It was considered whether the patients referred had access to remote primary care dental services, fulfilled the criteria required to be deemed a dental emergency as mandated by NHS guidance, and what the outcomes of referrals were. Results: At the primary care centre, 100% of patients were referred by general dental practitioners and had access to remote primary care dental services. 95.5% of referrals were deemed appropriate and were seen for treatment. At the secondary care site, 94.5% of referrals were direct from the patient by contacting NHS 111. 40% had received triaging to include ‘advice, analgesia and antimicrobial’ from a general dental practitioner, and 25.5% were deemed appropriate and resulted in treatment. Conclusion: Urgent dental centres face many issues, and it would seem that easy access to primary care services, collaboration between primary care clinicians and urgent dental centres, and training of triaging staff are important in operating a successful system.

scholarly journals The orthopaedic waiting list crisis

2021 ◽  
Vol 2 (7) ◽  
pp. 530-534
Author(s):  
Matthew Hampton ◽  
Ella Riley ◽  
Naren Garneti ◽  
Alexander Anderson ◽  
Kevin Wembridge
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Waiting Lists ◽  
Waiting List ◽  
Retrospective Data ◽  
Day Case ◽  
Number Of Patients ◽  
Robust Planning ◽  
Therapy Services ◽  
Patient Referrals

Aims Due to widespread cancellations in elective orthopaedic procedures, the number of patients on waiting list for surgery is rising. We aim to determine and quantify if disparities exist between inpatient and day-case orthopaedic waiting list numbers; we also aim to determine if there is a ‘hidden burden’ that already exists due to reductions in elective secondary care referrals. Methods Retrospective data were collected between 1 April 2020 and 31 December 2020 and compared with the same nine-month period the previous year. Data collected included surgeries performed (day-case vs inpatient), number of patients currently on the orthopaedic waiting list (day-case vs inpatient), and number of new patient referrals from primary care and therapy services. Results There was a 52.8% reduction in our elective surgical workload in 2020. The majority of surgeries performed in 2020 were day case surgeries (739; 86.6%) with 47.2% of these performed in the independent sector on a ‘lift and shift’ service. The total number of patients on our waiting lists has risen by 30.1% in just 12 months. As we have been restricted in performing inpatient surgery, the inpatient waiting lists have risen by 73.2%, compared to a 1.6% rise in our day-case waiting list. New patient referral from primary care and therapy services have reduced from 3,357 in 2019 to 1,722 in 2020 (49.7% reduction). Conclusion This study further exposes the increasing number of patients on orthopaedic waiting lists. We observed disparities between inpatient and day-case waiting lists, with dramatic increases in the number of inpatients on the waiting lists. The number of new patient referrals has decreased, and we predict an influx of referrals as the pandemic eases, further adding to the pressure on inpatient waiting lists. Robust planning and allocation of adequate resources is essential to deal with this backlog. Cite this article: Bone Jt Open 2021;2(7):530–534.

Perinatal Depression and Use of Health Services in British Women of Pakistani Origin

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
I. Mukherjee ◽  
M. Husain ◽  
S. Khan ◽  
N. Husain
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Perinatal Depression ◽  
Perinatal Period ◽  
Health Events ◽  
Care Services ◽  
Significant Difference ◽  
Pakistani Origin ◽  
Health Event ◽  
Depressed Mothers

Background:Perinatal depression (PND) has adverse effects on the well being of the mother-infant dyad. Women with PND often show different patterns of help seeking behaviour.Objective:We aimed to examine the association between PND and the reporting of health events and healthcare use in a cohort of British women of Pakistani origin.Method:Participants were recruited from antenatal clinics in the North West of England and followed up 6 months postnatal. Sixty-seven women diagnosed with depression using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) were compared with 156 non depressed controls in terms of reporting of health events elicited using the Life Events and Difficulties Schedule (LEDS). Health events included any condition that involved attending primary or secondary care.Results:Depressed mothers were 1.5 times more likely to report a health event within the perinatal period (p=0.005) and 1.8 times more likely to report a health event (0.031) outside the perinatal period. Depressed mothers were more likely to attend secondary care services for their children (p=0.001) but there was no significant difference in terms of attendance at primary care.Conclusion:Depressed mothers were more likely to report personal health events and more likely to access secondary care rather than primary care services for health events affecting their children. This highlights the hidden costs of this condition and the need for adequate diagnosis and management of this treatable but under recognised illness.

scholarly journals Alapellátás, alapellátók Magyarországon, 2018

2019 ◽  
Vol 160 (24) ◽  
pp. 926-935
Author(s):  
Imre Rurik
Keyword(s):  
Primary Care ◽  
Professional Education ◽  
Undergraduate Education ◽  
Family Physicians ◽  
Policy Makers ◽  
Low Health Literacy ◽  
Number Of Patients ◽  
Care Guidelines ◽  
Performance Payment ◽  
Administrative Tasks

