Impact on Primary Care and Specialty Care

2021 ◽  
pp. 63-76
Author(s):  
Don L. Goldenberg
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Routine Care ◽  
Care Team ◽  
Team Management ◽  
Financial Loss ◽  
Medical Practices ◽  
Virtual Care ◽  
Community And Public Health ◽  
Primary Care Practices

Primary care practices (PCP) and specialty practices stopped most routine care and suffered major financial loss during the pandemic. Family practice, small PCP practices, and pediatrics were hit the hardest and are still having difficulty recovering. Increased use of virtual care, team management, and integration with community and public health were each utilized effectively during the pandemic and should continue to be incorporated in ambulatory medical practices.

Severity and Criteria Based Prompting for Treatment of Depressed Patients

2005 ◽  
Vol 35 (2) ◽  
pp. 149-159 ◽  
Author(s):  
Donald E. Nease ◽  
Michael S. Klinkman ◽  
James E. Aikens
Keyword(s):  
Primary Care ◽  
Symptom Severity ◽  
Primary Care Physicians ◽  
Routine Care ◽  
Future Research ◽  
Binomial Regression ◽  
Care Appointment ◽  
Depressive Symptom Severity ◽  
Primary Care Practices ◽  
The Impact

Purpose: Primary care physicians (PCPs) often do not respond to prompts based upon criteria-based depression screens, perhaps because these prompts do not account for depression severity. We conducted this pilot study to determine the feasibility of prompting for both diagnostic criteria and severity and to assess whether depression would be more attended to with positive “dual prompts” than prompts based on either criteria or symptom severity alone. Methods: Immediately prior to a routine care appointment, 87 adults from three primary care practices completed the PRIME-MD Clinician Evaluation Guide Mood Module (PRIME-MD; assesses depression criteria) and the Brief Depression Rating (BDR; assesses depressive symptom severity), and their results were issued in a salient PCP prompt on the chart. Immediately afterwards, patients reported the impact of the screening results upon treatment decisions during the encounter. Data were analyzed by χ2, analysis of variance, and binomial regression. Results: Compared to subjects screening positive on either depression criteria or severity alone ( n = 10), those patients on both ( n = 17) were more likely to report discussing depression, and agreement that the physician and patient decided treatment was needed and initiated or continued. There were no differences in patient satisfaction based on screening results. After accounting for PRIME-MD results, BDR scores predicted agreement with the physician and patient decided treatment was needed (OR = 22.03; 95% CI: 2.05–236.46). Conclusions: Supplementary severity-based depression screening is feasible, and might overcome the limitations of criteria-based screening alone. Future research could test this hypothesis in a large randomized trial.

scholarly journals Excess cases of influenza and the coronavirus epidemic in Catalonia: a time-series analysis of primary-care electronic medical records covering over 6 million people

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e039369 ◽  
Author(s):  
Ermengol Coma Redon ◽  
Nuria Mora ◽  
Albert Prats-Uribe ◽  
Francesc Fina Avilés ◽  
Daniel Prieto-Alhambra ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Time Series ◽  
Moving Average ◽  
Epidemic Curve ◽  
Imported Case ◽  
Moving Average Models ◽  
Community Transmission ◽  
Auto Regressive ◽  
Primary Care Practices

ObjectivesThere is uncertainty about when the first cases of COVID-19 appeared in Spain. We aimed to determine whether influenza diagnoses masked early COVID-19 cases and estimate numbers of undetected COVID-19 cases.DesignTime-series study of influenza and COVID-19 cases, 2010–2020.SettingPrimary care, Catalonia, Spain.ParticipantsPeople registered in primary-care practices, covering >6 million people and >85% of the population.Main outcome measuresWeekly new cases of influenza and COVID-19 clinically diagnosed in primary care.AnalysesDaily counts of both cases were computed using the total cases recorded over the previous 7 days to avoid weekly effects. Epidemic curves were characterised for the 2010–2011 to 2019–2020 influenza seasons. Influenza seasons with a similar epidemic curve and peak case number as the 2019–2020 season were used to model expected case numbers with Auto Regressive Integrated Moving Average models, overall and stratified by age. Daily excess influenza cases were defined as the number of observed minus expected cases.ResultsFour influenza season curves (2011–2012, 2012–2013, 2013–2014 and 2016–2017) were used to estimate the number of expected cases of influenza in 2019–2020. Between 4 February 2020 and 20 March 2020, 8017 (95% CI: 1841 to 14 718) excess influenza cases were identified. This excess was highest in the 15–64 age group.ConclusionsCOVID-19 cases may have been present in the Catalan population when the first imported case was reported on 25 February 2020. COVID-19 carriers may have been misclassified as influenza diagnoses in primary care, boosting community transmission before public health measures were taken. The use of clinical codes could misrepresent the true occurrence of the disease. Serological or PCR testing should be used to confirm these findings. In future, this surveillance of excess influenza could help detect new outbreaks of COVID-19 or other influenza-like pathogens, to initiate early public health responses.

