Understanding high and low patient experience scores in primary care: analysis of patients' survey data for general practices and individual doctors

We describe the trend of antibiotic prescribing in out-of-hours (OOH) general practices (GP) before and during England’s first wave of the COVID-19 pandemic. We analysed practice-level prescribing records between January 2016 to June 2020 to report the trends for the total prescribing volume, prescribing of broad-spectrum antibiotics and key agents included in the national Quality Premium. We performed a time-series analysis to detect measurable changes in the prescribing volume associated with COVID-19. Before COVID-19, the total prescribing volume and the percentage of broad-spectrum antibiotics continued to decrease in-hours (IH). The prescribing of broad-spectrum antibiotics was higher in OOH (OOH: 10.1%, IH: 8.7%), but a consistent decrease in the trimethoprim-to-nitrofurantoin ratio was observed OOH. The OOH antibiotic prescribing volume diverged from the historical trend in March 2020 and started to decrease by 5088 items per month. Broad-spectrum antibiotic prescribing started to increase in OOH and IH. In OOH, co-amoxiclav and doxycycline peaked in March to May in 2020, which was out of sync with seasonality peaks (Winter) in previous years. While this increase might be explained by the implementation of the national guideline to use co-amoxiclav and doxycycline to manage pneumonia in the community during COVID-19, further investigation is required to see whether the observed reduction in OOH antibiotic prescribing persists and how this reduction might influence antimicrobial resistance and patient outcomes.

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Cross sectional study estimating prevalence of heart failure and left ventricular systolic dysfunction in community patients at risk

Heart ◽

10.1136/hrt.86.2.172 ◽

2001 ◽

Vol 86 (2) ◽

pp. 172-178 ◽

Cited By ~ 1

Author(s):

O W Nielsen ◽

J Hilden ◽

C T Larsen ◽

J F Hansen

Keyword(s):

Heart Failure ◽

Primary Care ◽

General Practice ◽

Heart Disease ◽

Left Ventricular Systolic Dysfunction ◽

Systolic Dysfunction ◽

Left Ventricular ◽

Ventricular Systolic Dysfunction ◽

Cross Sectional ◽

General Practices

OBJECTIVETo examine a general practice population to measure the prevalence of signs and symptoms of heart failure (SSHF) and left ventricular systolic dysfunction (LVSD).DESIGNCross sectional screening study in three general practices followed by echocardiography.SETTING AND PATIENTSAll patients ⩾ 50 years in two general practices and ⩾ 40 years in one general practice were screened by case record reviews and questionnaires (n = 2158), to identify subjects with some evidence of heart disease. Among these, subjects were sought who had SSHF (n = 115). Of 357 subjects with evidence of heart disease, 252 were eligible for examination, and 126 underwent further cardiological assessment, including 43 with SSHF.MAIN OUTCOME MEASURESPrevalence of SSHF as defined by a modified Boston index, LVSD defined as an indirectly measured left ventricular ejection fraction ⩽ 0.45, and numbers of subjects needing an echocardiogram to detect one case with LVSD.RESULTSSSHF afflicted 0.5% of quadragenarians and rose to 11.7% of octogenarians. Two thirds were handled in primary care only. At ⩾ 50 years of age 6.4% had SSHF, 2.9% had LVSD, and 1.9% (95% confidence interval 1.3% to 2.5%) had both. To detect one case with LVSD in primary care, 14 patients with evidence of heart disease without SSHF and 5.5 patients with SSHF had to be examined.CONCLUSIONSSHF is extremely prevalent in the community, especially in primary care, but more than two thirds do not have LVSD. The number of subjects with some evidence of heart disease needing an echocardiogram to detect one case of LVSD is 14.

