scholarly journals Understanding the use of email consultation in primary care using a retrospective observational study with data of Dutch electronic health records

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e019233 ◽  
Author(s):  
Martine W J Huygens ◽  
Ilse C S Swinkels ◽  
Robert A Verheij ◽  
Roland D Friele ◽  
Onno C P van Schayck ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Observational Study ◽  
Patient Characteristics ◽  
Retrospective Observational Study ◽  
Electronic Health Record Data ◽  
Face To Face ◽  
Patients With Diabetes ◽  
General Practices ◽  
Electronic Health

ObjectivesIt is unclear why the use of email consultation is not more widespread in Dutch general practice, particularly because, since 2006, its costs can be reimbursed. To encourage further implementation, it is needed to understand the current use of email consultations. This study aims to understand the use of email consultation by different patient groups, compared with other general practice (GP) consultations.SettingFor this retrospective observational study, we used Dutch routine electronic health record data obtained from NIVEL Primary Care Database for the years 2010 and 2014.Participants200 general practices were included in 2010 (734 122 registered patients) and 434 in 2014 (1 630 386 registered patients).Primary outcome measuresThe number and percentage of email consultations and patient characteristics (age, gender, neighbourhood socioeconomic status and diagnoses) of email consultation users were investigated and compared with those who had a telephone or face-to-face consultation. General practice characteristics were also taken into account.Results32.0% of the Dutch general practices had at least one email consultation in 2010, rising to 52.8% in 2014. In 2014, only 0.7% of the GP consultations were by email (the others comprised home visits, telephone and face-to-face consultations). Its use highly varied among general practices. Most email consultations were done for psychological (14.7%); endocrine, metabolic and nutritional (10.9%); and circulatory (10.7%) problems. These diagnosis categories appeared less frequently in telephone and face-to-face consultations. Patients who had an email consultation were older than patients who had a telephone or face-to-face consultation. In contrast, patients with diabetes who had an email consultation were younger.ConclusionEven though email consultation was done in half the general practices in the Netherlands in 2014, the actual use of it is extremely low. Patients who had an email consultation differ from those who had a telephone or face-to-face consultation. In addition, the use of email consultation by patients is dependent on its provision by GPs.

scholarly journals Use of a primary care online consultation system, by whom, when and why: evaluation of a pilot observational study in 36 general practices in South West England

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e016901 ◽  
Author(s):  
Hannah B Edwards ◽  
Elsa Marques ◽  
William Hollingworth ◽  
Jeremy Horwood ◽  
Michelle Farr ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Waiting Times ◽  
Telephone Consultation ◽  
Face To Face ◽  
Online Consultation ◽  
South West ◽  
Consultation System ◽  
General Practices ◽  
South West England

ObjectivesEvaluation of a pilot study of an online consultation system in primary care. We describe who used the system, when and why, and the National Health Service costs associated with its use.Design15-month observational study.SettingPrimary care practices in South West England.Results36 General practices covering 396 828 patients took part in the pilot. The online consultation website was viewed 35 981 times over the pilot period (mean 9.11 visits per 1000 patients per month). 7472 patients went on to complete an ‘e-consultation’ (mean 2.00 online consultations per 1000 patients per month). E-consultations were mainly performed on weekdays and during normal working hours. Patient records (n=485) were abstracted for eight practices and showed that women were more likely to use e-consultations than men (64.7% vs 35.3%) and users had a median age of 39 years (IQR 30–50). The most common reason for an e-consultation was an administrative request (eg, test results, letters and repeat prescriptions (22.5%)) followed by infections/immunological issues (14.4%). The majority of patients (65.2%) received a response within 2 days. The most common outcome was a face-to-face (38%) or telephone consultation (32%). The former were more often needed for patients consulting about new conditions (OR 1.56, 95% CI 1.05 to 2.27, p=0.049). The average cost of a practice’s response to an e-consultation was £36.28, primarily triage time and resulting face-to-face/telephone consultations needed.ConclusionsUse of e-consultations is very low, particularly at weekends. Unless this can be improved, any impact on staff workload and patient waiting times is likely to be negligible. It is possible that use of e-consultations increases primary care workload and costs. Online consultation systems could be developed to improve efficiency both for staff and patients. These findings have implications for software developers as well as primary care services and policy-makers who are considering investing in online consultation systems.

scholarly journals Patient complaints in general practice seen through the lens of professionalism: a retrospective observational study

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2020.0168
Author(s):  
Pieter C Barnhoorn ◽  
Geurt TJM Essers ◽  
Vera Nierkens ◽  
Mattijs E Numans ◽  
Walther NKA van Mook ◽  
...  
Keyword(s):  
General Practice ◽  
Observational Study ◽  
Waiting Times ◽  
Retrospective Observational Study ◽  
Exact Nature ◽  
Out Of Hours ◽  
Face To Face ◽  
Patient Complaints ◽  
Rich Diversity ◽  
Open Coding

