Associations of types of primary care facilities with adult vaccination and cancer screening in Japan

Abstract Objective To examine the association between primary care facility types and the quality of preventive care, especially adult vaccination and cancer screening, with a focus on the differences between community clinics and hospitals. Design Multicenter cross-sectional study. Setting A primary care practice-based research network in Japan (25 primary care facilities). Participants Adult outpatients for whom the participating facility serves as their usual source of care. Intervention None. Main Outcome Measures Influenza and pneumococcal vaccination delivery and performance of colorectal, breast and cervical cancer screening. Results Data collected from 1725 primary care outpatients were analyzed. After adjustment of possible confounders and clustering within facilities, hospital-based practices were significantly associated with poorer uptake of influenza [adjusted odds ratio (aOR) = 0.64, 95% confidence interval (CI) 0.42–0.96] and pneumococcal vaccines (aOR = 0.55, 95% CI 0.40–0.75) and colorectal cancer screening (aOR = 0.59, 95% CI 0.39–0.88) compared with clinic-based practices. In contrast, the associations of types of primary care facilities with uptake of breast and cervical cancer screening were not statistically significant. Conclusions Differences in the performance of adult vaccination and cancer screening raised concerns about the provision of preventive care at hospital-based compared with clinic-based primary care practices. Efforts to improve preventive care at hospital-based primary care practices should help to promote equalization of the quality of primary care. Further study is needed on the comparisons of other quality indicators among different structures of primary care facilities.

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Organizational Change: A Way to Increase Colon, Breast and Cervical Cancer Screening in Primary Care Practices

Journal of Community Health ◽

10.1007/s10900-010-9309-7 ◽

2010 ◽

Vol 36 (2) ◽

pp. 281-288 ◽

Cited By ~ 14

Author(s):

Ana Maria Arroyave ◽

Eribeth K. Penaranda ◽

Carmen L. Lewis

Keyword(s):

Primary Care ◽

Cervical Cancer ◽

Organizational Change ◽

Cancer Screening ◽

Cervical Cancer Screening ◽

Breast And Cervical Cancer ◽

Care Practices ◽

Primary Care Practices

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Associations of primary care structures with polypharmacy and patient-reported indicators in patients with complex multimorbidity: a multicentre cross-sectional study in Japan

BMJ Open ◽

10.1136/bmjopen-2021-054348 ◽

2022 ◽

Vol 12 (1) ◽

pp. e054348

Author(s):

Takuya Aoki ◽

Yasuki Fujinuma ◽

Masato Matsushima

Keyword(s):

Primary Care ◽

Cross Sectional Study ◽

Lower Prevalence ◽

Cross Sectional ◽

Community Orientation ◽

Patient Reported ◽

Care Facilities ◽

Care Practices ◽

Primary Care Practices

ObjectivesEvidence supporting the effects of primary care structures on the quality of care for patients with complex multimorbidity, which is one of the most important challenges facing primary care, is scarce internationally. This study aimed to examine the associations of the types of primary care facilities with polypharmacy and patient-reported indicators in patients with complex multimorbidity, with a focus on differences between community clinics and hospitals.DesignMulticentre cross-sectional study.SettingA total of 25 primary care facilities (19 community clinics and 6 small- and medium-sized hospitals).ParticipantsAdult outpatients with complex multimorbidity, which was defined as the co-occurrence of three or more chronic conditions affecting three or more different body systems within one person.Primary outcome measurePolypharmacy, the Patient-Reported Experience Measure using the Japanese version of Primary Care Assessment Tool Short Form (JPCAT-SF) and the Patient-Reported Outcome Measure using self-rated health status (SRH).ResultsData were analysed for 492 patients with complex multimorbidity. After adjustment for possible confounders and clustering within facilities, clinic-based primary care practices were significantly associated with a lower prevalence of polypharmacy, higher JPCAT-SF scores in coordination and community orientation, and a lower prevalence of poor or fair SRH compared with hospital-based primary care practices. In contrast, the JPCAT-SF score in first contact was significantly lower in clinic-based practices. The associations between the types of primary care facilities and JPCAT-SF scores in longitudinality and comprehensiveness were not statistically significant.ConclusionsClinic-based primary care practices were associated with a lower prevalence of polypharmacy, better patient experience of coordination and community orientation, and better SRH in patients with complex multimorbidity compared with hospital-based primary care practices. In the primary care setting, small and tight teams may improve the quality of care for patients with complex multimorbidity.

