scholarly journals Medication reviews in hospitalized patients: a qualitative study on perceptions of primary and secondary care providers on interprofessional collaboration

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Bregje Walraven ◽  
Godelieve Ponjee ◽  
Wieke Heideman ◽  
Fatma Karapinar Çarkit
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Secondary Care ◽  
Interprofessional Collaboration ◽  
Primary Care Providers ◽  
Care Providers ◽  
Hospitalised Patients ◽  
Medication Reviews ◽  
Insight Into

Abstract Background In-hospital medication reviews are regularly performed. However, discontinuity in care could occur because secondary care providers lack insight into the outpatient history. Furthermore, for the implementation or follow-up of some medication review-based interventions, the help of primary care providers is essential. This requires interprofessional collaboration between secondary and primary care. Therefore, the aim of this qualitative study was to gain insight into the perceptions of primary and secondary care providers on interprofessional collaboration on medication reviews in hospitalised patients. Methods Ten face-to-face semi-structured interviews and three focus group discussions were conducted with 20 healthcare providers from three hospitals and community health services. The interviews were aimed at exploring general practitioners’, community pharmacists’, geriatricians’, and hospital pharmacists’ experiences, attitudes, and views of interprofessional collaboration. Focus groups consisted of representatives of all professional groups. Through group discussion, interprofessional collaboration was explored by addressing three main questions: 1) What are the benefits of in-hospital medication reviews? 2) What are the barriers to in-hospital medication reviews from an interprofessional collaboration perspective? 3) Given the barriers mentioned, how should this interprofessional collaboration between primary and secondary care be designed? Data were analysed using a thematic-content approach. Results The need for in-hospital medication reviews was underlined due to their many benefits, such as reducing potentially preventable re-admissions. Barriers regarding interprofessional collaboration between primary and secondary care can be subdivided into three main themes: 1) defining in-hospital medication reviews (e.g., lack of clear goals), 2) execution of medication reviews (e.g., hospital setting is dynamic), and 3) follow-up after discharge (e.g., unclear instructions). Care providers suggested solutions for each of the barriers mentioned, for example, by using supportive staff in order to overcome the gap between primary and secondary care providers and making clear agreements on proper means of communication. Conclusion Primary and secondary care providers recognise the importance of in-hospital medication reviews and the need for interprofessional collaboration. To create satisfying interprofessional collaboration, conditions should be met on defining in-hospital medication reviews across settings and involving both primary and secondary care providers in implementing medication reviews and organising their follow-up.

scholarly journals Facilitating treatment of HCV in primary care in regional Australia: closing the access gap

2018 ◽  
Vol 10 (3) ◽  
pp. 210-216 ◽  
Author(s):  
Lauren White ◽  
Ali Azzam ◽  
Lauren Burrage ◽  
Clare Orme ◽  
Barbara Kay ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Transient Elastography ◽  
Liver Stiffness ◽  
Primary Care Providers ◽  
Treatment Recommendation ◽  
Care Providers ◽  
Hcv Treatment ◽  
Community Based

