scholarly journals Vertical integration of primary care practices with acute hospitals in England and Wales: why, how and so what? Findings from a qualitative, rapid evaluation

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e053222
Author(s):  
Manbinder Sidhu ◽  
Jack Pollard ◽  
Jon Sussex
Keyword(s):  
Primary Care ◽  
Vertical Integration ◽  
Secondary Care ◽  
Primary Care Providers ◽  
Health Economy ◽  
Service Utilisation ◽  
England And Wales ◽  
Acute Hospitals ◽  
Care Practices ◽  
Primary Care Practices

ObjectivesTo understand the rationale, implementation and early impact of vertical integration between primary care medical practices and the organisations running acute hospitals in the National Health Service in England and Wales.Design and settingA qualitative, cross-comparative case study evaluation at two sites in England and one in Wales, consisting of interviews with stakeholders at the sites, alongside observations of strategic meetings and analysis of key documents.ResultsWe interviewed 52 stakeholders across the three sites in the second half of 2019 and observed four meetings from late 2019 to early 2020 (further observation was prevented by the onset of the COVID-19 pandemic). The single most important driver of vertical integration was found to be to maintain primary care local to where patients live and thereby manage demand pressure on acute hospital services, especially emergency care. The opportunities created by maintaining local primary care providers—to develop patient services in primary care settings and better integrate them with secondary care—were exploited to differing degrees across the sites. There were notable differences between sites in operational and management arrangements, and in organisational and clinical integration. Closer organisational integration was attributed to previous good relationships between primary and secondary care locally, and to historical planning and preparation towards integrated working across the local health economy. The net impact of vertical integration on health system costs is argued by local stakeholders to be beneficial.ConclusionsVertical integration is a valuable option when primary care practices are at risk of closing, and may be a route to better integration of patient care. But it is not the only route and vertical integration is not attractive to all primary care physicians. A future evaluation of vertical integration is intended; of patients’ experience and of the impact on secondary care service utilisation.

A novel continuum-based framework for translating behavioral health integration to primary care settings

2020 ◽  
Vol 10 (3) ◽  
pp. 580-589 ◽  
Author(s):  
Matthew L Goldman ◽  
Ekaterina Smali ◽  
Talia Richkin ◽  
Harold A Pincus ◽  
Henry Chung
Keyword(s):  
Primary Care ◽  
Behavioral Health ◽  
Technical Assistance ◽  
New York State ◽  
Behavioral Health Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Behavioral Health Integration ◽  
Care Practices ◽  
Primary Care Practices

Abstract Although evidence-based behavioral health integration models have been demonstrated to work well when implemented properly, primary care practices need practical guidance on the steps they can take to build behavioral health integration capacities. This is especially true for practice settings with fewer resources. This study is a pilot field test of a framework continuum composed of core components of behavioral health integration that can be used to translate the implementation of behavioral health into diverse clinical settings guided by a practice's priorities and available resources. This framework, in combination with technical assistance by the study team, was piloted in 11 small primary care sites (defined as ≤5 primary care providers) throughout New York State. Surveys were collected at baseline, 6 months, and 12 months. Informal check-in calls and site visits using qualitative semistructured individual and group interviews were conducted with 10 of the 11 sites. A mixed-methods approach was used to incorporate the survey data and qualitative thematic analysis. All practices advanced at least one level of behavioral health integration along various components of the framework. These advances included implementing depression screening, standardizing workflows for positive screens, integrating patient tracking tools for follow-up behavioral health visits, incorporating warm hand-offs to on-site or off-site behavioral health providers, and formalized external referrals using collaborative agreements. Practices reported they had overall positive experiences using the framework and offered feedback for how to improve future iterations. The framework continuum, in combination with technical assistance, was shown to be useful for primary care practices to advance integrated behavioral health care based on their priorities and resource availability. The results combined with feedback from the practices have yielded a revised “Framework 2.0” that includes a new organization as well as the addition of a “Sustainability” domain.

scholarly journals Beyond BMI: a feasibility study implementing NutriSTEP in primary care practices using electronic medical records (EMRs)

