scholarly journals Patient-Reported Use of the After Visit Summary in a Primary Care Internal Medicine Practice

2019 ◽  
Vol 7 (5) ◽  
pp. 703-707
Author(s):  
Sarita Pathak ◽  
Gregory Summerville ◽  
Celia P Kaplan ◽  
Sarah S Nouri ◽  
Leah S Karliner
Keyword(s):  
Primary Care ◽  
Multivariable Analysis ◽  
Free Text ◽  
Primary Care Visit ◽  
Communication Tool ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Visit ◽  
Patient Reported ◽  
Communication Errors

Participants completed a cross-sectional survey about their use of the after visit summary (AVS) at a previous primary care visit. Of 355 participants, 294 (82.8%) recalled receiving it, 67.4% consulted it, 45.9% consulted it more than once, and 31.6% shared the AVS. In multivariable analysis, higher education and older age were associated with AVS consultation. Among the subset of 133 patients recalling personalized free-text instructions, 96% found them easy to understand and 94.4% found them useful. Our findings suggest that the AVS is a useful communication tool and improvement efforts should emphasize clarity for those most vulnerable to communication errors.

Benefits and Challenges of Using Virtual Primary Care During the COVID-19 Pandemic: An International Cross-sectional Survey Study (Preprint)

2021 ◽  
Author(s):  
Edmond Li ◽  
Rosy Tsopra ◽  
Geronimo Jimenez ◽  
Alice Serafini ◽  
Gustavo Gusso ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Delivery ◽  
Lessons Learned ◽  
Survey Study ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Face To Face ◽  
Remote Care

BACKGROUND With the onset of COVID-19, general practitioners (GPs) and patients worldwide swiftly transitioned from face-to-face to digital remote consultations. There is a need to evaluate how this global shift has impacted patient care, healthcare providers, patient and carer experience, and health systems. OBJECTIVE We explored GPs’ perspectives on the main benefits and challenges of using digital remote care. METHODS GPs across 20 countries completed an online questionnaire between June – September 2020. GPs’ perceptions on main barriers and challenges were explored using free-text questions. Thematic analysis was used to analyse the data. RESULTS A total of 1,605 respondents participated in our survey. The benefits identified included reducing COVID-19 transmission risks, guaranteeing access and continuity of care, improved efficiency, faster access to care, improved convenience and communication with patients, greater work flexibility for providers, and hastening the digital transformation of primary care and accompanying legal frameworks. Main challenges included patient’s preference for face-to-face consultations, digital exclusion, lack of physical examinations, clinical uncertainty, delays in diagnosis and treatment, overuse and misuse of digital remote care, and unsuitability for certain types of consultations. Other challenges include the lack of formal guidance, higher workloads, remuneration issues, organisational culture, technical difficulties, implementation and financial issues, and regulatory weaknesses. CONCLUSIONS At the frontline of care delivery, GPs can provide important insights on what worked well, why, and how during the pandemic. Lessons learned can be used to inform the adoption of improved virtual care solutions, and support the long-term development of platforms that are more technologically robust, secure. INTERNATIONAL REGISTERED REPORT RR2-10.2196/30099

scholarly journals Computer-assisted textual analysis of free-text comments in the Swiss Cancer Patient Experiences (SCAPE) survey

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Chantal Arditi ◽  
Diana Walther ◽  
Ingrid Gilles ◽  
Saphir Lesage ◽  
Anne-Claude Griesser ◽  
...  
Keyword(s):  
Cancer Patient ◽  
Cancer Care ◽  
Textual Analysis ◽  
Questionnaire Development ◽  
Patient Experiences ◽  
Computer Assisted ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Patient Reported

