scholarly journals Optimising laboratory monitoring of chronic conditions in primary care: a quality improvement framework

2019 ◽  
Vol 8 (1) ◽  
pp. e000349 ◽  
Author(s):  
Darunee Whiting ◽  
Richard Croker ◽  
Jessica Watson ◽  
Andy Brogan ◽  
Alex J Walker ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Chronic Disease ◽  
Liver Function ◽  
Chronic Conditions ◽  
Blood Count ◽  
Full Blood Count ◽  
Similar Amount ◽  
Blood Tests ◽  
Ordering Systems

Monitoring of chronic conditions accounts for a significant proportion of blood testing in UK primary care; not all of this is based on evidence or guidelines. National benchmarking shows significant variation in testing rates for common blood tests. This project set out to standardise the blood tests used for monitoring of chronic conditions in primary care across North Devon, and to measure and reduce the harms of unwarranted testing. Chronic disease test groups were developed in line with current guidelines and implemented using one-click electronic test ordering systems. The main difference from previous general practitioner practice algorithms was removing the requirement for full blood count and liver function test monitoring for many conditions. Baseline harms of testing were measured and included significant costs, workload and patient anxiety. By defining the scale of the problem, we were able to leverage change across several cycles of quality improvement, using a pathology optimisation forum for peer-led improvement, and developing a framework focusing on what matters to patients. Overall primary care testing rates in North Devon fell by 14% for full blood count testing and 22% for liver function tests, but without a reduction in the number of tests showing possible significant pathology. We estimate that this has reduced testing costs by £200 000 across a population of around 180 000 people and has reduced downstream referral costs by a similar amount. Introduction of simple chronic disease test groups into primary care electronic ordering systems, when used alongside engagement with clinicians, leads to both quality improvement and reduction in system costs.

scholarly journals Implementation of data management and effect on chronic disease coding in a primary care organisation: A parallel cohort observational study

2016 ◽  
Vol 23 (3) ◽  
pp. 580 ◽  
Author(s):  
Michelle Greiver ◽  
Kimberly Wintemute ◽  
Babak Aliarzadeh ◽  
Ken Martin ◽  
Shahriar Khan ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Data Management ◽  
Chronic Conditions ◽  
Primary Care Physicians ◽  
Analytical Data ◽  
Data Repository ◽  
Chronic Obstructive ◽  
Care Organisation ◽  
Primary Care Organisation

Background Consistent and standardized coding for chronic conditions is associated with better care; however, coding may currently be limited in electronic medical records (EMRs) used in Canadian primary care.Objectives To implement data management activities in a community-based primary care organisation and to evaluate the effects on coding for chronic conditions.Methods Fifty-nine family physicians in Toronto, Ontario, belonging to a single primary care organisation, participated in the study. The organisation implemented a central analytical data repository containing their EMR data extracted, cleaned, standardized and returned by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a large validated primary care EMR-based database. They used reporting software provided by CPCSSN to identify selected chronic conditions and standardized codes were then added back to the EMR. We studied four chronic conditions (diabetes, hypertension, chronic obstructive pulmonary disease and dementia). We compared changes in coding over six months for physicians in the organisation with changes for 315 primary care physicians participating in CPCSSN across Canada.Results Chronic disease coding within the organisation increased significantly more than in other primary care sites. The adjusted difference in the increase of coding was 7.7% (95% confidence interval 7.1%–8.2%, p < 0.01). The use of standard codes, consisting of the most common diagnostic codes for each condition in the CPCSSN database, increased by 8.9% more (95% CI 8.3%–9.5%, p < 0.01).Conclusions Data management activities were associated with an increase in standardized coding for chronic conditions. Exploring requirements to scale and spread this approach in Canadian primary care organisations may be worthwhile.

scholarly journals Identifying opportunities for timely diagnosis through patterns of primary care tests in patients with bladder and renal cancer: a longitudinal linked data study