2020 ◽  
Vol 40 (1) ◽  
pp. 1-10
Author(s):  
Lesley Andrade ◽  
Kathy Moran ◽  
Susan J. Snelling ◽  
Darshaka Malaviarachchi ◽  
Joanne Beyers ◽  
...  
Keyword(s):  
Primary Care ◽  
Eating Habits ◽  
Qualitative Interviews ◽  
Primary Care Providers ◽  
Early Years ◽  
Successful Implementation ◽  
Care Providers ◽  
Nutrition Risk ◽  
Care Practices ◽  
Primary Care Practices

Introduction Primary care providers have a role to play in supporting the development of healthy eating habits, particularly in a child’s early years. This study examined the feasibility of implementing the NutriSTEP® screen—a 17-item nutrition risk screening tool validated for use with both toddler and preschooler populations—integrated with an electronic medical record (EMR) in primary care practices in Ontario, Canada, to inform primary care decision-making and public health surveillance. Methods Five primary care practices implemented the NutriSTEP screen as a standardized form into their EMRs. To understand practitioners’ experiences with delivery and assess factors associated with successful implementation, we conducted semi-structured qualitative interviews with primary care providers who were most knowledgeable about NutriSTEP implementation at their site. We assessed the quality of the extracted patient EMR data by determining the number of fully completed NutriSTEP screens and documented growth measurements of children. Results Primary care practices implemented the NutriSTEP screen as part of a variety of routine clinical contacts; specific data collection processes varied by site. Valid NutriSTEP screen data were captured in the EMRs of 80% of primary care practices. Approximately 90% of records had valid NutriSTEP screen completions and 70% of records had both valid NutriSTEP screen completions and valid growth measurements. Conclusion Integration of NutriSTEP as a standardized EMR form is feasible in primary care practices, although implementation varied in our study. The application of EMR-integrated NutriSTEP screening as part of a comprehensive childhood healthy weights surveillance system warrants further exploration.

scholarly journals Adult Asthma Diagnosis: Physician Reported Challenges in Alberta-Based Primary Care Practices

2020 ◽  
Vol 6 ◽  
pp. 237796082092598
Author(s):  
H. Sharpe ◽  
F. C. Claveria-Gonzalez ◽  
W. Davidson ◽  
A. D. Befus ◽  
J. P. Leung ◽  
...  
Keyword(s):  
Primary Care ◽  
Pulmonary Function ◽  
Primary Care Providers ◽  
Pulmonary Function Testing ◽  
Objective Measurement ◽  
Care Providers ◽  
Asthma Diagnosis ◽  
Care Practices ◽  
Primary Care Practices ◽  
Function Testing

Introduction An estimated 8.1% of Canadians adults have asthma. While there are challenges associated with the use of objective measurement of lung function in the diagnosis of asthma, we are uncertain of the barriers that impact the use of objective measures, and have limited understanding of the challenges experienced by primary care providers in diagnosis of asthma. The objectives of this quality improvement initiative were to identify primary care providers’ methods of diagnosing asthma and to identify challenges with diagnosis. Methods An online survey was disseminated using a snowball methodology. Setting Primary care practices in Alberta, Canada. Participants A total of 84 primary care providers completed the survey. Main Outcome Measures Participants were asked their ideal and sufficient methods for diagnosing asthma and to identify challenges in their practice related to asthma diagnosis. Results They identified full pulmonary function testing (54%), pre- and postbronchodilator spirometry (54%), complete history and physical (42%), peak flow measurement overtime (26%), pulmonary consult (26%), and trial of asthma medication(s) (23%), as ideal methods of diagnosing asthma. The most significant barriers to diagnosis included episodic care–care provided typically during times of worsening symptoms without ongoing preventative/maintenance care (55%), patient follow-up (44%), conflict between clinical impression and pulmonary function results (43%), patient already on asthma medications (43%), and interpreting spirometry/pulmonary function results (39%). Conclusion The results of this survey indicate that the majority of primary care providers would choose full pulmonary function testing or pre- and postbronchodilator spirometry as the ideal methods of diagnosing asthma. However, barriers related to the nature of asthma care, patient factors, and challenges with diagnostic testing create challenges. This study also highlights that primary care providers have adapted to challenges in leveraging objective measurement and may rely upon other methods for diagnosis such as trials of medications.

