scholarly journals A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Briana S. Last ◽  
Alison M. Buttenheim ◽  
Anne C. Futterer ◽  
Cecilia Livesey ◽  
Jeffrey Jaeger ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Depression Screening ◽  
Care Practice ◽  
Participatory Methods ◽  
Patient Support ◽  
Medical Assistants ◽  
Care Practices ◽  
Primary Care Practices ◽  
Innovation Tournament

Abstract Background Most individuals with depression go unidentified and untreated. In 2016 the US Preventive Services Task Force released guidelines recommending universal screening in primary care to identify patients with depression and to link them to treatment. Feasible, acceptable, and effective strategies to implement these guidelines are needed. Methods This three-phased study employed rapid participatory methods to design and test strategies to increase depression screening at Penn Medicine, a large health system with 90 primary care practices. First, researchers solicited ideas and barriers from stakeholders to increase screening using an innovation tournament—a crowdsourcing method that invites stakeholders to submit ideas to address a workplace challenge. Second, a panel of stakeholders and scientists deliberated over and ranked the tournament ideas. An instant runoff election was held to select the winning idea. Third, the research team piloted the winning idea in a primary care practice using rapid prototyping, an approach that quickly refines and iterates strategy designs. Results The innovation tournament yielded 31 ideas and 32 barriers from diverse stakeholders (12 primary care physicians, 10 medical assistants, 4 nurse practitioners, 2 practice managers, and 4 patient support assistants). A panel of 6 stakeholders and scientists deliberated on the ideas and voted for patient self-report (i.e., through tablet computers, text message, or an online patient portal) as the winning idea. The research team rapid prototyped tablets in one primary care practice with one physician over 5 five-hour shifts to examine the feasibility, acceptability, and effectiveness of the strategy. Most patients, the physician, and medical assistants found the tablets acceptable and feasible. However, patient support assistants struggled to incorporate them in their workflow and expressed concerns about scaling up the process. Depression screening rates were higher using tablets compared to usual care; follow-up was comparable between tablets and usual care. Conclusions Rapid participatory methods engaged and amplified the voices of diverse stakeholders in primary care. These methods helped design an acceptable and feasible implementation strategy that showed promise for increasing depression screening in a primary care setting. The next step is to evaluate the strategy in a randomized controlled trial across primary care practices.

scholarly journals A Pilot Study of Participatory and Rapid Implementation Approaches to Increase Depression Screening in Primary Care

2021 ◽  
Author(s):  
Briana S. Last ◽  
Alison M. Buttenheim ◽  
Anne C. Futterer ◽  
Cecilia Livesey ◽  
Jeffrey Jaeger ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Depression Screening ◽  
Care Practice ◽  
Participatory Methods ◽  
Patient Support ◽  
Medical Assistants ◽  
Care Practices ◽  
Primary Care Practices ◽  
Innovation Tournament

Abstract Background: Most individuals with depression go unidentified and untreated. In 2016 the US Preventive Services Task Force released guidelines recommending universal screening in primary care to identify patients with depression and to link them to treatment. Feasible, acceptable, and effective strategies to implement these guidelines are needed. Methods: This three-phased study employed rapid participatory methods to design and test strategies to increase depression screening at Penn Medicine, a large health system with 90 primary care practices. First, researchers solicited ideas and barriers from stakeholders to increase screening using an innovation tournament—a crowdsourcing method that invites stakeholders to submit ideas to address a workplace challenge. Second, a panel of stakeholders and scientists deliberated over and ranked the tournament ideas. An instant runoff election was held to select the winning idea. Third, the research team piloted the winning idea in a primary care practice using rapid prototyping, an approach that quickly refines and iterates strategy designs. Results: The innovation tournament yielded 31 ideas and 32 barriers from diverse stakeholders (12 primary care physicians, 10 medical assistants, 4 nurse practitioners, 2 practice managers, and 4 patient support assistants). A panel of 6 stakeholders and scientists deliberated on the ideas and voted for patient self-report (i.e., through tablet computers, text message, or an online patient portal) as the winning idea. The research team rapid prototyped tablets in one primary care practice with one physician over 5 five-hour shifts to examine the feasibility, acceptability, and effectiveness of the strategy. Most patients, the physician, and medical assistants found the tablets acceptable and feasible. However, patient support assistants struggled to incorporate them in their workflow and expressed concerns about scaling up the process. Depression screening rates were higher using tablets compared to usual care; follow-up was comparable between tablets and usual care. Conclusions: Rapid participatory methods engaged and amplified the voices of diverse stakeholders in primary care. These methods helped design an acceptable and feasible implementation strategy that showed promise for increasing depression screening in a primary care setting. The next step is to evaluate the strategy in a randomized controlled trial across primary care practices.

