scholarly journals Deprescribing conversations: a closer look at prescriber–patient communication

2018 ◽  
Vol 9 (12) ◽  
pp. 687-698 ◽  
Author(s):  
Justin P. Turner ◽  
Claude Richard ◽  
Marie-Thérèse Lussier ◽  
Marie-Eve Lavoie ◽  
Barbara Farrell ◽  
...  
Keyword(s):  
Primary Care ◽  
Content Analysis ◽  
Proton Pump Inhibitor ◽  
Healthcare Provider ◽  
Descriptive Analysis ◽  
Healthcare Providers ◽  
Provider Communication ◽  
Care Practices ◽  
Primary Care Practices

Background: Little is known about the initiation, style and content of patient and healthcare provider communication around deprescribing. We report the findings from a content analysis of audio-recorded discussions of proton pump inhibitor (PPI) and benzodiazepine deprescribing in primary care. Methods: Participants were healthcare providers ( n = 13) from primary care practices ( n = 3) and patients aged ⩾65 ( n = 24) who were chronic users of PPIs or benzodiazepines. The EMPOWER educational brochures were distributed prior to ( n = 15) or after ( n = 9) the patient’s usual healthcare provider appointment. Conversations were audio-recorded and coded using MEDICODE to analyze who initiated different themes, whether they followed a monologue or dialogue style, and to what extent the thematic content addressed issues pertaining to: ‘dosage/instructions,’ ‘medication action and efficacy,’ ‘risk/adverse effects,’ ‘attitudes/emotions,’ ‘adherence’ and ‘follow up.’ Descriptive analysis of the conversations was performed with comparison between patients who received the EMPOWER brochure before or after their appointments. Results: Patients were mostly women (67%) with a mean age of 74 ± 6 years. For PPI users, prior education resulted in a greater proportion of themes initiated by patients (44% versus 17%) and maintaining dialogue-style conversations (48% versus 28%). Among benzodiazepine users, conversation initiation (52% versus 47%) and conversation style was similar between both groups. The content of deprescribing conversations for PPIs revealed that patients and their healthcare providers focused less on ‘dosage/instructions,’ and more on the ‘medication action and efficacy’ and the necessity for ‘follow up.’ Conversations about stopping benzodiazepines were more likely to stagnate on the ‘if’ rather than the ‘how.’ Conclusion: The initiation, style and content of the conversations varied between PPI and benzodiazepine users, suggesting that healthcare providers will need to tailor deprescribing conversations accordingly.

scholarly journals Depression risk in patients with heart failure in primary care practices in Germany

2016 ◽  
Vol 28 (11) ◽  
pp. 1889-1894
Author(s):  
Marcel Konrad ◽  
Jens Bohlken ◽  
Michael A Rapp ◽  
Karel Kostev
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Health Insurance ◽  
Control Group ◽  
Patients With Heart Failure ◽  
Study Population ◽  
Care Practices ◽  
One Year ◽  
Primary Care Practices

ABSTRACTBackground:The goal of this study was to estimate the prevalence of and risk factors for diagnosed depression in heart failure (HF) patients in German primary care practices.Methods:This study was a retrospective database analysis in Germany utilizing the Disease Analyzer® Database (IMS Health, Germany). The study population included 132,994 patients between 40 and 90 years of age from 1,072 primary care practices. The observation period was between 2004 and 2013. Follow-up lasted up to five years and ended in April 2015. A total of 66,497 HF patients were selected after applying exclusion criteria. The same number of 66,497 controls were chosen and were matched (1:1) to HF patients on the basis of age, sex, health insurance, depression diagnosis in the past, and follow-up duration after index date.Results:HF was a strong risk factor for diagnosed depression (p < 0.0001). A total of 10.5% of HF patients and 6.3% of matched controls developed depression after one year of follow-up (p < 0.001). Depression was documented in 28.9% of the HF group and 18.2% of the control group after the five-year follow-up (p < 0.001). Cancer, dementia, osteoporosis, stroke, and osteoarthritis were associated with a higher risk of developing depression. Male gender and private health insurance were associated with lower risk of depression.Conclusions:The risk of diagnosed depression is significantly increased in patients with HF compared to patients without HF in primary care practices in Germany.

