Oxford Handbook of Primary Care and Community Nursing

2020 ◽  
Keyword(s):  
Primary Care ◽  
Good Practice ◽  
Community Setting ◽  
Community Health Services ◽  
Clinical Knowledge ◽  
Long Term Conditions ◽  
Care Services ◽  
Health And Social Care ◽  
And Child Health

Concise and comprehensive, this handbook provides the reader with both evidence-based clinical knowledge as well as the organizational structure of community health services. Chapters range from common adult and child health problems, to more specific targeted advice for service users with extra needs and people with long-term conditions. The handbook includes information on how health and social care services are organized and funded, from common technical care procedures to complex situations, alongside detailed aspects of health promotion in adults, children, and adolescents. This handbook provides an accessible and instant resource, and a benchmark of good practice, for all healthcare professionals working in the primary care and community setting.

Electronic Patient Records (EPR), Library Services (LS) and Multidisciplinary Team (MDT) Meetings

2017 ◽  
pp. 179-197
Author(s):  
Shahid Muhammad ◽  
Malcolm Rigler ◽  
Meshia Adams
Keyword(s):  
Primary Care ◽  
Multidisciplinary Team ◽  
Library Services ◽  
Patient Records ◽  
Electronic Patient Records ◽  
Long Term Conditions ◽  
Health Records ◽  
Care Services ◽  
Primary Care Services

Patients with Long-Term Conditions (LTCs) account for around 50% of General Practitioner (GP) appointments, 64% of outpatient appointments and 70% of hospital bed days. There needs to be a wider access to knowledge and understanding such as directories with information leaflets, documents, books on lifestyle, helpful contacts and sources to information that can support patients and the general public on the most important elements their health. This cannot be achieved just through patients accessing their health records in sole. The objective of this paper is to 1) highlight the importance of integrating General Practice (GP), Electronic Patient Records (EPR) with Library Services (LS) and 2) also explore why it would be advantageous to implement patient-centred Multidisciplinary Team (MDT) meetings in primary care for patients with Long-Term Conditions (LTCs). This article provides a UK glance and how primary care services can be improved, integrating for the better. Having access to Electronic Patient Records (EPR) alone will not help or encourage a patient to gain confidence and/ or understanding especially if patients are overwhelmed by their healthcare choices and Health Literacy (HL) complexities. Patients' whose first language is not English for example, approaching more methods to support HL is/ will be challenging. Library and Health Services partnerships should be initiated to allowing access to wider resources. In addition, patient-centred Multidisciplinary Team (MDT) meetings should be arranged at dedicated time points between a doctor and patient/ carer and these can take place in a private section within library setting involving wider participation in care plans. Given that more patients and the public will have opportunity to access their health records, a “Libraries and Health” partnership can help integrate primary healthcare better thus allowing all to access health-related literature, using books, leaflets and digital media in a comfortable environment in a setting that also has staff that can support with HL and technology. An EPR and MDT initiative should be supported with library and health partnerships; this needs to be encouraged.

scholarly journals Understanding variation in unplanned admissions of people aged 85 and over: a systems-based approach

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e026405 ◽  
Author(s):  
Andrew Wilson ◽  
Richard Baker ◽  
John Bankart ◽  
Jay Banerjee ◽  
Ran Bhamra ◽  
...  
Keyword(s):  
Primary Care ◽  
Social Care ◽  
Primary Care Trust ◽  
Community Health Services ◽  
Shared Vision ◽  
Admission Rates ◽  
Care Services ◽  
Health And Social Care ◽  
Study Sites ◽  
Unplanned Admissions

AimTo examine system characteristics associated with variations in unplanned admission rates in those aged 85+.DesignMixed methods.SettingPrimary care trusts in England were ranked according to changes in admission rates for people aged 85+ between 2007 and 2009, and study sites selected from each end of the distribution: three ‘improving’ sites where rates had declined by more than 4% and three ‘deteriorating’ sites where rates had increased by more than 20%. Each site comprised an acute hospital trust, its linked primary care trust/clinical commissioning group, the provider of community health services and adult social care.ParticipantsA total of 142 representatives from these organisations were interviewed to understand how policies had been developed and implemented. McKinsey’s 7S framework was used as a structure for investigation and analysis.ResultsIn general, improving sites provided more evidence of comprehensive system focused strategies backed by strong leadership, enabling the development and implementation of policies and procedures to avoid unnecessary admissions of older people. In these sites, primary and intermediate care services appeared more comprehensive and better integrated with other parts of the system, and policies in emergency departments were more focused on providing alternatives to admission.ConclusionsHealth and social care communities which have attenuated admissions of people aged 85+ prioritised developing a shared vision and strategy, with sustained implementation of a suite of interventions.

