scholarly journals Fighting against COVID-19: preparedness and implications on clinical practice in primary care in Shenzhen, China

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Desiree Man-Sik Tse ◽  
Zhuo Li ◽  
Ye Lu ◽  
Yang Li ◽  
Ying Liu ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Online Survey ◽  
Disease Outbreaks ◽  
Logistic Models ◽  
Training Needs ◽  
Vital Role ◽  
Infectious Disease Outbreak ◽  
Care Services ◽  
Perceived Preparedness

Abstract Background The new coronavirus pneumonia (NCP) caused by COVID-19 has affected more than 46 million people worldwide. In China, primary care has played a vital role during the COVID-19 outbreak, and it is important to examine the challenges faced by general practitioners (GPs). This study investigated the roles, preparedness and training needs of GPs in China in managing the NCP outbreak. Based on the outcomes of the study, we hope to take lessons and identify how GPs could be supported in delivering their gatekeeping roles and clinical duties in times of infectious disease outbreak. Methods An online survey on the official website of Shenzhen Continuing Education Center. It included questions on GPs’ demographics, their awareness of COVID-19 and their preparedness in managing suspected cases of NCP, as well as referrals and their training needs. Conditional multi-variate logistic models were used to investigate the relationships between GPs’ preparedness, situational confidence and anxiety. Results GPs’ clinical practice was significantly affected. GPs endeavoured to answer a flood of COVID-19-related enquiries, while undertaking community preventive tasks. In addition to in-person consultations, GP promoted COVID-19 awareness and education through telephone consultations, physical posters and social media. Overall GPs in Shenzhen felt well supported with adequate Personal Protective Equipment (PPE) and resources from secondary care services. Higher levels of self-perceived preparedness (OR = 2.19; 95%CI, 1.04–4.61), lower level of anxiety (OR = 0.56; 95%CI, 0.29–1.09) and fewer perceived family worries (OR = 0.37; 95%CI, 0.12–1.12) were associated with better confidence in coping at work. Conclusions Training and supporting GPs while reducing their (and their families’) anxiety increase their confidence in delivering the important roles of gatekeeping in face of major disease outbreaks.

scholarly journals Seeking Healthcare During Lockdown: Challenges, Opportunities and Lessons for the Future

2021 ◽  
Author(s):  
Fiona Imlach ◽  
Eileen McKinlay ◽  
Jonathan Kennedy ◽  
Megan Pledger ◽  
Lesley Middleton ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Health Services ◽  
Online Survey ◽  
Influential Factors ◽  
System Level ◽  
Practice Environment ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Practices

Background: In Aotearoa/New Zealand, the first nation-wide coronavirus disease 2019 (COVID-19) lockdown occurred from March 23, 2020 to May 13, 2020, requiring most people to stay at home. Health services had to suddenly change how they delivered healthcare and some services were limited or postponed. This study investigated access to healthcare during this lockdown period, whether patients delayed seeking healthcare and reasons for these delays, focusing on the accessibility of primary care services. Methods: Adults (aged 18 years or older) who had contact with primary care services were invited through social media and email lists to participate in an online survey (n = 1010) and 38 people were recruited for in-depth interviews. We thematically analysed qualitative data from the survey and interviews, reported alongside relevant descriptive survey results. Results: More than half (55%) of survey respondents delayed seeking healthcare during lockdown. Factors at a national or health system-level that could influence delay were changing public service messages, an excessive focus on COVID-19 and urgent issues, and poor service integration. Influential factors at a primary care-level were communication and outreach, use of technology, gatekeeping, staff manner and the safety of the clinical practice environment. Factors that influenced patients’ individual decisions to seek healthcare were the ability to self-manage and self-triage, consciousness of perceived pressure on health services and fear of infection. Conclusion: In future pandemic lockdowns or crises, appropriate access to primary care services can be improved by unambiguous national messages and better integration of services. Primary care practices should adopt rapid proactive outreach to patients, fostering a calm but safe clinical practice environment. More support for patients to self-manage and self-triage appropriately could benefit over-burdened health systems during lockdowns and as part of business as usual in less extraordinary times.