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Assessing methods for measurement of clinical outcomes and quality of care in primary care practices

BMC Health Services Research ◽

10.1186/1472-6963-12-214 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 23

Author(s):

Michael E Green ◽

William Hogg ◽

Colleen Savage ◽

Sharon Johnston ◽

Grant Russell ◽

...

Keyword(s):

Primary Care ◽

Quality Of Care ◽

Clinical Outcomes ◽

Care Practices ◽

Primary Care Practices

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A qualitative study of high-performing primary care practices during the COVID-19 pandemic

BMC Family Practice ◽

10.1186/s12875-021-01589-4 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Stephanie L. Albert ◽

Margaret M. Paul ◽

Ann M. Nguyen ◽

Donna R. Shelley ◽

Carolyn A. Berry

Keyword(s):

Primary Care ◽

Chronic Disease ◽

Disease Management ◽

Service Delivery ◽

Preventive Care ◽

Chronic Disease Management ◽

High Performing ◽

Care Processes ◽

Care Practices ◽

Primary Care Practices

Abstract Background Primary care practices have remained on the frontline of health care service delivery throughout the COVID-19 pandemic. The purpose of our study was to understand the early pandemic experience of primary care practices, how they adapted care processes for chronic disease management and preventive care, and the future potential of these practices’ service delivery adaptations. Methods We interviewed 44 providers and staff at 22 high-performing primary care practices located throughout the United States between March and May 2020. Interviews were transcribed and coded using a modified rapid assessment process due to the time-sensitive nature of the study. Results Practices reported employing a variety of adaptations to care during the COVID-19 pandemic including maintaining safe and socially distanced access through increased use of telehealth visits, using disease registries to identify and proactively outreach to patients, providing remote patient education, and incorporating more home-based monitoring into care. Routine screening and testing slowed considerably, resulting in concerns about delayed detection. Patients with fewer resources, lower health literacy, and older adults were the most difficult to reach and manage during this time. Conclusion Our findings indicate that primary care structures and processes developed for remote chronic disease management and preventive care are evolving rapidly. Emerging adapted care processes, most notably remote provision of care, are promising and may endure beyond the pandemic, but issues of equity must be addressed (e.g., through payment reform) to ensure vulnerable populations receive the same benefit.

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Inappropriate use of fecal occult blood testing for colorectal cancer screening in primary care practices at a VA hospital

Gastroenterology ◽

10.1016/s0016-5085(08)83006-5 ◽

2001 ◽

Vol 120 (5) ◽

pp. A604-A605 ◽

Cited By ~ 1

Author(s):

Furquaan Ahmed ◽

Uma K. Murthy ◽

Ronald D. Szyjkowski ◽

Ronald P. Schmidt

Keyword(s):

Colorectal Cancer ◽

Primary Care ◽

Cancer Screening ◽

Occult Blood ◽

Fecal Occult Blood Testing ◽

Fecal Occult Blood ◽

Inappropriate Use ◽

Fecal Occult ◽

Care Practices ◽

Primary Care Practices

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Supporting Goal-Oriented Primary Health Care for Seniors’ with Multimorbidity and Complex Care Needs using Mobile Technology: Mixed-Methods, Stepped-Wedge Cluster Randomized Trial of the ePRO Tool. (Preprint)

10.2196/preprints.29071 ◽

2021 ◽

Author(s):

Carolyn Steele Gray ◽

Phat (Eduard) Chau ◽

Farah Tahsin ◽

Sarah Harvey ◽

Mayura Loganathan ◽

...

