The Effects Of Practice Size On Quality Of Care In Primary Care Settings: A Systematic Review

Background: As people age, they become increasingly vulnerable to the untoward effects of medicines due to changes in body systems. These may result in medicines related problems (MRPs) and consequent decline or deterioration in health. Aim: To identify MRPs, indicators of deterioration associated with these MRPs, and preventative interventions from the literature. Design and Setting: Systematic review of primary studies on MRPs originating in Primary Care in older people. Methods: Relevant studies published between 2001 and April 2018 were obtained from Medline (via PubMed), CINAHL, Embase, Psych Info, PASCAL, Scopus, Cochrane Library, Science Direct, and Zetoc. Falls, delirium, pressure ulcer, hospitalization, use of health services and death were agreed indicators of deterioration. The methodological quality of included studies was assessed using the Down and Black tool. Results: There were 1858 articles retrieved from the data bases. Out of these, 21 full text articles met inclusion criteria for the review. MRPs identified were medication error, potentially inappropriate medicines, adverse drug reaction and non-adherence. These were associated with indicators of deterioration. Interventions that involved doctors, pharmacists and patients in planning and implementation yielded benefits in halting MRPs. Conclusion: This Systematic review summarizes MRPs and associated indicators of deterioration. Appropriate interventions appeared to be effective against certain MRPs and their consequences. Further studies to explore deterioration presented in this systematic review is imperative.

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Physical activity promotion for multimorbid patients in primary care settings: A protocol for a systematic review evaluating health benefits and harms.

10.31219/osf.io/ka8yu ◽

2020 ◽

Author(s):

Simone Schweda ◽

Inga Krauß

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Systematic Review ◽

Primary Care ◽

Health Benefits ◽

The Body ◽

Cochrane Library ◽

Primary Care Settings ◽

Activity Promotion

Background: To date multimorbidity has not received much attention in health policies, even though multiple chronic diseases put high demands on the health care system in industrial nations. Enormous costs of care and a physically, mentally and socially reduced quality of life are common consequences of multimorbidity. Physical activity (PA) has a positive preventive and therapeutic effect on common non-communicable . The objective of this study will be to evaluate the halth benefits and harms of PA interventions for sedentary adults with multimorbidity in primary care settings. Methods: This is the study protocol for a systematic review. We will serach PubMed, MEDLINE (Ovid), Web of Science, CINHAL and the Cochrane Library (from inception onwards). In addition, clinical trial registers and reference lists of included studies will be searched. We will include randomised controlled trials, quasi-experimental and non-randomised trials examining the health benefits and harms of PA interventions with or without additional lifestyle interventions for sedentary adult patients with multimorbidity (e.g. two or more chronic non-communicable diseases) in primary care. Eligible control groups will be standard care, placebo or medications. Two reviewers will independently screen all citations, abstracts data and full text articles. The primary outcomes will be health related quality of life and mortality. Secondary outcomes will include cardiovascular fitness, muscular strength and disease specific outcomes (e.g. depression score), biomarkers as well as control of metabolic risk factors (e.g. blood pressure, HBA1c, body weight) and any adverse event. The study methodological quality will be appraised using appropriate tools. If feasible, we will conduct random effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g. study design, geographical location, or type of intervention). Strength of the body of evidence will be assessed according to the Grading of Recommendations Assessment (GRADE). Discussion: This review will evaluate the evidence on health benefits and harms of PA interventions for sedentary adults with multimorbidity in primary care settings. We anticipate our findings to be of interest to patients, their families, caregivers and healthcare professionals in selecting and conducting optimal health promotion programs. Possible implications for further research will be discussed.

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Effectiveness of community-based peer-led diabetes self-management programmes (COMP-DSMP) for improving clinical outcomes and quality of life of adults with diabetes in primary care settings in low and middle-income countries (LMIC): a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2015-007635 ◽

2015 ◽

Vol 5 (7) ◽

pp. e007635 ◽

Cited By ~ 10

Author(s):

Mahmoud Werfalli ◽

Peter Raubenheimer ◽

Mark Engel ◽

Nasheeta Peer ◽

Sebastiana Kalula ◽

...

