scholarly journals Missed Opportunities for Chronic Disease Education in the Longitudinal Primary Care Clerkship?

2018 ◽  
Vol 93 (7) ◽  
pp. 962 ◽  
Author(s):  
Jordan D. Anderson ◽  
Brian W. Powers
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Missed Opportunities

Managing chronic disease in primary care: a review

2020 ◽  
pp. 504-508
Author(s):  
Meriam Alabdallah ◽  
Abdulmajeed Almalki ◽  
Ahmed Alsaedi ◽  
Ahmed Abdullah ◽  
Faisal Aljuhine ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease

scholarly journals Long-term effectiveness of elderly health care voucher scheme strategies: a system dynamics simulation analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ka Chun Chong ◽  
Hong Fung ◽  
Carrie Ho Kwan Yam ◽  
Patsy Yuen Kwan Chau ◽  
Tsz Yu Chow ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Public Sector ◽  
System Dynamics ◽  
The Elderly ◽  
Healthcare Services ◽  
Dynamics Simulation ◽  
Public And Private ◽  
The Public ◽  
The Impact

Abstract Background The elderly healthcare voucher (EHCV) scheme is expected to lead to an increase in the number of elderly people selecting private primary healthcare services and reduce reliance on the public sector in Hong Kong. However, studies thus far have reported that this scheme has not received satisfactory responses. In this study, we examined changes in the ratio of visits between public and private doctors in primary care (to measure reliance on the public sector) for different strategic scenarios in the EHCV scheme. Methods Based on comments from an expert panel, a system dynamics model was formulated to simulate the impact of various enhanced strategies in the scheme: increasing voucher amounts, lowering the age eligibility, and designating vouchers for chronic conditions follow-up. Data and statistics for the model calibration were collected from various sources. Results The simulation results show that the current EHCV scheme is unable to reduce the utilization of public healthcare services, as well as the ratio of visits between public and private primary care among the local aging population. When comparing three different tested scenarios, even if the increase in the annual voucher amount could be maintained at the current pace or the age eligibility can be lowered to include those aged 60 years, the impact on shifts from public-to-private utilization were insignificant. The public-to-private ratio could only be marginally reduced from 0.74 to 0.64 in the first several years. Nevertheless, introducing a chronic disease-oriented voucher could result in a significant drop of 0.50 in the public-to-private ratio during the early implementation phase. However, the effect could not be maintained for an extended period. Conclusions Our findings will assist officials in improving the design of the EHCV scheme, within the wider context of promoting primary care among the elderly. We suggest that an additional chronic disease-oriented voucher can serve as an alternative strategy. The scheme must be redesigned to address more specific objectives or provide a separate voucher that promotes under-utilized healthcare services (e.g., preventive care), instead of services designed for unspecified reasons, which may lead to concerns regarding exploitation.

scholarly journals Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management

2021 ◽  
Vol 18 (6) ◽  
pp. 2926
Author(s):  
Chuan De Foo ◽  
Shilpa Surendran ◽  
Geronimo Jimenez ◽  
John Pastor Ansah ◽  
David Bruce Matchar ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Early Stage ◽  
Healthcare Delivery ◽  
Stage Of Development ◽  
Facilitators And Barriers ◽  
Design Options ◽  
First Contact

The primary care network (PCN) was implemented as a healthcare delivery model which organises private general practitioners (GPs) into groups and furnished with a certain level of resources for chronic disease management. A secondary qualitative analysis was conducted with data from an earlier study exploring facilitators and barriers GPs enrolled in PCN’s face in chronic disease management. The objective of this study is to map features of PCN to Starfield’s “4Cs” framework. The “4Cs” of primary care—comprehensiveness, first contact access, coordination and continuity—offer high-quality design options for chronic disease management. Interview transcripts of GPs (n = 30) from the original study were purposefully selected. Provision of ancillary services, manpower, a chronic disease registry and extended operating hours of GP practices demonstrated PCN’s empowering features that fulfil the “4Cs”. On the contrary, operational challenges such as the lack of an integrated electronic medical record and disproportionate GP payment structures limit PCNs from maximising the “4Cs”. However, the enabling features mentioned above outweighs the shortfalls in all important aspects of delivering optimal chronic disease care. Therefore, even though PCN is in its early stage of development, it has shown to be well poised to steer GPs towards enhanced chronic disease management.

scholarly journals Identifying Missed Opportunities for the Pneumococcal Conjugate Vaccine (PCV13)

2017 ◽  
Vol 34 (1) ◽  
pp. 24-27 ◽  
Author(s):  
Lauren Jindracek ◽  
Jennifer E. Stark
Keyword(s):  
Primary Care ◽  
Influenza Vaccine ◽  
Conjugate Vaccine ◽  
Health Care Professionals ◽  
Pneumococcal Conjugate Vaccine ◽  
Unexpected Finding ◽  
Primary Care Visit ◽  
Electronic Reminder ◽  
Missed Opportunities ◽  
Care Appointment

Background: The recommendation for the pneumococcal conjugate vaccine (PCV13) in adults 65 years and older is recent, and the dosing schedule of PCV13 and the pneumococcal polysaccharide vaccine (PPSV23) can be complex in this population. Objective: The authors assessed the rate of PCV13 immunization in patients 65 years of age and older and identified barriers that contributed to missed opportunities for PCV13. Methods: This retrospective review evaluated outpatient Veterans age 65 years or older who did not receive PCV13 at a scheduled primary care appointment despite an electronic reminder. Investigators recorded any documented reason for the patient not receiving PCV13. Results: The rate of PCV13 immunizations administered during the primary care visit study period was 37% (89 of 239 PCV13 eligible patients). Of the 150 patients identified who did not receive PCV13, 92% were not offered the vaccine, 6.7% declined vaccination, and 0.7% reported an allergy to vaccination. Electronic immunization records revealed that 48 of the 150 patients who did not receive PCV13 at their clinic appointment did receive PCV13 later the same year. Most patients received PCV13 in influenza vaccine season on the same day as receiving the influenza vaccine. Conclusion: The main barrier identified was not offering the vaccination during primary care visits. Pneumococcal vaccine administration was delayed until the influenza vaccine season in a significant portion of patients. This unexpected finding represents a target for education: ensuring health care professionals are reminded that PCV13 is not a seasonal vaccine like the influenza vaccine, but should be offered throughout the year.

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

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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