NHS’s botched outsourcing of primary care support services put patients at risk, says watchdog

BackgroundIdentifying patients at risk of harm in general practice is challenging for busy clinicians. In UK primary care, trigger tools and case note reviews are mainly used to identify rates of harm in sample populations.AimThis study explores how adaptions to existing trigger tool methodology can identify patient safety events and engage clinicians in ongoing reflective work around safety.Design and settingMixed-method quantitative and narrative evaluation using thematic analysis in a single East London training practice.MethodThe project team developed and tested five trigger searches, supported by Excel worksheets to guide the case review process. Project evaluation included summary statistics of completed worksheets and a qualitative review focused on ease of use, barriers to implementation, and perception of value to clinicians.ResultsTrigger searches identified 204 patients for GP review. Overall, 117 (57%) of cases were reviewed and 62 (53%) of these cases had patient safety events identified. These were usually incidents of omission, including failure to monitor or review. Key themes from interviews with practice members included the fact that GPs’ work is generally reactive and GPs welcomed an approach that identified patients who were ‘under the radar’ of safety. All GPs expressed concern that the tool might identify too many patients at risk of harm, placing further demands on their time.ConclusionElectronic trigger tools can identify patients for review in domains of clinical risk for primary care. The high yield of safety events engaged clinicians and provided validation of the need for routine safety checks.

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Identifying Patients at Risk for Fibrosis in a Primary Care NAFLD Cohort

Journal of Clinical Gastroenterology ◽

10.1097/mcg.0000000000001585 ◽

2021 ◽

Vol Publish Ahead of Print ◽

Author(s):

Andrew D. Schreiner ◽

Sherry Livingston ◽

Jingwen Zhang ◽

Mulugeta Gebregziabher ◽

Justin Marsden ◽

...

Keyword(s):

Primary Care ◽

At Risk ◽

Patients At Risk

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130Improving the implementation of anti-coagulation therapy in AF patients at risk of stroke in a primary care setting

EP Europace ◽

10.1093/europace/eux283.123 ◽

2017 ◽

Vol 19 (suppl_1) ◽

pp. i53-i53

Author(s):

S.E Agdomar

Keyword(s):

Primary Care ◽

At Risk ◽

Care Setting ◽

Primary Care Setting ◽

Coagulation Therapy ◽

Patients At Risk

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Effectiveness of the nurse-led Activate intervention in patients at risk of cardiovascular disease in primary care: a cluster-randomised controlled trial

European Journal of Cardiovascular Nursing ◽

10.1177/1474515120919547 ◽

2020 ◽

pp. 147451512091954

Author(s):

Heleen Westland ◽

Marieke J Schuurmans ◽

Irene D Bos-Touwen ◽

Marjolein A de Bruin-van Leersum ◽

Evelyn M Monninkhof ◽

...

Keyword(s):

Physical Activity ◽

Cardiovascular Disease ◽

Primary Care ◽

At Risk ◽

Controlled Trial ◽

Cluster Randomised Controlled Trial ◽

Self Management ◽

Patients At Risk ◽

Secondary Outcomes ◽

Randomised Controlled

Background To understand better the success of self-management interventions and to enable tailoring of such interventions at specific subgroups of patients, the nurse-led Activate intervention is developed targeting one component of self-management (physical activity) in a heterogeneous subgroup (patients at risk of cardiovascular disease) in Dutch primary care. Aim The aim of this study was to evaluate the effectiveness of the Activate intervention and identifying which patient-related characteristics modify the effect. Methods A two-armed cluster-randomised controlled trial was conducted comparing the intervention with care as usual. The intervention consisted of four nurse-led behaviour change consultations within a 3-month period. Data were collected at baseline, 3 months and 6 months. Primary outcome was the daily amount of moderate to vigorous physical activity at 6 months. Secondary outcomes included sedentary behaviour, self-efficacy for physical activity, patient activation for self-management and health status. Prespecified effect modifiers were age, body mass index, level of education, social support, depression, patient provider relationship and baseline physical activity. Results Thirty-one general practices ( n = 195 patients) were included (intervention group n = 93; control group n = 102). No significant between-group difference was found for physical activity (mean difference 2.49 minutes; 95% confidence interval -2.1; 7.1; P = 0.28) and secondary outcomes. Patients with low perceived social support ( P = 0.01) and patients with a low baseline activity level ( P = 0.02) benefitted more from the intervention. Conclusion The Activate intervention did not improve patients’ physical activity and secondary outcomes in primary care patients at risk of cardiovascular disease. To understand the results, the intervention fidelity and active components for effective self-management require further investigation. Trial registration: ClinicalTrials.gov NCT02725203.

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Predictors of Health-Related Quality of Life in Patients at Risk for Cardiovascular Disease in European Primary Care

PLoS ONE ◽

10.1371/journal.pone.0029334 ◽

2011 ◽

Vol 6 (12) ◽

pp. e29334 ◽

Cited By ~ 29

Author(s):

Sabine Ludt ◽

Michel Wensing ◽

Joachim Szecsenyi ◽

Jan van Lieshout ◽

Justine Rochon ◽

...