scholarly journals Psychiatry Residents' Perceptions and Reported Practices in Providing Primary Care

2017 ◽  
Vol 9 (2) ◽  
pp. 237-240 ◽  
Author(s):  
Lisa M. Wehr ◽  
Erik R. Vanderlip ◽  
Patrick H. Gibbons ◽  
Jess G. Fiedorowicz
Keyword(s):  
Primary Care ◽  
Online Survey ◽  
Psychiatry Residents ◽  
Medical Conditions ◽  
Residency Programs ◽  
Care Services ◽  
Preventive Counseling ◽  
Primary Care Services ◽  
Primary Care Specialty ◽  
Improve Health

ABSTRACT Background Patients with psychiatric disorders have higher rates of chronic medical conditions and decreased life expectancy. Integrating medical and psychiatric care is likely to improve health outcomes for these patients. Objective This study examined what proportion of psychiatry residents viewed psychiatry as a primary care specialty, how important they felt it was to provide primary care to patients, and how this perception altered self-reported comfort and practice patterns in providing screening and treatment for select general medical conditions. Methods An online survey was sent to current psychiatry residents of US residency programs. Results A total of 268 residents from 40 programs completed the survey (25% response rate), with 55% (147 of 265) of respondents considering psychiatry to be a primary care specialty. Residents who held this opinion gave higher ratings for the importance of providing preventive counseling and reported counseling a higher percentage of patients on a variety of topics. They also reported screening more patients for several medical conditions. Residents who considered psychiatry to be primary care did not report greater comfort with treating these conditions, with the exception of dyslipidemia. The most commonly cited barrier to integrating primary care services was lack of time. Conclusions Residents' perceptions of psychiatry as a primary care field appears to be associated with a higher reported likelihood of counseling about, and screening for, medical conditions in their patients.

A health profile of adults with multiple sclerosis living in the community

2008 ◽  
Vol 14 (8) ◽  
pp. 1099-1105 ◽  
Author(s):  
R Vazirinejad ◽  
J Lilley ◽  
C Ward
Keyword(s):  
Multiple Sclerosis ◽  
Primary Care ◽  
Health Care Services ◽  
Community Sample ◽  
Vital Role ◽  
Postal Survey ◽  
Service Needs ◽  
Related Services ◽  
Care Services ◽  
Primary Care Services

Objective To describe the frequency of impairments, disabilities, and related services used in a community sample of adults with multiple sclerosis (MS) to estimate the service needs of this population. Methods A community-based postal survey conducted using a self-completion questionnaire consisting of MSQOL-54 questionnaire, Nottingham Extended Activities of Daily Living (NEADL) and some demographic items as well as items to ask about MS-related symptoms and/or problems and using available services. Adults with a diagnosis of MS confirmed by a neurologist were recruited via primary care services in Southern Derbyshire, UK. Results Questionnaires were sent to 310 adults with MS and 201 completed questionnaires were returned – a response rate of 65%. The most commonly reported symptoms and/or problems were fatigue, sexual problems, urinary problems, and painful muscle spasms. Most respondents reported at least one contact with their general practitioner (GP) during the previous 12 months. However, contacts with other services potentially able to alleviate specific symptoms and/or problems were low. Conclusions The findings suggest under-use of existing health care services by those who experience potentially treatable symptoms and/or problems associated with MS. More needs to be done to raise awareness among people with MS and their carers about the services available to them. Given the very high proportion of people with MS known to make contact with primary care services, GPs have a vital role in providing this information.

scholarly journals Midwives’ Role in Providing Nutrition Advice during Pregnancy: Meeting the Challenges? A Qualitative Study