Case Management for Long‐Term Conditions: The Role of Networks in Health and Social Care Services

2010 ◽  
Vol 18 (1) ◽  
pp. 45-52 ◽  
Author(s):  
Jessica Abell ◽  
Jane Hughes ◽  
Siobhan Reilly ◽  
Kathryn Berzins ◽  
David Challis
Keyword(s):  
Case Management ◽  
Social Care ◽  
Long Term Conditions ◽  
Care Services ◽  
Health And Social Care

De-professionalism as defined by services deemed unconventional, under-performing or ineffectual

2020 ◽  
pp. 121-142
Author(s):  
Nigel Malin
Keyword(s):  
Primary Care ◽  
Critical Care ◽  
Chronic Illness ◽  
Social Care ◽  
Public Spending ◽  
Care Services ◽  
Primary Care Services ◽  
Health And Social Care ◽  
Under Performing

This chapter discusses reports that some hospitals and primary care services are ‘under-performing’ due to a lack of health and social care professionals, particularly in areas like critical care, long-term and chronic illness. Similarly, in schools there are continuing claims that core funding remains a serious issue, that they are struggling to get and keep enough teachers, and standards are threatened as a result. Austerity is an extension of the neo-liberal logic to characterise any form of public spending as ‘unproductive’.

scholarly journals Association between receipt of social care and multimorbidity: evidence from a population-sized cohort in Scotland

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
David Henderson ◽  
Iain Atherton ◽  
Nick Bailey ◽  
Colin McCowan ◽  
Stewart Mercer
Keyword(s):  
Social Care ◽  
Developed Countries ◽  
Societal Implications ◽  
Term Care ◽  
Long Term Conditions ◽  
Care Services ◽  
Health And Social Care ◽  
Care Survey ◽  
The Relationship

Multimorbidity, the presence of two or more long-term conditions, is associated with numerous negative outcomes. Little is known, however, about the relationship between multimorbidity and social care use (also known as long-term care). This is important as many developed countries seek to integrate health and social care services as a means of improving quality of services at the same time as making efficiency savings. The aim of the study was to assess the relationship between receipt of formal social care services, sociodemographic variables, and two proxy measures of multimorbidity. For this retrospective population-based observational study including all individuals over the age of 65 in Scotland in financial years 2014/15 and 2015/16 (n= 975,265), we linked the Scottish Social Care Survey (which holds information on those receiving social care from local authorities) to administrative NHS community prescribing and demographic records. The main outcome binary measure was presence or not in the social care survey. Two proxy measures of multimorbidity were derived from prescribing data. We used logistic regression models and report Average Marginal Effects (AME). Fifteen percent of all individuals received formal social care services. After adjustment for other modelled factors, multimorbidity showed an increasing magnitude of effect on receipt of social care (AME 16.4% (95% CI 16.2-16.6%) increased probability for 9+ medicines compared to 0-2 medicines, AME 18.8% (95% CI 18.5-19.1%) increased probability for 6+ BNF chapters compared to 0 BNF chapters). The magnitude of effect of deprivation on social care receipt was lower (AME 5.1% (95% CI 4.8-5.4%) increased probability in the most deprived area decile compared to the most affluent) after adjusting for multimorbidity and other demographic factors. This is one of the first studies to demonstrate an association between multimorbidity and receipt of social care. Increasing prevalence of multimorbidity has greater societal implications than previously described.

Primary care improvement for patients with complex long-term conditions

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696989
Author(s):  
Zenobia Sheikh ◽  
Helen Crump ◽  
Chris Sherlaw-Johnson ◽  
Mike Gill ◽  
Colleen Atkinson ◽  
...  
Keyword(s):  
Primary Care ◽  
Multidisciplinary Team ◽  
Hospital Admissions ◽  
Third Sector ◽  
Qualitative Evaluation ◽  
Long Term Conditions ◽  
Complex Patients ◽  
Health And Social Care ◽  
Care Improvement

BackgroundPatients with five or more long-term conditions have been shown in Barking, Havering and Redbridge Clinical Commissioning Groups to be the heaviest users of health and social care. An innovative new model of primary care, ‘Health 1000’ was thus established. Comprising a fully integrated multidisciplinary team (including third sector, a social worker and dual skilled ‘keyworkers’) this practice aligned the care of complex patients and endeavoured to avoid unnecessary hospital admissions.AimTo test the hypothesis that Health 1000 (a multidisciplinary GP practice with consultant geriatrician support) would align and improve quality of care and health/social outcomes for complex patients with five-plus long-term conditions.MethodUsing anonymised disease registers, an eligible cohort was identified and invited by their existing practices to re-register with Health 1000. Each patient received comprehensive initial consultation at registration, encompassing reviews of pill burden and social need. Biweekly multidisciplinary discussion ensured their care was aligned and met to a high quality. Independent qualitative evaluation was undertaken by the Nuffield Trust using face to face/telephone interviews with staff/patients.Results408 patients (from an eligible cohort of approximately 2000) were registered. Most patients were extremely satisfied with the new service highlighting friendly welcoming atmosphere, speed of service, key workers’ responsiveness, availability of phone consultations with GPs, longer appointment slots and home visits.ConclusionQualitative outcomes were very positive and suggest that there is benefit for patients with multiple long-term conditions from embedding a multidisciplinary team in primary care with specialist expertise.