2021 ◽  
pp. BJGP.2021.0282
Author(s):  
Yin Zhou ◽  
Fiona M Walter ◽  
Luke Timothy Allan Mounce ◽  
Gary A Abel ◽  
Hardeep Singh ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Patients ◽  
Renal Cancer ◽  
Population Level ◽  
Full Blood Count ◽  
Blood Tests ◽  
Cancer Registry Data ◽  
Organ Specific ◽  
Diagnostic Window ◽  
Test Use

Background: Understanding pre-diagnostic test use could reveal diagnostic windows where more timely evaluation for cancer may be indicated. Aim: To examine pre-diagnostic patterns of results of abnormal blood tests in bladder and renal cancer patients. Design and setting: Retrospective cohort study using primary care and cancer registry data on bladder and renal cancer patients diagnosed between 2012-2015 in England. Method: We examined the rates of patients with a first abnormal result in the year before diagnosis, for “generic” (full blood count components, inflammatory markers, calcium) and “organ-specific” blood tests (creatinine, liver function test components) which may lead to subsequent detection of incidental cancers. We used Poisson regression, to detect the month during which the cohort’s rate of each abnormal test started to increase from baseline, and examined the proportion of patients with a test found in the first half of the window, as these ‘early’ tests might represent opportunities where further evaluation could be initiated. Results: Data from 4,533 bladder and renal cancer patients were analysed. The monthly rate of patients with a first abnormal test increased towards the time of cancer diagnosis. Abnormalities of both generic and organ-specific tests started to increase from 6-8 months pre-diagnosis, with 25-40% of these patients having an abnormal test in the “early half” of the diagnostic window. Conclusion: Population-level signals of bladder and renal cancer can be observed in abnormalities in commonly performed primary care blood tests up to 8 months before diagnosis, indicating the potential for earlier diagnosis in some patients.

scholarly journals Gastro-intestinal Mycobacterium avium complex as a cause of anaemia

2010 ◽  
Vol 11 (2) ◽  
Author(s):  
Annemarie Van de Vyver ◽  
Adele Visser
Keyword(s):  
Chronic Disease ◽  
Mycobacterium Avium Complex ◽  
Blood Count ◽  
Clinical Case ◽  
Population Group ◽  
Common Finding ◽  
Full Blood Count ◽  
Hiv Positive ◽  
Anaemia Of Chronic Disease ◽  
Hiv Negative

Anaemia is a relatively common finding in HIV-positive patients, with rates (among females) as high as 37%, compared with their HIV negative counterparts (17%). Anaemia of chronic disease plays a very important role in this population group, and is estimated to occur in 18 - 95% of cases. For this reason, it is imperative to distinguish this condition from other underlying or concurrent causes of anaemia that may warrant treatment. This clinical case illustrates the value of critically evaluating the parameters of a full blood count and haematinic screen, to so determine which patients warrant further workup.

scholarly journals The evaluation of anaemia in an older primary care population: retrospective population-based study

BJGP Open ◽  
2017 ◽  
Vol 1 (4) ◽  
pp. bjgpopen17X101157
Author(s):  
David McCartney ◽  
Brian Shine ◽  
Deborah Hay ◽  
Daniel S Lasserson
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Blood Count ◽  
Iron Status ◽  
World Health Organisation ◽  
Population Based ◽  
World Health ◽  
Full Blood Count ◽  
Mean Cell Volume ◽  
Normocytic Anaemia