Abstract Background Patient experience surveys are increasingly conducted in cancer care as they provide important results to consider in future development of cancer care and health policymaking. These surveys usually include closed-ended questions (patient-reported experience measures (PREMs)) and space for free-text comments, but published results are mostly based on PREMs. We aimed to identify the underlying themes of patients’ experiences as shared in their own words in the Swiss Cancer Patient Experiences (SCAPE) survey and compare these themes with those assessed with PREMs to investigate how the textual analysis of free-text comments contributes to the understanding of patients’ experiences of care. Methods SCAPE is a multicenter cross-sectional survey that was conducted between October 2018 and March 2019 in French-speaking parts of Switzerland. Patients were invited to rate their care in 65 closed-ended questions (PREMs) and to add free-text comments regarding their cancer-related experiences at the end of the survey. We conducted computer-assisted textual analysis using the IRaMuTeQ software on the comments provided by 31% (n = 844) of SCAPE survey respondents (n = 2755). Results We identified five main thematic classes, two of which consisting of a detailed description of ‘cancer care pathways’. The remaining three classes were related to ‘medical care’, ‘gratitude and praise’, and the way patients lived with cancer (‘cancer and me’). Further analysis of this last class showed that patients’ comments related to the following themes: ‘initial shock’, ‘loneliness’, ‘understanding and acceptance’, ‘cancer repercussions’, and ‘information and communication’. While closed-ended questions related mainly to factual aspects of experiences of care, free-text comments related primarily to the personal and emotional experiences and consequences of having cancer and receiving care. Conclusions A computer-assisted textual analysis of free-text in our patient survey allowed a time-efficient classification of free-text data that provided insights on the personal experience of living with cancer and additional information on patient experiences that had not been collected with the closed-ended questions, underlining the importance of offering space for comments. Such results can be useful to inform questionnaire development, provide feedback to professional teams, and guide patient-centered initiatives to improve the quality and safety of cancer care.

Associations of At-Risk Drinking, Current Smoking, and Their Co-Occurrence With Primary Care Service Utilization

2021 ◽  
pp. 089011712110561
Author(s):  
John R. Moore ◽  
Yessenia Castro ◽  
Catherine Cubbin ◽  
Kirk von Sternberg
Keyword(s):  
Primary Care ◽  
At Risk ◽  
Substance Use ◽  
Smoking Status ◽  
Care Service ◽  
Care Utilization ◽  
Primary Care Visit ◽  
Cross Sectional ◽  
Care Visit ◽  
Primary Care Utilization

Purpose Smoking and at-risk drinking are each associated with lower primary care utilization, but the influence of their co-occurrence is not known. The current study compared associations of endorsement of one behavior vs endorsement of both with primary care utilization. Design Cross-sectional telephone survey. Setting All United States and Territories. Subjects 246 801 adults aged 18–64. Measures The outcome was endorsement of attending a past-year primary care visit. Predictor variables included drinking and smoking status examined individually and combined. Analysis Multivariable logistic regressions, adjusted for socio-demographics and number of chronic health conditions. Results The odds of attending a past-year primary care visit were 24% lower for persons who drank at risk levels compared to the odds of persons who did not drink and 36% lower for persons who smoked vs those who did not smoke. Among persons who endorsed at least one risk behavior, the odds of attending a past-year primary care visit were 25–35% lower for those who engaged in multiple behaviors compared to the odds of persons who engaged in one behavior. Conclusion Substance use screening and intervention services in primary care may not be reaching individuals with the greatest need for services. Proactive outreach and identification of primary care utilization barriers are needed, with special consideration of those with co-occurring substance use.

Association of teledermatology workflows with standardising co-management of rashes by primary care physicians and dermatologists

2020 ◽  
pp. 1357633X2093045
Author(s):  
Jennifer R Dusendang ◽  
Sangeeta Marwaha ◽  
Stacey E Alexeeff ◽  
Eileen Crowley ◽  
Michael Haiman ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Primary Care Physicians ◽  
Multivariable Analysis ◽  
Office Visit ◽  
Primary Care Visit ◽  
Kaiser Permanente ◽  
Care Visit ◽  
High Level

Introduction For patients with a rash, the effect of teledermatology workflow on utilization has not been defined. We compared utilization across four teledermatology workflows in patients with a rash. Methods The observational longitudinal cohort study included 28,857 Kaiser Permanente Northern California members with a new rash diagnosis seen in primary care and with dermatology advice obtained using teledermatology. The workflows differed in camera and image quality; who took the picture; how the image was forwarded; and synchronicity and convenience. Results On average, 23% of patients had a follow-up office visit in dermatology within 90 days of their primary care visit. In multivariable analysis, the four technologies differed substantially in the likelihood of a follow-up dermatology office visit. In contrast, the likelihood was only negligibly related to medical centre or primary care provider. Discussion Technologies and workflows that offer the mobility of a smartphone with a high level of synchronicity in communication were associated with standardised co-management of rashes.

scholarly journals Nationwide evaluation of the advanced clinical practitioner role in England: a cross-sectional survey

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e055475
Author(s):  
Lauren Jade Fothergill ◽  
Amani Al-Oraibi ◽  
Jonathan Houdmont ◽  
Joy Conway ◽  
Catrin Evans ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Workforce Development ◽  
Continuing Professional Development ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Study Objective ◽  
Levels Of Care ◽  
The Uk