2017 ◽  
Vol 2017 ◽  
pp. 1-11 ◽  
Author(s):  
Jamila Arrish ◽  
Heather Yeatman ◽  
Moira Williamson
Keyword(s):  
Pregnant Women ◽  
Maternity Care ◽  
Online Survey ◽  
Descriptive Analysis ◽  
Vital Role ◽  
Collaborative Approach ◽  
Structural Barriers ◽  
Model Of Care ◽  
Telephone Interviews ◽  
Care Services

This study explored the Australian midwives’ role in the provision of nutrition advice. Little is known about their perceptions of this role, the influence of the model of care, and the barriers and facilitators that may influence them providing quality nutrition advice to pregnant women. Semistructured telephone interviews were undertaken with a subsample (n=16) of the members of the Australian College of Midwives who participated in an online survey about midwives’ nutrition knowledge, attitudes, and their confidence in providing nutrition advice during pregnancy. Thematic descriptive analysis was used to analyse the data. Midwives believed they have a vital role in providing nutrition advice to pregnant women in the context of health promotion. However, this was not reflected in the advice many of them provided, which in many accounts was passive and medically directed. The extent and efficacy of their role appear to be challenged by many structural barriers. Midwives suggested facilitators that may assist in overcoming these challenges. Midwives need assistance, support, and guidance to provide holistic nutrition advice that assists women to achieve healthy pregnancies. A collaborative approach between midwifery bodies, nutrition and education experts, and maternity care services may provide an effective way forward.

scholarly journals 191 A classification of primary care pathways in emergency departments: a multi-methods study comprising cross-sectional survey; site visits with observations; semi-structured and informal interviews

2020 ◽  
Vol 37 (12) ◽  
pp. 841.2-842
Author(s):  
Michelle Edwards ◽  
Alison Cooper ◽  
Davies Freya ◽  
Andrew Carson-Stevens ◽  
Thomas Hughes ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Departments ◽  
Online Survey ◽  
Local Context ◽  
Framework Analysis ◽  
Front Door ◽  
Care Services ◽  
Primary Care Services

Aims/Objectives/BackgroundWe aim to describe and classify the predominant streaming pathways on arrival in Emergency Departments (EDs) in England and Wales and explain how they operate in different models of emergency department primary care services. Recent policy has encouraged a method whereby nurses stream from the emergency department front door to GPs working in a separate GP service operating within or alongside an ED. However, there is variation in methods of assessing and streaming patients on arrival at EDs. Conflated terminology causes difficulties in assessing relative performance, improving quality or gathering evidence about safety, clinical effectiveness. Our findings present a new classification of current streaming pathways from emergency departments to primary care services.Methods/DesignWe used a multi-stage method approach, including an online survey completed by 77 EDs across England & Wales, interviews with 21 clinical leads, and finally, undertaking case studies of 13 EDs. Qualitative data were triangulated and analysed using a framework analysis approach.Results/ConclusionsThe most common ED pathways to primary care services were: front door streaming before ED registration; streaming inside the ED; or without streaming but GPs selecting patients. Pathways were often adapted, to suit local circumstances such as department layout, patient demand levels, skill mix and interests of GPs practitioners and the accessibility of community primary care services. Pathways to redirect patients with non-urgent primary care problems to community primary care services were also used, with local variation in protocols based on staffing, patient demand and links to community primary care services. Local clinical leads and managers need to consider which pathway(s) may best suit their local context and needs. Consistency of terminology used to describe pathways between EDs and primary care services is necessary for multi-site evaluation, quality improvement and performance measurement.

scholarly journals Identification of the multimorbidity training needs of primary care professionals: Protocol of a survey

2021 ◽  
Vol 11 ◽  
pp. 263355652110247
Author(s):  
Francisca Leiva-Fernández ◽  
Alba González-Hevilla ◽  
Juan Daniel Prados-Torres ◽  
Fuensanta Casas-Galán ◽  
Eva García-Domingo ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Professionals ◽  
Online Survey ◽  
National Health System ◽  
Training Needs ◽  
Ordinal Scale ◽  
Health Determinants ◽  
Multiple Choice Questions ◽  
Training Interventions ◽  
Doctors And Nurses

