Commissioning for menopause specialist services: A local perspective: An internet-based survey to assess the potential demand for menopause care in West Cheshire and the skills of local primary care clinicians in this field, with a view to informing future commissioning locally

2015 ◽  
Vol 21 (3) ◽  
pp. 98-104 ◽  
Author(s):  
Jane F Wilkinson ◽  
Hannah L Short ◽  
Sam Wilkinson ◽  
Anthony Mander
PRiMER ◽  
2021 ◽  
Vol 5 ◽  
Author(s):  
Crystal Lin ◽  
Jimmy Zheng ◽  
Vinita Shivakumar ◽  
Erika Schillinger ◽  
Tracy A. Rydel ◽  
...  

Background and Objectives: The growing demand for primary care clinicians in the United States continues to outstrip their dwindling supply. Many allopathic medical schools, including Stanford University School of Medicine, are not adequately meeting this shortage. We sought to develop a preclerkship elective to increase the visibility and desirability of primary care at our institution. Methods: A novel 9-week preclerkship elective titled “Primary Care Defined: Perspectives and Procedures,” was designed as a series of procedural workshops followed by interactive sessions with local primary care clinicians. A total of 36 medical and physician assistant students were enrolled. We administered a questionnaire pre- and postcourse to evaluate the impact of the elective on learner interest and attitudes toward primary care. Results: Twenty-four enrolled and 10 nonenrolled learners completed the questionnaire both pre- and postcourse. A one-way analysis of covariance controlling for gender, program (medical doctor versus physician assistant), and precourse responses demonstrated that enrollees had a significantly increased interest in primary care compared to nonenrollees after the course (F1,32=9.22, P=.005). Enrollees also more positively rated their attitudes toward compensation, scope of practice, and job fulfillment than nonenrollees. Both groups had high levels of agreement on statements concerning patient-physician interactions and the importance of primary care to the health care system. Conclusion: The design and content of this elective offers a framework for other institutions looking to promote the value of primary care specialties, particularly family medicine. Creating opportunities for experiential learning and early student-faculty engagement may encourage preclerkship learners to consider a career in primary care.  


2019 ◽  
Author(s):  
Sally Ann Hull ◽  
Vian Rajabzadeh ◽  
Nicola Thomas ◽  
Sec Hoong ◽  
Gavin Dreyer ◽  
...  

Abstract BACKGROUND Evidence from the UK national chronic kidney disease (CKD) audit, identifies deficits in the identification and management of CKD within primary care. Aligning the requirement of GPs for a responsive nephrology service, with the capacity of renal services and the need to prioritise patients with progressive disease requires a re-think of traditional models of care. Utilising the health data in the primary care electronic health record (EHR) to bridge the primary secondary divide is one way forward. METHODS We describe a novel community kidney service based in the renal department at Barts Health NHS Trust and four clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices. RESULTS Analysis of the virtual clinic data shows a rapid rise in referrals. The majority (>80%) do not require a traditional face to face appointment but can be managed with advice to the referring clinician. The wait for a nephrology opinion fell from 64 to 5 days.
The age adjusted referral rate was 2.5 per 1000 registered patients. Primary care clinicians expressed positive views including the rapid response to clinical queries, increased confidence in CKD management, improved access for patients unable to travel to clinic, and reported patient satisfaction. Nephrologists valued seeing the entire clinical record which improved clinical advice, but had concerns about the volume of referrals and changes to working practices. CONCLUSIONS It is feasible to develop ‘virtual’ specialist services using shared access to the primary care EHR.
Such services expand capacity to deliver timely advice based on a review of the entire EHR. To use both specialist and generalist expertise efficiently such services are best supported by community interventions which engage primary care clinicians in a data driven programme of service improvement.


2019 ◽  
Author(s):  
Sally Ann Hull ◽  
Vian Rajabzadeh ◽  
Nicola Thomas ◽  
Sec Hoong ◽  
Gavin Dreyer ◽  
...  

Abstract BACKGROUND Evidence from the UK national chronic kidney disease (CKD) audit, identifies deficits in the identification and management of CKD within primary care. Aligning the requirement of GPs for a responsive nephrology service, with the capacity of renal services and the need to prioritise patients with progressive disease requires a re-think of traditional models of care. Utilising the health data in the primary care electronic health record (EHR) to bridge the primary secondary divide is one way forward. METHODS We describe a novel community kidney service based in the renal department at Barts Health NHS Trust and four clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices. RESULTS Analysis of the virtual clinic data shows a rapid rise in referrals. The majority (>80%) do not require a traditional face to face appointment but can be managed with advice to the referring clinician. The wait for a nephrology opinion fell from 64 to 5 days.
The age adjusted referral rate was 2.5 per 1000 registered patients. Primary care clinicians expressed positive views including the rapid response to clinical queries, increased confidence in CKD management, improved access for patients unable to travel to clinic, and reported patient satisfaction. Nephrologists valued seeing the entire clinical record which improved clinical advice, but had concerns about the volume of referrals and changes to working practices. CONCLUSIONS It is feasible to develop ‘virtual’ specialist services using shared access to the primary care EHR.
Such services expand capacity to deliver timely advice based on a review of the entire EHR. To use both specialist and generalist expertise efficiently such services are best supported by community interventions which engage primary care clinicians in a data driven programme of service improvement.


2020 ◽  
Vol 21 (1) ◽  
Author(s):  
S. A. Hull ◽  
V. Rajabzadeh ◽  
N. Thomas ◽  
S. Hoong ◽  
G. Dreyer ◽  
...  