Vaccine Hesitancy in Pediatric Primary Care Practices

2018 ◽  
Vol 28 (13) ◽  
pp. 2071-2080 ◽  
Author(s):  
Salini Mohanty ◽  
Amy Carroll-Scott ◽  
Marissa Wheeler ◽  
Cecilia Davis-Hayes ◽  
Renee Turchi ◽  
...  
Keyword(s):  
Primary Care ◽  
Vaccine Hesitancy ◽  
Structured Interviews ◽  
Vaccine Acceptance ◽  
Multiple Strategies ◽  
Efficiency And Effectiveness ◽  
Care Practices ◽  
Barriers And Challenges ◽  
Primary Care Practices

Understanding how pediatric practices handle parental vaccine hesitancy is important as it impacts the efficiency and effectiveness of pediatric practices. In total, 21 semi-structured interviews with pediatric practice staff within a primary care network were conducted between May 2012 and March 2013. Thematic analysis focused on the barriers and challenges of vaccine hesitancy and strategies to reduce the burden at the practice level. Barriers and challenges of vaccine hesitancy included time constraints, administrative challenges, financial challenges and strained patient-provider relationships. Strategies to minimize the burden of vaccine hesitancy included training for vaccine counseling, screening for vaccine hesitancy prior to immunization visits, tailored vaccine counseling, and primary care provider visits for follow-up immunization. Pediatric practices reported many challenges when caring for vaccine-hesitant families. Multiple strategies were identified to reduce the burden of vaccine hesitancy, which future studies should explore to determine how effective they are in increasing vaccine acceptance in pediatric practices.

scholarly journals Primary care in the time of COVID-19: monitoring the effect of the pandemic and the lockdown measures on 34 quality of care indicators calculated for 288 primary care practices covering about 6 million people in Catalonia

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Ermengol Coma ◽  
Núria Mora ◽  
Leonardo Méndez ◽  
Mència Benítez ◽  
Eduardo Hermosilla ◽  
...  
Keyword(s):  
Primary Care ◽  
Positive Change ◽  
Paired Data ◽  
Negative Change ◽  
Negative Effect ◽  
Care Practices ◽  
Primary Care Practices ◽  
The Impact ◽  
Quaternary Prevention

Abstract Background To analyse the impact of the COVID-19 epidemic and the lockdown measures on the follow-up and control of chronic diseases in primary care. Methods Retrospective study in 288 primary care practices (PCP) of the Catalan Institute of Health. We analysed the results of 34 indicators of the Healthcare quality standard (EQA), comprising different types: treatment (4), follow-up (5), control (10), screening (7), vaccinations (4) and quaternary prevention (4). For each PCP, we calculated each indicator’s percentage of change in February, March and April 2020 respective to the results of the previous month; and used the T-Student test for paired data to compare them with the percentage of change in the same month of the previous year. We defined indicators with a negative effect those with a greater negative change or a lesser positive change in 2020 in comparison to 2019; and indicators with a positive effect those with a greater positive change or a lesser negative change. Results We observed a negative effect on 85% of the EQA indicators in March and 68% in April. 90% of the control indicators had a negative effect, highlighting the control of LDL cholesterol with a reduction of − 2.69% (95%CI − 3.17% to − 2.23%) in March and − 3.41% (95%CI − 3.82% to − 3.01%) in April; and the control of blood pressure with a reduction of − 2.13% (95%CI − 2.34% to − 1.9%) and − 2.59% (95%CI − 2.8% to − 2.37%). The indicators with the greatest negative effect were those of screening, such as the indicator of diabetic foot screening with a negative effect of − 2.86% (95%CI − 3.33% to − 2.39%) and − 4.13% (95%CI − 4.55% to − 3.71%) in March and April, respectively. Only one vaccination indicator, adult Measles-Mumps-Rubella vaccine, had a negative effect in both months. Finally, among the indicators of quaternary prevention, we observed negative effects in March and April although in that case a lower inadequacy that means better clinical outcome. Conclusions The COVID-19 epidemic and the lockdown measures have significantly reduced the results of the follow-up, control, screening and vaccination indicators for patients in primary care. On the other hand, the indicators for quaternary prevention have been strengthened and their results have improved.

scholarly journals An Automated Email or Phone Survey System for Patients of Primary Care Practices: assessing mode preferences, response rates, and mode effect (Preprint)

2020 ◽  
Author(s):  
Sharon Johnston ◽  
William Hogg ◽  
Sabrina T. Wong ◽  
Fred Burge ◽  
Sandra Peterson
Keyword(s):  
Primary Care ◽  
Response Rates ◽  
Patient Survey ◽  
Waiting Room ◽  
Phone Survey ◽  
Patient Reported ◽  
Mode Effect ◽  
Care Practices ◽  
Primary Care Practices