Background and study objectiveIn response to growing pressures on healthcare systems, the advanced clinical practice (ACP) role has been implemented widely in the UK and internationally. In England, ACP is a level of practice applicable across various healthcare professions, who exercise a level of autonomy across four domains, referred to as the four pillars of practice (education, leadership, research and clinical practice). A national framework for ACP was established in 2017 to ensure consistency across the ACP role, however current ACP governance, education and support is yet to be evaluated. This study aimed to analyse data from a national survey of the ACP role to inform the development and improvement of policies relating to ACP in the National Health Service (NHS) in England.DesignA cross-sectional survey with free-text comments.SettingThe survey was distributed across primary and secondary levels of care to three distinct groups in England, including individual ACPs, NHS provider organisations and Trusts and primary care settings.ParticipantsA total of 4365 surveys were returned, from ACP staff (n=4013), NHS provider organisations and Trusts (n=166) and primary care organisations (n=186).ResultsConsiderable variation was found in role titles, scope of practice, job descriptions and educational backgrounds of ACPs. Differing approaches to governance were noted, which led to inconsistent ACP frameworks in some organisations. A further challenge highlighted included committing time to work across the four pillars of advanced practice, particularly the research pillar. ACPs called for improvements in supervision and continuing professional development alongside further support in navigating career pathways.ConclusionsA standardised approach may support ACP workforce development in England and enable ACPs to work across the four pillars of practice. Due to the wide uptake of ACP roles internationally, this study has relevance across professions for global healthcare workforce transformation

scholarly journals The Frequency and Content of Discussions About Alcohol Use in Primary Care and Application of the Chief Medical Officer’s Low-Risk Drinking Guidelines: A Cross-Sectional Survey of General Practitioners and Practice Nurses in the UK

2020 ◽  
Author(s):  
Jack M Birch ◽  
Nathan Critchlow ◽  
Lynn Calman ◽  
Robert Petty ◽  
Gillian Rosenberg ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Low Risk ◽  
Screening Tools ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Practice Nurses ◽  
Patient Reported ◽  
The Uk ◽  
Do So

Abstract Aims To examine how often general practitioners (GPs) and practice nurses (PNs) working in primary care discuss alcohol with patients, what factors prompt discussions, how they approach patient discussions and whether the Chief Medical Officers’ (CMO) revised low-risk drinking guidelines are appropriately advised. Methods Cross-sectional survey with GPs and PNs working in primary care in the UK, conducted January–March 2017 (n = 2020). A vignette exercise examined what factors would prompt a discussion about alcohol, whether they would discuss before or after a patient reported exceeded the revised CMO guidelines (14 units per week) and whether the CMO drinking guidelines were appropriately advised. For all patients, participants were asked how often they discussed alcohol and how they approached the discussion (e.g. used screening tool). Results The most common prompts to discuss alcohol in the vignette exercise were physical cues (44.7% of participants) or alcohol-related symptoms (23.8%). Most practitioners (70.1%) said they would wait until a patient was exceeding CMO guidelines before instigating discussion. Two-fifths (38.1%) appropriately advised the CMO guidelines in the vignette exercise, with PNs less likely to do so than GPs (odds ratio [OR] = 0.77, P = 0.03). Less than half (44.7%) reportedly asked about alcohol always/often with all patients, with PNs more likely to ask always/often than GPs (OR = 2.22, P < 0.001). Almost three-quarters said they would enquire by asking about units (70.3%), compared to using screening tools. Conclusion Further research is required to identify mechanisms to increase the frequency of discussions about alcohol and appropriate recommendation of the CMO drinking guidelines to patients.

scholarly journals General practitioners’ views on use of patient reported outcome measures in primary care: a cross-sectional survey and qualitative study

2019 ◽  
Author(s):  
Grace M Turner ◽  
Ian Litchfield ◽  
Sam Finnikin ◽  
Olalekan Lee Aiyegbusi ◽  
Melanie Calvert
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Outcome Measures ◽  
Qualitative Interviews ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Patient Reported ◽  
Clinical Systems