BackgroundProfessionalism is a key competence for physicians. Patient complaints provide a unique insight into patient expectations regarding professionalism. Research exploring the exact nature of patient complaints in general practice, especially focused on professionalism, is limited.AimTo characterise patient complaints in primary care and to explore in more detail which issues with professionalism exist.Design & settingA retrospective observational study in which all unsolicited patient complaints to a representative out-of-hours general practice (OOH GP) service provider in The Netherlands were analysed over a 10-year period (2009–2019).MethodComplaints were coded for general characteristics and thematically categorised using the CanMEDS Physician Competency Framework (CanMEDS) as sensitising concepts. Complaints categorised as professionalism were subdivided using open coding.ResultsOut of 746 996 patient consultations (telephone, face-to-face, and home visits) 484 (0.065%) resulted in eligible complaint letters. The majority consisted of two or more complaints, resulting in 833 different complaints. Most complaints concerned GPs (80%); a minority (19%) assistants. Thirty-five per cent concerned perceived professionalism lapses of physicians. A rich diversity in the wording of professionalism lapses was found, where 'not being taken seriously' was mentioned most often. Forty-five per cent related to medical expertise, such as missed diagnoses or unsuccessful clinical treatment. Nineteen per cent related to management problems, especially waiting times and access to care. Communication issues were only explicitly mentioned in 1% of the complaints.ConclusionMost unsolicited patient complaints were related to clinical problems. A third, however, concerned professionalism issues. Not being taken seriously was the most frequent mentioned theme within the professionalism category.

scholarly journals Efficiency of primary spine care as compared to conventional primary care: a retrospective observational study at an Academic Medical Center

2022 ◽  
Vol 30 (1) ◽  
Author(s):  
Serena Bezdjian ◽  
James M. Whedon ◽  
Robb Russell ◽  
Justin M. Goehl ◽  
Louis A. Kazal
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Opioid Analgesic ◽  
Primary Care Clinic ◽  
Patient Characteristics ◽  
Retrospective Observational Study ◽  
Initial Visit ◽  
Care Clinic ◽  
Spine Care ◽  
Primary Spine

Abstract Background Primary Spine Care (PSC) is an innovative model for the primary management of patients with spine-related disorders (SRDs), with a focus on the use of non-pharmacological therapies which now constitute the recommended first-line approach to back pain. PSC clinicians serve as the initial or early point of contact for spine patients and utilize evidence-based spine care pathways to improve outcomes and reduce escalation of care (EoC; e.g., spinal injections, diagnostic imaging, hospitalizations, referrals to a specialist). The present study examined 6-month outcomes to evaluate the efficiency of care for patients who received PSC as compared to conventional primary care. We hypothesized that patients seen by a PSC clinician would have lower rates of EoC compared to patients who received usual care by a primary care (PC) clinician. Methods This was a retrospective observational study. We evaluated 6-month outcomes for two groups seen and treated for an SRD between February 01, 2017 and January 31, 2020. Patient groups were comprised of N = 1363 PSC patients (Group A) and N = 1329 PC patients (Group B). We conducted Pearson chi-square and logistic regression (adjusting for patient characteristics that were unbalanced between the two groups) to determine associations between the two groups and 6-month outcomes. Results Within six months of an initial visit for an SRD, a statistically significantly smaller proportion of PSC patients utilized healthcare resources for spine care as compared to the PC patients. When adjusting for patient characteristics, those who received care from the PSC clinician were less likely within 6 months of an initial visit to be hospitalized (OR = .47, 95% CI .23–.97), fill a prescription for an opioid analgesic (OR = .43; 95% CI .29–.65), receive a spinal injection (OR = .56, 95% CI .33–.95), or have a visit with a specialist (OR = .48, 95% CI .35–.67) as compared to those who received usual primary care. Conclusions Patients who received PSC in an academic primary care clinic experienced significantly less escalation of their spine care within 6 months of their initial visit. The PSC model may offer a more efficient approach to the primary care of spine problems for patients with SRDs, as compared to usual primary care.

scholarly journals Online and telephone access to general practice: a cross sectional patient survey

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2020.0179
Author(s):  
Carol Bryce ◽  
Matthew DL. O'Connell ◽  
Jeremy Dale ◽  
Martin Underwood ◽  
Helen Atherton
Keyword(s):  
General Practice ◽  
Patient Characteristics ◽  
Patient Survey ◽  
Remote Access ◽  
Online Information ◽  
Online Services ◽  
Cross Sectional ◽  
Face To Face ◽  
The United Kingdom ◽  
General Practices

