Assessing the impact of colonoscopy complications on use of colonoscopy among primary care physicians and other connected physicians: an observational study of older Americans

Purpose Canada’s primary care system has been described as “a culture of pilot projects” with little evidence of converting successful initiatives into funded, permanent programs or sharing project outcomes and insights across jurisdictions. Health services pilot projects are advocated as an effective strategy for identifying promising models of care and building integrated care partnerships in local settings. In the qualitative study reported here, the purpose of this paper is to investigate the strengths and challenges of this approach. Design/methodology/approach Semi-structured interviews were conducted with 34 primary care physicians who discussed their experiences as pilot project leads. Following thematic analysis methods, broad system issues were captured as well as individual project information. Findings While participants often portrayed themselves as advocates for vulnerable patients, mobilizing healthcare organizations and providers to support new models of care was discussed as challenging. Competition between local healthcare providers and initiatives could impact pilot project success. Participants also reported tensions between their clinical, project management and research roles with additional time demands and skill requirements interfering with the work of implementing and evaluating service innovations. Originality/value Study findings highlight the complexity of pilot project implementation, which encompasses physician commitment to addressing care for vulnerable populations through to the need for additional skill set requirements and the impact of local project environments. The current pilot project approach could be strengthened by including more multidisciplinary collaboration and providing infrastructure supports to enhance the design, implementation and evaluation of health services improvement initiatives.

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Response: Re: The Impact of Prior Authorization Requirements on Primary Care Physicians' Offices: Report of Two Parallel Network Studies

The Journal of the American Board of Family Medicine ◽

10.3122/jabfm.2013.03.130074 ◽

2013 ◽

Vol 26 (3) ◽

pp. 340-341 ◽

Cited By ~ 1

Author(s):

C. P. Morley ◽

D. J. Badolato ◽

J. Hickner ◽

J. W. Epling

Keyword(s):

Primary Care ◽

Primary Care Physicians ◽

Prior Authorization ◽

Parallel Network ◽

Network Studies ◽

The Impact

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Reforming respiratory outpatient services: a before-and-after observational study assessing the impact of a quality improvement project applying British Thoracic Society criteria to the discharge of patients to primary care

Primary Care Respiratory Journal ◽

10.4104/pcrj.2013.00013 ◽

2013 ◽

Vol 22 (1) ◽

pp. 72-78 ◽

Cited By ~ 4

Author(s):

Alice M Turner ◽

Satinder Kaur Dalay ◽

Ambika Talwar ◽

Catherine Snelson ◽

Rahul Mukherjee

Keyword(s):

Primary Care ◽

Quality Improvement ◽

Observational Study ◽

Quality Improvement Project ◽

British Thoracic Society ◽

Outpatient Services ◽

Improvement Project ◽

Before And After ◽

The Impact

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The impact of childhood acute rotavirus gastroenteritis on the parents’ quality of life: prospective observational study in European primary care medical practices

BMC Pediatrics ◽

10.1186/1471-2431-12-58 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 22

Author(s):

Javier Diez Domingo ◽

Marian Patrzalek ◽

Luigi Cantarutti ◽

Benoit Arnould ◽

Juliette Meunier ◽

...

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Observational Study ◽

Prospective Observational Study ◽

Medical Practices ◽

Rotavirus Gastroenteritis ◽

The Impact

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Severity and Criteria Based Prompting for Treatment of Depressed Patients

The International Journal of Psychiatry in Medicine ◽

10.2190/dh9k-meyu-9yhy-nekv ◽

2005 ◽

Vol 35 (2) ◽

pp. 149-159 ◽

Cited By ~ 1

Author(s):

Donald E. Nease ◽

Michael S. Klinkman ◽

James E. Aikens

Keyword(s):

