scholarly journals Feasibility and acceptability of breath research in primary care: a prospective, cross-sectional, observational study

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e044691
Author(s):  
Georgia Woodfield ◽  
Ilaria Belluomo ◽  
Piers R Boshier ◽  
Annabelle Waller ◽  
Maya Fayyad ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Phase Iii ◽  
Study Phase ◽  
Cross Sectional ◽  
Hub And Spoke ◽  
Breath Testing ◽  
Care Practices ◽  
Primary Care Practices ◽  
Recruitment Model

ObjectivesTo examine the feasibility and acceptability of breath research in primary care.DesignNon-randomised, prospective, mixed-methods cross-sectional observational study.SettingTwenty-six urban primary care practices.Participants1002 patients aged 18–90 years with gastrointestinal symptoms.Main outcome measuresDuring the first 6 months of the study (phase 1), feasibility of patient enrolment using face-to-face, telephone or SMS-messaging (Short Message Service) enrolment strategies, as well as processes for breath testing at local primary care practices, were evaluated. A mixed-method iterative study design was adopted and outcomes evaluated using weekly Plan-Do-Study-Act cycles, focus groups and general practitioner (GP) questionnaires.During the second 6 months of the study (phase 2), patient and GP acceptability of the breath test and testing process was assessed using questionnaires. In addition a ‘single practice’ recruitment model was compared with a ‘hub and spoke’ centralised recruitment model with regards to enrolment ability and patient acceptability.Throughout the study feasibility of the collection of a large number of breath samples by clinical staff over multiple study sites was evaluated and quantified by the analysis of these samples using mass spectrometry.Results1002 patients were recruited within 192 sampling days. Both ‘single practice’ and ‘hub and spoke’ recruitment models were effective with an average of 5.3 and 4.3 patients accrued per day, respectively. The ‘hub and spoke’ model with SMS messaging was the most efficient combined method of patient accrual. Acceptability of the test was high among both patients and GPs. The methodology for collection, handling and analysis of breath samples was effective, with 95% of samples meeting quality criteria.ConclusionsLarge-scale breath testing in primary care was feasible and acceptable. This study provides a practical framework to guide the design of Phase III trials examining the performance of breath testing in primary care.

Observational study of ezetimibe discontinuation in primary care practices in the UK

2013 ◽  
Vol 29 (12) ◽  
pp. 1737-1745
Author(s):  
Gillian C. Hall ◽  
Vian Amber ◽  
Chris O’Regan ◽  
Kevin Jameson
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Care Practices ◽  
The Uk ◽  
Primary Care Practices

scholarly journals Scaling-up social needs screening in practice: a retrospective, cross-sectional analysis of data from electronic health records from Bronx county, New York, USA

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e053633
Author(s):  
Kevin P Fiori ◽  
Caroline G Heller ◽  
Anna Flattau ◽  
Nicole R Harris-Hollingsworth ◽  
Amanda Parsons ◽  
...  
Keyword(s):  
Primary Care ◽  
New York ◽  
Electronic Health Records ◽  
Social Care ◽  
Social Needs ◽  
Cross Sectional ◽  
Health Records ◽  
Care Practices ◽  
Electronic Health ◽  
Primary Care Practices

ObjectivesThere has been renewed focus on health systems integrating social care to improve health outcomes with relatively less related research focusing on ‘real-world’ practice. This study describes a health system’s experience from 2018 to 2020, following the successful pilot in 2017, to scale social needs screening of patients within a large urban primary care ambulatory network.SettingAcademic medical centre with an ambulatory network of 18 primary care practices located in an urban county in New York City (USA).ParticipantsThis retrospective, cross-sectional study used electronic health records of 244 764 patients who had a clinical visit between 10 April 2018 and 8 December 2019 across any one of 18 primary care practices.MethodsWe organised measures using the RE-AIM framework domains of reach and adoption to ascertain the number of patients who were screened and the number of providers who adopted screening and associated documentation, respectively. We used descriptive statistics to summarise factors comparing patients screened versus those not screened, the prevalence of social needs screening and adoption across 18 practices.ResultsBetween April 2018 and December 2019, 53 093 patients were screened for social needs, representing approximately 21.7% of the patients seen. Almost one-fifth (19.6%) of patients reported at least one unmet social need. The percentage of screened patients varied by both practice location (range 1.6%–81.6%) and specialty within practices. 51.8% of providers (n=1316) screened at least one patient.ConclusionsThese findings demonstrate both the potential and challenges of integrating social care in practice. We observed significant variability in uptake across the health system. More research is needed to better understand factors driving adoption and may include harmonising workflows, establishing unified targets and using data to drive improvement.

scholarly journals What You Don’t Know Might Hurt You: Cost Variations for Fecal Immunochemical Tests in Primary Care Practices

2021 ◽  
Author(s):  
Jennifer Coury ◽  
Katrina Ramsey ◽  
Rose Gunn ◽  
Jon Judkins ◽  
Melinda Davis
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
P Value ◽  
Fecal Occult Blood ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Effective Manner ◽  
Care Practices ◽  
Primary Care Practices ◽  
The Cost

Abstract Background Colorectal cancer (CRC) screening can improve health outcomes, but screening rates remain low across the US. Fecal immunochemical testing (FIT) is an effective way to screen more people for colorectal cancer, but barriers exist to implementation in clinical practice. Little research examines the impacts of cost on FIT selection and implemention. Methods We administered a multi-modal, cross-sectional survey to 252 primary care practices to assess readiness and implementation of direct mail fecal testing programs, including the cost and types of FIT used. We analyzed the range of costs for the tests, and identified practice and test procurement factors. We examined the distributions of practice characteristics for FIT use and costs answers using the non-parametric Wilcoxon rank-sum test. We used Pearson's chi-squared test of association and interpreted a low p-value (e.g. <0.05) as evidence of association between a given practice characteristic and knowing the cost of FIT or fecal occult blood test (FOBT). Results Among the 84 practice survey responses, more than 10 different types of FIT/FOBTs were in use; 76% of practices used one of the five most common FIT types. Only 40 practices (48%) provided information on the cost of their FIT/FOBTs. Thirteen (32%) of these practices received the tests for free while 27 (68%) paid for their tests; median reported cost of a FIT was $3.04, with a range from $0.83 to $6.41 per test. Costs were not statistically significant different by FIT type. However, practices who received FITs from vendors were more likely to know the cost (p = 0.0002) and, if known, report a higher cost (p = 0.0002). Conclusions Our findings indicate that most practices without lab or health system supplied FITs are spending more to procure tests. Cost of FIT may impact the willingness of practices to distribute FITs in clinic-based encounters as well as through population outreach strategies, such as mailed FIT. Differences in the ability to obtain FIT tests in a cost-effective manner could have far reaching consequences for addressing colorectal cancer screening disparities in primary care practices.

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