scholarly journals Open communication strategies between a triad of ‘experts’ facilitates death in usual place of residence: A realist evaluation

2018 ◽  
Vol 32 (5) ◽  
pp. 980-989 ◽  
Author(s):  
Sonia Dalkin ◽  
Monique Lhussier ◽  
Diana Jones ◽  
Pete Phillipson ◽  
William Cunningham
Keyword(s):  
Primary Care ◽  
Logistic Regression Model ◽  
Care Pathway ◽  
Communication Strategies ◽  
Realist Evaluation ◽  
Mixed Effects ◽  
Place Of Residence ◽  
Open Communication ◽  
Audit Data ◽  
Integrated Care Pathway

Background: In order to meet policy drivers on death in usual place of residence, it is key to understand how shared decision-making can be facilitated in practice. An integrated care pathway was implemented in primary care in the North East of England to facilitate death in usual place of residence. Aim: To understand how, for whom and in which circumstances death in usual place of residence is facilitated. Design: A mixed method realist evaluation was employed. Local primary care practice death audit data were analysed to identify outcomes using a mixed effects logistic regression model. Focus groups and interviews with staff of the integrated care pathway and bereaved relatives were analysed to identify the related contexts and mechanisms. Setting/participants: Death audit data of 4182 patients were readily available from 14 general practitioner practices. Three focus groups were conducted with primary and secondary care staff, voluntary sector organisations and care home representatives. Interviews with bereaved relatives were carried out in participants’ homes ( n = 5). Results: A mixed effects logistic regression model indicated a significant effect of year on death in usual place of residence when compared to a model without year using an analysis of deviance ( p = 0.016). Qualitative analysis suggested that this outcome was achieved when a triad of ‘experts’ (comprising patient, family members/family carers/formal carers and healthcare professionals) used open communication strategies. Conclusion: An empirically supported theory of how, for whom and in which circumstances death in usual place of residence happens is provided, which has important implications for both policy and practice.

scholarly journals 22. Patient Satisfaction Remains Unchanged Following Implementation of an Antibiotic Stewardship Intervention in Primary Care

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S11-S12
Author(s):  
Zachary Hostetler ◽  
Keith W Hamilton ◽  
Leigh Cressman ◽  
McWelling H Todman ◽  
Ebbing Lautenbach ◽  
...  
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Odds Ratio ◽  
Logistic Regression Model ◽  
Adjusted Odds Ratio ◽  
Primary Care Providers ◽  
Mixed Effects ◽  
Antibiotic Prescribing ◽  
Care Providers ◽  
Targeted Intervention

Abstract Background Inappropriate prescription of antibiotics for respiratory tract infections (RTIs) in ambulatory care settings is common, increasing the risk of adverse health outcomes. Behavioral and educational interventions targeting primary care providers (PCPs) have shown promise in reducing inappropriate antibiotic prescribing for RTIs. While one perceived barrier to such interventions is the concern that these adversely impact patient satisfaction, few data exist in this area. Here, we examine whether a recent PCP-targeted intervention that significantly reduced antibiotic prescribing for RTIs was associated with a change in patient satisfaction. Methods The PCP-targeted intervention involved monthly education sessions and peer benchmarking reports delivered to 31 clinics within an academic health system, and was previously shown to reduce antibiotic prescribing. Here, we performed a retrospective, secondary analysis of Press Ganey (PG) surveys associated with the outpatient encounters in the pre- and post-intervention periods. We evaluated the impact on patient perceptions of PCPs based on provider exposure to the intervention using a mixed effects logistic regression model. Results There were 17,416 out of 197,744 encounters (8.8%) with associated PG surveys for the study time period (July 2016 to September 2018). In the multivariate model, patient satisfaction with PCPs was most strongly associated with patient-level characteristics (age, race, health status, education status) and survey-level characteristics (survey response time, patient’s usual provider) (Figure 1). Satisfaction with PCPs did not change following delivery of the provider-based intervention even after adjusting for patient- and survey-level characteristics [adjusted odds ratio (95% CI): 1.005 (0.928, 1.087)]. However, a small increase in satisfaction associated with receiving antibiotics during the entire study period was seen [adjusted odds ratio (95% CI): 1.146 (1.06, 1.244)]. Figure 1: Association of a provider-targeted intervention as well as patient, provider, and practice characteristics with patient satisfaction in a multivariable mixed effects logistic regression model Conclusion Patient perceptions of PCPs remain unchanged following the delivery of a behavioral and educational intervention to primary care providers that resulted in observable decreases in antibiotic prescribing practices for RTIs. Disclosures All Authors: No reported disclosures