scholarly journals The Evolving Role of Medical Assistants in Primary Care Practice: Divergent and Concordant Perspectives from MAs and Family Physicians

2020 ◽  
pp. 107755872096614
Author(s):  
Erin P. Fraher ◽  
Allison Cummings ◽  
Dana Neutze
Keyword(s):  
Primary Care ◽  
Patient Education ◽  
Population Health ◽  
Low Cost ◽  
Family Physicians ◽  
Direct Patient Care ◽  
Care Practice ◽  
Medical Assistants ◽  
Care Practices ◽  
Primary Care Practices

Medical assistants (MAs) are a flexible and low-cost resource for primary care practices and their roles are swiftly transforming. We surveyed MAs and family physicians in primary care practices in North Carolina to assess concordance in their perspectives about MA roles, training, and confidence in performing activities related to visit planning; direct patient care; documentation; patient education, coaching or counseling; quality improvement; population health and communication. For most activities, we did not find evidence of role confusion between MAs and physicians, physician resistance to delegate tasks to properly trained MAs, or MA reluctance to pursue training to take on new roles. Three areas emerged where the gap between the potential and actual implementation of MA role transformation could be narrowed—population health and panel management; patient education, coaching, and counseling; and scribing. Closing these gaps will become increasingly important as our health care system moves toward value-based models of care.

Collaborative Care in Primary Care: The Influence of Practice Interior Architecture on Informal Face-to-Face Communication—An Observational Study

2020 ◽  
pp. 193758672093966
Author(s):  
Sonya Morgan ◽  
Susan Pullon ◽  
Eileen McKinlay ◽  
Susan Garrett ◽  
Jonathan Kennedy ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Care Staff ◽  
Care Practice ◽  
Interior Architecture ◽  
Face To Face ◽  
Shared Spaces ◽  
Care Practices ◽  
Primary Care Practices ◽  
Primary Care Staff

Background: Quality patient care in primary care settings, especially for patients with complex long-term health needs, is improved by interprofessional collaborative practice. Effective collaboration is achieved in large part by frequent informal face-to-face “on-the-fly” communication between team members. Research undertaken in hospitals shows that interior architecture influences informal communication and collaboration between staff. However, little is known about how the interior architecture of primary care practices might facilitate or hinder informal communication and collaboration among primary care staff. Objectives: This research explores the influence of primary care practice interior architecture on face-to-face on-the-fly communication for collaborative care. Methods: An observational study was undertaken to compare face-to-face informal interactions between staff in three primary care practices of differing interior architecture. Data collected from practices included: direct observations floor plans, photographs, interviews, and surveys. Results: Most primary care staff engaged in frequent, brief face-to-face interactions, which appeared to be key to the delivery of effective collaboration. Features of primary care practice designs that were associated with increased frequency of staff interaction included shared spaces, staff proximity/visibility, and the presence of convenient circulatory and transitional spaces where staff were able to easily engage in timely on-the-fly communication with colleagues. Conclusions: The interior architecture of primary care practices has an important impact on staff collaboration. Although more research is needed to investigate further details in more practices, close attention should nevertheless be paid to maximizing opportunities for brief face-to-face communication in well-designed shared spaces in primary care practices.

scholarly journals Utilizing the Learning Health System Adaptation to guide Family Medicine Practice to COVID-19 response

2020 ◽  
Vol 11 ◽  
pp. 215013272096640
Author(s):  
Niharika Khanna ◽  
Elena N. Klyushnenkova ◽  
Alexander Kaysin ◽  
David L. Stewart
Keyword(s):  
Primary Care ◽  
Health System ◽  
Primary Care Practice ◽  
Care Practice ◽  
Learning Health System ◽  
System Adaptation ◽  
Care Practices ◽  
Effectiveness And Efficiency ◽  
Current Guidance ◽  
Primary Care Practices

COVID-19 supportive quarantine care in the community is managed by primary care practices. There is no current guidance on how a primary care practice with high volumes of patients screened for COVID-19 can re-configure itself to become responsive to the pandemic. We examined Learning Health System guidance from the National Academies of Science, Engineering and Medicine and adapted it to our primary care practice to create an efficient, effective, adaptive response to the COVID-19 pandemic. We suggest evaluating this response in the future for effectiveness and efficiency.

scholarly journals “I Felt I Was Reaching a Point with My Health”: Understanding Reasons for Engagement and Acceptability of Treatment Services for Unhealthy Alcohol Use in Primary Care

2021 ◽  
Vol 12 ◽  
pp. 215013272110030
Author(s):  
Megan A. O’Grady ◽  
Joseph Conigliaro ◽  
Svetlana Levak ◽  
Jeanne Morley ◽  
Sandeep Kapoor ◽  
...  
Keyword(s):  
Primary Care ◽  
Alcohol Use ◽  
Primary Care Practice ◽  
Care Practice ◽  
Unhealthy Alcohol Use ◽  
Unhealthy Alcohol ◽  
Program Support ◽  
Primary Care Patients ◽  
Care Practices ◽  
Primary Care Practices

