scholarly journals Learning health systems in primary care: a systematic scoping review

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Danielle M. Nash ◽  
Zohra Bhimani ◽  
Jennifer Rayner ◽  
Merrick Zwarenstein
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health Systems ◽  
Scoping Review ◽  
Early Stage ◽  
Point Of Care ◽  
The United States ◽  
Stage Of Development ◽  
Integrated Health ◽  
Google Search

Abstract Background Learning health systems have been gaining traction over the past decade. The purpose of this study was to understand the spread of learning health systems in primary care, including where they have been implemented, how they are operating, and potential challenges and solutions. Methods We completed a scoping review by systematically searching OVID Medline®, Embase®, IEEE Xplore®, and reviewing specific journals from 2007 to 2020. We also completed a Google search to identify gray literature. Results We reviewed 1924 articles through our database search and 51 articles from other sources, from which we identified 21 unique learning health systems based on 62 data sources. Only one of these learning health systems was implemented exclusively in a primary care setting, where all others were integrated health systems or networks that also included other care settings. Eighteen of the 21 were in the United States. Examples of how these learning health systems were being used included real-time clinical surveillance, quality improvement initiatives, pragmatic trials at the point of care, and decision support. Many challenges and potential solutions were identified regarding data, sustainability, promoting a learning culture, prioritization processes, involvement of community, and balancing quality improvement versus research. Conclusions We identified 21 learning health systems, which all appear at an early stage of development, and only one was primary care only. We summarized and provided examples of integrated health systems and data networks that can be considered early models in the growing global movement to advance learning health systems in primary care.

scholarly journals Primary Care Networks and Starfield’s 4Cs: A Case for Enhanced Chronic Disease Management

2021 ◽  
Vol 18 (6) ◽  
pp. 2926
Author(s):  
Chuan De Foo ◽  
Shilpa Surendran ◽  
Geronimo Jimenez ◽  
John Pastor Ansah ◽  
David Bruce Matchar ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
Early Stage ◽  
Healthcare Delivery ◽  
Stage Of Development ◽  
Facilitators And Barriers ◽  
Design Options ◽  
First Contact

The primary care network (PCN) was implemented as a healthcare delivery model which organises private general practitioners (GPs) into groups and furnished with a certain level of resources for chronic disease management. A secondary qualitative analysis was conducted with data from an earlier study exploring facilitators and barriers GPs enrolled in PCN’s face in chronic disease management. The objective of this study is to map features of PCN to Starfield’s “4Cs” framework. The “4Cs” of primary care—comprehensiveness, first contact access, coordination and continuity—offer high-quality design options for chronic disease management. Interview transcripts of GPs (n = 30) from the original study were purposefully selected. Provision of ancillary services, manpower, a chronic disease registry and extended operating hours of GP practices demonstrated PCN’s empowering features that fulfil the “4Cs”. On the contrary, operational challenges such as the lack of an integrated electronic medical record and disproportionate GP payment structures limit PCNs from maximising the “4Cs”. However, the enabling features mentioned above outweighs the shortfalls in all important aspects of delivering optimal chronic disease care. Therefore, even though PCN is in its early stage of development, it has shown to be well poised to steer GPs towards enhanced chronic disease management.

Mobility Assistants to Support Multi-Modal Routes in Smart Cities: A Scoping Review

2021 ◽  
Vol 3 (1) ◽  
pp. 26-40
Author(s):  
Nelson Pacheco Rocha ◽  
Gonçalo Santinha ◽  
Mário Rodrigues ◽  
Carlos Rodrigues ◽  
Alexandra Queirós ◽  
...  
Keyword(s):  
Scoping Review ◽  
Early Stage ◽  
Smart Cities ◽  
Research Trends ◽  
Exclusion Criteria ◽  
Major Barrier ◽  
Stage Of Development ◽  
Electronic Search ◽  
Inclusion Results

Objectives - This study aimed to identify: (i) the current research trends related to mobility assistants to support multi-modal routes in smart cities; (ii) the types of smart cities’ data being used; (iii) the methods applied to assess the proposed solutions; and iv) the major barriers for their dissemination. Methods - An electronic search was conducted in several databases, combining relevant keywords. Then titles and abstracts were screened against inclusion and exclusion criteria. Finally, the full texts of the eligible articles were retrieved and screened for inclusion. Results - A total of 19 articles were included. These articles either propose algorithms to optimize routes planning or presenting specific applications that make use of a broad range of smart cities’ data. Conclusion - The number of included articles is very reduced when compared with the total number of articles related to smart cities, which means that the mobility assistants to support multi-modal routes are still not significant within the smart cities’ research. Moreover, most of the included articles report applications in an early stage of development, which is a major barrier for the respective dissemination.