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Factors associated with initiation of bone-health medication among older adults in primary care in Ireland

Age and Ageing ◽

10.1093/ageing/afab033 ◽

2021 ◽

Cited By ~ 1

Author(s):

Mary E Walsh ◽

Mari Nerdrum ◽

Tom Fahey ◽

Frank Moriarty

Keyword(s):

Primary Care ◽

Fracture Risk ◽

Bone Health ◽

Retrospective Cohort ◽

Hormone Replacement ◽

Inverse Association ◽

High Fracture ◽

Factors Associated ◽

General Practices ◽

Multimorbid Patients

Abstract Background Adults at high risk of fragility fracture should be offered pharmacological treatment when not contraindicated, however, under-treatment is common. Objective This study aimed to investigate factors associated with bone-health medication initiation in older patients attending primary care. Design This was a retrospective cohort study. Setting The study used data from forty-four general practices in Ireland from 2011–2017. Subjects The study included adults aged ≥ 65 years who were naïve to bone-health medication for 12 months. Methods Overall fracture-risk (based on QFracture) and individual fracture-risk factors were described for patients initiated and not initiated onto medication and compared using generalised linear model regression with the Poisson distribution. Results Of 36,799 patients (51% female, mean age 75.4 (SD = 8.4)) included, 8% (n = 2,992) were observed to initiate bone-health medication during the study. One-fifth of all patients (n = 8,193) had osteoporosis or had high fracture-risk but only 21% of them (n = 1,687) initiated on medication. Female sex, older age, state-funded health cover and osteoporosis were associated with initiation. Independently of osteoporosis and co-variates, high 5-year QFracture risk for hip (IRR = 1.33 (95% CI = 1.17–1.50), P < 0.01) and all fractures (IRR = 1.30 (95% CI = 1.17–1.44), P < 0.01) were associated with medication initiation. Previous fracture, rheumatoid arthritis and corticosteroid use were associated with initiation, while liver, kidney, cardiovascular disease, diabetes and oestrogen-only hormone replacement therapy showed an inverse association. Conclusions Bone-health medication initiation is targeted at patients at higher fracture-risk but much potential under-treatment remains, particularly in those >80 years and with co-morbidities. This may reflect clinical uncertainty in older multimorbid patients, and further research should explore decision-making in preventive bone medication prescribing.

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Use of CAHPS® patient experience survey data as part of a patient-centered medical home quality improvement initiative

Journal of Healthcare Leadership ◽

10.2147/jhl.s69963 ◽

2015 ◽

pp. 41

Author(s):

Ron Hays ◽

Denise Quigley ◽

Peter Mendel ◽

Zachary Predmore ◽

Alex Y. Chen

Keyword(s):

Quality Improvement ◽

Survey Data ◽

Patient Experience ◽

Medical Home ◽

Quality Improvement Initiative ◽

Patient Centered Medical Home ◽

Patient Centered ◽

Experience Survey

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What Resources Do NHS Commissioning Organisations Use to Support Antimicrobial Stewardship in Primary Care in England?

Antibiotics ◽

10.3390/antibiotics9040158 ◽

2020 ◽

Vol 9 (4) ◽

pp. 158 ◽

Cited By ~ 1

Author(s):

Rosalie Allison ◽

Donna M. Lecky ◽

Elizabeth Beech ◽

Diane Ashiru-Oredope ◽

Céire Costelloe ◽

...

Keyword(s):

Primary Care ◽

Antimicrobial Stewardship ◽

Professional Education ◽

Action Planning ◽

Health Economy ◽

Medicines Management ◽

Out Of Hours ◽

Primary Care Settings ◽

General Practices ◽

Primary Care Practitioners

Professional education and public engagement are fundamental components of any antimicrobial stewardship (AMS) strategy. The National Institute for Health and Care Excellence (NICE), Public Health England (PHE), Health Education England (HEE) and other professional organisations, develop and publish resources to support AMS activity in primary care settings. The aim of this study was to explore the adoption and use of education/training and supporting AMS resources within NHS primary care in England. Questionnaires were sent to the medicines management teams of all 209 Clinical Commissioning Groups (CCGs) in England, in 2017. Primary care practitioners in 168/175 (96%) CCGs received AMS education in the last two years. Respondents in 184/186 (99%) CCGs reported actively promoting the TARGET Toolkit to their primary care practitioners; although 137/176 (78%) did not know what percentage of primary care practitioners used the TARGET toolkit. All respondents were aware of Antibiotic Guardian and 132/167 (79%) reported promoting the campaign. Promotion of AMS resources to general practices is currently excellent, but as evaluation of uptake or effect is poor, this should be encouraged by resource providers and through quality improvement programmes. Trainers should be encouraged to promote and highlight the importance of action planning within their AMS training. AMS resources, such as leaflets and education, should be promoted across the whole health economy, including Out of Hours and care homes. Primary care practitioners should continue to be encouraged to display a signed Antibiotic Guardian poster as well as general AMS posters and videos in practice, as patients find them useful and noticeable.

