scholarly journals Chronic rhinosinusitis: a qualitative study of patient views and experiences of current management in primary and secondary care

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e022644 ◽  
Author(s):  
Jane Vennik ◽  
Caroline Eyles ◽  
Mike Thomas ◽  
Claire Hopkins ◽  
Paul Little ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Rhinosinusitis ◽  
Secondary Care ◽  
Holistic Approach ◽  
Coordinated Care ◽  
Current Management ◽  
Telephone Interviews ◽  
Patient Views ◽  
Appropriate Treatment ◽  
The Uk

ObjectivesTo explore patient views and perspectives of current management of chronic rhinosinusitis (CRS) in primary and secondary care.DesignSemistructured qualitative telephone interviews as part of the MACRO programme (Defining best Management for Adults with Chronic RhinOsinusitis).SettingPrimary care and secondary care ear, nose and throat outpatient clinics in the UK.ParticipantsTwenty-five patients consented to in-depth telephone interviews. Transcribed recordings were managed using NVivo software and analysed using inductive thematic analysis.ResultsCRS has a significant impact on patients’ quality of life, affecting their ability to work effectively, their social interactions and daily living. Patients seek help when symptoms become unmanageable, but can become frustrated with the primary care system with difficulties obtaining an appointment, and lack of continuity of care. Patients perceive that general practitioners can be dismissive of CRS symptoms, and patients often prioritise other concerns when they consult. Health system barriers and poor communication can result in delays in accessing appropriate treatment and referral. Adherence to intranasal steroids is a problem and patients are uncertain about correct technique. Nasal irrigation can be time-consuming and difficult for patients to use. Secondary care consultations can appear rushed, and patients would like specialists to take a more ‘holistic’ approach to their management. Surgery is often considered a temporary solution, appropriate when medical options have been explored.ConclusionsPatients are frustrated with the management of their CRS, and poor communication can result in delays in receiving appropriate treatment and timely referral. Patients seek better understanding of their condition and guidance to support treatments decisions in light of uncertainties around the different medical and surgical options. Better coordinated care between general practice and specialist settings and consistency of advice has the potential to increase patient satisfaction and improve outcomes.

scholarly journals Management strategies for chronic rhinosinusitis: a qualitative study of GP and ENT specialist views of current practice in the UK

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e022643 ◽  
Author(s):  
Jane Vennik ◽  
Caroline Eyles ◽  
Mike Thomas ◽  
Claire Hopkins ◽  
Paul Little ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Treatment ◽  
Chronic Rhinosinusitis ◽  
Secondary Care ◽  
Nasal Polyps ◽  
Patient Choice ◽  
Care Pathways ◽  
Telephone Interviews ◽  
Best Management ◽  
The Uk

ObjectivesTo explore general practitioner (GP) and ears, nose and throat (ENT) specialist perspectives of current treatment strategies for chronic rhinosinusitis (CRS) and care pathways through primary and secondary care.DesignSemi-structured qualitative telephone interviews as part of the MACRO programme (Defining best Management for Adults with Chronic Rhinosinusitis)SettingPrimary care and secondary care ENT outpatient clinics in the UK.ParticipantsTwelve GPs and 9 ENT specialists consented to in-depth telephone interviews. Transcribed recordings were managed using NVivo software and analysed using inductive thematic analysis.Main outcome measuresHealthcare professional views of management options and care pathways for CRS.ResultsGPs describe themselves as confident in recognising CRS, with the exception of assessing nasal polyps. In contrast, specialists report common missed diagnoses (eg, allergy; chronic headache) when patients are referred to ENT clinics, and attribute this to the limited ENT training of GPs. Steroid nasal sprays provide the foundation of treatment in primary care, although local prescribing restrictions can affect treatment choice and poor adherence is perceived to be the causes of inadequate symptom control. Symptom severity, poor response to medical treatment and patient pressure drive referral, although there is uncertainty about optimal timing. Treatment decisions in secondary care are based on disease severity, polyp status, prior medical treatment and patient choice, but there is major uncertainty about the place of longer courses of antibiotics and the use of oral steroids. Surgery is regarded as an important treatment option for patients with severe symptoms or with nasal polyps, although timing of surgery remains unclear, and the uncertainty about net long-term benefits of surgery makes balancing of benefits and risks more difficult.ConclusionsClinicians are uncertain about best management of patients with CRS in both primary and secondary care and practice is varied. An integrated care pathway for CRS is needed to improve patient management and timely referral.

