scholarly journals Improving continuity of patient care across sectors: study protocol of the process evaluation of a quasi-experimental multi-centre study regarding an admission and discharge model in Germany (VESPEERA)

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e031245
Author(s):  
Johanna Forstner ◽  
Aline Kunz ◽  
Cornelia Straßner ◽  
Lorenz Uhlmann ◽  
Stephanie Kuemmel ◽  
...  
Keyword(s):  
General Practice ◽  
Patient Care ◽  
Process Evaluation ◽  
Study Protocol ◽  
Care Providers ◽  
Total N ◽  
Outcomes Evaluation ◽  
Quasi Experimental ◽  
Discharge Model ◽  
General Practices

IntroductionHospital stays are critical events as they often disrupt continuity of care. This process evaluation aims to describe and explore the implementation of the VESPEERA programme (Improving continuity of patient care across sectors: An admission and discharge model in general practices and hospitals, Versorgungskontinuitaet sichern: Patientenorientiertes Einweisungs- und Entlassmanagement in Hausarztpraxen und Krankenhauesern). The evaluation concerns the intervention fidelity, reach in targeted populations, perceived effects, working mechanisms, feasibility, determinants for implementation, including contextual factors, and associations with the outcomes evaluation. The aim of the VESPEERA programme is the development, implementation and evaluation of a structured admission and discharge programme in general practices and hospitals.Methods and analysisThe process evaluation is linked to the VESPEERA outcomes evaluation, which has a quasi-experimental multi-centre design with four study arms and is conducted in hospitals and general practices in Germany. The VESPEERA programme comprises several components: an assessment before admission, an admission letter, a telephonic discharge conversation between hospital and general practice before discharge, discharge information for patients, structured planning of follow-up care after discharge in the general practice and a telephone monitoring for patients with a risk of rehospitalisation. The process evaluation has a mixed-methods design, incorporating interviews (patients, both care providers who do and do not participate in the VESPEERA programme, total n=75), questionnaires (patients and care providers who participate in the VESPEERA programme, total n=475), implementation plans of hospitals, data documented in general practices, claims-based data and hospital process data. Data analysis is descriptive and explorative. Qualitative data will be transcribed and analysed using framework analysis based on the Consolidated Framework for Implementation Research. Associations between the outcomes of the program and measures in the process evaluation will be explored in regression models.Ethics and disseminationEthics approval has been obtained by the ethics committee of the Medical Faculty Heidelberg prior to the start of the study (S-352/2018). Results will be disseminated through a final report to the funding agency, articles in peer-reviewed journals and conferences.Trial registration numberhttp://www.drks.de/DRKS00015183.Trial statusThe study protocol on hand is the protocol V.1.1 from 18 June 2018. Recruitment for interviews started on 3 September 2018 and will approximately be completed by the end of May 2019.

scholarly journals Study Protocol Feasibility and Pilot Trial of Brief Behaviour Change Counseling Using Five as and a Guiding Style From Motivational Interviewing on Lifestyle Behaviour in Patients With Hypertension or Diabetes in Mangochi, Malawi: BBCC+5 A's+GS Quasi-experimental Study Protocol

2021 ◽  
Author(s):  
prosper Mukobelwa Lutala ◽  
Adamson Muula
Keyword(s):  
Motivational Interviewing ◽  
Process Evaluation ◽  
Behaviour Change ◽  
Study Protocol ◽  
Pilot Trial ◽  
Intervention Group ◽  
Sub Saharan Africa ◽  
Behavioural Intervention ◽  
Positive Effects ◽  
Quasi Experimental

Abstract BackgroundDiabetes and hypertension and their lifestyle risk factors are on the increase in sub-Saharan Africa. Despite positive effects of behavioural intervention such as brief behaviour change in some African countries, there has not been significant implementation of the same in Malawi. We therefore decided to conduct this study aimed at implementing brief behaviour change counseling using 5 As and a guiding style from motivational interviewing (BBCC + 5 As + GS) in Mangochi with specific objectives of determining its feasibility and its efficacy.MethodsThis study is a mixed, quasi-experimental, feasibility study which comprises an exploratory 2 arms quantitative part with a qualitative component at the end of the trial. Fifty consecutive eligible participants will be recruited among patients attending two Non-Communicable Diseases (NCDs) clinics (Mangochi District Hospital and Monkey Bay Rural Hospital) and allocated equally to intervention group (receiving brief behaviour change counseling) and non-intervention (routine care only). In addition to a qualitative process evaluation at the end of the third time points, the groups will be assaessed at baseline - 12 weeks and 24 weeks’ post-implementation on the following factors: feasibility outcomes, sociodemographic factors, lifestyle factors, body mass index, waist circumference, hip to waist ratio, lipids (cholesterols, triglycerides), glycated hemoglobin, quality of life domains and theory of planned behaviour constructs’ changes and process evaluation. DiscussionIt is anticipated that the results of this pilot trial will help to determine and assess the feasibility and the provisional efficacy of this intervention, as well as key useful elements of this trial in order to develop it for further exploration in a larger trial.Registration and status of the trialTrial registration: ClinicalTrials.gov, NCT04625452, registered 12 November 2020, https://clinicaltrials.gov/ct2/show/NCT04625452, and recruitment: June 1, 2021.

