Paediatric NHS 111 Clinical Assessment Services pilot: an observational study

2021 ◽  
pp. archdischild-2021-322908
Author(s):  
Philippa Anna Stilwell ◽  
Gareth Stuttard ◽  
Robert Scott-Jupp ◽  
Adrian Boyle ◽  
Simon Kenny ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Nurse Practitioners ◽  
Clinical Assessment ◽  
Self Care ◽  
Data Sets ◽  
Reporting Framework ◽  
Telephone Advice ◽  
Future Work ◽  
The Impact

ObjectiveTo determine the feasibility and impact of having paediatric clinicians working in the Clinical Assessment Services (CAS) within NHS 111, a national telephone advice service.DesignObservational study.SettingSix NHS 111 providers across England with CAS where volunteer paediatric clinicians (doctors and advanced nurse practitioners (ANPs)) worked between May and December 2020. A data reporting framework was used to compare the outcomes of calls taken by paediatric vs non-paediatric clinicians.PatientsUnder 16-year-olds prompting calls to NHS 111 over the study period.Main outcome measuresThe disposition (final outcome of calls) taken by paediatric versus non-paediatric clinicians, paediatric clinicians’ and patient experience.Results70 paediatric clinicians (66 doctors and 4 ANPs) worked flexible shifts in six NHS 111 providers’ CAS over the study period: 2535 calls for under 16-year-olds were taken by paediatric clinicians and 137 008 by non-paediatric clinicians. Overall, disposition rates differed significantly between the calls taken by paediatric versus (vs) non-paediatric clinicians: 69% vs 43% were advised on self-care only, 13% vs 18% to attend emergency departments (EDs), 13% vs 29% to attend primary care, 1% vs 4% to receive an urgent ambulance call out and 4% vs 6% referred to another health service, respectively. When compared with recent (all age) national whole data sets, the feedback from calls taken by paediatricians noted a greater proportion of patients/carers reporting that their problem was fully resolved (92% vs 27%).ConclusionsIntroducing paediatric specialists into NHS 111 CAS is likely to increase self-care dispositions, and reduce onward referrals to primary care, ED and ambulances. Future work will evaluate the impact of a national paediatric clinical assessment service to which specific case types are streamed.

Improving Primary Care Access to Respirologists Using eConsult

2021 ◽  
Author(s):  
Jean-Grégoire Leduc ◽  
Erin Keely ◽  
Clare Liddy ◽  
Amir Afkham ◽  
Misha Marovac ◽  
...  
Keyword(s):  
Primary Care ◽  
Median Time ◽  
Nurse Practitioners ◽  
Clinical Course ◽  
Primary Care Providers ◽  
Clinical Question ◽  
Care Providers ◽  
Provider Perspectives ◽  
Course Of Action ◽  
The Impact

Abstract Background: Patients and primary care providers (PCP) can experience frustration about poor access to specialist care. The Champlain Building Access to Specialists through eConsultation (BASETM) is a secure online platform that allows PCPs to ask a clinical question to 142 different specialty groups. The specialist is expected to respond within 7 days. Methods: This is a retrospective review of the Champlain BASETM respirology eConsults from January 2017 to December 2018. The eConsults were categorized by types of question asked by the referring provider, and by the clinical content of the referral. Specialists’ response time and time spent answering the clinical question was analyzed. Referring providers close out surveys were reviewed to assess the impact of the respirology eConsult service on traditional referral rates and clinical course of action. Results: Of the 26,679 cases submitted to the Champlain BASE TM eConsult service 268 were respirology cases (1%). 91% were sent by family physicians, 9% by nurse practitioners. The median time to respond by specialists was 0.8 days, and the median time billed by specialists was 20 minutes. The most common topics were pulmonary nodules and masses (16.4%), cough (10.4%), infective problems (8.6%), COPD (8.6%) and dyspnea NYD (7.8%). The most common types of question asked by PCP were related to investigations warranted (43.1% of cases), general management (17.5%), monitoring (12.6%), need for a respirology referral (12.3%), and drug of choice (6.3%). In 23% of cases the PCP indicated they were planning to refer the patient and no longer need to (avoided referrals) and in 13% of cases the PCP was not going to refer but did after receiving the eConsult advice (prompted referrals). The eConsult led to a new or additional clinical course of action by the PCP in 49% of cases. In 51% of cases the PCP suggested the clinical topic would be well suited to a CME event. Conclusions: Participation in eConsult services can improve timely access to respirologists while potentially avoiding clinic visit and significantly impacting referring PCPs clinical course of action. Using the most common clinical topics and types of question for CME planning should be considered. Future research may include a cost analysis, and provider perspectives on the role of eConsult in respirology care.