Primary care

2018 ◽  
Author(s):  
Philippa Edwards
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Holistic Approach ◽  
Professional Relationship ◽  
Respiratory Problems ◽  
Diagnostic Skills ◽  
The Family ◽  
The Common ◽  
The Uk ◽  
William Osler

General practitioners (GPs) are the gatekeepers of the National Health Service in the UK, and virtually all referrals to secondary care are made through them. The breadth and depth of the discipline can at times seem overwhelming, although the old adage ‘common things occur commonly’ still holds. GPs need to be confident in the diagnosis and management of conditions from birth to the grave, and to know their boundaries of competence and when to refer to secondary care. The complexity of the GP consultation includes the following two points: 1. Many conditions present in a relatively undifferentiated form to the GP, whose job it is to try to identify whether the condition is normal or abnormal, and whether it is serious or minor. 2. GPs develop a close professional relationship with many of their patients and may also be the point of contact for other members of the family, neighbours, and friends of the patient. This knowledge is an important aspect of their holistic approach to medicine and is much valued by their patients. As the nineteenth-century physician Sir William Osler (1849–1919) said, ‘The good physician treats the disease; the great physician treats the patient who has the disease.’ The commonest presentations to GPs in the UK are for respiratory problems, chronic disease management, musculoskeletal disorders, and psychological problems. Health promotion, in particular smoking cessation and the management of obesity, is also important in preventing chronic illness. Although many presentations are minor and self-limiting, serious illnesses also occur, and GPs need to be able to recognize them, sometimes in the early stages. The questions in this chapter will assess your knowledge in the common areas that present, testing diagnostic skills and reasoning. They also test negotiating skills to ensure patient compliance, teamworking within the primary care setting, and risk management.

scholarly journals Referrals to Urgent Dental Centres During the COVID-19 Pandemic: A Multi-Site Analysis Research Project

2021 ◽  
Vol 10 (1) ◽  
pp. 40-45
Author(s):  
Adam Shathur ◽  
Samuel Reeves ◽  
Faizal Sameja ◽  
Vishal Patel ◽  
Allan Jones
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Easy Access ◽  
Dental Services ◽  
Care Services ◽  
Dental Practitioners ◽  
Consultation And Referral ◽  
Care Systems ◽  
Access To Primary Care ◽  
The Uk

Introduction: The COVID-19 pandemic enforced the cessation of routine dentistry and the creation of local urgent dental care systems in the UK. General dental practices are obligated by NHS guidance to remain open and provide remote consultation and referral where appropriate to patients having pain or problems. Aims: To compare two urgent dental centres with different triage and referral systems with regard to quality and appropriateness of referrals, and patient management outcomes. Methods: 110 consecutive referrals received by a primary care urgent dental centre and a secondary care urgent dental centre were assessed. It was considered whether the patients referred had access to remote primary care dental services, fulfilled the criteria required to be deemed a dental emergency as mandated by NHS guidance, and what the outcomes of referrals were. Results: At the primary care centre, 100% of patients were referred by general dental practitioners and had access to remote primary care dental services. 95.5% of referrals were deemed appropriate and were seen for treatment. At the secondary care site, 94.5% of referrals were direct from the patient by contacting NHS 111. 40% had received triaging to include ‘advice, analgesia and antimicrobial’ from a general dental practitioner, and 25.5% were deemed appropriate and resulted in treatment. Conclusion: Urgent dental centres face many issues, and it would seem that easy access to primary care services, collaboration between primary care clinicians and urgent dental centres, and training of triaging staff are important in operating a successful system.

THUR 121 Identifying participants with parkinson’s disease in uk biobank

2018 ◽  
Vol 89 (10) ◽  
pp. A13.2-A13
Author(s):  
Bush Kathryn ◽  
Rannikmae Kristiina ◽  
Schnier Christian ◽  
Wilkinson Timothy ◽  
Nolan John ◽  
...  
Keyword(s):  
Primary Care ◽  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Secondary Care ◽  
Large Population ◽  
Free Text ◽  
Uk Biobank ◽  
Predictive Values ◽  
Diagnostic Codes ◽  
The Uk