Motivations and Objections to Implement a Spondyloarthritis Integrated Care Pathway. A Qualitative Study With Primary Care Physicians

2013 ◽  
Vol 9 (2) ◽  
pp. 85-89
Author(s):  
Virginia Villaverde ◽  
Loreto Carmona ◽  
Juan Carlos López Robledillo ◽  
Serafina Serrano ◽  
Milena Gobbo
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Integrated Care ◽  
Primary Care Physicians ◽  
Care Pathway ◽  
Integrated Care Pathway

scholarly journals Promoting seamless transfer-of-care for stroke patients in primary care: development of the integrated care pathway for post stroke services

2014 ◽  
Vol 14 (S1) ◽  
Author(s):  
Aznida Firzah Abdul Aziz ◽  
Noor Azah Abd Aziz ◽  
Nor Azlin Mohd Nordin ◽  
Saperi Sulong ◽  
Syed Mohamed Aljunid
Keyword(s):  
Primary Care ◽  
Integrated Care ◽  
Care Pathway ◽  
Stroke Patients ◽  
Transfer Of Care ◽  
Post Stroke ◽  
Stroke Services ◽  
Integrated Care Pathway ◽  
Seamless Transfer ◽  
Care Development

Glottalization and linking in the L2 speech of Czech learners of Spanish, Italian and Portuguese

2021 ◽  
pp. 026765832110158
Author(s):  
Radek Skarnitzl ◽  
Petr Čermák ◽  
Pavel Šturm ◽  
Zora Obstová ◽  
Jan Hricsina
Keyword(s):  
Logistic Regression Model ◽  
Native Speakers ◽  
Mixed Effects ◽  
Lexical Stress ◽  
The Other ◽  
Target Language ◽  
Romance Languages ◽  
Short Text ◽  
Sound Pattern ◽  
Frequent Use

The use of linking or glottalization contributes to the characteristic sound pattern of a language, and the use of one in place of the other may affect a speaker’s comprehensibility and fluency in certain contexts. In this study, native speakers of Czech, a language that is associated with a frequent use of glottalization in vowel-initial word onsets, are examined in the second language (L2) context of three Romance languages that predominantly employ linking between words (Spanish, Italian and Portuguese). In total, 29 native speakers and 51 non-native learners were asked to read a short text in the respective language. The learners were divided into two groups based on their experience with the target language. A number of other factors were examined in a mixed-effects logistic regression model (segmental context, lexical stress, prosodic breaks, and the semantic status of the words). The main results show that, regardless of the target language, the more experienced (ME) learners displayed significantly lower rates of glottalization than the less experienced (LE) learners, but significantly higher rates than native speakers. The pedagogical implications of the results are discussed.

scholarly journals Improving mobility and participation of older people with vertigo, dizziness and balance disorders in primary care using a care pathway: feasibility study and process evaluation

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Eva Seckler ◽  
Verena Regauer ◽  
Melanie Krüger ◽  
Anna Gabriel ◽  
Joachim Hermsdörfer ◽  
...  
Keyword(s):  
Primary Care ◽  
Data Collection ◽  
Older People ◽  
Process Evaluation ◽  
Feasibility Study ◽  
Health Professionals ◽  
Implementation Strategy ◽  
Care Pathway ◽  
Main Trial ◽  
Telephone Helpline