Background: Current epidemiological situation has prompted the consideration of multimorbility (MM) as a prevalent condition, influenced by age, educational level and social support, related to unfavorable social and health determinants. Primary Care (PC) has a key role in its approach but further training of professionals in MM is required. The evidence on the effectiveness of training interventions in MM is still limited. Knowing the experiences, opinions and training needs of professionals is essential to enhance training interventions. Objectives: Identify perceived training needs by PC health professionals (doctors and nurses) in MM and polypharmacy. Methods: Design: Cross-sectional study based on an online survey (anonymous-ad hoc questionnaire). Participants and recruitment: 384 doctors and nurses working in healthcare centers and out-of-hospital emergencies of the Spanish National Health System. Non-probabilistic convenience sampling via email addressed to Health Institutions, and social networks. Data: Demographic characteristics and professional profile data (close-ended and multiple-choice questions) will be collected. Open-ended questions will be used to identify training needs, difficulties and resources about MM; required skills to care patients with MM will be assessed using a 4-item ordinal scale. Analysis: Coding of data prior to analysis. Descriptive statistical analysis, participation and completion rates of the questionnaire and estimation of absolute and relative frequencies and 95% confidence intervals in close-ended questions. Content analysis with inductive methodology in open-ended questions. Ethics: Ethical approval, Online informed consent. Conclusions: The identification of training needs of health professionals who care for patients with MM will be necessary data for developing highly effective training activities.

scholarly journals Establishment of a sentinel surveillance network for sexually transmissible infections and blood borne viruses in Aboriginal primary care services across Australia: the ATLAS project

2019 ◽  
Author(s):  
Clare Bradley ◽  
Belinda Hengel ◽  
Katy Crawford ◽  
Salenna Elliott ◽  
Basil Donovan ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Health Service ◽  
Health Services ◽  
Clinical Guidelines ◽  
Program Planning ◽  
Sentinel Surveillance ◽  
Surveillance Network ◽  
Care Services ◽  
Primary Care Services

Abstract Background Sexually transmissible infection (STI) and blood-borne virus (BBV) notification data is a mainstay of the Australian National Notifiable Diseases Surveillance System (NNDSS) and is a mandatory requirement in all Australian jurisdictions. The system focuses on STI and BBV diagnoses alone, without testing, treatment or management data, leaving major gaps in the understanding of epidemics, especially among priority populations like Aboriginal and Torres Strait Islander peoples. Further information is required to supplement the NNDSS to better understand epidemics, the impact of interventions and health care delivery against clinical guidelines. Here we describe the rationale, processes and expected outcomes of establishing a national STI and BBV sentinel surveillance network in Aboriginal primary care services—known as the ATLAS network.Methods Researchers invited participation and consultation with Aboriginal Community-Controlled Health Services (ACCHS) clustered in five clinical hubs across four jurisdictions, representative of urban, regional and remote regions. Site-specific participation agreements were developed for each clinical hub and individual ACCHS. De-identified electronic medical record (EMR) data relating to STI and BBV testing, treatment and care are collected passively from each health service via the GRHANITE tm data extraction tool. These data are analysed centrally to inform 12 performance indicators which are included in surveillance reports generated for each health service and clinical hub.Results The ATLAS network currently involves 29 ACCHS representing all five clinical hubs. The ATLAS network provides detailed surveillance reports to individual ACCHS as well as contributing to aggregate comparative analyses at the clinical hub, jurisdictional and national levels. Data derived from the ATLAS network is used to assess clinical practice within each site. Aggregated data will inform clinical guidelines and extend the research potential of participating ACCHS sites. The ATLAS infrastructure can be expanded to include other health services and potentially linked to other data sources using GRHANITE.Conclusions The ATLAS network will supplement the NNDSS and contribute to improved understanding of local, regional and national patterns of clinical care of STI and BBV to inform clinical practice, policy, and program-planning.

