scholarly journals A national evaluation of the Irish public health counselling in primary care service– examination of initial effectiveness data

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Charles Brand ◽  
Fiona Ward ◽  
Niamh MacDonagh ◽  
Sharon Cunningham ◽  
Ladislav Timulak
Keyword(s):  
Primary Care ◽  
Large Scale ◽  
Care Service ◽  
Outcome Data ◽  
Primary Care Service ◽  
Observational Research ◽  
Research Approach ◽  
Growth Curve Analysis ◽  
Republic Of Ireland ◽  
Post Therapy

Abstract Background The Counselling in Primary Care service (CIPC) is the first and only nationally available public counselling service in the Republic of Ireland. This study provides initial data for the effectiveness of short-term psychotherapy delivered in a primary care setting in Ireland for the first time. Method A practice-based observational research approach was employed to examine outcome data from 2806 clients receiving therapy from 130 therapists spread over 150 primary care locations throughout Ireland. Pre-post outcomes were assessed using the CORE-OM and reliable and clinically significant change proportions. Binary logistic regression examined the effect of pre therapy symptom severity on the log odds of recovering. Six and 12 month follow up data from a subsample of 276 clients were also analysed using growth curve analysis. Results Of 14,156 referred clients, 5356 presented for assessment and 52.3% (N = 2806) consented to participate. Between assessment and post-therapy a large reduction in severity of symptoms was observed- Cohen’s d = 0.98. Furthermore, 47% of clients achieved recovery,a further 15.5% reliably improved, 2.7% reliably deteriorated and34.7% showed no reliable improvement. Higher initial severity was associated with less chance of recovering at post-therapy. Significant gains were maintained between assessment and12 months after therapy- Cohen’s d = 0.50. Conclusions Outcomes for clients in the CIPC service compared favourably with large scale counselling and psychotherapy services in jurisdictions in the U.K., the U.S.A., Norway and Sweden. This study expands the international primary care psychotherapy research base to include the entire Republic of Ireland jurisdiction.

scholarly journals Providing a primary care service for psychiatric in-patients

2004 ◽  
Vol 28 (5) ◽  
pp. 167-170 ◽  
Author(s):  
Enone Welthagen ◽  
Sarah Talbot ◽  
Oliver Harrison ◽  
Michael Phelan
Keyword(s):  
Primary Care ◽  
Chronic Conditions ◽  
Psychiatric Care ◽  
Care Service ◽  
Primary Care Service ◽  
Clinical Implications ◽  
Model Of Care ◽  
Wide Range ◽  
Set Up ◽  
Acute Psychiatric Care

Aims and MethodA prospective descriptive study was set up to evaluate the feasibility, acceptability and activity of an innovative weekly primary care service for patients admitted for acute psychiatric care.ResultsDuring 10 months, 36 clinics were held and 123 appointments were attended. Presenting complaints included a wide range of acute and chronic conditions, affecting all body systems. As well as treating specific complaints, the doctor providing this service undertook considerable health promotion work and gave advice about patient management to junior psychiatrists.Clinical ImplicationsIt appears that there is considerable need for primary care expertise within an acute psychiatric unit, and that a weekly clinic is a feasible model of care.

scholarly journals Roll-over test in primigravidae attending a public primary care service

1997 ◽  
Vol 115 (5) ◽  
pp. 1533-1536
Author(s):  
Luiz Francisco Marcopito
Keyword(s):  
Blood Pressure ◽  
Primary Care ◽  
Roc Curve ◽  
Operating Characteristic ◽  
Care Setting ◽  
Care Service ◽  
Primary Care Service ◽  
Pregnancy Induced Hypertension ◽  
Predictive Values ◽  
Induced Hypertension

OBJECTIVE:To determine the roll-over test (ROT) performance in predicting pregnancy-induced hypertension (PIH) in primigravidae aged 15-29 years in a public primary care service. METHOD: Prospective cohort study enrolling 369 consecutive and initially normotensive primigravidae. The ROT was applied within 28-32 weeks of pregnancy. PIH was defined as diastolic blood pressure (DBP) 90 mm Hg or systolic blood pressure (SBP) 140 mm Hg, or a rise in DBP 15 mm Hg or a rise in SBP 30 mm Hg. The ROT prognostic properties were calculated, and a receiver operating characteristic (ROC) curve was constructed. RESULTS: For the 20 mm Hg cutoff point, sensitivity was 20% and specificity was 93%. Positive and negative predictive values were, respectively, 23% and 92%, for a PIH cumulative incidence of 9.5%. With other cutoff points, the ROC curve showed a poor discriminatory value of the test. CONCLUSION: The ROT was not useful for predicting PIH in a primary prenatal care setting.

scholarly journals Characteristics of Patients Using Different Patient Portal Functions and the Impact on Primary Care Service Utilization and Appointment Adherence: Retrospective Observational Study

10.2196/14410 ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. e14410 ◽  
Author(s):  
Xiang Zhong ◽  
Jaeyoung Park ◽  
Muxuan Liang ◽  
Fangyun Shi ◽  
Pamela R Budd ◽  
...  
Keyword(s):  
Primary Care ◽  
Service Utilization ◽  
Care Delivery ◽  
Care Service ◽  
Primary Care Service ◽  
Patient Portal ◽  
Patient Portals ◽  
Appointment Adherence ◽  
Primary Care Patients ◽  
The Impact