scholarly journals Surveillance and Care for Confirmed and Suspected Patients with COVID-19 in General Practice (CovidCare): Study Protocol for an Observational Trial

2021 ◽  
Author(s):  
Mariell Hoffmann ◽  
Sandra Stengel ◽  
Johanna Forstner ◽  
Annika Baldauf ◽  
Gunter Laux ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
General Practice ◽  
Process Evaluation ◽  
Sickness Fund ◽  
Initial Assessment ◽  
Observational Trial ◽  
Centered Care ◽  
General Practices ◽  
Prospective Longitudinal

Abstract BackgroundA SARS-CoV-2 infection can lead from asymptomatic through to critical disease in a dynamic and unpredictable course within a few days. The challenge in outpatient monitoring the highly contagious COVID-19 disease during the ongoing pandemic is to filter severe courses followed by admission to hospital with the aim of preventing an overburdening of clinics. However, little is known of the effect of risk factors on the course of the infection of outpatient patients. To support general practices in managing high risk patients, we designed a COVID-19 surveillance and care tool (CovidCare). It includes an initial assessment of yet known risk factors and symptoms and a continuous telephone monitoring of signs and symptoms. This study aims to investigate the effects of different risk factors on the course of the COVID-19 disease, utilisation of different health care services and to gain insights into the utilisation of CovidCare in general practices. MethodsWe will conduct a multi-centered prospective, longitudinal non-controlled observational trial of COVID-19 patients in general practices. Overall, 700 GPs who participate in general-practice centered care by the AOK Baden-Württemberg (large German sickness fund) are eligible and will be invited for study participation, including adult, outpatient COVID-19 patients (or urgent suspicion and ≥ 50 years) with at least one additional known risk factor, who participate in general-practice centered care. The primary outcome is hospitalisation due to COVID-19. Secondary outcomes are diagnosis of pneumonia, utilisation of palliative care, mortality rate, anxiety and identification of predictive risk factors. Quantitative data analysis will focus on valid descriptive figures and mixed regression models. The accompanying process evaluation is based on interviews and questionnaires from general practice staff and patients. The analysis of the process evaluation is descriptive and explorative. DiscussionThe use of the COVID-19 surveillance and care tool is expected to encourage the provision of structured quality of care during the ongoing pandemic. This trial will provide an understanding of the COVID-19-disease and the effect of several risk factors on the course of the disease and health care utilisation. The results can be used for a better management of the COVID-19 pandemic and its consequences. Trial registration: German Clinical Trials Register DRKS00022054; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022054

scholarly journals Surveillance and care for confirmed and suspected patients with COVID-19 in general practice (CovidCare): study protocol for an observational trial

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Mariell Hoffmann ◽  
Sandra Stengel ◽  
Johanna Forstner ◽  
Annika Baldauf ◽  
Gunter Laux ◽  
...  
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
General Practice ◽  
Process Evaluation ◽  
Sickness Fund ◽  
Initial Assessment ◽  
Observational Trial ◽  
Centered Care ◽  
General Practices ◽  
Prospective Longitudinal

Abstract Background A SARS-CoV-2 infection can lead from asymptomatic through to critical disease in a dynamic and unpredictable course within a few days. The challenge in outpatient monitoring the highly contagious COVID-19 disease during the ongoing pandemic is to filter severe courses followed by admission to hospital with the aim of preventing an overburdening of clinics. However, little is known of the effect of risk factors on the course of the infection of outpatient patients. To support general practices in managing high risk patients, we designed a COVID-19 surveillance and care tool (CovidCare). It includes an initial assessment of yet known risk factors and symptoms and a continuous telephone monitoring of signs and symptoms. This study aims to investigate the effects of different risk factors on the course of the COVID-19 disease, utilisation of different health care services and to gain insights into the utilisation of CovidCare in general practices. Methods We will conduct a multi-centered prospective, longitudinal non-controlled observational trial of COVID-19 patients in general practices. Overall, 700 GPs who participate in general-practice centered care by the AOK Baden-Württemberg (large German sickness fund) are eligible and will be invited for study participation, including adult, outpatient COVID-19 patients (or urgent suspicion and ≥ 50 years) with at least one additional known risk factor, who participate in general-practice centered care. The primary outcome is hospitalisation due to COVID-19. Secondary outcomes are diagnosis of pneumonia, utilisation of palliative care, mortality rate, anxiety and identification of predictive risk factors. Quantitative data analysis will focus on valid descriptive figures and mixed regression models. The accompanying process evaluation is based on interviews and questionnaires from general practice staff and patients. The analysis of the process evaluation is descriptive and explorative. Discussion The use of the COVID-19 surveillance and care tool is expected to encourage the provision of structured quality of care during the ongoing pandemic. This trial will provide an understanding of the COVID-19-disease and the effect of several risk factors on the course of the disease and health care utilisation. The results can be used for a better management of the COVID-19 pandemic and its consequences. Trial registration German Clinical Trials Register DRKS00022054.