Abstract: Trends and the main problems since the introduction of primary care (PC) system in Hungary (1992) were evaluated. Shortage of human resources, reduced professional competences, enormous administrative burden, and inappropriate health policy is described. There are no primary care guidelines and reliable quality indicators. Professional education of family physicians, working nowadays in the PC system, is appropriate. Their workload and the number of patients’ visit are high, mainly because of the low health literacy in the general population and due to the administrative requirements. Although financing has been increased in the previous years, it is less than desired. PC needs a priority in the healthcare system; providers need higher income and attractive professional carrier, more focus to PC in the undergraduate education. Legislations in PC should be based on conceptual planning and consensus of professional bodies. Decision making needs a previous evaluation of expected outcomes, quality insurance should be developed, appropriate performance payment, less and rational administrative tasks, new structures of PC provision should be implemented respecting the local needs, supported by a clear communication of policy makers. PC system at higher level could have more benefit for the population. Orv Hetil. 2019; 160(24): 926–935.

Phased return to dental services during the delay phase of the COVID-19 pandemic

2020 ◽  
Vol 11 (4) ◽  
pp. 186-189
Author(s):  
Jose Rodriguez ◽  
Harpoonam Kalsi
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Scoring System ◽  
Efficient Allocation ◽  
Allocation Of Resources ◽  
Dental Services ◽  
Patient Risk ◽  
Number Of Patients ◽  
High Clinical Risk ◽  
Dental Appointments

A high number of patients in primary and secondary care had their dental treatments cancelled following the suspension of all primary care routine dental services in late March 2020 in response to the COVID-19 pandemic. This article outlines a protocol which can be used to classify patients according to their clinical needs and their COVID-19 risk to prioritise appointments appropriately during the delay phase of the COVID-19 pandemic. Patients should be classified into low or high clinical risk, and low or high COVID-19 risk. Both scores are entered into a matrix which gives a score that can be used to prioritise their needs. From the scores, it is possible to determine which treatments can be delayed, which patients need virtual consultations, and which patients need to be seen urgently. The scoring system can be used in primary and secondary care, across all dental specialties, and allows efficient allocation of resources, ensuring that patients with urgent clinical needs are prioritised accordingly. Classifying patient risk using a priority scoring system will allow for appropriate workforce distribution and allocation of dental appointments.

scholarly journals The role of trust and hope in antipsychotic medication reviews between GPs and service users a realist review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
L. M. Grünwald ◽  
C. Duddy ◽  
R. Byng ◽  
N. Crellin ◽  
J. Moncrieff
Keyword(s):  
Primary Care ◽  
Antipsychotic Medication ◽  
Perceived Risk ◽  
Secondary Care ◽  
Realist Review ◽  
Service Users ◽  
Programme Theory ◽  
Care Services ◽  
Low Expectations ◽  
Medication Reviews

Abstract Background Increasing number of service users diagnosed with schizophrenia and psychosis are being discharged from specialist secondary care services to primary care, many of whom are prescribed long-term antipsychotics. It is unclear if General Practitioners (GPs) have the confidence and experience to appropriately review and adjust doses of antipsychotic medication without secondary care support. Aim To explore barriers and facilitators of conducting antipsychotic medication reviews in primary care for individuals with no specialist mental health input. Design & setting Realist review in general practice settings. Method A realist review has been conducted to synthesise evidence on antipsychotic medication reviews conducted in primary care with service users diagnosed with schizophrenia or psychosis. Following initial scoping searches and discussions with stakeholders, a systematic search and iterative secondary searches were conducted. Articles were systematically screened and analysed to develop a realist programme theory explaining the contexts (C) and mechanisms (M) which facilitate or prevent antipsychotic medication reviews (O) in primary care settings, and the potential outcomes of medication reviews. Results Meaningful Antipsychotic medication reviews may not occur for individuals with only primary care medical input. Several, often mutually reinforcing, mechanisms have been identified as potential barriers to conducting such reviews, including low expectations of recovery for people with severe mental illness, a perceived lack of capability to understand and participate in medication reviews, linked with a lack of information shared in appointments between GPs and Service Users, perceived risk and uncertainty regarding antipsychotic medication and illness trajectory. Conclusions The review identified reciprocal and reinforcing stereotypes affecting both GPs and service users. Possible mechanisms to counteract these barriers are discussed, including realistic expectations of medication, and the need for increased information sharing and trust between GPs and service users.

scholarly journals Implementation of a standardised annual anticoagulation specialist review in primary care