Background Patient portals are now widely available and increasingly adopted by patients and providers. Despite the growing research interest in patient portal adoption, there is a lack of follow-up studies describing the following: whether patients use portals actively; how frequently they use distinct portal functions; and, consequently, what the effects of using them are, the understanding of which is paramount to maximizing the potential of patient portals to enhance care delivery. Objective To investigate the characteristics of primary care patients using different patient portal functions and the impact of various portal usage behaviors on patients’ primary care service utilization and appointment adherence. Methods A retrospective, observational study using a large dataset of 46,544 primary care patients from University of Florida Health was conducted. Patient portal users were defined as patients who adopted a portal, and adoption was defined as the status that a portal account was opened and kept activated during the study period. Then, users were further classified into different user subgroups based on their portal usage of messaging, laboratory, appointment, and medication functions. The intervention outcomes were the rates of primary care office visits categorized as arrived, telephone encounters, cancellations, and no-shows per quarter as the measures of primary care service utilization and appointment adherence. Generalized linear models with a panel difference-in-differences study design were then developed to estimate the rate ratios between the users and the matched nonusers of the four measurements with an observational window of up to 10 quarters after portal adoption. Results Interestingly, a high propensity to adopt patient portals does not necessarily imply more frequent use of portals. In particular, the number of active health problems one had was significantly negatively associated with portal adoption (odds ratios [ORs] 0.57-0.86, 95% CIs 0.51-0.94, all P<.001) but was positively associated with portal usage (ORs 1.37-1.76, 95% CIs 1.11-2.22, all P≤.01). The same was true for being enrolled in Medicare for portal adoption (OR 0.47, 95% CI 0.41-0.54, P<.001) and message usage (OR 1.44, 95% CI 1.03-2.03, P=.04). On the impact of portal usage, the effects were time-dependent and specific to the user subgroup. The most salient change was the improvement in appointment adherence, and patients who used messaging and laboratory functions more often exhibited a larger reduction in no-shows compared to other user subgroups. Conclusions Patients differ in their portal adoption and usage behaviors, and the portal usage effects are heterogeneous and dynamic. However, there exists a lack of match in the patient portal market where patients who benefit the most from patient portals are not active portal adopters. Our findings suggest that health care delivery planners and administrators should remove the barriers of adoption for the portal beneficiaries; in addition, they should incorporate the impact of portal usage into care coordination and workflow design, ultimately aligning patients’ and providers’ needs and functionalities to effectively deliver patient-centric care.

Role of out of hours primary care service in limiting inappropriate access to emergency department

2017 ◽  
Vol 13 (4) ◽  
pp. 549-555 ◽  
Author(s):  
Andrea Posocco ◽  
Maria Paola Scapinello ◽  
Irene De Ronch ◽  
Francesco Castrogiovanni ◽  
Gianluca Lollo ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Care Service ◽  
Primary Care Service ◽  
Out Of Hours

PP19 Primary care streaming in emergency departments- contexts and mechanisms associated with perceived effectiveness outcomes: a realist evaluation

2021 ◽  
Vol 38 (9) ◽  
pp. A9.1-A9
Author(s):  
Michelle Edwards ◽  
Alison Cooper ◽  
Freya Davies ◽  
Andrew Carson Stevens ◽  
Adrian Edwards ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Emergency Departments ◽  
Patient Flow ◽  
Care Service ◽  
Realist Evaluation ◽  
Primary Care Service ◽  
Evaluation Methodology ◽  
Service Development ◽  
Service Models

BackgroundRecent policy has encouraged emergency departments (EDs) to deploy nurses to stream patients from the ED front door to GPs working in a separate GP service operating within or alongside an ED. We aimed to describe mechanisms relating to effectiveness of streaming in different primary care service models identified in EDs. We explored perceptions of whether patients were perceived to be appropriately streamed to emergency care, primary care, other hospital services or community primary care services; and effects on patient flow (waiting times and length of stay in the ED); and safe streaming outcomes.MethodsWe used realist evaluation methodology to explore perceived streaming effectiveness. We visited 13 EDs with different primary care service models (purposively selected across England & Wales; 8 streamed primary care patients to a primary care clinician) and carried out observations of triage/streaming and patient flow and interviews with key members of staff (consultants, GPs, nurses). Field notes and audio-recorded interviews were transcribed and analysed by creating context, mechanism and outcome configurations to refine and develop theories relating to streaming effectiveness.ResultsWe identified five contexts (nurses’ knowledge and experience, streaming guidance, teamwork and communication, operational management and strategic management) that facilitated mechanisms that influenced the effectiveness of streaming (streaming to an appropriate service, patient flow, delivering safe care). We integrated a middle range psychological theory (cognitive continuum theory) with our findings to recommend a focus for training nurses in streaming and service improvements.ConclusionsWe identified key mechanisms relating to the effectiveness of primary care streaming in different models of service. We recommend a collaborative approach to service development, guidance and training (including input from ED clinicians and primary care clinicians) and a range of training strategies that are suitable for less experienced junior nurses and more experienced senior nurses and nurse practitioners.

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