Information Technology in Primary Care Practice in the United States

2011 ◽  
pp. 131-163
Author(s):  
James G. Anderson ◽  
E. Andres Balas
Keyword(s):  
Primary Care ◽  
Information Technology ◽  
Primary Care Physicians ◽  
Point Of Care ◽  
Medical Specialty ◽  
The United States ◽  
Care Practice ◽  
It Applications ◽  
The Cost ◽  
Privacy And Confidentiality

The objective of this study was to assess the current level of information technology used by primary care physicians in the U.S. Primary care physicians listed by the American Medical Association were contacted by e-mail and asked to complete a Web-based questionnaire. A total of 2,145 physicians responded. Overall between 20% and 25% of primary care physicians reported using electronic medical records, e-prescribing, point-of-care decision support tools and electronic communication with patients. This indicates a slow rate of adoption since 2000-2001. Differences in adoption rates suggest that future surveys need to differentiate primary care and office-based physicians by specialty. An important finding is that one-third of the physicians surveyed expressed no interest in the four IT applications. Overcoming this barrier may require efforts by medical specialty societies to educate their members as to the benefits of IT in practice. The majority of physicians perceived benefits of IT, but they cited costs, vendor inability to deliver acceptable products and concerns about privacy and confidentiality as major barriers to implementation of IT applications. Overcoming the cost barrier may require that payers and the federal government share the costs of implementing these IT applications.

scholarly journals Computerization of Primary Care in the United States

2010 ◽  
pp. 385-409
Author(s):  
James G. Anderson ◽  
E. Andrew Balas
Keyword(s):  
Primary Care ◽  
Technology Use ◽  
Primary Care Physicians ◽  
Point Of Care ◽  
Medical Specialty ◽  
The United States ◽  
Web Based ◽  
It Applications ◽  
The Cost ◽  
Privacy And Confidentiality

The objective of this study was to assess the current level of information technology use by primary care physicians in the U.S. Primary care physicians listed by the American Medical Association were contacted by e-mail and asked to complete a Web-based questionnaire. A total of 2,145 physicians responded. Overall, between 20% and 25% of primary care physicians reported using electronic medical records, e-prescribing, point-of-care decision support tools, and electronic communication with patients. This indicates a slow rate of adoption since 2000. Differences in adoption rates suggest that future surveys need to differentiate primary care and office-based physicians by specialty. An important finding is that one-third of the physicians surveyed expressed no interest in the four IT applications. Overcoming this barrier may require efforts by medical specialty societies to educate their members in the benefits of IT in practice. The majority of physicians perceived benefits of IT, but they cited costs, vendor inability to deliver acceptable products, and concerns about privacy and confidentiality as major barriers to implementation of IT applications. Overcoming the cost barrier may require that payers and the federal government share the costs of implementing these IT applications.

scholarly journals Evidence of integrated health service delivery during COVID-19 in low- and middle-income countries: protocol for a scoping review

2020 ◽  
Author(s):  
Rachel Neill ◽  
Md Zabir Hasan ◽  
Priyanka Das ◽  
Vasuki Venugopal ◽  
Nishant Jain ◽  
...  
Keyword(s):  
Health Service ◽  
Service Delivery ◽  
Health Systems ◽  
Scoping Review ◽  
Health Service Delivery ◽  
World Health ◽  
Research Database ◽  
Middle Income ◽  
Middle Income Countries ◽  
Integrated Health