BackgroundImproving access to primary healthcare in the United Kingdom has focused on the use of telephone and online access but little is known about how awareness of and use varies between different patient groups.AimTo determine how patients are interacting with telephone and online channels for accessing general practice services and information, and to analyse how this varies according to patient characteristics and health status.Design & settingA cross sectional self-administered survey of adult patients in general practices across the West Midlands, UK.MethodDescriptive statistics were used to show participants’ awareness of and interaction with online information sources and remote access. Multivariable logistic regression was used to model the relationships between demographic and health characteristics and awareness and use of online services and alternatives to face to face consultations (e.g. telephone).Results2789 patients (response rate 19.0%) from 43 general practices participated. 60.8% (1651/2715) of participants were aware of online services and 30.3% (811/2674) reported having used one. Daily internet usage and frequently visiting the GP showed the strongest associations with knowledge and use of online services.ConclusionWe have shown that there is the potential for inequitable awareness and use of telephone and online services in general practice populations. Given that their use has greatly increased due to the COVID-19 pandemic future service design will need to ensure this is taken into account.

scholarly journals Standing order use in general practice: the views of medicine, nursing and pharmacy stakeholder organisations

2017 ◽  
Vol 9 (1) ◽  
pp. 47 ◽  
Author(s):  
Robyn Taylor ◽  
Eileen McKinlay ◽  
Caroline Morris
Keyword(s):  
General Practice ◽  
General Practitioner ◽  
Access To Health Care ◽  
Timely Manner ◽  
Face To Face ◽  
Standing Order ◽  
Access To Health ◽  
General Practices ◽  
Pharmacy Data ◽  
The Impact

ABSTRACT INTRODUCTION Standing orders are used by many general practices in New Zealand. They allow a practice nurse to assess patients and administer and/or supply medicines without needing intervention from a general practitioner. AIM To explore organisational strategic stakeholders’ views of standing order use in general practice nationally. METHODS Eight semi-structured, qualitative, face-to-face interviews were conducted with participants representing key primary care stakeholder organisations from nursing, medicine and pharmacy. Data were analysed using a qualitative inductive thematic approach. RESULTS Three key themes emerged: a lack of understanding around standing order use in general practice, legal and professional concerns, and the impact on workforce and clinical practice. Standing orders were perceived to extend nursing practice and seen as a useful tool in enabling patients to access medicines in a safe and timely manner. DISCUSSION The variability in understanding of the definition and use of standing orders appears to relate to a lack of leadership in this area. Leadership should facilitate the required development of standardised resources and quality assurance measures to aid implementation. If these aspects are addressed, then standing orders will continue to be a useful tool in general practice and enable patients to have access to health care and, if necessary, to medicines without seeing a general practitioner.

scholarly journals Influence of serum iron test results on the diagnosis of iron deficiency in children: a retrospective observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e046865
Author(s):  
Gorkem Sezgin ◽  
Ling Li ◽  
Johanna Westbrook ◽  
Elisabeth Wearne ◽  
Denise Azar ◽  
...  
Keyword(s):  
Iron Deficiency ◽  
Observational Study ◽  
General Practitioners ◽  
Serum Ferritin ◽  
Serum Iron ◽  
Estimating Equation ◽  
Normal Serum ◽  
Retrospective Observational Study ◽  
Test Results ◽  
General Practices

Background and objectiveSerum iron results are not indicative of iron deficiency yet may be incorrectly used to diagnose iron deficiency instead of serum ferritin results. Our objective was to determine the association between serum iron test results and iron-deficiency diagnosis in children by general practitioners.Design, setting, patients and main outcome measuresA retrospective observational study of 14 187 children aged 1–18 years with serum ferritin and serum iron test results from 137 general practices in Victoria, Australia, between 2008 and 2018. Generalised estimating equation models calculating ORs were used to determine the association between serum iron test results (main exposure measure) and iron-deficiency diagnosis (outcome measure) in the following two population groups: (1) iron-deplete population, defined as having a serum ferritin <12 µg/L if aged <5 years and <15 µg/L if aged ≥5 years and (2) iron-replete population, defined as having a serum ferritin >30 µg/L.Results3484 tests were iron deplete and 15 528 were iron replete. Iron-deplete children were less likely to be diagnosed with iron deficiency if they had normal serum iron levels (adjusted OR (AOR): 0.73; 95% CI 0.57 to 0.96). Iron-replete children had greater odds of an iron-deficiency diagnosis if they had low serum iron results (AOR: 2.59; 95% CI 1.72 to 3.89). Other contributors to an iron-deficiency diagnosis were female sex and having anaemia.ConclusionSerum ferritin alone remains the best means of diagnosing iron deficiency. Reliance on serum iron test results by general practitioners is leading to significant overdiagnosis and underdiagnosis of iron deficiency in children.

Sign in / Sign up

Export Citation Format

Share Document