scholarly journals Long-Term Conditions Questionnaire (LTCQ): initial validation survey among primary care patients and social care recipients in England

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e019235 ◽  
Author(s):  
Caroline M Potter ◽  
Laurie Batchelder ◽  
Christine A’Court ◽  
Louise Geneen ◽  
Laura Kelly ◽  
...  
Keyword(s):  
Primary Care ◽  
Construct Validity ◽  
Social Care ◽  
Outcome Measurement ◽  
Intraclass Correlation ◽  
Long Term Conditions ◽  
Care Recipients ◽  
Health And Social Care ◽  
Patient Reported

ObjectiveThe aim of this study was to validate a new generic patient-reported outcome measure, the Long-Term Conditions Questionnaire (LTCQ), among a diverse sample of health and social care users in England.DesignCross-sectional validation survey. Data were collected through postal surveys (February 2016–January 2017). The sample included a healthcare cohort of patients recruited through primary care practices, and a social care cohort recruited through local government bodies that provide social care services.Participants1211 participants (24% confirmed social care recipients) took part in the study. Healthcare participants were recruited on the basis of having one of 11 specified long-term conditions (LTCs), and social care participants were recruited on the basis of receiving social care support for at least one LTC. The sample exhibited high multimorbidity, with 93% reporting two or more LTCs and 43% reporting a mental health condition.Outcome measuresThe LTCQ’s construct validity was tested with reference to the EQ-5D (5-level version), the Self-Efficacy for Managing Chronic Disease scale, an Activities of Daily Living scale and the Bayliss burden of morbidity scale.ResultsLow levels of missing data for each item indicate acceptability of the LTCQ across the sample. The LTCQ exhibits high internal consistency (Cronbach’s α=0.95) across the scale’s 20 items and excellent test–retest reliability (intraclass correlation coefficient=0.94, 95% CI 0.93 to 0.95). Associations between the LTCQ and all reference measures were moderate to strong and in the expected directions, indicating convergent construct validity.ConclusionsThis study provides evidence for the reliability and validity of the LTCQ, which has potential for use in both health and social care settings. The LTCQ could meet a need for holistic outcome measurement that goes beyond symptoms and physical function, complementing existing measures to capture fully what it means to live well with LTCs.

Long-term conditions in older adults using primary care services

2016 ◽  
Vol 26 (2) ◽  
pp. 31-35 ◽  
Author(s):  
Abdullah Alkhawaldeh ◽  
Omar ALOmari ◽  
Mohammed ALBashtawy ◽  
Ma’en Aljezawi ◽  
Mohammad Suliman ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Long Term Conditions ◽  
Care Services ◽  
Primary Care Services

scholarly journals The frontline of social prescribing – How do we ensure Link Workers can work safely and effectively within primary care?

2019 ◽  
pp. 174239531988206 ◽  
Author(s):  
Caroline Frostick ◽  
Marcello Bertotti
Keyword(s):  
Primary Care ◽  
Clinical Supervision ◽  
Work Experience ◽  
Qualitative Data ◽  
Clear Understanding ◽  
Long Term Conditions ◽  
Social Prescribing ◽  
Care Services ◽  
Primary Care Services

Objective To identify the training, skills and experience social prescribing Link Workers, working with patients presenting with long-term conditions, need to carry out their role safely and effectively within primary care services. Method Qualitative data were collected from Link Workers as part of the evaluation of three social prescribing schemes. Interviews and focus groups were audio-recorded and transcribed. Results Link Workers describe the complexity of the work and the need to define the boundaries of their role within existing services. Previous life and work experience were invaluable and empathy was seen as a key skill. A variety of training was valued with counselling skills felt to be most critical. Clinical supervision and support were felt to be essential to conduct the work safely. Discussion Social prescribing is a significant theme within UK health policy and internationally and schemes in primary care services are common. Patient accounts consistently suggest that the Link Worker is key to the success of the pathway. Link Workers can facilitate positive behaviour change; however they must be recruited, trained and supported with a clear understanding of the demands of this complex role.

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