Keyword(s):

Quality Of Life ◽

Cardiovascular Disease ◽

Primary Care ◽

At Risk ◽

Health Related Quality ◽

Related Quality ◽

Health Related ◽

Patients At Risk

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The Opioid Renewal Clinic: A Primary Care, Managed Approach to Opioid Therapy in Chronic Pain Patients at Risk for Substance Abuse

Pain Medicine ◽

10.1111/j.1526-4637.2006.00254.x ◽

2007 ◽

Vol 8 (7) ◽

pp. 573-584 ◽

Cited By ~ 106

Author(s):

Nancy L. Wiedemer ◽

Paul S. Harden ◽

Isabelle O. Arndt ◽

Rollin M. Gallagher

Keyword(s):

Primary Care ◽

At Risk ◽

Substance Abuse ◽

Chronic Pain ◽

Opioid Therapy ◽

Chronic Pain Patients ◽

Patients At Risk ◽

Pain Patients

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Managing Patients at Risk of Medication Related Complications Requiring Dental Extractions in Primary Care

Primary Dental Journal ◽

10.1177/2050168420943977 ◽

2020 ◽

Vol 9 (3) ◽

pp. 54-58

Author(s):

Jamie Toole ◽

Gerry McKenna ◽

Joanna Smyth

Keyword(s):

Primary Care ◽

At Risk ◽

Dual Antiplatelet Therapy ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Clinical Effectiveness ◽

Bleeding Risk ◽

Antiresorptive Drugs ◽

Patients At Risk ◽

Primary Care Clinicians

When undertaking dental extractions in modern dental practice, two of the complications that have the potential to cause most apprehension for clinicians are the risks of osteonecrosis of the jaws and uncontrollable haemorrhage. This is especially the case when treating older patients because of the increased likelihood of co-morbidities and accompanying polypharmacy which can predispose patients to these problems. Specific medications of concern to practitioners in relation to osteonecrosis risk are antiangiogenic and antiresorptive drugs. Patients taking dual antiplatelet therapy and direct oral anticoagulants require consideration in relation to bleeding risk. With these medications coming increasingly to the forefront over recent years, guidance has been developed by organisations such as the Scottish Dental Clinical Effectiveness Programme (SDCEP). Appropriate use of these guideline should ensure that patients felt to be at particular risk of these complications can frequently be safely managed in primary care. This article aims to provide advice on recognising patients at risk, and to discuss how to utilise key messages within published guidelines when making treatment decisions. The overall intent is to help primary care clinicians who are likely to encounter these patients more and more.

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Evaluation of the Fracture Liaison Service within the Canadian Healthcare Setting

Journal of Osteoporosis ◽

10.1155/2020/6742604 ◽

2020 ◽

Vol 2020 ◽

pp. 1-6

Author(s):

Matthew Wong-Pack ◽

Nawazish Naqvi ◽

George Ioannidis ◽

Ramy Khalil ◽

Alexandra Papaioannou ◽

...

Keyword(s):

Primary Care ◽

At Risk ◽

Primary Care Physicians ◽

Osteoporotic Fractures ◽

Fracture Liaison Service ◽

Care Physician ◽

Osteoporosis Management ◽

Patients At Risk ◽

Fracture Liaison ◽

Canadian Healthcare

Previous studies evaluating fracture liaison service (FLS) programs have found them to be cost-effective, efficient, and reduce the risk of fracture. However, few studies have evaluated the clinical effectiveness of these programs. We compared the patient populations of those referred for osteoporosis management by FLS to those referred by primary care physicians (PCP), within the Canadian healthcare system in the province of Ontario. Specifically, we investigated if a referral from FLS is similarly effective as PCP at identifying patients at risk for future osteoporotic fractures and if osteoporosis therapies have been previously initiated. A retrospective chart review of patients assessed by a single Ontario rheumatology practice affiliated with FLS between January 1, 2014, and December 31, 2017, was performed identifying two groups: those referred by FLS within Hamilton and those referred by their PCP for osteoporosis management. Fracture risk of each patient was determined using FRAX. A total of 573 patients (n = 225 (FLS group) and n = 227 (PCP group)) were evaluated. Between the FLS and PCP groups, there were no significant differences in the absolute 10-year risk of a major osteoporotic fracture (15.6% (SD = 10.2) vs 15.3% (SD = 10.3)) and 10-year risk of hip fracture (4.7% (SD = 8.3) vs 4.7% (SD = 6.8)), respectively. 10.7% of patients referred by FLS and 40.5% of patients referred by their PCP were on osteoporosis medication prior to fracture. Our study suggests that referral from FLS is similarly effective as PCP at identifying patients at risk for future osteoporotic fractures, and clinically effective at identifying the care gap with the previous use of targeted osteoporosis therapies from referral from PCP being low and much lower in those referred by FLS. Interventional programs such as FLS can help close the treatment gap by providing appropriate care to patients that were not previously identified to be at risk for fracture by their primary care physician and initiate proper medical management.

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