BackgroundAnaemia is common in older people and the identification of potentially reversible haematinic deficiencies relies on appropriate investigation, often undertaken in primary care.AimTo determine the laboratory prevalence of anaemia, the types of anaemia observed, and the biochemical and haematological investigations undertaken to characterise any associated haematinic abnormality in older primary care patients.Design & settingA retrospective primary care based study of patients aged >65 years undergoing a full blood count in Oxfordshire, UK between 1 January 2012 and 31 December 2013.MethodConsecutive patients aged >65 years with a full blood count were identified retrospectively from a laboratory database. Patient demographics, number of blood tests and additional laboratory investigations requested were recorded. World Health Organisation (WHO) criteria were used to define anaemia.ResultsIn total 151 473 full blood counts from 53 890 participants were included: 29.6% of patients were anaemic. The majority had a normocytic anaemia (82.4%) and 46.0% of participants with anaemia had no additional investigations performed. The mean haemoglobin was lower in the anaemic group that underwent further investigation than those who did not (Hb 10.68 g/dl versus 11.24 g/dl, P<0.05): 33.2 % of patients with a microcytic anaemia (mean cell volume <80) did not have any markers of iron status measured.ConclusionA large proportion of older adults in primary care with a recent blood test are anaemic, the majority with a normocytic anaemia, with evidence of inadequate investigation. Those with lower haemoglobin are more likely to be further investigated. Further work is needed to understand the approach to anaemia in older adults in primary care.

scholarly journals Comparison of routine hematological indicators of liver and kidney function, blood count and lipid profile in healthy people and stroke patients

PeerJ ◽  
2020 ◽  
Vol 8 ◽  
pp. e8545
Author(s):  
Xiaofang Cui ◽  
Wei Wei ◽  
Xiao Qin ◽  
Fei Hou ◽  
Jin Zhu ◽  
...  
Keyword(s):  
Renal Function ◽  
Ischemic Stroke ◽  
Liver Function ◽  
Blood Cells ◽  
Blood Count ◽  
Full Blood Count ◽  
Stroke Patients ◽  
Clinical Indicators ◽  
Distribution Width ◽  
Hematological Indicators

Background and methods Stroke has become a major public health problem worldwide. In this article, we carried out statistical analysis, correlation analysis and principal component analysis (PCA) to evaluate the clinical value of routine hematological indicators in early diagnosis of ischemic stroke using R language. Results For the full blood count comparisons, stroke patients had obvious differences in the distribution width of red blood cells (RDW-CV), average distribution width of red blood cells (RDW-SD), mean hemoglobin concentrations, platelet large cell ratio, mean platelet volume and lymphocytes. Patients with ischemic stroke also exhibited different degrees of abnormalities in liver function test. With respect to renal function, stroke patients had obvious changes in uric acid and urea levels. Finally, when comparing the lipid profile, triglyceride concentrations were increased and high-density lipoprotein cholesterol concentrations were reduced in stroke patients. In addition, correlation analysis among these clinical indicators indicated that there were both common characteristics and differences between patients and health controls. Furthermore, the results of PCA indicated that these clinical indicators could distinguish patients from the healthy controls. Conclusion Conventional hematological clinical indicators, such as liver function, renal function, full blood count and lipid concentration profiles highly correlated with the occurrence of ischemic stroke. Therefore, the detection and analyzation of these clinical indicators are of great significance for the prediction of ischemic stroke.

Interpreting the full blood count

2022 ◽  
pp. 175573802110657
Author(s):  
Martin Haywood
Keyword(s):  
Laboratory Tests ◽  
Blood Count ◽  
Blood Film ◽  
Full Blood Count ◽  
State Of Health ◽  
General State ◽  
Blood Tests ◽  
Morphological Findings ◽  
Individual Laboratory ◽  
Clinical Presentations

The full blood count (FBC) is one of the most commonly requested blood tests in medical practice and can provide a wealth of useful information about a patient’s general state of health, as well as highlighting abnormalities which indicate systemic or sinister pathologies. This article seeks to explore the different parameters of the FBC, and how these relate to some more common clinical presentations, as well as their relation to morphological findings seen on the blood film. As with most investigations, differential diagnoses suggested by any individual laboratory tests are wide and are most valuable when combined with history and examination.