scholarly journals Relationship between patient activation measurement and self-rated health in patients with chronic diseases

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Nina Tusa ◽  
Hannu Kautiainen ◽  
Pia Elfving ◽  
Sanna Sinikallio ◽  
Pekka Mäntyselkä
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Chronic Diseases ◽  
Patient Activation ◽  
Self Care ◽  
Analysis Of Covariance ◽  
Significant Linear Trend ◽  
Activation Measurement ◽  
Self Rated Health ◽  
The Impact

Abstract Background In the aging population, chronic diseases and multimorbidity are common. Therefore, it is important to engage patients in their self-care. The aim of this study was to analyze the relationship between activity in self-care and self-rated health among primary care patients with chronic diseases. Methods The data of the present study were derived from a research project on the Participatory Patient Care Planning in Primary Care (4PHC). A total of 605 patients were recruited in the Siilinjärvi Health Center from those patients who were being monitored due to the treatment of hypertension, ischemic heart disease or diabetes. We evaluated the level of patient’s activity in self-care with the Patient Activation Measurement (PAM). Self-rated health (SRH) was measured with the 5-item Likert scale. An adjusted hypothesis of linearity across categories of PAM and self-rated health was estimated using analysis of covariance (ANCOVA). Results It was found that 76 patients had low activity, 185 had moderate while 336 patients had high activity as measured with PAM. Patients with the highest activity were younger, less depressed, had a lower body mass index and a higher level of physical activity than those with the lower activity. Correspondingly, good SRH was perceived by 29, 45 and 67% of the patients in these three PAM groups adjusted with sex, age, depressive symptoms (BDI) and number of diseases. There was a significant linear trend (adjusted with age, number of diseases and depressive symptoms) between SRH and PAM, p < 0.001. Conclusions Activity in self-care had an independent, linear relationship with the self-rated health. The present findings suggest that Patient Activation Measurement has the potential to categorize the patients according to their perceived health and their needs related to their disease management and self-care. The present results warrant longitudinal studies on the impact of promoting patient activation levels. Trial registration ClinicalTrials.gov Identifier: NCT02992431. Registered 14 December 2016 https://clinicaltrials.gov/ct2/show/NCT02992431

scholarly journals Cognitive behavioural treatment for insomnia in primary care: a systematic review of sleep outcomes

2019 ◽  
Vol 69 (686) ◽  
pp. e657-e664 ◽  
Author(s):  
Judith R Davidson ◽  
Ciara Dickson ◽  
Han Han
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Nurse Practitioners ◽  
Severity Index ◽  
Sleep Diary ◽  
Behavioural Treatment ◽  
Positive Effects ◽  
Cognitive Behavioural ◽  
Hypnotic Medication ◽  
The Impact

BackgroundPractice guidelines recommend that chronic insomnia be treated first with cognitive behavioural therapy for insomnia (CBT-I), and that hypnotic medication be considered only when CBT-I is unsuccessful. Although there is evidence of CBT-I’s efficacy in research studies, systematic reviews of its effects in primary care are lacking.AimTo review the effects on sleep outcomes of CBT-I delivered in primary care.Design and settingSystematic review of articles published worldwide.MethodMedline, PsycINFO, EMBASE, and CINAHL were searched for articles published from January 1987 until August 2018 that reported sleep results and on the use of CBT-I in general primary care settings. Two researchers independently assessed and then reached agreement on the included studies and the extracted data. Cohen’s d was used to measure effects on sleep diary outcomes and the Insomnia Severity Index.ResultsIn total, 13 studies were included. Medium-to-large positive effects on self-reported sleep were found for CBT-I provided over 4–6 sessions. Improvements were generally well maintained for 3–12 months post-treatment. Studies of interventions in which the format or content veered substantially from conventional CBT-I were less conclusive. In only three studies was CBT-I delivered by a GP; usually, it was provided by nurses, psychologists, nurse practitioners, social workers, or counsellors. Six studies included advice on withdrawal from hypnotics.ConclusionThe findings support the effectiveness of multicomponent CBT-I in general primary care. Future studies should use standard sleep measures, examine daytime symptoms, and investigate the impact of hypnotic tapering interventions delivered in conjunction with CBT-I.