Developing and evaluating a training intervention to address fear of cancer recurrence.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 13-13
Author(s):  
Julie Berrett-Abebe ◽  
Peter Maramaldi ◽  
Tamara Cadet
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Continuing Education ◽  
Self Efficacy ◽  
Cancer Recurrence ◽  
Primary Care Providers ◽  
Fear Of Cancer Recurrence ◽  
Care Practices ◽  
Fear Of Cancer ◽  
Primary Care Practices

13 Background: Growing numbers of cancer survivors are increasingly receiving care from primary care providers (PCPs), who often lack cancer-specific expertise. In addition to long-term effects from cancer, survivors tend to be older with multiple chronic conditions, often leaving psychosocial concerns such as fear of cancer recurrence (FCR) unaddressed. This study reports the development and testing of a continuing education intervention to train PCPs to identify and address FCR. Methods: The training was developed through key-informant interviews with 42 health care professionals, researchers, and cancer survivors. The 30-minute training was then delivered and pilot-tested with a total of 46 participants, including physicians, PAs, NPs, nurses, and social workers in six discrete primary care practices. A one group pre-test, post-test design was used to evaluate the effectiveness of the training. Participants completed self-report surveys consisting of 5 domains developed from Social Cognitive Theory and Kirkpatrick’s Evaluation of Training Programs. Data were analyzed using descriptive statistics, paired-sample t-tests, and ANOVAs. Results: ± 10.9. Participants reported high levels of confidence that the training would change their practice, although they also identified barriers to action. Results of t-tests indicated that the training significantly increased participants’ knowledge and self-efficacy. With the except of 1 knowledge domain, no significant differences were found in multivariate analyses. Conclusions: This study demonstrated that a brief, on-site interprofessional training is feasible in a range of primary care practices, well-received by participants, and achieved goals of improved knowledge, self-efficacy and confidence to implement anticipated practice behavior changes. Such training efforts are important, as quality healthcare for increasing numbers of cancer survivors can be improved through continuing education efforts for their PCPs.

scholarly journals Acceptability of Physician Associate Interns in Primary Care: Results from a Service Evaluation

2020 ◽  
Author(s):  
Elizabeth Cottrell ◽  
Victoria Silverwood ◽  
Alex Strivens-Joyce ◽  
Lucy Minshull ◽  
John J Edwards ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
Secondary Care ◽  
Service Evaluation ◽  
Full Potential ◽  
Primary Care Workforce ◽  
Form Part ◽  
Care Practices ◽  
One Year ◽  
Primary Care Practices

Abstract Background: Physician associates (PA) form part of the policy-driven response to increased primary care demand and a general practitioner recruitment and retention crisis. However, they are novel to the primary care workforce, have limitations such as being unable to prescribe and order ionising radiation investigations, and there are very limited directly-relevant data to guide the integration of PAs into primary care. To address this, a novel internship scheme was established in Staffordshire to support PAs entering primary care. This evaluation was designed to establish the acceptability of Physician Associate (PA) Interns within primary care.Methods: The Staffordshire PA Internship (SPAI) scheme was introduced in Staffordshire in 2017. PAs were concurrently working in primary and secondary care posts for one year, with protected weekly education sessions to equip them for work in primary care. Within the nine primary care practices hosting 10 PA interns in the first two cohorts, the PA interns, supervising GPs and practice managers, and patients who attended an appointment with a PA intern were invited to participate in the evaluation.Results: By evaluation end, eight of the ten PAs had completed the internship. Overall PA interns were acceptable to practices and patients, however there was ambiguity about the PA role itself, and how best to communicate this, as well as how to operationalise their roles. An expectation-preparedness gap was identified for PAs working in primary care. This resulted in high levels of supervision required for PA interns early within the internship. The internship provided a platform upon which the expectation-preparedness gap could be closed and made the high supervision requirements more acceptable to practices.Conclusions: This test-of-concept SPAI has highlighted that, to ensure successful integration of new PAs into primary care and to support them to reach their full potential, commitments to longer-term, sustainable, cohesive and appropriately funded schemes, including structured and standardised education and supervision, need to be delivered. Without such investment, there is a risk that acceptability of PAs in primary care, and PAs’ views of primary care careers, will be undermined before the profession has attained its full potential.

