scholarly journals Consultations for gastroenteritis in general practice and out-of-hours services in Norway 2006–15

2019 ◽  
Vol 36 (5) ◽  
pp. 614-620
Author(s):  
Knut Erik Emberland ◽  
Knut-Arne Wensaas ◽  
Sverre Litleskare ◽  
Guri Rortveit
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Young Adults ◽  
Young Children ◽  
Health Care Services ◽  
Point Of Care ◽  
Outcome Variable ◽  
Gastrointestinal Infections ◽  
Out Of Hours ◽  
Children And Young Adults

Abstract Background Most of the patients with gastroenteritis seeking health care services are managed in primary care; yet, little is known about these consultations. Syndromic-based surveillance of gastrointestinal infections is used in several countries, including Norway. Aim To investigate the extent of, and explore characteristics associated with, consultations for gastroenteritis in primary care and to compare consultations in daytime general practice and out-of-hours (OOH) services in Norway. Design and Setting Registry-based study using reimbursement claims data from all consultations in general practice and OOH services in Norway over the 10-year period, 2006–15. Methods The main outcome variable was whether the consultation took place in general practice or OOH services. Possible associations with patient age and sex, time and use of point-of-care C-reactive protein (CRP) testing and sickness certificate issuing were investigated. Results Gastroenteritis consultations (n = 1 281 048) represented 0.9% of all consultations in primary care (n = 140 199 637), of which 84.4% were conducted in general practice and 15.6% in OOH services. Young children and young adults dominated among the patients. Point-of-care CRP testing was used in 36.1% of the consultations. Sickness certificates were issued in 43.6% of consultations with patients in working age. Age-specific time variations in consultation frequencies peaking in winter months were observed. Conclusions The proportion of gastroenteritis consultations was higher in the OOH services when compared with daytime general practice. Young children and young adults dominated among the patients. The seasonal variation in consultation frequency is similar to that shown for gastroenteritis caused by norovirus.

scholarly journals Prospective analysis of phoned potassium results and what general practitioners do with them: a pilot study

2018 ◽  
Vol 55 (6) ◽  
pp. 710-712
Author(s):  
Jennifer S Johnstone ◽  
Michael J Murphy
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Pilot Study ◽  
Information Management ◽  
Laboratory Information Management System ◽  
Information Management System ◽  
Prospective Analysis ◽  
Out Of Hours ◽  
A Prospective Study ◽  
Laboratory Information Management

Background Communicating abnormal results to requesting clinicians is an essential part of clinical authorisation. Guidance from the Royal College of Pathologists on communication of critical/unexpected results is issued as ‘advice to pathologists’. The 2017 guidelines advise rapid communication of serum potassium results ≤2.5 mmol/L and ≥6.5 mmol/L. Little is known about what happens after the results have been communicated. We wished to establish answers to the following questions: Are phoned results acted on? If so, when? What is the outcome of any action taken? Methods A prospective study of primary care potassium results authorised out of hours was undertaken. Potassium requests from primary care were retrieved from the laboratory information management system. The potassium result was recorded, along with other data. Data were analysed for potassium results that were validated out of hours (18:00 h–08:00 h). Results Over six months, 220 potassium results <3.1 mmol/L and >5.9 mmol/L from primary care were validated out of hours. A subset of these (27) were phoned to the general practice out of hours ‘hub’, and 16 patients referred to hospital out of hours, on account of the potassium results. The remaining potassium results phoned out of hours were acted on subsequently. Conclusions Critical potassium results were phoned urgently and are acted on, although not always out of hours. For potassium results phoned out of hours, the most frequent action was to refer to hospital out of hours. Different actions occurred for similar potassium results, reflecting the fact that actions taken and their urgency depend on the patient, the clinician and the practice policy for handling results.

scholarly journals Daytime use of general practice and use of the Out-of-Hours Primary Care Service for patients with chronic disease: a cohort study

2014 ◽  
Vol 15 (1) ◽  
Author(s):  
Lone Flarup ◽  
Grete Moth ◽  
Morten Bondo Christensen ◽  
Mogens Vestergaard ◽  
Frede Olesen ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Cohort Study ◽  
Chronic Disease ◽  
Care Service ◽  
Primary Care Service ◽  
Out Of Hours

scholarly journals Provider perspectives on general practice in Henan, China: a mixed-methods study