scholarly journals The Impact of Case Finding on the Recruitment Yield for COPD Research in Primary Care: An Observational Study

Respiration ◽  
2016 ◽  
Vol 92 (5) ◽  
pp. 308-315 ◽  
Author(s):  
Stefan Markun ◽  
Thomas Rosemann ◽  
Kaba Dalla-Lana ◽  
Claudia Steurer-Stey
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Case Finding ◽  
The Impact

Generation of “Biking Schedules” for Bicycle Travel Analysis

2018 ◽  
Vol 2672 (36) ◽  
pp. 83-91 ◽  
Author(s):  
Amr Mohamed ◽  
Alexander Y. Bigazzi
Keyword(s):  
Data Sets ◽  
Calibration Data ◽  
Data Set ◽  
Construction Methods ◽  
Potential Applications ◽  
Road Grade ◽  
Calibration Data Set ◽  
Future Work ◽  
The Impact ◽  
Travel Analysis

With an increasing focus on bicycling as a mode of urban transportation, there is a pressing need for improved tools for bicycle travel analysis and modeling. This paper introduces “biking schedules” to represent archetypal urban cycling dynamics, analogous to driving schedules used in vehicle emissions analysis. Three different methods of constructing biking schedules with both speed and road grade attributes are developed from the driving schedule literature. The methods are applied and compared using a demonstration data set of 55 h of 1-Hz on-road GPS data from three cyclists. Biking schedules are evaluated based on their ability to represent the speed dynamics, power output, and breathing rates of a calibration data set and then validated for different riders. The impact of using coarser 3, 5, and 10 s GPS logging intervals on the accuracy of the schedules is also evaluated. Results indicate that the best biking schedule construction method depends on the volume and resolution of the calibration data set. Overall, the biking schedules successfully represent most of the assessed characteristics of cycling dynamics in the calibration data set (speed, acceleration, grade, power, and breathing) within 5%. Future work will examine the precision of biking schedules constructed from larger data sets in more diverse cycling conditions and explore additional refinements to the construction methods. This research is considered a first step toward adopting biking schedules in bicycle travel analysis and modeling, and potential applications are discussed.

scholarly journals Emergency care access to primary care records: an observational study

2020 ◽  
Vol 27 (3) ◽  
pp. e100153
Author(s):  
Thomas Bowden ◽  
David Lyell ◽  
Enrico Coiera
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Hospital Admission ◽  
Emergency Care ◽  
Patient Characteristics ◽  
Care Access ◽  
Process Outcomes ◽  
Primary Care Record ◽  
Access To Primary Care ◽  
The Impact

ObjectiveTo measure lookup rates of externally held primary care records accessed in emergency care and identify patient characteristics, conditions and potential consequences associated with access.MeasuresRates of primary care record access and re-presentation to the emergency department (ED) within 30 days and hospital admission.DesignA retrospective observational study of 77 181 ED presentations over 4 years and 9 months, analysing 8184 index presentations in which patients’ primary care records were accessed from the ED. Data were compared with 17 449 randomly selected index control presentations. Analysis included propensity score matching for age and triage categories.Results6.3% of overall ED presentations triggered a lookup (rising to 8.3% in year 5); 83.1% of patients were only looked up once and 16.9% of patients looked up on multiple occasions. Lookup patients were on average 25 years older (z=−9.180, p<0.001, r=0.43). Patients with more urgent triage classifications had their records accessed more frequently (z=−36.47, p<0.001, r=0.23). Record access was associated with a significant but negligible increase in hospital admission (χ2 (1, n=13 120)=98.385, p<0.001, phi=0.087) and readmission within 30 days (χ2 (1, n=13 120)=86.288, p<0.001, phi=0.081).DiscussionEmergency care clinicians access primary care records more frequently for older patients or those in higher triage categories. Increased levels of inpatient admission and re-presentation within 30 days are likely linked to age and triage categories.ConclusionFurther studies should focus on the impact of record access on clinical and process outcomes and which record elements have the most utility to shape clinical decisions.

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