Abstract Background Early identification of people with CKD in primary care, particularly those with risk factors such as diabetes and hypertension, enables proactive management and referral to specialist services for progressive disease. The 2019 NHS Long Term Plan endorses the development of digitally-enabled services to replace the ‘unsustainable’ growth of the traditional out-patient model of care.Shared views of the complete health data available in the primary care electronic health record (EHR) can bridge the divide between primary and secondary care, and offers a practical solution to widen timely access to specialist advice. Methods We describe an innovative community kidney service based in the renal department at Barts Health NHS Trust and four local clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices. Results Prior to the start of the service the general nephrology referral rate was 0.8/1000 GP registered population, this rose to 2.5/1000 registered patients by the second year of the service. The majority (> 80%) did not require a traditional outpatient appointment, but could be managed with written advice for the referring clinician. The wait for specialist advice fell from 64 to 6 days. General practitioners (GPs) had positive views of the service, valuing the rapid response to clinical questions and improved access for patients unable to travel to clinic. They also reported improved confidence in managing CKD, and high levels of patient satisfaction. Nephrologists valued seeing the entire primary care record but reported concerns about the volume of referrals and changes to working practices. Conclusions ‘Virtual’ specialist services using shared access to the complete primary care EHR are feasible and can expand capacity to deliver timely advice. To use both specialist and generalist expertise efficiently these services require support from community interventions which engage primary care clinicians in a data driven programme of service improvement.


2019 ◽  
Author(s):  
Sally Ann Hull ◽  
Vian Rajabzadeh ◽  
Nicola Thomas ◽  
Sec Hoong ◽  
Gavin Dreyer ◽  
...  

Abstract BACKGROUND Evidence from the UK national chronic kidney disease (CKD) audit, identifies deficits in the identification and management of CKD within primary care. Aligning the requirement of GPs for a responsive nephrology service, with the capacity of renal services and the need to prioritise patients with progressive disease requires a re-think of traditional models of care. Utilising the health data in the primary care electronic health record (EHR) to bridge the primary secondary divide is one way forward. METHODS We describe a novel community kidney service based in the renal department at Barts Health NHS Trust and four clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices. RESULTS Analysis of the virtual clinic data shows a rapid rise in referrals. The majority (>80%) do not require a traditional face to face appointment but can be managed with advice to the referring clinician. The wait for a nephrology opinion fell from 64 to 5 days.
The age adjusted referral rate was 2.5 per 1000 registered patients. Primary care clinicians expressed positive views including the rapid response to clinical queries, increased confidence in CKD management, improved access for patients unable to travel to clinic, and reported patient satisfaction. Nephrologists valued seeing the entire clinical record which improved clinical advice, but had concerns about the volume of referrals and changes to working practices. CONCLUSIONS It is feasible to develop ‘virtual’ specialist services using shared access to the primary care EHR.
Such services expand capacity to deliver timely advice based on a review of the entire EHR. To use both specialist and generalist expertise efficiently such services are best supported by community interventions which engage primary care clinicians in a data driven programme of service improvement.


2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697277
Author(s):  
James Durrand ◽  
F McHardy ◽  
E Land ◽  
Z Llewellyn ◽  
C Norman ◽  
...  

BackgroundPrehabilitation prior to major surgery mandates cross-sector working. Utilising the preoperative window from referral requires clinician engagement. Awareness of perioperative risk factors is crucial. A national survey uncovered gaps in knowledge and understanding.AimCreate an open-access, online educational resource for primary care clinicians.MethodOur multidisciplinary team developed a focused CPD resource targeting lifestyle factors and chronic health conditions influencing perioperative risk (www.prepwell.co.uk).ResultsPREP highlights seven risk factors influencing perioperative risk: Smoking, alcohol, inactivity, anaemia, cognitive impairment, frailty and low BMI. A case study frames each factor alongside perioperative impact and prehabilitation strategies.ConclusionPREP is the first educational resource of its type. Early evaluation through local clinicians, the RCGP and RCOA has resulted in very positive feedback. We are working with Royal College representatives to gain formal endorsement and facilitate wider scale rollout, a major step towards raised clinician awareness and enhanced collaboration for improved perioperative outcomes.


2021 ◽  
Vol 17 (6) ◽  
pp. 499-509
Author(s):  
Elizabeth C. Danielson, PhD ◽  
Christopher A. Harle, PhD ◽  
Sarah M. Downs, MPH ◽  
Laura Militello, MA ◽  
Olena Mazurenko, MD, PhD

Objective: The 2016 Centers for Disease Control and Prevention guideline for prescribing opioids for chronic pain aimed to assist primary care clinicians in safely and effectively prescribing opioids for chronic noncancer pain. Individual states, payers, and health systems issued similar policies imposing various regulations around opioid prescribing for patients with chronic pain. Experts argued that healthcare organizations and clinicians may be misapplying the federal guideline and subsequent opioid prescribing policies, leading to an inadequate pain management. The objective of this study was to understand how primary care clinicians involve opioid prescribing policies in their treatment decisions and in their conversations with patients with chronic pain.Design: We conducted a secondary qualitative analysis of data from 64 unique primary care visits and 87 post-visit interviews across 20 clinicians from three healthcare systems in the Midwestern United States. Using a multistep process and thematic analysis, we systematically analyzed data excerpts addressing opioid prescribing policies.Results: Opioid prescribing policies influenced clinicians’ treatment decisions to not initiate opioids, prescribe fewer opioids overall (theme #1), and begin tapering and discontinuation of opioids (theme #2) for most patients with chronic pain. Clinical precautions, described in the opioid prescribing policies to monitor use, were directly invoked during visits for patients with chronic pain (theme #3).Conclusions: Opioid prescribing policies have multidimensional influence on clinician treatment decisions for patients with chronic pain. Our findings may inform future studies to explore mechanisms for aligning pressures around opioid prescribing, stemming from various opioid prescribing policies, with the need to deliver individualized pain care.


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