Primary Care ◽

Symptom Severity ◽

Primary Care Physicians ◽

Routine Care ◽

Future Research ◽

Binomial Regression ◽

Care Appointment ◽

Depressive Symptom Severity ◽

Primary Care Practices ◽

The Impact

Purpose: Primary care physicians (PCPs) often do not respond to prompts based upon criteria-based depression screens, perhaps because these prompts do not account for depression severity. We conducted this pilot study to determine the feasibility of prompting for both diagnostic criteria and severity and to assess whether depression would be more attended to with positive “dual prompts” than prompts based on either criteria or symptom severity alone. Methods: Immediately prior to a routine care appointment, 87 adults from three primary care practices completed the PRIME-MD Clinician Evaluation Guide Mood Module (PRIME-MD; assesses depression criteria) and the Brief Depression Rating (BDR; assesses depressive symptom severity), and their results were issued in a salient PCP prompt on the chart. Immediately afterwards, patients reported the impact of the screening results upon treatment decisions during the encounter. Data were analyzed by χ2, analysis of variance, and binomial regression. Results: Compared to subjects screening positive on either depression criteria or severity alone ( n = 10), those patients on both ( n = 17) were more likely to report discussing depression, and agreement that the physician and patient decided treatment was needed and initiated or continued. There were no differences in patient satisfaction based on screening results. After accounting for PRIME-MD results, BDR scores predicted agreement with the physician and patient decided treatment was needed (OR = 22.03; 95% CI: 2.05–236.46). Conclusions: Supplementary severity-based depression screening is feasible, and might overcome the limitations of criteria-based screening alone. Future research could test this hypothesis in a large randomized trial.

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Comparative Study Between Preferential Consultations And Most Common Diagnoses

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1639 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S451-S451

Author(s):

C. Manso Bazús ◽

J. Valdes Valdazo ◽

E. Garcia Fernandez ◽

L.T. Velilla Diez ◽

J. Min Kim ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Health Care ◽

Observational Study ◽

Affective Disorders ◽

Primary Care Physicians ◽

The Other ◽

Health Care Burden ◽

Competing Interest ◽

The One

IntroductionTo the specialized attention arrives as preferred patients with minor diagnosis.ObjectiveWe do a relation between the type (normal/preferential) derivation of the first consultations and their corresponding diagnosis.MethodologyRetrospective observational study with data gathered during 3 months, which handle 2 variables: on the one hand, type of derivation and on the other, effected diagnosis.ResultsThe most frequent diagnosis found are adaptative disorders and affective disorders, corresponding to 45.45% and 9.1%, respectively of preferred leads.ConclusionsAlmost half of preferential queries (consultations) could be treated in first instance by primary care physicians releasing mental health care burden.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Physician speciality and pain reduction in patients with depressive symptoms under treatment with venlafaxine

European Psychiatry ◽

10.1016/j.eurpsy.2009.10.004 ◽

2010 ◽

Vol 25 (8) ◽

pp. 455-460 ◽

Cited By ~ 1

Author(s):

S. Begré ◽

M. Traber ◽

M. Gerber ◽

R. von Känel

Keyword(s):

Primary Care ◽

Depressive Symptoms ◽

General Practitioners ◽

Primary Care Physicians ◽

Depressive Symptomatology ◽

Pain Reduction ◽

Integrated Treatment ◽

Medical Speciality ◽

Iatrogenic Complications ◽

The Impact

AbstractObjectivesExcessive pain perception may lead to unnecessary diagnostic testing or invasive procedures resulting in iatrogenic complications and prolonged disability. Naturalistic studies on patients with chronic pain and depressive symptoms investigating the impact of medical speciality on treatment outcome in a primary care setting are lacking.MethodsIn this observational study, we examined whether the magnitude of pain reduction in 444 patients with depressive symptomatology under venlafaxine would relate differently to the medical speciality of the 122 treating physicians, namely psychiatrists (n = 110 patients), general practitioners (n = 236 patients), and internists (n = 98 patients).ResultsIndependent of age, gender, patient's region of origin, comorbidity, severity and duration of pain, and depressive symptoms at study entry, patients seemed to benefit significantly less in terms of pain reduction (p < 0.001) and of reduction in severity of depressive symptomatology by psychiatrists as compared to general practitioners (p < 0.019) and internists (p < 0.002).ConclusionsThe findings suggest that patients referred to psychiatrists are more difficult to treat than those referred to general practitioners and internists, and might not have been adequately prepared for psychiatric interventions. A supporting cooperation and networking between psychiatrists and primary care physicians may contribute to an integrated treatment concept and therefore, may lead to a better outcome in this challenging patient group.

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