scholarly journals Adapting primary care for new migrants: a formative assessment

BJGP Open ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. bjgpopen17X100701 ◽  
Author(s):  
Elizabeth Such ◽  
Elizabeth Walton ◽  
Brigitte Delaney ◽  
Janet Harris ◽  
Sarah Salway
Keyword(s):  
Primary Care ◽  
Case Studies ◽  
Online Survey ◽  
Resource Constraints ◽  
Sample Survey ◽  
Service Development ◽  
Care Provision ◽  
Care Services ◽  
Primary Care Services ◽  
The Uk

BackgroundImmigration rates have increased recently in the UK. Migrant patients may have particular needs that are inadequately met by existing primary care provision. In the absence of national guidance, local adaptations are emerging in response to these new demands.AimTo formatively assess the primary care services offered to new migrants and the ways in which practitioners and practices are adapting to meet need.Design & settingOnline survey and case studies of current practice across primary care in the UK. Case studies were selected from mainstream and specialist general practice as well as primary care provision in the third sector.MethodNon-probability sample survey of primary care practitioners (n = 70) with descriptive statistical analysis. Qualitative case studies (n = 8) selected purposively; in-depth exploration of organisational and practitioner adaptations to services. Analysis is structured around the principles of equitable care.ResultsSurvey results indicated that practitioners focused on working with communities and external agencies and adapting processes of, for example, screening, vaccination, and health checks. Lack of funding was cited most frequently as a barrier to service development (n = 51; 73%). Case studies highlighted the prominence partnership working and of an organisational and practitioner focus on equitable care. Adaptations centred on addressing wider social determinants, trauma, and violence, and additional individual needs; and on delivering culturally-competent care.ConclusionDespite significant resource constraints, some primary care services are adapting to the needs of new migrants. Many adapted approaches can be characterised as equity-oriented.

Developing a Home-Based Primary Care Disaster Preparedness Toolkit

2016 ◽  
Vol 11 (1) ◽  
pp. 56-63 ◽  
Author(s):  
Tamar Wyte-Lake ◽  
Maria Claver ◽  
Claudia Der-Martirosian ◽  
Darlene Davis ◽  
Aram Dobalian
Keyword(s):  
Primary Care ◽  
Disaster Preparedness ◽  
Online Survey ◽  
Vital Role ◽  
Clinical Expertise ◽  
Veterans Health ◽  
Health Administration ◽  
Preparedness Plan ◽  
Home Based Primary Care ◽  
Home Based

AbstractObjectiveHealth agencies working with the homebound play a vital role in bolstering a community’s resiliency by improving the preparedness of this vulnerable population. Nevertheless, this role is one for which agencies lack training and resources, which leaves many homebound at heightened risk. This study examined the utility of an evidence-based Disaster Preparedness Toolkit in Veterans Health Administration (VHA) Home-Based Primary Care (HBPC) programs.MethodsWe conducted an online survey of all VHA HBPC program managers (N=77/146; 53% response rate).ResultsRespondents with fewer years with the HBPC program rated the toolkit as being more helpful (P<0.05). Of those who implemented their program’s disaster protocol most frequently, two-thirds strongly agreed that the toolkit was relevant. Conversely, of those who implemented their disaster protocols very infrequently or never, 23% strongly agreed that the topics covered in the toolkit were relevant to their work (P<0.05).ConclusionThis toolkit helps support programs as they fulfill their preparedness requirements, especially practitioners who are new to their position in HBPC. Programs that implement disaster protocols infrequently may require additional efforts to increase understanding of the toolkit’s utility. Engaging all members of the team with their diverse clinical expertise could strengthen a patient’s personal preparedness plan. (Disaster Med Public Health Preparedness. 2017;11:56–63)

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