scholarly journals Impact of event notification services on timely follow-up and rehospitalization among primary care patients at two Veterans Affairs Medical Centers

2021 ◽  
Author(s):  
Brian E Dixon ◽  
Kimberly M Judon ◽  
Ashley L Schwartzkopf ◽  
Vivian M Guerrero ◽  
Nicholas S Koufacos ◽  
...  
Keyword(s):  
Primary Care ◽  
Usual Care ◽  
Acute Care ◽  
Health Systems ◽  
Veterans Affairs ◽  
Care Team ◽  
Primary Care Team ◽  
Medical Centers ◽  
Event Notification

Abstract Objective To examine the effectiveness of event notification service (ENS) alerts on health care delivery processes and outcomes for older adults. Materials and methods We deployed ENS alerts in 2 Veterans Affairs (VA) medical centers using regional health information exchange (HIE) networks from March 2016 to December 2019. Alerts targeted VA-based primary care teams when older patients (aged 65+ years) were hospitalized or attended emergency departments (ED) outside the VA system. We employed a concurrent cohort study to compare postdischarge outcomes between patients whose providers received ENS alerts and those that did not (usual care). Outcome measures included: timely follow-up postdischarge (actual phone call within 7 days or an in-person primary care visit within 30 days) and all-cause inpatient or ED readmission within 30 days. Generalized linear mixed models, accounting for clustering by primary care team, were used to compare outcomes between groups. Results Compared to usual care, veterans whose primary care team received notification of non-VA acute care encounters were 4 times more likely to have phone contact within 7 days (AOR = 4.10, P < .001) and 2 times more likely to have an in-person visit within 30 days (AOR = 1.98, P = .007). There were no significant differences between groups in hospital or ED utilization within 30 days of index discharge (P = .057). Discussion ENS was associated with increased timely follow-up following non-VA acute care events, but there was no associated change in 30-day readmission rates. Optimization of ENS processes may be required to scale use and impact across health systems. Conclusion Given the importance of ENS to the VA and other health systems, this study provides guidance for future research on ENS for improving care coordination and population outcomes. Trial Registration ClinicalTrials.gov NCT02689076. “Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization.” Registered February 23, 2016.

scholarly journals Evaluating the Effectiveness of Diabetes Shared Medical Appointments (SMAs) as Implemented in Five Veterans Affairs Health Systems: a Multi-site Cluster Randomized Pragmatic Trial

2021 ◽  
Author(s):  
Michele Heisler ◽  
Jennifer Burgess ◽  
Jeffrey Cass ◽  
John F. Chardos ◽  
Alexander B. Guirguis ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Usual Care ◽  
Health Systems ◽  
Pragmatic Trial ◽  
Veterans Affairs ◽  
Control Group ◽  
Shared Medical Appointments ◽  
Site Cluster ◽  
Cluster Randomized

Abstract Objective To examine whether diabetes shared medical appointments (SMAs) implemented as part of usual clinical practice in diverse health systems are more effective than usual care in improving and sustaining A1c improvements. Research Design and Methods A multi-site cluster randomized pragmatic trial examining implementation in clinical practice of diabetes SMAs in five Veterans Affairs (VA) health systems was conducted from 2016 to 2020 among 1537 adults with type 2 diabetes and elevated A1cs. Eligible patients were randomly assigned to either: (1) invitation to participate in a series of SMAs totaling 8–9 h; or (2) continuation of usual care. Relative change in A1c (primary outcome) and in systolic blood pressure, insulin starts, statin starts, and anti-hypertensive medication classes (secondary outcomes) were measured as part of usual clinical care at baseline, at 6 months and at 12 months (~7 months after conclusion of the final SMA in four of five sites). We examined outcomes in three samples of SMA participants: all those scheduled for a SMA, those attending at least one SMA, and those attending at least half of SMAs. Results Baseline mean A1c was 9.0%. Participants scheduled for an SMA achieved A1c reductions 0.35% points greater than the control group between baseline and 6-months follow up (p = .001). Those who attended at least one SMA achieved reductions 0.42 % points greater (p < .001), and those who attended at least half of scheduled SMAs achieved reductions 0.53 % points greater (p < .001) than the control group. At 12-month follow-up, the three SMA analysis samples achieved reductions from baseline ranging from 0.16 % points (p = 0.12) to 0.29 % points (p = .06) greater than the control group. Conclusions Diabetes SMAs as implemented in real-life diverse clinical practices improve glycemic control more than usual care immediately after the SMAs, but relative gains are not maintained. Our findings suggest the need for further study of whether a longer term SMA model or other follow-up strategies would sustain relative clinical improvements associated with this intervention. Trial Registration ClinicalTrials.gov ID NCT02132676

The follow up of Acute Otitis Media general practice

1995 ◽  
Vol 81 (2) ◽  
pp. 127-134
Author(s):  
A P Newton
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Otitis Media ◽  
Otitis Media With Effusion ◽  
Acute Otitis Media ◽  
Care Team ◽  
Primary Care Team ◽  
Common Condition ◽  
Glue Ear

AbstractAcute Otitis Media is a common condition of childhood which potentially has a number of significant sequelae including the development of Otitis Media with Effusion (‘Glue Ear’). A general practice based study is described which assesses the implementation of a protocol for the follow up of Acute Otitis Media by the primary care team. The results of this study show that following the introduction of a follow up protocol a significantly improved rate of followup was achieved with resultant improvements in the identification of ‘Glue Ear’ and hence more appropriate referral for ENT care.