scholarly journals General Practitioners, Paramedics and the Primary Care Team; the Potential for Mutual Benefit

2018 ◽  
Vol 3 (2) ◽  
Author(s):  
Ray O'Connor ◽  
Claire Armstrong ◽  
Fintan Feerick
Keyword(s):  
Primary Care ◽  
Interprofessional Collaboration ◽  
Routine Care ◽  
Care Team ◽  
Primary Care Team ◽  
Ageing Population ◽  
Consultation Rate ◽  
Positive Effects ◽  
The Past ◽  
Part Time

<p><strong>Background</strong></p><p>General practice is entering a challenging phase. Increased workload and complexity with an increasing consultation rate is coming about as a result of an ageing population, extension of care that is free at the point of delivery to more people, and the trend to move routine care of chronic illness from secondary care to primary care[<a title="Behan, 2013 #6" href="file:///C:/Users/claire.armstrong/Documents/Claire/Paramedic%20skills/Abstract.Cork%20Paramedics%20Journal%20Oct%202018.docx#_ENREF_1">1</a>]. This is all coming about at a time when the GP population is ageing and doctors graduating from GP training are choosing to emigrate or work part time[<a title="Pericin, 2018 #1" href="file:///C:/Users/claire.armstrong/Documents/Claire/Paramedic%20skills/Abstract.Cork%20Paramedics%20Journal%20Oct%202018.docx#_ENREF_2">2</a>].</p><p>It will be difficult to continue this work without changes to current practice. In the past nurses have been employed by GPs to help deliver care [<a title="O'Kelly M, 2016 #5" href="file:///C:/Users/claire.armstrong/Documents/Claire/Paramedic%20skills/Abstract.Cork%20Paramedics%20Journal%20Oct%202018.docx#_ENREF_3">3</a>], however there is a shortage of nurses that challenges this model. It has been suggested that the unique skillset of Paramedics would complement those of GPs [<a title="O’Meara, 2016 #4" href="file:///C:/Users/claire.armstrong/Documents/Claire/Paramedic%20skills/Abstract.Cork%20Paramedics%20Journal%20Oct%202018.docx#_ENREF_4">4</a>]. Various models of paramedics working primarily in primary care have been described. This practice of paramedics working with and under the guidance of GPs would be expected to have the benefit of keeping patients out of hospital and managed in the community . The skillsets of paramedics would be kept up by appropriate deployment in the community, especially in quieter country areas where their presence is necessary geographically for emergencies, but they do not get to practice their skills at an optimum rate. Barriers exist to such deployment but can be overcome resulting in a well-functioning PCT with good levels of interprofessional collaboration and generally positive effects [<a title="Pullon, 2016 #8" href="file:///C:/Users/claire.armstrong/Documents/Claire/Paramedic%20skills/Abstract.Cork%20Paramedics%20Journal%20Oct%202018.docx#_ENREF_5">5</a>]. Paramedics have shown a willingness to be engaged in such work [<a title="Steeps, 2017 #7" href="file:///C:/Users/claire.armstrong/Documents/Claire/Paramedic%20skills/Abstract.Cork%20Paramedics%20Journal%20Oct%202018.docx#_ENREF_6">6</a>].</p><p><strong>Proposed methodology</strong></p><p>Questionnaire survey of GPs associated with the UL GEMS (ULEARN) based on what skills they would use that would be shared by paramedics. Attitudinal study of GPs and paramedics on their attitudes towards this novel way of practice.</p><p><strong>Anticipated outcomes</strong></p><p>GPs and paramedics have shown flexibility in the past. Literature review indicates that this is ongoing. It is anticipated that this would mean that respondents would attitudinally favour this move to make paramedic practitioners an integral part of the primary care team.</p>

scholarly journals Access to Care During a Pandemic: Improving Planning Efforts to Incorporate Community Primary Care Practices and Public Health Stakeholders