BackgroundLinkage to routinely collected NHS data from primary, secondary care and death certificates enables identification of participants with Parkinson’s Disease (PD) within the UK Biobank cohort of 5 00 000 adults. Validation of the accuracy of this data is required prior to their use in research studies.MethodIn this validation study participants (n=125) with a code indicating PD were identified from a sample of 17 000 participants in the cohort. Diagnoses were validated by expert adjudicators, based on free text electronic medical records. Positive predictive values (PPV,% of cases identified that are true cases) were calculated.ResultsPrimary care diagnostic codes identified 93% of PD cases, with a PPV of 95%. Combined secondary care and death data identified 42% of PD cases with a PPV of 84%.Combining diagnostic and medication codes identified more participants, but did not increase the PPV.ConclusionsThis study suggests that linkage to routinely collected healthcare data is a reliable method for identifying participants with PD in the UK Biobank cohort.Primary care diagnostic codes identified the highest proportion of participants and had the highest PPV, demonstrating the value of using primary care data to identify cases of disease in large population based cohort studies.

scholarly journals Cross-sectional observation study to investigate the impact of risk-based stratification on care pathways for patients with chronic kidney disease: protocol paper

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e027315 ◽  
Author(s):  
Harjeet Kaur Bhachu ◽  
Paul Cockwell ◽  
Anuradhaa Subramanian ◽  
Krishnarajah Nirantharakumar ◽  
Derek Kyte ◽  
...  
Keyword(s):  
Primary Care ◽  
Kidney Disease ◽  
Secondary Care ◽  
Health Improvement ◽  
Cross Sectional ◽  
Risk Equation ◽  
Failure Risk ◽  
The Health Improvement Network ◽  
The Uk ◽  
The Impact

IntroductionChronic kidney disease (CKD) management in the UK is usually primary care based, with National Institute for Health and Care Excellence (NICE) guidelines defining criteria for referral to secondary care nephrology services. Estimated glomerular filtration rate (eGFR) is commonly used to guide timing of referrals and preparation of patients approaching renal replacement therapy. However, eGFR lacks sensitivity for progression to end-stage renal failure; as a consequence, the international guideline group, Kidney Disease: Improving Global Outcomes has recommended the use of a risk calculator. The validated Kidney Failure Risk Equation may enable increased precision for the management of patients with CKD; however, there is little evidence to date for the implication of its use in routine clinical practice. This study will aim to determine the impact of the Kidney Failure Risk Equation on the redesignation of patients with CKD in the UK for referral to secondary care, compared with NICE CKD guidance.Method and analysisThis is a cross-sectional population-based observational study using The Health Improvement Network database to identify the impact of risk-based designation for referral into secondary care for patients with CKD in the UK. Adult patients registered in primary care and active in the database within the period 1 January 2016 to 31 March 2017 with confirmed CKD will be analysed. The proportion of patients who meet defined risk thresholds will be cross-referenced with the current NICE guideline recommendations for referral into secondary care along with an evaluation of urinary albumin–creatinine ratio monitoring.Ethics and disseminationApproval was granted by The Health Improvement Network Scientific Review Committee (Reference number: 18THIN061). Study outcomes will inform national and international guidelines including the next version of the NICE CKD guideline. Dissemination of findings will also be through publication in a peer-reviewed journal, presentation at conferences and inclusion in the core resources of the Think Kidneys programme.

scholarly journals EP.FRI.422 Over 100,000 COVID-19 deaths calls for a radical reform of health and care system in the UK

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Shruti Bodapati ◽  
Raghvinder Gambhir
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Secondary Care ◽  
Face To Face ◽  
Radical Reform ◽  
National Statistics ◽  
The Uk ◽  
Second Wave ◽  
Excess Deaths ◽  
Care System

Abstract Aim With over 100,000 deaths due to COVID 19 and still counting, is it a wake-up call to overhaul our health and care system. Methods Review of NHS England, Office of National Statistics (ONS) and Public Health England (PHE) data to determine where the deaths occurred and what role did the primary care, secondary care, play in delivering the service. Results The data shows that it took 40 weeks to get to the first 50,000 deaths and just another 10 weeks to add another 50,000 deaths. Among the OECD UK ranked number 1 for deaths due to COVID 19.  69.9%   of deaths occurred in hospitals, 24.1% in care homes, while 4.9% occurred at homes. The primary care effectively remained shut for face to face consultation, effectively leaving people to manage themselves at home on their own or reach A & E when things got worse. The hospitals where overwhelmed and coped by shutting out all elective work and converting normal wards to COVID wards and that is where the maximum deaths occurred. There were over 80000 excess deaths above the five-year average. Conclusion We may have been underprepared for the first wave but had the PPE and plans to battle the second wave yet we had the highest mortality in Europe. Is it a price we paid for our disjointed health and care system. There is a need for radical changes to prepare for future disasters.

