Income-related differences in out-of-hours primary care telephone triage: using national registration data

2021 ◽  
pp. emermed-2020-209649
Author(s):  
Tessa Jansen ◽  
Karin Hek ◽  
François G Schellevis ◽  
Anton E Kunst ◽  
Robert A Verheij
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Telephone Triage ◽  
Electronic Health Record Data ◽  
Out Of Hours ◽  
Vulnerable Patients ◽  
Follow Up Care ◽  
Healthcare Need ◽  
Ses Differences

BackgroundTelephone triage is used to facilitate efficient and adequate acute care allocation, for instance in out-of-hours primary care services (OPCSs). Remote assessment of health problems is challenging and could be impeded by a patient’s ambiguous formulation of his or her healthcare need. Socioeconomically vulnerable patients may experience more difficulty in expressing their healthcare need. We aimed to assess whether income differences exist in the patient’s presented symptoms, assessed urgency and allocation of follow-up care in OPCS.MethodData were derived from Nivel Primary Care Database encompassing electronic health record data of 1.3 million patients from 28 OPCSs in 2017 in the Netherlands. These were linked to sociodemographic population registry data. Multilevel logistic regression analyses (contacts clustered in patients), adjusted for patient characteristics (eg, age, sex), were conducted to study associations of symptoms, urgency assessment and follow-up care with patients’ income (standardised for household size as socioeconomic status (SES) indicator).ResultsThe most frequently presented symptoms deduced during triage slightly differed across SES groups, with a larger relative share of trauma in the high-income groups. No SES differences were observed in urgency assessment. After triage, low income was associated with a higher probability of receiving telephone advice and home visits, and fewer consultations at the OPCS.ConclusionsSES differences in the patient’s presented symptom and in follow-up in OPCS suggest that the underlying health status and the ability to express care needs affect the telephone triage process . Further research should focus on opportunities to better tailor the telephone triage process to socioeconomically vulnerable patients.

Guideline-concordant surveillance and follow-up care among low-income patients with breast cancer: The role of primary care medical homes.

2012 ◽  
Vol 30 (34_suppl) ◽  
pp. 171-171
Author(s):  
Stephanie B. Wheeler ◽  
Racquel Elizabeth Kohler ◽  
Ravi K. Goyal ◽  
Kristen Hassmiller Lich ◽  
Alexis Moore ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Cancer Survivors ◽  
Cancer Survivorship ◽  
Low Income ◽  
Breast Cancer Survivors ◽  
Breast Cancer Survivorship ◽  
Medical Homes ◽  
Follow Up Care

171 Background: Community Care of North Carolina (CCNC) initiated an innovative medical home (MH) program in the 1990s to improve primary care in Medicaid-insured populations. CCNC has been successful in improving asthma, diabetes, and cardiovascular outcomes, but has not been evaluated in the context of cancer care. We sought to determine whether MH enrollment was associated with guideline-concordant surveillance and follow-up care among breast cancer survivors. Methods: Using state cancer registry records matched to Medicaid claims, we identified women ages 18-64 diagnosed with stage 0, I, or II breast cancer from 2003-2007 and tracked their CCNC enrollment. Using published American Society for Clinical Oncology breast cancer survivorship guidelines to define our outcomes, we employed multivariate logistic regressions to examine correlates of receipt of surveillance mammogram and at least two physical exams within 15 months post-diagnosis. Results: In total, 840 women were included in our sample. Approximately half were enrolled in a CCNC MH during the study period, 38% were enrolled for more than 7 months post-diagnosis. Enrollment in a MH for at least 7 months post-diagnosis was strongly associated with receiving guideline-recommended surveillance mammogram (p<0.01) and at least 2 physical exams (p<0.01) within 15 months post-diagnosis. Conclusions: Results suggest that MH enrollment is associated with higher quality breast cancer survivorship care among women insured by Medicaid. Given the growing population of cancer survivors and increased emphasis on primary care MH, more research is needed to explore how medical homes can enhance and ensure the provision of guideline-recommended care during cancer survivorship.

Reliability and validity of an original nurse telephone triage tool for out-of-hours primary care calls: the SALOMON algorithm

2021 ◽  
pp. 1-7
Author(s):  
Edmond Brasseur ◽  
Allison Gilbert ◽  
Anne-Françoise Donneau ◽  
Justine Monseur ◽  
Alexandre Ghuysen ◽  
...  
Keyword(s):  
Primary Care ◽  
Reliability And Validity ◽  
Telephone Triage ◽  
Out Of Hours

scholarly journals Factors Associated with Meeting the Psychosocial Needs of Cancer Survivors in Nova Scotia, Canada

2020 ◽  
Vol 28 (1) ◽  
pp. 13-25
Author(s):  
Soleil Chahine ◽  
Gordon Walsh ◽  
Robin Urquhart
Keyword(s):  
Primary Care ◽  
Nova Scotia ◽  
Cancer Survivors ◽  
Sociodemographic Factors ◽  
Patient Navigator ◽  
Care Providers ◽  
Psychosocial Needs ◽  
Factors Associated ◽  
Follow Up Care

