Evaluation of a collaborative care approach between general practitioners and clinical pharmacists in primary care community settings in elderly patients on polypharmacy in Slovenia: a cohort retrospective study reveals positive evidence for implementation

Rationale, aims and objectives: Depression is a major and complex problem in primary care. Stepped Collaborative Care (SCC) models for depression have been developed to support primary care in diagnostic and therapeutic procedures. This study aimed to compare barriers and facilitators experienced by general practitioners (GPs), practice nurses for psychosocial care, primary care psychologists and patients working with SCC for depression and to discuss possible solutions for barriers in daily practice.Method: Conventional content analysis of focus group data. Nine mono-disciplinary focus groups including 16 general practitioners (GPs), 4 practice nurses, 6 psychologists and 23 patients.Results: All 4 participant groups appeared to perceive a need for more skills, support and time for GPs to adequately assess symptoms and initiate psychosocial management accordingly. Psychologists often ignore a GP’s diagnosis. The GPs’ diagnostic uncertainty and their unfamiliarity with psychological therapies can result in inappropriate treatments, incorrect referrals and long waiting lists. To improve stepped collaborative care programs for psychosocial symptoms, improving initial symptom assessment by the GP, seems the most important aspect. All participants agreed that diagnostic tools/questionnaires should be used in primary care, but such activities should not be complicated and should not add to the GPs’ workload. Patients need more information to share decisions with their care providers.Conclusion: There is a need for a diagnostic-therapeutic tool to support GPs in regulating the influx of patients in SCC models and enhancing the effect of SCC in daily practice in order to improve the person-centeredness and efficiency of primary healthcare.

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A preliminary qualitative study of general practitioners’ views on malnutrition management and oral nutritional supplementation prescription in the community

Proceedings of The Nutrition Society ◽

10.1017/s0029665120002803 ◽

2020 ◽

Vol 79 (OCE2) ◽

Author(s):

Patricia Domínguez Castro ◽

Sharon Kennelly ◽

Barbara Clyne ◽

Gerard Bury ◽

Catriona Bradley ◽

...

Keyword(s):

Primary Care ◽

At Risk ◽

Qualitative Study ◽

General Practitioners ◽

Health Care Professionals ◽

Inappropriate Prescribing ◽

Community Setting ◽

Community Dwelling ◽

Care Community ◽

Oral Nutritional Supplements

AbstractMalnutrition, arising from a deficiency of energy and protein intake, occurs commonly among community-dwelling individuals. Oral nutritional supplements (ONS) are an effective method of managing malnutrition if prescribed for patients who are malnourished or at risk of malnutrition. However, previous research indicates that inappropriate prescribing of ONS occurs frequently in the community setting (30–70% prevalence). Moreover, it has been previously shown that the management of patients ‘at risk’ of malnutrition in the primary care/community setting in Ireland is sub-optimal, with low awareness of the condition and its management among non-dietetic health care professionals (HCPs). In Ireland, general practitioners (GPs) are the main prescribers of ONS in primary care. They are also on many occasions the first point of contact for individuals in the community who are malnourished or at risk of malnutrition. Therefore, exploring their experiences and perceptions can provide insight into the complexities of managing malnutrition and ONS prescribing in the community. The aim of this qualitative study was to explore GPs’ experiences and opinions on the management of malnutrition and the prescription of ONS in the primary care/community setting in Ireland. Semi-structured interviews were conducted with nine GPs. The interview explored among others the following domains; Barriers and facilitators in the management of malnutrition, ONS prescribing in the primary care/community setting, and future directions in the management of malnutrition and ONS prescribing. Recorded interviews were transcribed and analysed using inductive thematic analysis. Three main themes were identified; i) Malnutrition a secondary concern, encapsulating the idea that malnutrition is not something that GPs screen for in isolation ii) Resources and support for managing malnutrition are needed in the community iii) Reluctance to prescribe ONS. GPs reported not screening for malnutrition, but viewed it as a consequence of other conditions and social factors. According to the GPs, they should not have sole responsibility for malnutrition management and more dietitians and trained community nurses would be desirable to support them to deal with malnutrition in the community. A preference to avoid supplementation and implement dietary changes first was expressed by GPs. As main prescribers, GPs thought that they should receive further independent trainingon the different ONS available in the market as currently they did not feel confident prescribing a range of them. Awareness of ONS cost and its misuse by certain patients were reported as reasons that made GPs reluctant to prescribe them, potentially leading to under prescribing.

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Development and assessment of an active strategy for the implementation of a collaborative care approach for depression in primary care (the INDI·i project)

BMC Health Services Research ◽

10.1186/s12913-017-2774-2 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 2

Author(s):

Enric Aragonès ◽

Diego Palao ◽

Germán López-Cortacans ◽

Antonia Caballero ◽

Narcís Cardoner ◽

...

Keyword(s):

Primary Care ◽

Collaborative Care ◽

Active Strategy ◽

Care Approach

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Collaborative Care Between Clinical Pharmacists and General Practitioners in Patients with Alzheimer's Disease in Slovenia

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.1729 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S474-S474 ◽

Cited By ~ 1

Author(s):

M. Stuhec ◽

A. Premus Marusic

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

General Practitioners ◽

Collaborative Care ◽

Clinical Pharmacist ◽

Inappropriate Prescribing ◽

European Countries ◽

Clinical Pharmacists ◽

Number Of Patients ◽

Additional Costs

BackgroundAlzheimer's disease (AD) patients are often treated with inadequate doses of AD's medications, which can lead to harms and additional costs.ObjectiveIn most European countries, there is no data on inappropriate prescribing (IP) in patients with AD in terms of inadequate doses. In Slovenia, the interest for a collaborative care between clinical pharmacists and physicians is increasing, mainly because of payer's interest to reduce several additional costs.AimThe main aim of this paper was to present the benefits of clinical pharmacist interventions in AD patients in community health centres in Eastern Slovenia.MethodsAll included outpatients with AD in 2013 were included, where clinical pharmacists’ interventions were ordered by the general practitioners (GPs). All study data from the patients’ records were obtained from the clinical pharmacists’ reports and patients’ charts. Main outcome measures were obtained from the summary of the patients’ treatments and the questionnaires.ResultsSix hundred and twenty-nine patients were included. Before the clinical pharmacist medications review, 39 patients were treated with AD medications (10 without established AD). In 51.0% of these cases, the suggestions to GPs were provided (mainly dose adjustment). In 70.0% of all cases, the recommendations were accepted by GPs, which led to a total reduction in the number of patients with IP (before 20 and after 6).ConclusionsA clinical pharmacist could help GPs in recognizing IP in patients with AD. These data will guide health system directors and clinical coordinators in allocating resources to establish this cooperation in more European countries.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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