Burden of child and adolescent obesity on health services in England

2017 ◽  
Vol 103 (3) ◽  
pp. 247-254 ◽  
Author(s):  
Russell M Viner ◽  
Sanjay Kinra ◽  
Dasha Nicholls ◽  
Tim Cole ◽  
Anthony Kessel ◽  
...  
Keyword(s):  
Primary Care ◽  
Childhood Obesity ◽  
Young People ◽  
Secondary Care ◽  
Service Use ◽  
Lifestyle Modification ◽  
Glycated Haemoglobin ◽  
Obesity Management ◽  
Care Assessment ◽  
The Uk

ObjectiveTo assess the numbers of obese children and young people (CYP) eligible for assessment and management at each stage of the childhood obesity pathway in England.DesignPathway modelling study, operationalising the UK National Institute for Health and Care Excellence guidance on childhood obesity management against national survey data.SettingData on CYP aged 2–18 years from the Health Survey for England 2006 to 2013.Main outcome measuresClinical obesity (body mass index (BMI) >98th centile), extreme obesity (BMI ≥99.86th centile); family history of cardiovascular disease or type 2 diabetes; obesity comorbidities defined as primary care detectable (hypertension, orthopaedic or mobility problems, bullying or psychological distress) or secondary care detectable (dyslipidaemia, hyperinsulinaemia, high glycated haemoglobin, abnormal liver function).Results11.2% (1.22 million) of CYP in England were eligible for primary care assessment and for community lifestyle modification. 2.6% (n=283 500) CYP were estimated to be likely to attend primary care. 5.1% (n=556 000) were eligible for secondary care referral. Among those aged 13–18 years, 8.2% (n=309 000) were eligible for antiobesity drug therapy and 2.4% (90 500) of English CYP were eligible for bariatric surgery. CYP from the most deprived quintile were 1.5-fold to 3-fold more likely to be eligible for obesity management.ConclusionsThere is a mismatch between population burden and available data on service use for obesity in CYP in England, particularly among deprived young people. There is a need for consistent evidence-based commissioning of services across the childhood obesity pathway based on population burden.

scholarly journals Embedding online patient record access in UK primary care: a survey of stakeholder experiences

2012 ◽  
Vol 3 (5) ◽  
pp. 1-7 ◽  
Author(s):  
Claudia Pagliari ◽  
Tim Shand ◽  
Brian Fisher
Keyword(s):  
Primary Care ◽  
Health Knowledge ◽  
Patient Record ◽  
Daily Lives ◽  
Telephone Interviews ◽  
Negative Beliefs ◽  
Resource Requirements ◽  
Barriers To Implementation ◽  
Set Up ◽  
The Uk

Summary Objectives To explore the integration of online patient Record Access within UK Primary Care, its perceived impacts on workload and service quality, and barriers to implementation. Design Mixed format survey of clinicians, administrators and patients. Telephone interviews with non-users. Setting Primary care centres within NHS England that had offered online record access for the preceding year. Participants Of the 57 practices initially agreeing to pilot the system, 32 had adopted it and 16 of these returned questionnaires. The 42 individual respondents included 14 practice managers, 15 clinicians and 13 patients. Follow-up interviews were conducted with one participant from 15 of the 25 non-adopter practices. Results Most professionals believed that the system is easy to integrate within primary care; while most patients found it easy to integrate within their daily lives. Professionals perceived no increase in the volume of patient queries or clinical consultations as a result of Record Access; indeed some believed that these had decreased. Most clinicians and patients believed that the service had improved mutual trust, communication, patients’ health knowledge and health behaviour. Inhibiting factors included concerns about security, liability and resource requirements. Non-adoption was most frequently attributed to competing priorities, rather than negative beliefs about the service. Conclusions Record access has an important role to play in supporting patient-focused healthcare policies in the UK and may be easily accommodated within existing services. Additional materials to facilitate patient recruitment, inform system set-up processes, and assure clinicians of their legal position are likely to encourage more widespread adoption.

scholarly journals Status of primary and secondary mental healthcare of people with severe mental illness: an epidemiological study from the UK PARTNERS2 programme

BJPsych Open ◽  
2021 ◽  
Vol 7 (2) ◽  
Author(s):  
Siobhan Reilly ◽  
Catherine McCabe ◽  
Natalie Marchevsky ◽  
Maria Green ◽  
Linda Davies ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Severe Mental Illness ◽  
Medical Records ◽  
Secondary Care ◽  
Mental Healthcare ◽  
The Uk