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Acceptability of a vocational advice service for patients consulting in primary care with musculoskeletal pain: A qualitative exploration of the experiences of general practitioners, vocational advisers and patients

Scandinavian Journal of Public Health ◽

10.1177/1403494817723194 ◽

2017 ◽

Vol 47 (1) ◽

pp. 78-85 ◽

Cited By ~ 2

Author(s):

Tom Sanders ◽

Gwenllian Wynne-Jones ◽

Bie Nio Ong ◽

Majid Artus ◽

Nadine Foster

Keyword(s):

Primary Care ◽

Controlled Trial ◽

Comparative Method ◽

Qualitative Interviews ◽

Cluster Randomised Controlled Trial ◽

Key Factors ◽

Constant Comparative Method ◽

General Practices ◽

Randomised Controlled ◽

Qualitative Exploration

Aims: Using qualitative interviews, this study explored the experiences of GPs, vocational advisers and patients towards a new vocational advice (VA) service in primary care. Methods: This study was nested within the Study of Work and Pain (SWAP) cluster randomised controlled trial. The SWAP trial located a VA service within three general practices in Staffordshire. Interviews took place with 10 GPs 12 months after the introduction of the VA service, four vocational advisers whilst the VA service was running and 20 patients on discharge from the VA service. The data were analysed using the constant comparative method, which is a variation of grounded theory. Results: The key factors determining the acceptability and perceived effectiveness of the VA service from the perspective of the three groups of stakeholders were (1) the timing of referrals to the VA, (2) the perceived lack of patient demand for the service and (3) role uncertainty experienced by VAs. Conclusions: Early vocational intervention may not be appropriate for all musculoskeletal patients with work difficulties. Indeed, many patients felt they did not require the support of a VA, either because they had self-limiting work difficulties and/or already had support mechanisms in place to return to work. Future VA interventions may be better implemented in a targeted way so that appropriate patients are identified with characteristics which can best be addressed by the VA service.

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Using in situ simulation to improve care of the acutely ill patient by enhancing interprofessional working: a qualitative proof of concept study in primary care in England

BMJ Open ◽

10.1136/bmjopen-2018-028572 ◽

2019 ◽

Vol 9 (7) ◽

pp. e028572

Author(s):

Amy Halls ◽

Mohan Kanagasundaram ◽

Margaret Lau-Walker ◽

Hilary Diack ◽

Simon Bettles

Keyword(s):

Primary Care ◽

Training Session ◽

Medical Emergency ◽

Future Research ◽

Proof Of Concept ◽

In Situ Simulation ◽

Concept Study ◽

Interprofessional Working ◽

General Practices

ObjectiveAcutely unwell patients in the primary care setting are uncommon, but their successful management requires involvement from staff (clinical and non-clinical) working as a cohesive team. Despite the advantages of interprofessional education being well documented, there is little research evidence of this within primary care. Enhancing interprofessional working could ultimately improve care of the acutely ill patient. This proof of concept study aimed to develop an in situ simulation of a medical emergency to use within primary care, and assess its acceptability and utility through participants’ reported experiences.SettingThree research-active General Practices in south east England. Nine staff members per practice consented to participate, representing clinical and non-clinical professions.MethodsThe intervention of an in situ simulation scenario of a cardiac arrest was developed by the research team. For the evaluation, staff participated in individual qualitative semistructured interviews following the in situ simulation: these focused on their experiences of participating, with particular attention on interdisciplinary training and potential future developments of the in situ simulation.ResultsThe in situ simulation was appropriate for use within the participating General Practices. Qualitative thematic analysis of the interviews identified four themes: (1) apprehension and (un)willing participation, (2) reflection on the simulation design, (3) experiences of the scenario and (4) training.ConclusionsThis study suggests in situ simulation can be an acceptable approach for interdisciplinary team training within primary care, being well-received by practices and staff. This contributes to a fuller understanding of how in situ simulation can benefit both workforce and patients. Future research is needed to further refine the in situ simulation training session.

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