Pharmacists on a primary care team at a Veterans Affairs medical center

1997 ◽  
Vol 54 (11) ◽  
pp. 1280-1287 ◽  
Author(s):  
Christine Chandler ◽  
Patricia Barriuso ◽  
Karine Rozenberg-Ben-Dror ◽  
Brian Schmitt
Keyword(s):  
Primary Care ◽  
Medical Center ◽  
Veterans Affairs ◽  
Care Team ◽  
Primary Care Team

scholarly journals Family Physician’s and Primary Care Team’s Perspectives on Supporting Family Caregivers in Primary Care Networks

2021 ◽  
Vol 18 (6) ◽  
pp. 3293
Author(s):  
Jasneet Parmar ◽  
Sharon Anderson ◽  
Marjan Abbasi ◽  
Saeed Ahmadinejad ◽  
Karenn Chan ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Caregivers ◽  
Healthcare Providers ◽  
Family Physicians ◽  
Care Team ◽  
Primary Care Team ◽  
Caregiver Support ◽  
Team Members ◽  
Primary Care Teams ◽  
Support Family

Background. Research, practice, and policy have focused on educating family caregivers to sustain care but failed to equip healthcare providers to effectively support family caregivers. Family physicians are well-positioned to care for family caregivers. Methods. We adopted an interpretive description design to explore family physicians and primary care team members’ perceptions of their current and recommended practices for supporting family caregivers. We conducted focus groups with family physicians and their primary care team members. Results. Ten physicians and 42 team members participated. We identified three major themes. “Family physicians and primary care teams can be a valuable source of support for family caregivers” highlighted these primary care team members’ broad recognition of the need to support family caregiver’s health. “What stands in the way” spoke to the barriers in current practices that precluded supporting family caregivers. Primary care teams recommended, “A structured approach may be a way forward.” Conclusion. A plethora of research and policy documents recommend proactive, consistent support for family caregivers, yet comprehensive caregiver support policy remains elusive. The continuity of care makes primary care an ideal setting to support family caregivers. Now policy-makers must develop consistent protocols to assess, and care for family caregivers in primary care.

Primary Care Team of the Year: Primary care that makes a difference

BMJ ◽  
2011 ◽  
Vol 342 (apr12 1) ◽  
pp. d2118-d2118
Author(s):  
H. Macdonald ◽  
D. MacAuley
Keyword(s):  
Primary Care ◽  
Care Team ◽  
Primary Care Team

Applying the interprofessional patient aligned care team in the Department of Veterans Affairs: Transforming primary care.

2014 ◽  
Vol 69 (4) ◽  
pp. 399-408 ◽  
Author(s):  
Lisa K. Kearney ◽  
Edward P. Post ◽  
Andrew S. Pomerantz ◽  
Antonette M. Zeiss
Keyword(s):  
Primary Care ◽  
Veterans Affairs ◽  
Care Team ◽  
Department Of Veterans Affairs

scholarly journals A Psychiatric Clinic in General Practice

1987 ◽  
Vol 11 (4) ◽  
pp. 114-117 ◽  
Author(s):  
Sally M. Browning ◽  
Michael F. Ford ◽  
Cait A. Goddard ◽  
Alexander C. Brown
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
General Practice ◽  
Psychiatric Disorder ◽  
Personality Disorders ◽  
Psychiatric Service ◽  
Significant Degree ◽  
Care Team ◽  
Primary Care Team ◽  
Psychiatric Clinic

Only a minority suffering from mental illness are treated by the specialist psychiatric service. The majority of psychiatrically ill patients seen in general practice suffer from minor neuroses, personality disorders and situational reactions and can be appropriately treated by the primary care team. However, a significant degree of morbidity, some of it severe, fails to be identified in general practice and the identification and treatment of psychiatric disorder varies according to the GP's interest and attitudes.

scholarly journals Connecting Primary Care Patients to Community Resources: Lessons Learned From the Development of a New Lay Primary Care Team Role

2016 ◽  
Vol 3 (3) ◽  
pp. 218
Author(s):  
Clarissa W Hsu ◽  
Erin Hertel ◽  
June BlueSpruce ◽  
Tyler R Ross ◽  
Allen Cheadle ◽  
...  
Keyword(s):  
Primary Care ◽  
Lessons Learned ◽  
Care Team ◽  
Primary Care Team ◽  
Community Resources ◽  
Primary Care Patients
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