Basic investigations

2019 ◽  
pp. 839-858
Keyword(s):  
Chronic Infection ◽  
Blood Count ◽  
Clinical Chemistry ◽  
Bone Marrow Failure ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Full Blood Count ◽  
Blood Tests ◽  
Clotting Cascade ◽  
Electrocardiogram Interpretation

The chapter aims to provide a brief but thorough reference for the commonest urine and blood tests that medical students will encounter on the wards and in clinic. The chapter focuses in detail on the wealth of information provided by a simple urine dip, including signs of infection, haematuria, pregnancy (or ectopic pregnancy), and metabolic disorders. The chapter discusses in detail how to read a full blood count which can give clues not only to infection but also to chronic infection, leukaemias, parasites, allergy, iron deficiency, and many other disease processes. The chapter also discusses the use of the reticulocyte count to help differentiate between haemolytic anaemias (raised) and bone marrow failure (decreased, e.g. from cancer). A guide to findings on blood films is also given. The clotting cascade and clotting parameters are summarized. The commonest tests in clinical chemistry, including blood glucose, renal and liver function, and bone profile are also discussed. A guide to blood gas analysis, with common examples, is also covered, along with a systematic approach to electrocardiogram interpretation.

scholarly journals Perceived facilitators and barriers to chronic disease management in primary care networks of Singapore: a qualitative study

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e046010
Author(s):  
Chuan De Foo ◽  
Shilpa Surendran ◽  
Chen Hee Tam ◽  
Elaine Ho ◽  
David Bruce Matchar ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Qualitative Study ◽  
Chronic Conditions ◽  
Chronic Disease Management ◽  
Primary Care Providers ◽  
Great Promise ◽  
Ageing Population ◽  
Facilitators And Barriers

ObjectiveThe increasing chronic disease burden has placed tremendous strain on tertiary healthcare resources in most countries, necessitating a shift in chronic disease management from tertiary to primary care providers. The Primary Care Network (PCN) policy was promulgated as a model of care to organise private general practitioners (GPs) into groups to provide GPs with resources to anchor patients with chronic conditions with them in the community. As PCN is still in its embryonic stages, there is a void in research regarding its ability to empower GPs to manage patients with chronic conditions effectively. This qualitative study aims to explore the facilitators and barriers for the management of patients with chronic conditions by GPs enrolled in PCN.DesignWe conducted 30 semistructured interviews with GPs enrolled in a PCN followed by a thematic analysis of audio transcripts until data saturation was achieved.SettingSingapore.ResultsOur results suggest that PCNs facilitated GPs to more effectively manage patients through (1) provision of ancillary services such as diabetic foot screening, diabetic retinal photography and nurse counselling to permit a ‘one-stop-shop’, (2) systematic monitoring of process and clinical outcome indicators through a chronic disease registry (CDR) to promote accountability for patients’ health outcomes and (3) funding streams for PCNs to hire additional manpower to oversee operations and to reimburse GPs for extended consultations. Barriers include high administrative load in maintaining the CDR due to the lack of a smart electronic clinic management system and financial gradient faced by patients seeking services from private GPs which incur higher out-of-pocket expenses than public primary healthcare institutions.ConclusionPCNs demonstrate great promise in empowering enrolled GPs to manage patients with chronic conditions. However, barriers will need to be addressed to ensure the viability of PCNs in managing more patients in the face of an ageing population.

Supporting quality care in general practice: The collaboratives approach

2008 ◽  
Vol 14 (2) ◽  
pp. 46 ◽  
Author(s):  
Catuscia Buiso ◽  
Bill Newton
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Quality Improvement ◽  
Chronic Disease ◽  
Quality Care ◽  
Quality Improvement Initiative ◽  
Building Practice ◽  
The Impact ◽  
International Phenomenon

An important role of divisions of general practice is to support general practice to build capacity for the delivery of quality care. The purpose of this paper is to discuss the National Primary Care Collaboratives Program and the impact this quality improvement initiative has had on building practice capacity to achieve improvements in the management of chronic disease. "The Collaboratives" are an international phenomenon, which, over the last three years, has been implemented in Australia and has achieved impressive results consistent with the success documented in other countries. This paper explores the key elements contributing to the success of the program and discusses the opportunities that have strengthened the ability of participating divisions to support general practice to deliver quality care.

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