Keyword(s):

Quality Of Life ◽

Systematic Review ◽

Primary Care ◽

Meta Analysis ◽

Self Management ◽

Community Based ◽

Middle Income ◽

Middle Income Countries ◽

Primary Care Settings

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Provider Workload and Quality of Care in Primary Care Settings

Medical Care ◽

10.1097/mlr.0b013e318277f1cb ◽

2013 ◽

Vol 51 (1) ◽

pp. 108-114 ◽

Cited By ~ 25

Author(s):

David C. Mohr ◽

Justin K. Benzer ◽

Gary J. Young

Keyword(s):

Primary Care ◽

Quality Of Care ◽

Primary Care Settings

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Inequalities in general practice remote consultations: A systematic review

BJGP Open ◽

10.3399/bjgpo.2021.0040 ◽

2021 ◽

pp. BJGPO.2021.0040

Author(s):

Ruth Parker ◽

Emma Figures ◽

Charlotte Paddison ◽

James Matheson ◽

David Blane ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

General Practice ◽

Quality Of Care ◽

Clinical Outcomes ◽

The Elderly ◽

Face To Face ◽

The Impact ◽

Remote Consultations

BackgroundCOVID-19 has led to rapid and widespread use of remote consultations in general practice, but the health inequalities impact remains unknown.AimTo explore the impact of remote consultations in general practice compared to face-to-face consultations on utilisation and clinical outcomes across socio-economic and disadvantaged groups.Design & settingSystematic reviewMethodWe undertook an electronic search of MEDLINE, EMBASE and Web of Science from inception to June 2020. We included studies which compared remote consultations to face-to-face consultations in primary care and reported outcomes by PROGRESS Plus criteria. Risk of bias was assessed using ROBINS-I. Data was synthesised narratively.ResultsBased on 13 studies, exploring telephone and internet-based consultations, we found that telephone consultations were used by younger working age people, the very old and non-immigrants, with internet-based consultations more likely to be used by younger people. Women consistently used more remote forms of consulting than men. Socio-economic and ethnicity findings were mixed, with weak evidence that patients from more affluent areas were more likely to use internet-based communication. Remote consultations appeared to help patients with opioid dependence remain engaged with primary care. No studies reported on the impact on quality of care or clinical outcomes.ConclusionRemote consultations in general practice are likely to be used more by younger working people, non-immigrants, the elderly and women, with internet-based consultations more by younger, affluent and educated groups. Wide-spread use of remote consultations should be treated with caution until the inequalities impact on clinical outcomes and quality of care is known.

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Impact of GP gatekeeping on quality of care, and health outcomes, use, and expenditure: a systematic review

British Journal of General Practice ◽

10.3399/bjgp19x702209 ◽

2019 ◽

Vol 69 (682) ◽

pp. e294-e303 ◽

Cited By ~ 9

Author(s):

Poompong Sripa ◽

Benedict Hayhoe ◽

Priya Garg ◽

Azeem Majeed ◽

Geva Greenfield

Keyword(s):

Systematic Review ◽

Primary Care ◽

Patient Satisfaction ◽

Quality Of Care ◽

Health Outcomes ◽

Direct Access ◽

Cochrane Library ◽

Patients With Cancer ◽

The Impact

BackgroundGPs often act as gatekeepers, authorising patients’ access to specialty care. Gatekeeping is frequently perceived as lowering health service use and health expenditure. However, there is little evidence suggesting that gatekeeping is more beneficial than direct access in terms of patient- and health-related outcomes.AimTo establish the impact of GP gatekeeping on quality of care, health use and expenditure, and health outcomes and patient satisfaction.Design and settingA systematic review.MethodThe databases MEDLINE, PreMEDLINE, Embase, and the Cochrane Library were searched for relevant articles using a search strategy. Two authors independently screened search results and assessed the quality of studies.ResultsElectronic searches identified 4899 studies (after removing duplicates), of which 25 met the inclusion criteria. Gatekeeping was associated with better quality of care and appropriate referral for further hospital visits and investigation. However, one study reported unfavourable outcomes for patients with cancer under gatekeeping, and some concerns were raised about the accuracy of diagnoses made by gatekeepers. Gatekeeping resulted in fewer hospitalisations and use of specialist care, but inevitably was associated with more primary care visits. Patients were less satisfied with gatekeeping than direct-access systems.ConclusionGatekeeping was associated with lower healthcare use and expenditure, and better quality of care, but with lower patient satisfaction. Survival rate of patients with cancer in gatekeeping schemes was significantly lower than those in direct access, although primary care gatekeeping was not otherwise associated with delayed patient referral. The long-term outcomes of gatekeeping arrangements should be carefully studied before devising new gatekeeping policies.

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