scholarly journals Motivations for the Adoption of Chronic Disease Information Systems in General Practice

2009 ◽  
Vol 4 (1) ◽  
Author(s):  
Daniel Carbone ◽  
Stephen Burgess
Keyword(s):  
Risk Management ◽  
General Practice ◽  
Information Systems ◽  
Patient Care ◽  
Financial Incentives ◽  
Successful Implementation ◽  
Care Gap ◽  
Disease Information ◽  
General Practices

The purpose of this paper is to highlight the key motivational factors that lead to the successful implementation of Chronic Diseases Information Systems (CDISs) in twenty eight general practices in a case study of a large general practice division network in Australia. The literature identified three major areas of CDIS motivation: patient care gap motivator, internal motivators and external motivators. Patient care emerged as the most important motivation for adopting CDIS, followed by risk management and financial incentives. However, the study also determined that the motivational forces are inter-related and suggests that the decision to adopt CDIS should consider a number of these identified factors.

scholarly journals ‘Motivational work’: a qualitative study of preventive health dialogues in general practice

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Marie Broholm-Jørgensen ◽  
Siff Monrad Langkilde ◽  
Tine Tjørnhøj-Thomsen ◽  
Pia Vivian Pedersen
Keyword(s):  
General Practice ◽  
General Practitioners ◽  
Support System ◽  
Preventive Intervention ◽  
Digital Health ◽  
Clinical Encounter ◽  
Preventive Health ◽  
Structured Interviews ◽  
General Practices ◽  
Municipal Health

Abstract Background The aim of this article is to explore preventive health dialogues in general practice in the context of a pilot study of a Danish primary preventive intervention ‘TOF’ (a Danish acronym for ‘Early Detection and Prevention’) carried out in 2016. The intervention consisted of 1) a stratification of patients into one of four groups, 2) a digital support system for both general practitioners and patients, 3) an individual digital health profile for each patient, and 4) targeted preventive services in either general practice or a municipal health center. Methods The empirical material in this study was obtained through 10 observations of preventive health dialogues conducted in general practices and 18 semi-structured interviews with patients and general practitioners. We used the concept of ‘motivational work’ as an analytical lens for understanding preventive health dialogues in general practice from the perspectives of both general practitioners and patients. Results While the health dialogues in TOF sought to reveal patients’ motivations, understandings, and priorities related to health behavior, we find that the dialogues were treatment-oriented and structured around biomedical facts, numeric standards, and risk factor guidance. Overall, we find that numeric standards and quantification of motivation lessens the dialogue and interaction between General Practitioner and patient and that contextual factors relating to the intervention framework, such as a digital support system, the general practitioners’ perceptions of their professional position as well as the patients’ understanding of prevention —in an interplay—diminished the motivational work carried out in the health dialogues. Conclusion The findings show that the influence of different kinds of context adds to the complexity of prevention in the clinical encounter which help to explain why motivational work is difficult in general practice.

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 The incidence and prevalence of inflammatory bowel disease in UK primary care: a retrospective cohort study of the IQVIA Medical Research Database

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Karoline Freeman ◽  
Ronan Ryan ◽  
Nicholas Parsons ◽  
Sian Taylor-Phillips ◽  
Brian H. Willis ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
General Practice ◽  
Cohort Study ◽  
Medical Research ◽  
Bowel Disease ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Research Database ◽  
Care Providers ◽  
Inflammatory Bowel

Abstract Background Our knowledge of the incidence and prevalence of inflammatory bowel disease (IBD) is uncertain. Recent studies reported an increase in prevalence. However, they excluded a high proportion of ambiguous cases from general practice. Estimates are needed to inform health care providers who plan the provision of services for IBD patients. We aimed to estimate the IBD incidence and prevalence in UK general practice. Methods We undertook a retrospective cohort study of routine electronic health records from the IQVIA Medical Research Database covering 14 million patients. Adult patients from 2006 to 2016 were included. IBD was defined as an IBD related Read code or record of IBD specific medication. Annual incidence and 12-month period prevalence were calculated. Results The prevalence of IBD increased between 2006 and 2016 from 106.2 (95% CI 105.2–107.3) to 142.1 (95% CI 140.7–143.5) IBD cases per 10,000 patients which is a 33.8% increase. Incidence varied across the years. The incidence across the full study period was 69.5 (95% CI 68.6–70.4) per 100,000 person years. Conclusions In this large study we found higher estimates of IBD incidence and prevalence than previously reported. Estimates are highly dependent on definitions of disease and previously may have been underestimated.

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

Heart ◽  
2001 ◽  
Vol 86 (2) ◽  
pp. 172-178 ◽  
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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