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e036240
Author(s):  
Jiming Zhu ◽  
Proochista Ariana
Keyword(s):  
Public Health ◽  
Primary Care ◽  
General Practice ◽  
Mixed Methods ◽  
Central Government ◽  
Point Of Care ◽  
Primary Care System ◽  
Common People ◽  
Provider Perspectives ◽  
Care System

ObjectiveSince 2011 China’s central government has committed to establishing a new ‘general practitioner’ (GP)-centred primary care system. To this end there have been great efforts to train an additional 300 000 GPs by 2020. This paper examines the perspective of practitioners in Henan, China, regarding general practice.DesignA mixed-methods approach using focus group discussions (FGD), and structured questionnaires.Setting/participantsSeven FGDs and responses to 1887 questionnaires included medical students, primary care doctors and GP residents in Henan.ResultsThe three surveyed medical groups have some awareness of the attributes of general practice (eg, comprehensiveness, first contact and coordination), but often misinterpret what being a GP entails. Five themes were identified through the FGDs and tested quantitatively for their prevalence with structured questionnaires. First, the GPs’ role as a comprehensive care provider was (mis)interpreted as an ‘all-round doctor’. Second, the GP’s responsibility as the first point of care was understood in two conflicting ways: private personal doctors of the rich and the powerful or village doctors for common people. Third, referral was understood as simply guiding patients to appropriate departments within the hospital while the gatekeeping role was interpreted to involve GPs being peoples’ health protectors rather than being also gatekeepers of specialty services. Traditional Chinese medicine now further complicates the understanding of GPs. And lastly, the GPs’ main responsibility was considered to be public health work.ConclusionThe misunderstandings of the roles and responsibilities of GPs render problematic the policy foundation of China’s GP-centred primary care system. Pursuing the quantity of GPs on its own is meaningless, since the number needed depends on the delineated role of GPs. Top priority is to establish clarity about the GP role, which requires reforming the health delivery system to address issues with fragmented care, strategically taking into account the development of GPs with work delegation and substitution and providing more clarity on the distinction between general practice and public health.

Pharmacist’s Demand for Optimal Primary Care Service Delivery in a Community Pharmacy: The OPTiPharm Study

2017 ◽  
Vol 51 (12) ◽  
pp. 1069-1076 ◽  
Author(s):  
Mark A. Munger ◽  
Michael Walsh ◽  
Jon Godin ◽  
Michael Feehan
Keyword(s):  
Primary Care ◽  
Community Pharmacy ◽  
Health Care Services ◽  
Point Of Care ◽  
Care Service ◽  
Community Pharmacists ◽  
Care Services ◽  
Primary Health ◽  
Primary Health Care Services ◽  
Pharmacy Setting

Background: The US population continues to expand providing the need for primary health care services. Community pharmacies integrated with medicine may provide greater access while providing high quality care. Objective: To gauge pharmacists’ demand for primary health care services delivered through community pharmacies. Methods: An online survey was administered to determine community pharmacists’ preferences for varying primary care services that could be offered in the community pharmacy setting. A Discrete Choice Experiment was employed to show pharmacists competing scenarios with varied primary care service offerings in the community pharmacy setting. Attributes evaluated were operation hours, service provider, medical records, service logistics, physical examinations, point-of-care diagnostic testing, preventative care, and drug prescribing. Respondents chose the scenario most likely to induce switching employment from base pharmacy to one providing advanced services. Results: The optimal service delivery model from 291 community pharmacists comprised: inclusion of patient prescriptions and health information into the patient’s medical record; provision of point of care testing and vital sign, including blood pressure, heart rate and breathing rate, and blood sugar and cholesterol measurement; and pharmacists prescribing (under physician oversight). Pharmacists were 4 times more likely to switch employment from their current pharmacy to their choice for advanced pharmacy services. Pharmacist demand was highest among those with a PharmD, less experience, working >40 hours per week, and in rural areas. Conclusions: This study provides empirical support for the model of pharmacists playing a greater role in the provision of primary care health services through community pharmacy settings.