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Control Period ◽

Self Management ◽

Care Needs ◽

Ethnographic Data ◽

Care Practices ◽

Primary Care Practices ◽

Complex Care Needs

BACKGROUND Goal-oriented care is being adopted to deliver person-centred primary care to older adults with multimorbidity and complex care needs. While this model holds promise, implementation remains a challenge. Digital health solutions may enable processes to improve adoption, however, they require evaluation to determine feasibility and impact. OBJECTIVE This study evaluates the implementation and effectiveness of the electronic Patient Reported Outcome (ePRO) mobile application and portal system, designed to enable goal-oriented care delivery in inter-professional primary care practices. The research questions driving this study are: 1) Does ePRO improve quality of life and self-management in older adults with complex needs, and 2) what mechanisms are likely driving observed outcomes? METHODS A multi-method pragmatic randomized control trial using a stepped-wedge design and ethnographic case studies was conducted over a 15-month period in 6 comprehensive primary care practices across Ontario with a target enrolment of 176 patients. The 6 practices were randomized into either early (3-month control period; 12-month intervention) or late (6-month control period; 9-month intervention) groups. The primary outcome measure of interest was the Assessment of Quality of Life-4D (AQoL-4D). Data were collected at baseline and at 3 monthly intervals for the duration of the trial. Ethnographic data included observations and interviews with patients and providers at the mid-point and end of the intervention. Outcome data were analyzed using linear models conducted at the individual level, accounting for cluster effects at the practice level, and ethnographic data was analyzed using qualitative description and framework analysis methods. RESULTS Recruitment challenges resulted in fewer sites and participants than expected; only 142 of the 176 eligible patients were identified due to lower than expected provider participation and fewer than expected patients willing to participate or perceived as ready to engage in goal setting. Of 142 patients approached, 45 patients participated (32%). Patients set a variety of goals related to self-management, mental health, social health and overall well-being. Due to underpowering, the impact of ePRO on quality of life could not be definitively assessed; however the intervention group, ePRO plus usual care (M = 15.28, SD = 18.60), demonstrated non-significant slight decrease in quality of life, t(24)= -1.20, P = 0.24, when compared to usual care only (M = 21.76, SD = 2.17). The ethnographic data reveals a complex implementation process, in which the meaningfulness (or coherence) of the technology to individuals lives and work acted as a key driver to adoption and tool appraisal. CONCLUSIONS This trial experienced many unexpected and significant implementation challenges related to recruitment and engagement. Future studies could be improved through better alignment of the research methods and intervention to the complex and diverse clinic settings, dynamic goal-oriented care process, and readiness of provider and patient participants. CLINICALTRIAL ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954?intr=epro&cntry=CA&rank=1

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The Association Between Continuity of Primary Care and Preventive Cancer Screening in Women With Intellectual Disability

American Journal on Intellectual and Developmental Disabilities ◽

10.1352/1944-7558-123.6.499 ◽

2018 ◽

Vol 123 (6) ◽

pp. 499-513 ◽

Cited By ~ 2

Author(s):

Natasha Plourde ◽

Hilary K. Brown ◽

Simone Vigod ◽

Virginie Cobigo

Keyword(s):

Primary Care ◽

Cervical Cancer ◽

Intellectual Disability ◽

Cancer Screening ◽

Social Services ◽

Continuity Of Care ◽

Pap Test ◽

Population Based ◽

Breast And Cervical Cancer ◽

To Receive

Abstract Women with intellectual disability have low screening rates for breast and cervical cancer. This population-based cohort study examined the association between the level of primary care continuity and breast and cervical cancer screening rates in women with intellectual disability. Data were obtained from the Institute for Clinical Evaluative Sciences and the Ontario Ministry of Community and Social Services. Neither high (adjusted OR [aOR] = 1.06; 95% CI: 0.88-1.29) nor moderate (aOR = 1.11; 95% CI: 0.91-1.36) continuity of care were associated with mammography screening. Women were less likely to receive a Pap test with high (aOR = 0.70; 95% CI: 0.64-0.77) and moderate (aOR = 0.81, 95% CI 0.74-0.89) versus low continuity of care. Improving continuity of care may not be sufficient for increasing preventive screening rates.

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