Introduction The importance of integrated, people-centered health systems has been recognized as a central component of achieving Universal Health Coverage. Integration has also been highlighted as a critical element for building resilient health systems that can stand the shock of health emergencies. However, there is dearth of research and systematic synthesis of evidence on the synergistic relationship between integrated health services and pandemic preparedness in low- and low-middle income countries (LMICs). Thus, the authors are organizing a scoping review aiming to explore application of integrated health service delivery approaches during the emerging COVID-19 pandemic in LMICs. Methods and analysis This scoping review adheres to the six steps for scoping reviews from Arksey and OMalley (2005). Peer reviewed scientific literature will be systematically assembled utilizing a standardized and replicable search strategy from seven electronic databases, including PubMed, Embase, Scopus, Web of Science, CINAHL Plus, the World Health Organization Global Research Database on COVID-19, and LitCovid. Initially, the title and abstract of the collected literature, published in English from December 2019 to June 2020, will be screened for inclusion which will be followed by a full text review by two independent reviewers. Data will be charted using a data extraction form and reported in narrative format with accompanying data matrices. Ethics and dissemination No ethical approval is required for the review. The study will be conducted from June to December 2020. Results from this study will provide a snapshot of the evidence currently being generated related to integrated health service delivery in response to the COVID-19 pandemic. The findings will be developed into reports and a peer-reviewed articles and will assist policy makers in making pragmatic and evidence-based decisions for current and future pandemic response.

Home-Based Primary Care Practices in the United States: Current State and Quality Improvement Approaches

2015 ◽  
Vol 63 (5) ◽  
pp. 963-969 ◽  
Author(s):  
Bruce Leff ◽  
Christine M. Weston ◽  
Sarah Garrigues ◽  
Kanan Patel ◽  
Christine Ritchie ◽  
...  
Keyword(s):  
United States ◽  
Primary Care ◽  
Quality Improvement ◽  
The United States ◽  
Current State ◽  
Home Based Primary Care ◽  
Home Based ◽  
Care Practices ◽  
Primary Care Practices

The supply of blood in England and Wales and the United States

2018 ◽  
pp. 27-52
Author(s):  
Richard M. Titmuss
Keyword(s):  
United States ◽  
Blood Transfusion ◽  
Blood Donation ◽  
Early Stage ◽  
The United States ◽  
England And Wales ◽  
Stage Of Development ◽  
Blood Transfusion Service ◽  
Annual Volume ◽  
Second World

This chapter assesses the supply of blood in England and Wales and the United States. It presents the main national statistics in the increase in blood donation between the introduction of the National Health Service in 1948 and 1968. Whereas in some countries at the end of the 1940s blood transfusion services were in an early stage of development, in England and Wales they had been expanded earlier. The effects of the Second World War, particularly the large quantities of blood required to deal adequately with the expected and actual civilian air raid casualties, greatly stimulated the growth of a blood transfusion service on a national scale. Unfortunately, it is not possible to present any series of statistics for the United States similar to those provided for England and Wales. It is not even possible to estimate with any degree of precision the total annual volume of blood collections, transfusions, and wastage.

scholarly journals Physiotherapy managers’ views of musculoskeletal physiotherapy service provision in Ireland: a qualitative study

2017 ◽  
Vol 19 (01) ◽  
pp. 77-87 ◽  
Author(s):  
Helen P. French ◽  
Rose Galvin
Keyword(s):  
Primary Care ◽  
Service Delivery ◽  
Service Provision ◽  
Urban Areas ◽  
Resource Constraints ◽  
Early Stage ◽  
Future Research ◽  
Structured Interviews ◽  
Physiotherapy Service ◽  
Stage Of Development

Aim Integrated multidisciplinary primary healthcare is still in a relatively early stage of development in Ireland, with significant restructuring occurring in the past decade. Musculoskeletal physiotherapy services traditionally provided in acute hospital settings have been relocated into the primary care setting where the physiotherapist works as part of the multidisciplinary team. This study aimed to explore physiotherapy managers’ experiences of managing musculoskeletal physiotherapy services in primary care to gain an insight into the opportunities and challenges in service delivery, changing roles and ongoing professional development needs of staff. Participants Qualitative design using semi-structured interviews with primary care physiotherapy managers in the Republic of Ireland was employed. Results Five interviews took in a mix of rural and urban areas nationally. The relationship with the GP was an important one in musculoskeletal physiotherapy services in primary care. Physiotherapists were well skilled but opportunities for professional and career development were restricted. Methods of optimising resources in the face of staffing restrictions were identified. Whilst there were many examples of innovations in service delivery, various barriers negatively impacted on optimal service including resource constraints and national strategy. Conclusions A number of factors that impact on musculoskeletal service delivery in primary care from the perspective of physiotherapy managers were identified in this study. Future research should explore the views of other stakeholders to provide a more thorough understanding of the relevant issues affecting musculoskeletal physiotherapy service provision in primary care in Ireland.