Purpose: The purpose of this study is to describe the psychosocial needs of cancer survivors and examine whether sociodemographic factors and health care providers accessed are associated with needs being met. Methods: All Nova Scotia survivors meeting specific inclusion and exclusion criteria are identified from the Nova Scotia Cancer Registry and sent an 83-item survey to assess psychosocial concerns and whether and how their needs were met. Descriptive statistics (frequencies, percentages) and Chi-square analyses are used to examine associations between sociodemographic and provider factors and outcomes. Results: Anxiety and fear of recurrence, depression, and changes in sexual intimacy are major areas of concern for survivors. Various sociodemographic factors, such as immigration status, education, employment, and internet use, are associated with reported psychosocial health and having one’s needs met. Having both a specialist and primary care provider in charge of follow-up care is associated with a significantly (p < 0.05) higher degree of psychosocial and informational needs met compared to only one physician or no follow-up physician in charge. Accessing a patient navigator also is significantly associated with a higher degree of needs met. Conclusions: Our study identifies the most prevalent psychosocial needs of cancer survivors and the factors associated with having a higher degree of needs met, including certain sociodemographic factors, follow-up care by both a primary care practitioner and specialist, and accessing a patient navigator.

Follow-up care of children identified with ADHD by primary care clinicians: A prospective cohort study

2004 ◽  
Vol 145 (6) ◽  
pp. 767-771 ◽  
Author(s):  
William Gardner ◽  
Kelly J. Kelleher ◽  
Kathleen Pajer ◽  
John V. Campo
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Follow Up Care ◽  
Primary Care Clinicians

scholarly journals Population’s unmet needs in relation to primary care in Romania- a pilot survey in County Brasov.

2019 ◽  
Author(s):  
Andrea Elena Neculau ◽  
Liliana Rogozea ◽  
Daniela Popa ◽  
Ioana Atudorei ◽  
Florin Leasu ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Unmet Needs ◽  
Family Doctor ◽  
Health Needs ◽  
Medical Services ◽  
Out Of Hours ◽  
Health Technologies ◽  
Healthcare Needs ◽  
Unmet Healthcare Needs

Abstract Background Patients’ expectations and needs for healthcare services are changing. These changes are correlated with changes in disease profiles, a higher prevalence of chronic diseases, the introduction of new and innovative treatments and health technologies, and the emergence of new social and economic contexts. National health reports on Romania show that decisions in healthcare planning are not correlated with the health needs of the population. At the same time, this report shows a high degree of unmet healthcare needs of the Romanian population (related to cost, distance and waiting times), especially for low-income populations. The objective of the study was to identify the unmet needs of the population in relation to primary care medical services in the context of actual health regulations through a pilot study in a representative county in Romania. Methods The study is survey-based, and part of a health needs assessment programme commissioned by the District Health Authority to the university. A questionnaire with 21 items was designed to gather information about the structures, processes and outcomes of primary care from the perspective of the population. A total of 877 questionnaires were returned and validated. The data were analysed with SPSS version 25. Results Access to primary care was considered to be good by most of the population. Most of the settlements have a family doctor, and 80.5% can schedule an appointment on the same or the following day. Most basic medical services are provided, except for out-of-hours primary care services and cervical cancer screening. The family doctors are considered to be a reliable health resource. Conclusions Despite limitations in the practice of family medicine in Romania and therefore a narrow spectrum of services offered by primary care in general, the level of contentment of the population with this healthcare resource is still high. Barriers to access are related to the lack of some essential services, especially preventive and out-of-hours services. Unmet needs are presumably not recognised by patients due to a lack of medical culture. Further research is needed to clarify this conclusion. Key words: unmet health needs, primary care, Romania

Population’s perceptions and availability of primary care services in Romania- a pilot survey in County Brasov.

2019 ◽  
Author(s):  
Andrea Elena Neculau ◽  
Liliana Rogozea ◽  
Daniela Popa ◽  
Ioana Atudorei ◽  
Florin Leasu ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Medicine ◽  
Low Income ◽  
National Level ◽  
Health Needs ◽  
Out Of Hours ◽  
Healthcare Planning ◽  
Healthcare Needs ◽  
Unmet Healthcare Needs ◽  
Health Services Needs