scholarly journals Integrating childhood obesity resources into the patient-centered medical home: Provider perspectives in the United States

2018 ◽  
Vol 23 (1) ◽  
pp. 63-78 ◽  
Author(s):  
Samareh G Hill ◽  
Thao-Ly T Phan ◽  
George A Datto ◽  
Jobayer Hossain ◽  
Lloyd N Werk ◽  
...  
Keyword(s):  
Primary Care ◽  
Childhood Obesity ◽  
Primary Care Providers ◽  
System Level ◽  
Pediatric Primary Care ◽  
Care Providers ◽  
Obesity Management ◽  
Ancillary Staff ◽  
Care Practices ◽  
Primary Care Practices

Pediatric primary care providers play a critical role in managing obesity yet often lack the resources and support systems to provide effective care to children with obesity. The objective of this study was to identify system-level barriers to managing obesity and resources desired to better managing obesity from the perspective of pediatric primary care providers. A 64-item survey was electronically administered to 159 primary care providers from 26 practices within a large pediatric primary care network. Bivariate analyses were performed to compare survey responses based on provider and practice characteristics. Also factor analysis was conducted to determine key constructs that effect pediatric interventions for obesity. Survey response rate was 69% ( n = 109), with the majority of respondents being female (77%), physicians (67%), and without prior training in obesity management (74%). Time constraints during well visits (86%) and lack of ancillary staff (82%) were the most frequently reported barriers to obesity management. Information on community resources (99%), an on-site dietitian (96%), and patient educational materials (94%) were most frequently identified as potentially helpful for management of obesity in the primary care setting. Providers who desired more ancillary staff were significantly more likely to practice in clinics with a higher percentage of obese, Medicaid, and Hispanic patients. Integrating ancillary lifestyle expert support into primary care practices and connecting primary care practices to community organizations may be a successful strategy for assisting primary care providers with managing childhood obesity, especially among vulnerable populations.

scholarly journals From Screening to Therapy: Anti-HCV Screening and Linkage to Care in a Network of General Practitioners and a Private Gastroenterology Practice

Pathogens ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1570
Author(s):  
David Petroff ◽  
Olaf Bätz ◽  
Katrin Jedrysiak ◽  
Anja Lüllau ◽  
Jan Kramer ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Linkage To Care ◽  
Drop Out ◽  
Hcv Rna ◽  
Care Practices ◽  
Hcv Screening ◽  
Primary Care Practices

(1) Background: Low rates of hepatitis C virus (HCV) diagnosis and sub-optimal linkage to care constitute barriers toward eliminating the infection. In 2012/2013, we showed that HCV screening in primary care detects unknown cases. However, hepatitis C patients may not receive further diagnostics and therapy because they drop out during the referral pathway to secondary care. Thus, we used an existing network of primary care physicians and a practice of gastroenterology to investigate the pathway from screening to therapy. (2) Methods: HCV screening was prospectively included in a routine check-up of primary care physicians who cooperated regularly with a private gastroenterology practice. Anti-HCV-positive patients were referred for further specialized diagnostics and treatment if indicated. (3) Results: Seventeen primary care practices screened 1875 patients. Twelve individuals were anti-HCV-positive (0.6%), six of them reported previous antiviral HCV therapy, and one untreated patient was HCV-RNA-positive (0.05% of the population). None of the 12 anti-HCV-positive cases showed up at the private gastroenterology practice. Further clinical details of the pathway from screening to therapy could not be analyzed. (4) Conclusions: The linkage between primary and secondary care appears to be problematic in the HCV setting even among cooperating partners, but robust conclusions require larger datasets.

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