scholarly journals Electronic Medical Record–Based Case Phenotyping for the Charlson Conditions: Scoping Review (Preprint)

2020 ◽  
Author(s):  
Seungwon Lee ◽  
Chelsea Doktorchik ◽  
Elliot Asher Martin ◽  
Adam Giles D'Souza ◽  
Cathy Eastwood ◽  
...  
Keyword(s):  
Health Systems ◽  
Scoping Review ◽  
Clinical Pathways ◽  
Clinical Care ◽  
Data Access ◽  
The United States ◽  
Case Definitions ◽  
Services Research ◽  
Algorithm Development ◽  
Scoping Reviews

BACKGROUND Electronic medical records (EMRs) contain large amounts of rich clinical information. Developing EMR-based case definitions, also known as EMR phenotyping, is an active area of research that has implications for epidemiology, clinical care, and health services research. OBJECTIVE This review aims to describe and assess the present landscape of EMR-based case phenotyping for the Charlson conditions. METHODS A scoping review of EMR-based algorithms for defining the Charlson comorbidity index conditions was completed. This study covered articles published between January 2000 and April 2020, both inclusive. Embase (Excerpta Medica database) and MEDLINE (Medical Literature Analysis and Retrieval System Online) were searched using keywords developed in the following 3 domains: terms related to EMR, terms related to case finding, and disease-specific terms. The manuscript follows the Preferred Reporting Items for Systematic reviews and Meta-analyses extension for Scoping Reviews (PRISMA) guidelines. RESULTS A total of 274 articles representing 299 algorithms were assessed and summarized. Most studies were undertaken in the United States (181/299, 60.5%), followed by the United Kingdom (42/299, 14.0%) and Canada (15/299, 5.0%). These algorithms were mostly developed either in primary care (103/299, 34.4%) or inpatient (168/299, 56.2%) settings. Diabetes, congestive heart failure, myocardial infarction, and rheumatology had the highest number of developed algorithms. Data-driven and clinical rule–based approaches have been identified. EMR-based phenotype and algorithm development reflect the data access allowed by respective health systems, and algorithms vary in their performance. CONCLUSIONS Recognizing similarities and differences in health systems, data collection strategies, extraction, data release protocols, and existing clinical pathways is critical to algorithm development strategies. Several strategies to assist with phenotype-based case definitions have been proposed. CLINICALTRIAL

scholarly journals An Ultra-Rapid Biosensory Point-of-Care (POC) Assay for Prostate-Specific Antigen (PSA) Detection in Human Serum

Sensors ◽  
2018 ◽  
Vol 18 (11) ◽  
pp. 3834 ◽  
Author(s):  
Sophie Mavrikou ◽  
Georgia Moschopoulou ◽  
Athanasios Zafeirakis ◽  
Konstantina Kalogeropoulou ◽  
Georgios Giannakos ◽  
...  
Keyword(s):  
Human Serum ◽  
Prostate Specific Antigen ◽  
High Throughput ◽  
Early Stage ◽  
Point Of Care ◽  
Low Cost ◽  
Specific Antigen ◽  
Serum Samples ◽  
Stage Of Development ◽  
Better Than

Prostate-specific antigen (PSA) is the established routine screening tool for the detection of early-stage prostate cancer. Given the laboratory-centric nature of the process, the development of a portable, ultra rapid high-throughput system for PSA screening is highly desirable. In this study, an advancedpoint-of-care system for PSA detection in human serum was developed based on a cellular biosensor where the cell membrane was modified by electroinserting a specific antibody against PSA. Thirty nine human serum samples were used for validation of this biosensory system for PSA detection. Samples were analyzed in parallel with a standard immunoradiometric assay (IRMA) and an established electrochemical immunoassay was used for comparison purposes. They were classified in three different PSA concentration ranges (0, <4 and ≥4 ng/mL). Cells membrane-engineered with 0.25 μg/mL anti-PSA antibody demonstrated a statistically lower response against the upper (≥4 ng/mL) PSA concentration range. In addition, the cell-based biosensor performed better than the immunosensor in terms of sensitivity and resolution against positive samples containing <4 ng/mL PSA. In spite of its preliminary, proof-of-concept stage of development, the cell-based biosensor could be used as aninitiative for the development of a fast, low-cost, and high-throughput POC screening system for PSA.

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