Abstract Background National health reports on Romania show that decisions in healthcare planning are not correlated with the health needs of the population and that there is a high degree of unmet healthcare needs of the population (related to cost, distance and waiting times), especially for low-income populations. Family medicine is facing underfinancing, slow pace of development. Methods The research is part of a wider project of health services needs assessment in county Brasov, Romania. A subset of questions where dedicated to identifying the perception of population on primary healthcare services. Comparison with previous national and international studies was done. Results The characteristics of the population questioned: predominantly women (67.2%), 61.1% graduates of high school or other professional schools. 97.4% are registered with a FD. The average number of visits at the FD is 11.25, higher than the national average of 7.7 reported in a previous study in 2009. Access to the FD is appreciated as satisfactory in terms of availability of doctors in the community (97.4%), opening times by (91.1%), phone access (90.5%). Only 26.6% of participants reported a same day opportunity to reach the FD. Continuity of care is reported as present in 58.7% of cases in out of hours centres. The population is appreciating the fact that FDs knows their history (90%), knows how to treat them (88.2%). Most of the preventative services are offered by FDs. 94.4% flu vaccination, 85.6% pregnancy monitoring, 90.7% well child visits. Procedures like blood draws, pap smear have less availability (46.2% respectively 63.1%). Conclusions Despite limitations in the practice of family medicine in Romania and therefore a narrow spectrum of services offered by primary care in general, the level of contentment of the population with this healthcare resource is still high. Barriers to access are related to the lack of some essential services, especially preventive and out-of-hours services. Research at national level should be done in order to better categorize population’ perceptions on primary care and be able to use their opinion to influence policies and healthcare planning. Key words: unmet health needs, population’s perception, primary care, Romania

Measuring follow-up care between primary care and specialty behavioral health settings for children and adolescents

2019 ◽  
Vol 17 (5) ◽  
pp. 627-638 ◽  
Author(s):  
Sean Lynch ◽  
Whitney Witt ◽  
Mir M. Ali ◽  
Judith Teich ◽  
Ryan Mutter ◽  
...  
Keyword(s):  
Primary Care ◽  
Children And Adolescents ◽  
Behavioral Health ◽  
Follow Up Care

Low-Income Senior Housing Residents’ Emergency Department Use and Care Transition Problems

2017 ◽  
Vol 31 (6) ◽  
pp. 610-616 ◽  
Author(s):  
Antoinette B. Coe ◽  
Leticia R. Moczygemba ◽  
Kelechi C. Ogbonna ◽  
Pamela L. Parsons ◽  
Patricia W. Slattum ◽  
...  
Keyword(s):  
Emergency Department ◽  
Low Income ◽  
Personal Health Record ◽  
Primary Care Providers ◽  
Adverse Outcomes ◽  
Transitions Of Care ◽  
Care Providers ◽  
Senior Housing ◽  
Follow Up Care

Older adults may be at risk of adverse outcomes after emergency department (ED) visits due to ineffective transitions of care. Semi-structured interviews were employed to identify and categorize reasons for ED use and problems that occur during transition from the ED back to home among 14 residents of low-income senior housing. Qualitative thematic and descriptive analyses were used. Ambulance use, timely ED use or a wait-and-see approach, and lack of health-care provider contact before ED visit were emergent themes. Delayed medication receipt, no current medication list, and medication knowledge gaps were identified. Lack of a personal health record, follow-up care instruction, and worsening symptoms education emerged as transition problems from ED to home. After an ED visit, education opportunities exist around seeing primary care providers for nonurgent conditions, follow-up care, medications, and worsening condition symptoms. Timely receipt of discharge medications and medication education may improve medication-related transition problems.

A Decision Support System (DSS) for Colorectal Cancer Follow-Up Program via a Semantic Framework

2015 ◽  
Vol 10 (1) ◽  
pp. 17-38 ◽  
Author(s):  
Kalpdrum Passi ◽  
Hongtao Zhao
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Decision Support ◽  
Cancer Patients ◽  
Support System ◽  
Web Application ◽  
Semantic Framework ◽  
Follow Up Care ◽  
The Web

This paper offers insights into evolving a decision support system (DSS) to aid primary care physicians and/or nurses in the post-surgical care of patients with Colorectal Cancer in a clinical setting. Presently, the oncologists in the cancer center, who are familiar with the Clinical Practice Guidelines (CPGs), are primarily responsible for the provision of follow-up care to their patients on the basis of the CPGs; in contrast, the attending primary care physician and/or nurse assisting the oncologist may be unfamiliar with these guidelines. These caregivers would, therefore, either require hardcopies of the CPGs or can be aided via a DSS for them to be able to provide the appropriate follow-up care for the respective cancer patients. Clearly, the Colorectal Cancer follow-up CPGs have to be analyzed and the ontology representing the knowledge embedded in the guidelines designed prior to realizing such a DSS. The designed ontology is often coded into Web Ontology Language (OWL) as a standard ontology that can be accessed through the Web. The authors' research team designed and presented the semantic framework of the web application, using the designed ontology that combines the current Web technology with database storage to achieve a unified development of the DSS. The authors also designed a user-friendly interface of the Web application to provide medical practitioners the functionality of the CPGs and the flexibility to customize the desired follow-up care schedule. The resulting DSS provides the physicians with follow-up program for the Colorectal Cancer patients based on the CPGs. The system was built using the semantic framework for the follow-up program and queries on the system are executed through SPARQL query engine.

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