Introduction/Objectives: Despite increasing need, there are large gaps in provision of care for unhealthy alcohol use. Primary care practices have become increasingly important in providing services for unhealthy alcohol use, yet little is known about the reasons patients engage in these services and their views on acceptability of such programs. The purpose of this study was to examine primary care patients’ reasons for engagement, experiences with, and acceptability of a primary care practice-based program for treating unhealthy alcohol use. Methods: This qualitative study was conducted in a primary care practice that was developing a collaborative care model for treating unhealthy alcohol use in primary care. Semi-structured interviews were conducted with 24 primary care patients. Data were analyzed using conventional qualitative content analysis. Results: Findings suggest that patients engaged for both internal (concerns about drinking and health) and external reasons (family or provider concern). Patient experiences in the program were shaped by their affective responses (enjoyable, enlightening), as well as therapeutic benefits (gaining new insights about drinking; staff/provider support). Acceptability was driven by core program elements (medication, therapy, integration) as well as positive impacts on drinking cognition and behavior and flexible, patient-centered approaches. Conclusions: Offering flexible and comprehensive programs with mutiple elements and both abstinence and moderation goals could also improve patient engagement and views on acceptability. Primary care practices will need to be thoughtful about the resources needed to implement these programs in terms of staffing, training, and program support.

scholarly journals Chronic kidney disease in cats attending primary care practice in the UK: a VetCompassTM study

2019 ◽  
Vol 184 (17) ◽  
pp. 526-526 ◽  
Author(s):  
Megan Conroy ◽  
David C Brodbelt ◽  
Dan O’Neill ◽  
Yu-Mei Chang ◽  
Jonathan Elliott
Keyword(s):  
Primary Care ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Primary Care Practice ◽  
Blood Pressure Measurement ◽  
Clinical Signs ◽  
Care Practice ◽  
The Uk ◽  
Primary Care Practices ◽  
Nested Case Control

Chronic kidney disease (CKD) is a frequent diagnosis in cats attending primary care practice and the most frequent cause of death in cats aged over five years, yet there is limited published research for CKD in cats attending primary care practice. This study aimed to estimate the prevalence of CKD and investigate risk factors for diagnosis and survival of cats diagnosed with CKD in UK primary care practices. The study included cats attending VetCompassTM practices from January 1, 2012 to December 31, 2013. A nested case-control and cohort study were undertaken. From 353,448 cats attending 244 clinics, the prevalence of CKD was estimated as 1.2 per cent (95 per cent CI 1.1 per cent to 1.3 per cent). Most cats with CKD had clinical signs at diagnosis (66.6 per cent). Few cats underwent investigations or monitoring of serum creatinine (32.6 per cent), urine protein:creatinine ratio (14.9 per cent) or blood pressure measurement (25.6 per cent). A proprietary renal diet was the most frequently prescribed management (63.8 per cent). Median survival time following diagnosis was 388 days (IQR 88–1042 days). This study provides generalisable evidence from the wider cat population to aid veterinarians in improved diagnosis and management of CKD that can benefit the health and welfare of cats with CKD in the UK.

scholarly journals Survival analysis of 219 dogs with hyperadrenocorticism attending primary care practice in England

2019 ◽  
Vol 186 (11) ◽  
pp. 348-348 ◽  
Author(s):  
Imogen Schofield ◽  
David C Brodbelt ◽  
Anna R L Wilson ◽  
Stijn Niessen ◽  
David Church ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Practice ◽  
Multivariable Analysis ◽  
Care Practice ◽  
Electronic Patient Records ◽  
Kaplan Meier ◽  
All Cause Mortality ◽  
Cox Proportional Hazard Regression ◽  
Primary Care Practitioners ◽  
Primary Care Practices

BackgroundHyperadrenocorticism is an endocrine disease routinely encountered within primary care practice; however, few studies evaluating survival beyond diagnosis have studied this population.MethodsThis retrospective cohort study analysed the electronic patient records of 219 cases of hyperadrenocorticism from a sample of dogs attending primary care practices in England. Kaplan-Meier plots examined the cumulative survival and Cox proportional hazard regression modelling identified factors associated with the hazard of all-cause mortality.ResultsIn the analysis, 179/219 (81.7 per cent) hyperadrenocorticism cases died during the study period with a median survival time from first diagnosis of 510 days (95% CI 412 to 618 days). Trilostane was used in 94.1 per cent of cases and differentiation between pituitary-dependent and adrenal-dependent disease was made in 20.1 per cent of cases. In the multivariable analysis, dogs weighing greater than or equal to 15 kg (HR 1.51, 95% CI 1.06 to 2.15, P=0.023) and those diagnosed greater than or equal to 13 years of age (HR 3.74, 95% CI 2.29 to 6.09, P<0.001) had increased hazards of all-cause mortality. Dogs that had their initial trilostane dose increased had a favourable prognosis (HR 0.49, 95% CI 0.32 to 0.76, P=0.015).ConclusionThis study shows that survival from diagnosis of hyperadrenocorticism appears fair for many dogs and provides primary care practitioners with relatable benchmark prognostic figures.