Abstract Background Community-dwelling older people are frequently affected by vertigo, dizziness and balance disorders (VDB). We previously developed a care pathway (CPW) to improve their mobility and participation by offering standardized approaches for general practitioners (GPs) and physical therapists (PTs). We aimed to assess the feasibility of the intervention, its implementation strategy and the study procedures in preparation for the subsequent main trial. Methods This 12-week prospective cohort feasibility study was accompanied by a process evaluation designed according to the UK Medical Research Council’s Guidance for developing and evaluating complex interventions. Patients with VDB (≥65 years), GPs and PTs in primary care were included. The intervention consisted of a diagnostic screening checklist for GPs and a guide for PTs. The implementation strategy included specific educational trainings and a telephone helpline. Data for mixed-method process evaluation were collected via standardized questionnaires, field notes and qualitative interviews. Quantitative data were analysed using descriptive statistics, qualitative data using content analysis. Results A total of five GP practices (seven single GPs), 10 PT practices and 22 patients were included in the study. The recruitment of GPs and patients was challenging (response rates: GP practices: 28%, PT practices: 39%). Ninety-one percent of the patients and all health professionals completed the study. The health professionals responded well to the educational trainings; the utilization of the telephone helpline was low (one call each from GPs and PTs). Familiarisation with the routine of application of the intervention and positive attitudes were emphasized as facilitators of the implementation of the intervention, whereas a lack of time was mentioned as a barrier. Despite difficulties in the GPs’ adherence to the intervention protocol, the GPs, PTs and patients saw benefit in the intervention. The patients’ treatment adherence to physical therapy was good. There were minor issues in data collection, but no unintended consequences. Conclusion Although the process evaluation provided good support for the feasibility of study procedures, the intervention and its implementation strategy, we identified a need for improvement in recruitment of participants, the GP intervention part and the data collection procedures. The findings will inform the main trial to test the interventions effectiveness in a cluster RCT. Trial registration Projektdatenbank Versorgungsforschung Deutschland (German registry Health Services Research) VfD_MobilE-PHY_17_003910, date of registration: 30.11.2017; Deutsches Register Klinischer Studien (German Clinical Trials Register) DRKS00022918, date of registration: 03.09.2020 (retrospectively registered).

scholarly journals Palliative care and complex chronic conditions since the perspective of healthcare professionals

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Doñate-Martínez ◽  
L Llop ◽  
J Garcés
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Early Identification ◽  
Chronic Conditions ◽  
Healthcare Professionals ◽  
Care Pathway ◽  
Holistic View ◽  
Complex Chronic Conditions ◽  
Symptom Intensity

Abstract Background According to the WHO, palliative care (PC) is applicable early in the course of illness together with other curative therapies. Early PC has demonstrated beneficial effects on quality of life and symptom intensity among cancer patients. However, PC is not as early integrated on the care pathway of complex chronic conditions (CCC). This abstract presents barriers and needs identified to effectively implement early PC on CCC performed under the EU-funded InAdvance project (ref.: 825750). Methods Semi-structured interviews were performed with 16 healthcare professionals (HPs) from primary care and hospital settings working with older patients with CCC in Valencia (Spain). Results Interviews reported that main needs identified to provide early PC are: (a) coordinated strategies between multi-setting HPs to an early identification of CCC patients in need of PC; (b) adequate resources to attend patients' PC needs from a holistic view, i.e. psychosocial and spiritual needs; and (c) early integration of basic PC at primary care teams. The main barriers identified were: (a) stereotypes associated to the traditional PC approach; (b) poor knowledge from HPs of the PC holistic approach; and (c) lack of specific protocols or pathways for CCC in need of PC. Conclusions Specific skills and resources are the most relevant needs to effectively provide early PC among patients with CCC. First, it is urgent to demystify the negative culture-related vision of PC that is commonly associated to sedation and last days of a person's life. Also, multidisciplinary HPs require specific training to identify and provide early PC tailored to CCC. And, it is required a strategic and multi-setting organizational approach with fluent information flow and coordinated roles. Key messages Healthcare expenditure would be considerably reduced, especially at hospital and emergency units, with an early identification of patients with CCC in need of PC. Empowering primary HPs in PC would improve the quality of care of patients with CCC.

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