scholarly journals Living large: the experiences of large-bodied women when accessing general practice services

2013 ◽  
Vol 5 (3) ◽  
pp. 199 ◽  
Author(s):  
Nicola Russell ◽  
Jenny Carryer
Keyword(s):  
Health Care ◽  
General Practice ◽  
Health Care Providers ◽  
Health Care Services ◽  
Point Of Care ◽  
Social Stigma ◽  
Care Providers ◽  
Care Needs ◽  
Care Services ◽  
Verbal Insults

INTRODUCTION: Numerous studies report high levels of stigma and discrimination experienced by obese/overweight women within the health care system and society at large. Despite general practice being the most utilised point of access for health care services, there is very little international or national exploration of the experiences of large-bodied women (LBW) accessing these services. The aim of this study was to explore LBW’s experiences of accessing general practice services in New Zealand. METHODS: This is a qualitative, descriptive, feminist study. Local advertising for participants resulted in eight self-identified, large-bodied women being interviewed. A post-structural feminist lens was applied to the data during thematic analysis. FINDINGS: The women in this study provided examples of verbal insults, inappropriate humour, negative body language, unmet health care needs and breaches of dignity from health care providers in general practice. Seven themes were identified: early experiences of body perception, confronting social stereotypes, contending with feminine beauty ideals, perceptions of health, pursuing health, respecting the whole person, and feeling safe to access care. CONCLUSION: Pressure for body size vigilance has, in effect, excluded the women in this study from the very locations of health that they are ‘encouraged’ to attend – including socialising and exercising in public, screening opportunities that require bodily exposure, and accessing first point of care health services. KEYWORDS: General practice; obesity; primary health care; social stigma; women

scholarly journals Point-of-care blood tests during home visits by out-of-hours primary care clinicians; a mixed methods evaluation of a service improvement

BMJ Open ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. e033428
Author(s):  
Gail Hayward ◽  
Sharon Dixon ◽  
Sophie Garland ◽  
Margaret Glogowska ◽  
Helen Hunt ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Point Of Care ◽  
Home Visits ◽  
Total Carbon ◽  
Secondary Outcome ◽  
Service Improvement ◽  
Team Approach ◽  
Out Of Hours ◽  
Blood Tests

ObjectivesWe aimed to evaluate test usage and patient and clinician experience following the introduction of point-of-care (POC) blood tests into a primary care out-of-hours service.DesignA mixed methods service evaluation comprising quantitative records of the clinical contexts of tests taken and qualitative interviews with clinicians. Research permissions and governance were obtained for patient interviews.SettingOut-of-hours primary care.ParticipantsAll patients requiring home visits from the service during the implementation period.InterventionsThe i-STAT POC blood test platform was introduced to two bases providing home visits for a period of 8 months. Venous blood samples were used and two cartridges were available. The CHEM8 cartridge measures sodium, potassium, chloride, total carbon dioxide (TCO2), anion gap, ionised calcium, glucose, urea, creatinine, haematocrit and haemoglobin. The CG4 cartridge measures lactate, pH, PaO2 and PCO2, TCO2, bicarbonate, base excess and oxygen saturation.Primary and secondary outcome measuresThe proportion of home visits where tests were taken, the clinical contexts of those tests, the extent to which clinicians felt the tests had influenced their decisions, time taken to perform the test and problems encountered. Clinician and patient experiences of using POC tests.Resultsi-STAT POC tests were infrequently used, with successful tests taken at just 47 contacts over 8 months of implementation. The patients interviewed felt that testing had been beneficial for their care. Clinician interviews suggested barriers to POC tests, including practical challenges, concerns about time, doubt over whether they would improve clinical decision making and concern about increased medicolegal risk. Suggestions for improving adoption included sharing learning, adopting a whole team approach and developing protocols for usage.ConclusionsPOC tests were not successfully adopted by an out-of-hours home visiting service in Oxfordshire. While some clinicians felt they could not add value, in other cases they resulted in improved patient experience. Adoption could be promoted by improving technical, team and education factors.

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