scholarly journals Do virtual renal clinics improve access to kidney care? A preliminary impact evaluation of a virtual clinic in East London

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
S. A. Hull ◽  
V. Rajabzadeh ◽  
N. Thomas ◽  
S. Hoong ◽  
G. Dreyer ◽  
...  
Keyword(s):  
Primary Care ◽  
Impact Evaluation ◽  
Service Improvement ◽  
Proactive Management ◽  
Specialist Services ◽  
Timely Access ◽  
Primary Care Record ◽  
Working Practices ◽  
Electronic Health ◽  
Primary Care Clinicians

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.

scholarly journals Do virtual renal clinics improve access to kidney care? an impact evaluation of a virtual clinic in east London

2019 ◽  
Author(s):  
Sally Ann Hull ◽  
Vian Rajabzadeh ◽  
Nicola Thomas ◽  
Sec Hoong ◽  
Gavin Dreyer ◽  
...  
Keyword(s):  
Primary Care ◽  
Impact Evaluation ◽  
Models Of Care ◽  
Service Improvement ◽  
Specialist Services ◽  
Working Practices ◽  
Electronic Health ◽  
Primary Care Clinicians ◽  
The Uk ◽  
Virtual Clinic

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.

scholarly journals Do virtual renal clinics improve access to kidney care? an impact evaluation of a virtual clinic in east London

2019 ◽  
Author(s):  
Sally Ann Hull ◽  
Vian Rajabzadeh ◽  
Nicola Thomas ◽  
Sec Hoong ◽  
Gavin Dreyer ◽  
...  
Keyword(s):  
Primary Care ◽  
Impact Evaluation ◽  
Models Of Care ◽  
Service Improvement ◽  
Specialist Services ◽  
Working Practices ◽  
Electronic Health ◽  
Primary Care Clinicians ◽  
The Uk ◽  
Virtual Clinic

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.

scholarly journals Do virtual renal clinics improve access to kidney care? an impact evaluation of a virtual clinic in east London

2019 ◽  
Author(s):  
Sally Ann Hull ◽  
Vian Rajabzadeh ◽  
Nicola Thomas ◽  
Sec Hoong ◽  
Gavin Dreyer ◽  
...  
Keyword(s):  
Primary Care ◽  
Impact Evaluation ◽  
Models Of Care ◽  
Service Improvement ◽  
Specialist Services ◽  
Working Practices ◽  
Electronic Health ◽  
Primary Care Clinicians ◽  
The Uk ◽  
Virtual Clinic

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.

scholarly journals Best Paper Selection

2021 ◽  
Vol 30 (01) ◽  
pp. 103-104
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Skin Cancer ◽  
Health Informatics ◽  
Digital Health ◽  
Health Record ◽  
Health Records ◽  
After Hours ◽  
Electronic Health ◽  
Primary Care Clinicians

Adler-Milstein J, Zhao W, Willard-Grace R, Knox M, Grumbach K. Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647261/ Brewer LC, Fortuna KL, Jones C, Walker R, Hayes SN, Patten CA, Cooper LA. Back to the Future: Achieving Health Equity Through Health Informatics and Digital Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996775/ Reading Turchioe M, Grossman LV, Myers AC, Baik D, Goyal P, Masterson Creber RM. Visual analogies, not graphs, increase patients' comprehension of changes in their health status. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309237 Tschandl P, Rinner C, Apalla Z, Argenziano G, Codella N, Halpern A, Janda M, Lallas A, Longo C, Josep Malvehy J, Paoli J, Puig S, Rosendahl C, Soyer HP, Zalaudek I, Kittler H. Human-computer collaboration for skin cancer recognition. https://www.nature.com/articles/s41591-020-0942-0

scholarly journals Natural language processing for disease phenotyping in UK primary care records for research: a pilot study in myocardial infarction and death

2019 ◽  
Vol 10 (S1) ◽  
Author(s):  
Anoop D. Shah ◽  
Emily Bailey ◽  
Tim Williams ◽  
Spiros Denaxas ◽  
Richard Dobson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Primary Care ◽  
Electronic Health Records ◽  
Natural Language ◽  
Cause Of Death ◽  
Free Text ◽  
Health Records ◽  
Death Registry ◽  
Primary Care Record ◽  
Electronic Health

Abstract Background Free text in electronic health records (EHR) may contain additional phenotypic information beyond structured (coded) information. For major health events – heart attack and death – there is a lack of studies evaluating the extent to which free text in the primary care record might add information. Our objectives were to describe the contribution of free text in primary care to the recording of information about myocardial infarction (MI), including subtype, left ventricular function, laboratory results and symptoms; and recording of cause of death. We used the CALIBER EHR research platform which contains primary care data from the Clinical Practice Research Datalink (CPRD) linked to hospital admission data, the MINAP registry of acute coronary syndromes and the death registry. In CALIBER we randomly selected 2000 patients with MI and 1800 deaths. We implemented a rule-based natural language engine, the Freetext Matching Algorithm, on site at CPRD to analyse free text in the primary care record without raw data being released to researchers. We analysed text recorded within 90 days before or 90 days after the MI, and on or after the date of death. Results We extracted 10,927 diagnoses, 3658 test results, 3313 statements of negation, and 850 suspected diagnoses from the myocardial infarction patients. Inclusion of free text increased the recorded proportion of patients with chest pain in the week prior to MI from 19 to 27%, and differentiated between MI subtypes in a quarter more patients than structured data alone. Cause of death was incompletely recorded in primary care; in 36% the cause was in coded data and in 21% it was in free text. Only 47% of patients had exactly the same cause of death in primary care and the death registry, but this did not differ between coded and free text causes of death. Conclusions Among patients who suffer MI or die, unstructured free text in primary care records contains much information that is potentially useful for research such as symptoms, investigation results and specific diagnoses. Access to large scale unstructured data in electronic health records (millions of patients) might yield important insights.

scholarly journals Polyclinics and psychiatry: risks and opportunities

2010 ◽  
Vol 34 (3) ◽  
pp. 106-109
Author(s):  
Linda Gask ◽  
Suresh Joseph ◽  
Michele Hampson
Keyword(s):  
Primary Care ◽  
National Health Service ◽  
Health Service ◽  
National Health ◽  
Health Centre ◽  
Mental Healthcare ◽  
Shared Space ◽  
Specialist Services ◽  
Working Practices ◽  
The Way

SummaryThe arrival of the ‘polyclinic’ or ‘GP-led health centre’ has been signalled in the review of the National Health Service. A variety of options have been proposed for the way in which polyclinics will incorporate specialist services to work alongside primary care, and the relevance of these models to mental healthcare is considered. Polyclinics provide new opportunities but with those possibilities come potential threats and risks. Of key importance is the threat that they will re-institutionalise mental healthcare after many years of breaking down such barriers. Buildings provide shared space, but new working practices are more difficult to achieve.

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