Abstract Background Patient reported outcome measures (PROMs) are increasingly used to assess impact of disease and treatment on quality of life and symptoms; however, their use in primary care is fragmented. We aimed to understand the current use of PROMs in primary care, barriers and facilitators, and how their use might be optimised. Methods Cross-sectional survey and semi-structured interviews among general practitioners (GPs) in England. GPs’ opinions were explored using an electronic, self-completed questionnaire disseminated to 100 GPs via an online doctors’ community and semi-structured qualitative interviews with 25 GPs. Results Most GPs surveyed (77/100; 77%) reported using one or more PROM, primarily to aid clinical management (n=66) or as screening/diagnostic tools (n=62). Qualitative interviews highlighted challenges in identifying and selecting PROMs; however, some GPs valued PROMs for shared decision making and to direct patient discussions. The interviews identified key barriers to PROM use including: time constraints; insufficient knowledge; lack of integration into clinical systems; and PROMs being mandated without consultation or explanation. Evidence of the benefit of PROMs is required to promote uptake and use of PROMs in primary care. Conclusion Implementation of PROMs in primary care requires integration with clinical systems, a bottom-up approach to PROM selection and system design involving meaningful consultation with patients and primary care clinicians and training/support for use.

scholarly journals Multimorbidity, eHealth and implications for equity: a cross-sectional survey of patient perspectives on eHealth

BMJ Open ◽  
2019 ◽  
Vol 9 (2) ◽  
pp. e023731 ◽  
Author(s):  
Dee Mangin ◽  
Jenna Parascandalo ◽  
Olga Khudoyarova ◽  
Gina Agarwal ◽  
Verdah Bismah ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Clinic ◽  
Internet Access ◽  
Research Network ◽  
The Internet ◽  
Free Text ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Care Clinic ◽  
Practice Based Research

ObjectiveThere is increasing awareness of the burden of medical care experienced by those with multimorbidity. There is also increasing interest and activity in engaging patients with chronic disease in technology-based health-related activities (‘eHealth’) in family practice. Little is known about patients’ access to, and interest in eHealth, in particular those with a higher burden of care associated with multimorbidity. We examined access and attitudes towards eHealth among patients attending family medicine clinics with a focus on older adults and those with polypharmacy as a marker for multimorbidity.DesignCross-sectional survey of consecutive adult patients attending consultations with family physicians in the McMaster University Sentinel and Information Collaboration practice-based research network. We used univariate and multivariate analyses for quantitative data, and thematic analysis for free text responses.SettingPrimary care clinics.Participants693 patients participated (response rate 70%). Inclusion criteria: Attending primary care clinic. Exclusions: Too ill to complete survey, cannot speak English.ResultsThe majority of participants reported access to the internet at home, although this decreased with age. Participants 70 years and older were less comfortable using the internet compared with participants under 70. Univariate analyses showed age, multimorbidity, home internet access, comfort using the internet, privacy concerns and self-rated health all predicted significantly less interest in eHealth. In the multivariate analysis, home internet access and multimorbidity were significant predictors of disinterest in eHealth. Privacy and loss of relational connection were themes in the qualitative analysis.ConclusionThere is a significant negative association between multimorbidity and interest in eHealth. This is independent of age, computer use and comfort with using the internet. These findings have important implications, particularly the potential to further increase health inequity.

scholarly journals General practitioners’ views on use of patient reported outcome measures in primary care: a cross-sectional survey and qualitative study

2019 ◽  
Author(s):  
Grace M Turner(Former Corresponding Author) ◽  
Ian Litchfield(New Corresponding Author) ◽  
Sam Finnikin ◽  
Olalekan Lee Aiyegbusi ◽  
Melanie Calvert
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Outcome Measures ◽  
Qualitative Interviews ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Patient Reported ◽  
Clinical Systems

Abstract Background Patient reported outcome measures (PROMs) are increasingly used to assess impact of disease and treatment on quality of life and symptoms; however, their use in primary care is fragmented. We aimed to understand how PROMs are currently being used in primary care, the barriers and facilitators of this use and if appropriate how it might be optimised.Methods Cross-sectional survey and semi-structured interviews among general practitioners (GPs) in England. GPs’ opinions were explored using an electronic, self-completed questionnaire disseminated to 100 GPs via an online doctors’ community and semi-structured qualitative interviews with 25 GPs.Results Most GPs surveyed (77/100; 77%) reported using one or more PROM, primarily to aid clinical management (n=66) or as screening/diagnostic tools (n=62). Qualitative interviews highlighted challenges in identifying and selecting PROMs; however, some GPs valued PROMs for shared decision making and to direct patient discussions. The interviews identified key barriers to PROM use including: time constraints; insufficient knowledge; lack of integration into clinical systems; and PROMs being mandated without consultation or explanation. Evidence of the benefit of PROMs is required to promote uptake and use of PROMs in primary care.Conclusion Implementation of PROMs in primary care requires integration with clinical systems, a bottom-up approach to PROM selection and system design involving meaningful consultation with patients and primary care clinicians and training/support for use.

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