scholarly journals What is the carbon footprint of primary care practices? A retrospective life-cycle analysis in Switzerland

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
John Nicolet ◽  
Yolanda Mueller ◽  
Paola Paruta ◽  
Julien Boucher ◽  
Nicolas Senn
Keyword(s):  
Primary Care ◽  
Life Cycle ◽  
Carbon Footprint ◽  
Carbon Emissions ◽  
Life Cycle Analysis ◽  
Care Practice ◽  
Worst Case ◽  
Patient Transport ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background The medical field causes significant environmental impact. Reduction of the primary care practice carbon footprint could contribute to decreasing global carbon emissions. This study aims to quantify the average carbon footprint of a primary care consultation, describe differences between primary care practices (best, worst and average performing) in western Switzerland and identify opportunities for mitigation. Methods We conducted a retrospective carbon footprint analysis of ten private practices over the year 2018. We used life-cycle analysis to estimate carbon emissions of each sector, from manufacture to disposal, expressing results as CO2 equivalents per average consultation and practice. We then modelled an average and theoretical best- case and worst-case practices. Collected data included invoices, medical and furniture inventories, heating and power supply, staff and patient transport, laboratory analyses (in/out-house) waste quantities and management costs. Results An average medical consultation generated 4.8 kg of CO2eq and overall, an average practice produced 30 tons of CO2eq per year, with 45.7% for staff and patient transport and 29.8% for heating. Medical consumables produced 5.5% of CO2eq emissions, while in-house laboratory and X-rays contributed less than 1% each. Emergency analyses requiring courier transport caused 5.8% of all emissions. Support activities generated 82.6% of the total CO2eq. Simulation of best- and worst-case scenarios resulted in a ten-fold variation in CO2eq emissions. Conclusion Optimizing structural and organisational aspects of practice work could have a major impact on the carbon footprint of primary care practices without large-scale changes in medical activities.

OP08 Using Real World Data To Support National Postmarketing Surveillance

2018 ◽  
Vol 34 (S1) ◽  
pp. 3-3
Author(s):  
Yeqin Zuo ◽  
Bernie Mullen ◽  
Rachel Hayhurst ◽  
Karen Kaye ◽  
Renee Granger ◽  
...  
Keyword(s):  
Primary Care ◽  
Real World ◽  
National Level ◽  
Clinical Information ◽  
Health Priorities ◽  
Care Practice ◽  
Postmarketing Surveillance ◽  
Care Practices ◽  
Primary Care Practices ◽  
Tract Infections

Introduction:While medicines and medical tests are developed in a controlled clinical trial environment, postmarketing surveillance in the real world can be challenging. MedicineInsight—a database of longitudinal patient-level clinical information from primary care practices in Australia—is a novel program that collects primary care data to improve postmarketing surveillance at a national level.Methods:MedicineInsight collects de-identified clinical information from primary care practice information systems using data extraction tools. MedicineInsight currently includes 3.6 million regular patients of 3,300 family physicians (general practitioners) from 650 primary care practices across Australia. MedicineInsight data include longitudinal clinical information on diagnosis and medicines (dose, strength, route of administration, medication switches over time, adverse events, and allergies), and pathology testing data. A series of observational studies was developed for postmarketing surveillance of management of a range of health priorities including type 2 diabetes mellitus (T2DM), chronic obstructive pulmonary disease (COPD), depression, and antibiotics use.Results:Forty-four percent of patients with T2DM in the MedicineInsight database did not have a recorded hemoglobin A1c result and thirty-one percent did not have a recorded blood pressure reading in the previous 6 months. While guidelines recommend a stepwise approach to the initiation of COPD therapy, forty-nine percent of patients with COPD (with or without asthma) were prescribed dual therapy at initiation and a small number (4.5 percent) were prescribed triple therapy. Between 2011 and 2015, the annual rate of antidepressant prescribing per 1,000 family physician encounters increased by eight percent. High volumes of antibiotics were prescribed for respiratory tract infections in Australian primary care, notwithstanding guideline recommendations that antibiotics are not recommended in most cases.Conclusions:Large scale, real-world clinical data from primary care practices can play an important role in postmarketing surveillance at a national level.

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