2020 ◽  
Vol 12 (3) ◽  
pp. 274-281
Author(s):  
Mary E. Schmidt ◽  
Michael E. von Fricken ◽  
Rachel N. Wofford ◽  
Russel C. Libby ◽  
Peggy J. Maddox
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Access To Care ◽  
Care Practices ◽  
Primary Care Practices

Medical Home Implementation Gaps for Seniors: Perceptions and Experiences of Primary Care Medical Practices

2016 ◽  
Vol 37 (7) ◽  
pp. 817-839 ◽  
Author(s):  
Timothy Hoff ◽  
Matthew DePuccio
Keyword(s):  
Primary Care ◽  
Medical Home ◽  
National Committee ◽  
Management Support ◽  
Study Objective ◽  
Medical Practices ◽  
Care Practices ◽  
Primary Care Practices ◽  
Specific Implementation ◽  
Implementation Gaps

Objective: The study objective was to better understand specific implementation gaps for various aspects of patient-centered medical home (PCMH) care delivered to seniors. The study illuminates the physician and staff experience by focusing on how individuals make sense of and respond behaviorally to aspects of PCMH implementation. Method: Qualitative data from 51 in-depth, semi-structured interviews across six different National Committee for Quality Assurance (NCQA)-accredited primary care practices were collected and analyzed. Results: Physicians and staff identified PCMH implementation gaps for their seniors: (a) performing in-depth clinical assessments, (b) identifying seniors’ life needs and linking them with community resources, and (c) care management and coordination, in particular self-management support for seniors. Prior experiences trying to perform these aspects of PCMH care for older adults produced collective understandings that led to inaction and avoidance by medical practices around the first two gaps, and proactive behavior that took strategic advantage of external incentives for addressing the third gap. Conclusion: Greater understanding of physician and staff’s PCMH implementation experiences, and the learning that accumulates from these experiences, allows for a deeper understanding of how primary care practices choose to enact the medical home model for seniors on an everyday basis.

scholarly journals Excess cases of influenza suggest an earlier start to the coronavirus epidemic in Spain than official figures tell us: an analysis of primary care electronic medical records from over 6 million people from Catalonia

2020 ◽  
Author(s):  
Ermengol Coma ◽  
Nuria Mora ◽  
Albert Prats-Uribe ◽  
Francesc Fina ◽  
Daniel Prieto-Alhambra ◽  
...  
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Electronic Medical Records ◽  
Medical Records ◽  
Current Crisis ◽  
Epidemic Curve ◽  
Imported Case ◽  
Asymptomatic Patients ◽  
Community Transmission ◽  
Primary Care Practices

AbstractObjectivesThere is uncertainty about when the first cases of COVID-19 appeared in Spain, as asymptomatic patients can transmit the virus. We aimed to determine whether influenza diagnoses masked early COVID-19 cases and, if so, estimate numbers of undetected COVID-19 cases in a large database of primary-care records covering >6 million people in Catalonia.DesignTime-series study of influenza and COVID-19 cases, using all influenza seasons from autumn-winter 2010-2011 to autumn-winter 2019-2020.SettingPrimary care, Catalonia, Spain.ParticipantsPeople registered in one of the contributing primary-care practices, covering >6 million people and >85% of the population.Main outcome measuresWeekly new cases of influenza and COVID-19 diagnosed in primary care.AnalysesDaily counts of both cases were computed using the total cases recorded over the previous 7 days to avoid weekly effects on recording practice. Epidemic curves were characterised for the 2010-2011 to 2019-2020 influenza seasons. Influenza seasons with a similar epidemic curve and peak case number as the 2019-2020 season were used to model predictions for 2019-2020. ARIMA models were fitted to the included influenza seasons, overall and stratified by age, to estimate expected case numbers. Daily excess influenza cases were defined as the number of observed minus expected cases.ResultsFour influenza season curves (2011-2012, 2012-2013, 2013-2014, and 2016-2017) were used to estimate the number of expected cases of influenza in 2019-2020. Between 4 February 2020 and 20 March 20202, 8,017 (95% CI: 1,841 to 14,718) excess influenza cases were identified. This excess was highest in the 15-64 age group.ConclusionsCOVID-19 cases may have been present in the Catalan population when the first imported case was reported on 25 February 2020. COVID-19 carriers may have been misclassified as influenza diagnoses in primary care, boosting community transmission before public health measures were taken. In future, the surveillance of excess influenza cases using widely available primary-care electronic medical records could help detect new outbreaks of COVID-19 or other influenza-like illness-causing pathogens. Earlier detection would allow public health responses to be initiated earlier than during the current crisis.