2020 ◽  
Vol 21 ◽  
Author(s):  
Nathan W. Hutchinson-Jones ◽  
Sophie K. Didcott ◽  
Matthew D. Jones ◽  
Josephine N. Crowe
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Anticoagulation Management ◽  
Risk Of Bleeding ◽  
Number Of Patients ◽  
Before And After ◽  
Inflammatory Drugs ◽  
Preventable Harm

Abstract An increasing number of patients are being prescribed direct oral anticoagulants (DOACs), while the patients who remain on warfarin are becoming more complex. There is currently a lack of a standardised anticoagulation review for patients in primary care, resulting in potentially preventable harm events. Our aim was to implement a new service, where a standardised review is carried out by a specialist multidisciplinary secondary care anticoagulation team. Overall, the implementation of a standardised review resulted in better optimisation of anticoagulation management for patients taking either a DOAC or a warfarin. Of the 172 eligible patients prescribed warfarin, 47 (27%) chose to switch a DOAC. The average time in therapeutic range for patients on warfarin before and after the pilot increased from 73.5% to 75%. Of 482 patients taking a DOAC, 35 (7%) were found to be on incorrect dose. In 32 (91%) of 35 patients, the dose was amended after notifying the patient’s general practitioner. We also found a significant number of patients inappropriately prescribed concomitant medication such as antiplatelet or non-steroidal anti-inflammatory drugs, potentially putting the patients at an elevated risk of bleeding. While further research is needed; we believe the results of this pilot can be used to help build a case to influence the commissioning of anticoagulation services. Secondary care anticoagulation teams, like our own, may be well-placed to provide or support such services, by working across the primary care and secondary care interface to support our primary care colleagues.

HealthPathways: creating a pathway for health systems reform

2015 ◽  
Vol 39 (1) ◽  
pp. 9 ◽  
Author(s):  
Suzanne Robinson ◽  
Richard Varhol ◽  
Colin Bell ◽  
Frances Quirk ◽  
Learne Durrington
Keyword(s):  
New Zealand ◽  
System Integration ◽  
Secondary Care ◽  
Waiting Times ◽  
Barriers And Facilitators ◽  
Care Services ◽  
Early Evidence ◽  
The Right ◽  
The Impact ◽  
Delivery Of Health Services

Inefficiencies in the co-ordination and integration of primary and secondary care services in Australia, have led to increases in waiting times, unnecessary presentations to emergency departments and issues around poor discharge of patients. HealthPathways is a program developed in Canterbury, New Zealand, that builds relationships between General Practitioners and Specialists and uses information technology so that efficiency is maximised and the right patient is given the right care at the right time. Healthpathways is being implemented by a number of Medicare Locals across Australia however, little is known about the impact HealthPathways may have in Australia. This article provides a short description of HealthPathways and considers what it may offer in the Australian context and some of the barriers and facilitators to implementation. What is known about the topic? Early evidence on HealthPathways suggests that the program does seem to be strengthening relationships between GPs and secondary care specialists. In New Zealand advances in efficiency and system integration have been noted. However, there is limited evidence on the effectiveness of HealthPathways in Australia. What does this paper add? It is one of the first published papers to provide a perspective around HealthPathways and draws existing evidence and research to explore some of the barriers and facilitators to the development and implementation of HealthPathways in Australia. What are the implications for practitioners’? Early evidence suggests HealthPathways could help GPs and other practitioners’ in the delivery of health services, it could also help to strengthen practitioner relationships.

Do rhinology care pathways in primary care influence the quality of referrals to secondary care?

2013 ◽  
Vol 127 (4) ◽  
pp. 364-367 ◽  
Author(s):  
N Su ◽  
P P Cheang ◽  
H Khalil
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Secondary Care ◽  
Evidence Based ◽  
Care Pathways ◽  
Diagnosis And Management ◽  
Care Guidelines ◽  
Evidence Based Guidelines ◽  
Referral Letters

AbstractBackground:Chronic sinusitis is the most common routine presentation for a general ENT surgeon. The 2007 ‘Primary Care Guidelines: European Position Paper on the Primary Care Diagnosis and Management of Rhinosinusitis and Nasal Polyps’ aimed to deliver evidence-based guidelines for the diagnosis and management of rhinosinusitis in specialist and primary care.Objective:The aim of this audit was to assess the information provided in the referral letters to the ENT department regarding patients with potential rhinosinusitis, and compare this to the information required for the rhinology care pathways.Method:We evaluated one month of referrals to the ENT department.Results:The quality of information in the referral letters was poor. Only 22 per cent of patient referrals included basic information about symptoms, duration and treatment.Conclusion:We plan to investigate why general practitioners are not complying with the pathway. In addition, the pathways will be more widely disseminated via the ‘Map of Medicine’ (an online resource for general practitioners). This should facilitate the receipt of the best evidence-based treatment for patients prior to referral to secondary care.

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