Background There is global interest in the reconfiguration of community mental health services, including primary care, to improve clinical and cost effectiveness. Aims This study seeks to describe patterns of service use, continuity of care, health risks, physical healthcare monitoring and the balance between primary and secondary mental healthcare for people with severe mental illness in receipt of secondary mental healthcare in the UK. Method We conducted an epidemiological medical records review in three UK sites. We identified 297 cases randomly selected from the three participating mental health services. Data were manually extracted from electronic patient medical records from both secondary and primary care, for a 2-year period (2012–2014). Continuous data were summarised by mean and s.d. or median and interquartile range (IQR). Categorical data were summarised as percentages. Results The majority of care was from secondary care practitioners: of the 18 210 direct contacts recorded, 76% were from secondary care (median, 36.5; IQR, 14–68) and 24% were from primary care (median, 10; IQR, 5–20). There was evidence of poor longitudinal continuity: in primary care, 31% of people had poor longitudinal continuity (Modified Modified Continuity Index ≤0.5), and 43% had a single named care coordinator in secondary care services over the 2 years. Conclusions The study indicates scope for improvement in supporting mental health service delivery in primary care. Greater knowledge of how care is organised presents an opportunity to ensure some rebalancing of the care that all people with severe mental illness receive, when they need it. A future publication will examine differences between the three sites that participated in this study.

scholarly journals SAT0653-HPR COMMUNITY RHEUMATOLOGY SERVICE IN THE UK – WHO BENEFITS THE MOST?

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1285.2-1286
Author(s):  
K. Szabo-Kocsis ◽  
M. Dare
Keyword(s):  
Primary Care ◽  
Connective Tissue ◽  
Waiting Time ◽  
Secondary Care ◽  
List Type ◽  
Ehlers Danlos Syndrome ◽  
Specialist Services ◽  
Wide Range ◽  
Set Up ◽  
The Uk

Background:Community rheumatology (CR) in the UK is a new form of rheumatologic service provision established in the last few years and run by few organisations such as Connect Health Ltd.CR is based on the principle of sharing the management of rheumatologic patients between community service and secondary care aiming to reduce the unreasonable referral flow from primary care to secondary care and to share the care of stable inflammatory patients between the services.In the traditional service model patients are referred by General Practitioners (GP) to the secondary care with a wide spectrum of conditions: from fibromyalgia through soft tissues rheumatisms to inflammatory or connective tissue diseases. Many of these patients will be discharged from the specialist service after their first visit with fibromyalgia, osteoarthritis, chronic pain syndrome or MSK diagnoses. The proportion of these patients versus those who have an inflammatory rheumatologic condition or connective tissue disease (CTD) varies significantly and can contribute to oversaturated specialist rheumatologic services with long waiting time where specialists deal with less relevant cases.Objectives:To determine how CR can improve quality of care and decrease the waiting time for appointment in secondary care rheumatology services. To set standards for referral pathways and measured outcomes of effectiveness in patient care.In the UK the regional Clinical Commissioning Groups would accept a maximum waiting time from the referral until patient treatment of up to 18 weeks and specialist services often breach that limit. This long interval may have a significant negative impact for the care of patients with rheumatological condition, reducing patient satisfaction and/or jeopardize patient safety. The solution to the above problem is the creation of CR service.Methods:Extensive search about the available resources within UK NHS system in regards CR service creation and set up. Web search, literature review in relation to CR in the UKResults:From the research different models of CR can be identified and one of these will be presented in details based on the experience of one of the largest organisation running CR services in the UK (Connect Health Ltd). This service is organised within community care set up and can accept patients referred by the primary care physicians with non-inflammatory symptoms (e.g. osteoarthritis, Ehlers - Danlos Syndrome, fibromyalgia) or PMR or gout. The service also can review stable inflammatory patients who are treated with DMARDs and are transferred from the secondary care service by their consultant. This presentation will demonstrate how CR provides safer, faster and more accessible services to the patients assisting the specialist services and allowing them to concentrate on the inflammatory and CTD patients who need faster access to these services than it is possible now. Particularly the presentation will emphasise on:Patient population coverTeam structure, their experience and trainingReferral criteria and IT set up for multidisciplinary connectionTime interval for appointment and patient feedbackImpact on the secondary care rheumatology serviceCases of misdiagnosis and inappropriate referralsCost effectiveness of the CRChallenges in the CR serviceConclusion:The CR service can be a safe addition to the specialist services taking over significant workload and provide new career opportunities for a wide range of Allied Health Professionals (AHP) for the bigger satisfaction of the patients who can access rheumatology service earlier and easier.Disclosure of Interests:None declared

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