scholarly journals General practitioners’ accounts of negotiating antibiotic prescribing decisions with patients: a qualitative study on what influences antibiotic prescribing in low, medium and high prescribing practices

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Marieke M. van der Zande ◽  
Melanie Dembinsky ◽  
Giovanni Aresi ◽  
Tjeerd P. van Staa
Keyword(s):  
Public Health ◽  
Primary Care ◽  
General Practitioners ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Structured Interviews ◽  
North West ◽  
Care Practices ◽  
Primary Care Practices ◽  
Supportive Practice

Abstract Background Antimicrobial resistance (AMR) is high on the UK public health policy agenda, and poses challenges to patient safety and the provision of health services. Widespread prescribing of antibiotics is thought to increase AMR, and mostly takes place in primary medical care. However, prescribing rates vary substantially between general practices. The aim of this study was to understand contextual factors related to general practitioners’ (GPs) antibiotic prescribing behaviour in low, high, and around the mean (medium) prescribing primary care practices. Methods Qualitative semi-structured interviews were conducted with 41 GPs working in North-West England. Participants were purposively sampled from practices with low, medium, and high antibiotic prescribing rates adjusted for the number and characteristics of patients registered in a practice. The interviews were analysed thematically. Results This study found that optimizing antibiotic prescribing creates tensions for GPs, particularly in doctor-patient communication during a consultation. GPs balanced patient expectations and their own decision-making in their communication. When not prescribing antibiotics, GPs reported the need for supportive mechanisms, such as regular practice meetings, within the practice, and in the wider healthcare system (e.g. longer consultation times). In low prescribing practices, GPs reported that increasing dialogue with colleagues, having consistent patterns of prescribing within the practice, supportive practice policies, and enough resources such as consultation time were important supports when not prescribing antibiotics. Conclusions Insight into GPs’ negotiations with patient and public health demands, and consistent and supportive practice-level policies can help support prudent antibiotic prescribing among primary care practices.

scholarly journals COVID Challenges and Adaptations Among Home-Based Medical Practices: Lessons for an Ongoing Pandemic

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 536-537
Author(s):  
Orla Sheehan ◽  
Naomi Gallopyn ◽  
Shanaz Sharieff ◽  
Abraham Brody ◽  
Bruce Leff ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Online Survey ◽  
Emotional Needs ◽  
Medical Practices ◽  
Home Based Primary Care ◽  
Virtual Care ◽  
Home Based ◽  
Concurrent Use

Abstract Home-based primary care (HBPC) practices rapidly adapted to maintain care during the COVID-19 pandemic. This mixed-methods national online survey of HBPC practices probed responses to COVID-19 surges, COVID-19 testing, the use of telemedicine, practice challenges due to COVID-19, and adaptations to address these challenges. Seventy-nine practices across 29 states were included in the analyses. Eighty-five percent of practices continued to provide in-person care and nearly half cared for COVID-19 patients. Most practices also pivoted to concurrent use of video visits. The top five practice challenges were: patient familiarity with telemedicine, patient and clinician anxiety, technical difficulties reaching patients, and supply shortages. Practices also described creative strategies to physically support the needs of patients. These findings illustrate the need to balance in-person and virtual care for this population, and attend to the emotional needs of patients and staff.

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