BACKGROUND A growing number of health care practices are adopting software systems that link with their existing electronic medical records (EMRs) to generate outgoing phone calls, emails, or text notifications to patients for appointment reminders or practice updates. While practices are adopting this software technology for service notifications to patients, its use for collection of patient-reported measures is still nascent. OBJECTIVE This study assessed the mode preferences, response rates, and mode effect for a practice-based automated patient survey (APS) using phone and email modalities to patients of primary care practices. METHODS This cross-sectional study analysed responses and respondent demographics for a short, fully automated, telephone or email patient survey sent to individuals within 72 hours of a visit to their regular primary care practice. Each survey consisted of five questions drawn from a larger study’s patient survey which all respondents completed in the waiting room at the time of their visit. APS responses were linked to self-reported sociodemographic information provided on the waiting room survey including age, sex, reported income, and health status. RESULTS 871 patients from 87 primary care practices in British Columbia, Ontario, and Nova Scotia, Canada agreed to the APS and 470 patients (45%) completed all five questions on the automated survey. Email administration of the follow up survey was preferred over phone-based administration, except amongst patients aged 75 years and older. Overall, response rates for those who selected an emailed survey (61%) were higher than those who received the phone-survey (38%). This held true irrespective of the age, sex, or chronic disease status of individuals. Response rates were also higher for email compared to phone surveys for all income groups except the lowest income quintile which had similar response rates for phone and email modes. We observed moderate agreement between waiting-room survey responses and those obtained in the follow-up automated survey. However, overall agreement in responses was poor for two questions relating to care-coordination. CONCLUSIONS An automated practice-based patient experience survey achieved significantly different response rates between phone and email and increased response rates for email as income group rose. Potential mode effects for the different survey modalities may limit multi-modal survey approaches. An automated minimal burden patient survey could facilitate the integration of patient reported outcomes into care planning and service organisation, supporting the move of our primary care practices towards a more responsive, patient-centred, continual learning system. However, practices must be attentive to furthering inequities in healthcare by underrepresenting the experience of certain groups in decision-making based on the reach of different survey modes.

scholarly journals Treatment Outcomes and Tolerability Following Initiation of GLP-1 Receptor Agonists Among Type 2 Diabetes Patients in Primary Care Practices in Germany

2016 ◽  
Vol 11 (2) ◽  
pp. 272-277 ◽  
Author(s):  
Qing Qiao ◽  
Kristina Johnsson ◽  
Susan Grandy ◽  
Karel Kostev
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Treatment Outcomes ◽  
Receptor Agonist ◽  
Baseline Hba1c ◽  
Care Practices ◽  
Primary Care Practices ◽  
Diabetes Patients

Background: The aim was to investigate real-world treatment outcomes and tolerability of GLP-1 receptor agonist (GLP-1RA) therapy in patients with type 2 diabetes in Germany. Methods: Patients from 323 primary care practices who started any GLP-1RA therapy (89 Byetta, 108 Bydureon, 347 Victoza patients) between January 1, 2011, and December 31, 2013 (index date) were analyzed retrospectively (Disease Analyzer database, Germany). Changes from baseline in HbA1c, weight, and hypoglycemia were evaluated in 3 follow-up periods of 0-6, 7-12, and 13-18 months. Results: A total of 544 diabetes patients (mean age: 57.9 years; men: 54%) were eligible for the study. Mean (SD) HbA1c (%) decreased from 8.3 (1.4) at baseline to 7.4 (1.2) in 6 months, 7.6 (1.3) in 7-12 months and 7.6 (1.4) in 13-18 months, respectively ( P < .001 for all), while the proportion of patients with HbA1c <7% increased from 15% at baseline to 38%, 36% and 35% in the corresponding periods ( P < .0001 for all). Multivariate-adjusted beta coefficients corresponding to changes in HbA1c (%) from baseline were –.52, –.44, and –.44, respectively, in the follow-up periods for baseline HbA1c (%) ( P < .0001 for all). The prevalence of hypoglycemia at baseline was 0.7%; this did not change significantly after treatment. Conclusions: In clinical practice, GLP-1RA treatment was associated with improved glycemic control without increased hypoglycemia for up to 18 months. The higher the baseline HbA1c, the greater the HbA1c reduction recorded.

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