BackgroundAustralia has unrestricted access to direct-acting antivirals (DAA) for hepatitis C virus (HCV) treatment. In order to increase access to treatment, primary care providers are able to prescribe DAA after fibrosis assessment and specialist consultation. Transient elastography (TE) is recommended prior to commencement of HCV treatment; however, TE is rarely available outside secondary care centres in Australia and therefore a requirement for TE could represent a barrier to access to HCV treatment in primary care.ObjectivesIn order to bridge this access gap, we developed a community-based TE service across the Sunshine Coast and Wide Bay areas of Queensland.DesignRetrospective analysis of a prospectively recorded HCV treatment database.InterventionsA nurse-led service equipped with two mobile Fibroscan units assesses patients in eight locations across regional Queensland. Patients are referred into the service via primary care and undergo nurse-led TE at a location convenient to the patient. Patients are discussed at a weekly multidisciplinary team meeting and a treatment recommendation made to the referring GP. Treatment is initiated and monitored in primary care. Patients with cirrhosis are offered follow-up in secondary care.Results327 patients have undergone assessment and commenced treatment in primary care. Median age 48 years (IQR 38–56), 66% male. 57% genotype 1, 40% genotype 3; 82% treatment naïve; 10% had cirrhosis (liver stiffness >12.5 kPa). The majority were treated with sofosbuvir-based regimens. 26% treated with 8-week regimens. All patients had treatment prescribed and monitored in primary care. Telephone follow-up to confirm sustained virological response (SVR) was performed by clinic nurses. 147 patients remain on treatment. 180 patients have completed treatment. SVR data were not available for 19 patients (lost to follow-up). Intention-to-treat SVR rate was 85.5%. In patients with complete data SVR rate was 95.6%.ConclusionCommunity-based TE assessment facilitates access to HCV treatment in primary care with excellent SVR rates.

scholarly journals ‘Welzijn op Recept’ (Social Prescribing): a helping hand in re-establishing social contacts – an explorative qualitative study

2017 ◽  
Vol 19 (03) ◽  
pp. 223-231 ◽  
Author(s):  
Miriam L. Heijnders ◽  
J. J. Meijs
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Psychosocial Problems ◽  
Well Being ◽  
Primary Care Providers ◽  
Care Providers ◽  
Social Contacts ◽  
Self Confidence ◽  
The Social

‘Welzijn op Recept’ is an intervention in which primary care providers refer patients with psychosocial problems to a community well-being organisation. Welzijn op Recept has been helping participants in the town of Nieuwegein, the Netherlands for more than three years. An impact study was carried out from September to December 2014. The qualitative study aimed to determine what happens in the chain of the social prescription and what changes the participant experiences in terms of social participation. The participants in this study were selected by the well-being coaches. A total of 10 semi-structured in-depth interviews were conducted. This study has shown that the participants had confidence in their referral to the community well-being organisation. The well-being coaches constitute a link between primary care providers, patients and the community well-being organisation. Participants have explicitly indicated that they experienced an increase in their own strength, self-confidence, self-reliance and the number of social contacts, and stated that they are experiencing better health. A point of special interest in the current programme is the planning of structured follow-up interviews after starting up an activity.

scholarly journals “She Knows Me Best”: A Qualitative Study of Patient and Caregiver Views on the Role of the Primary Care Physician Follow-Up Post-Discharge

2021 ◽  
Author(s):  
Sarah Griffiths ◽  
Gaibrie Stephen ◽  
Tara Kiran ◽  
Karen Okrainec
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Hospital Discharge ◽  
Care Provider ◽  
Primary Care Provider ◽  
Primary Care Providers ◽  
Care Providers ◽  
Post Discharge

Abstract BackgroundPatients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are at high-risk of readmission after hospital discharge. There is conflicting evidence however on whether timely follow-up with a primary care provider reduces that risk. The objective of this study is to understand the perspectives of patients with COPD and CHF, and their caregivers, on the role of primary care provider follow-up after hospital discharge.MethodsA qualitative study design with semi-structured interviews was conducted among patients or their family caregivers admitted with COPD or CHF who were enrolled in a multicenter mixed-methods study at three acute care hospitals in Ontario, Canada. Participants were interviewed between December 2017 to January 2019, the majority discharged from hospital at least 30 days prior to their interview. Interviews were analyzed independently by three authors using a deductive directed content analysis, with the fourth author cross-comparing themes.ResultsInterviews with 16 participants (eight patients and eight caregivers) revealed four main themes. First, participants valued visiting their primary care provider after discharge to build upon their longitudinal relationship. Second, primary care providers played a key role in coordinating care. Third, there were mixed views on the ideal time for follow-up, with many participants expressing a desire to delay follow-up to stabilize following their acute hospitalization. Fourth, the link between the post-discharge visit and preventing hospital readmissions was unclear to participants, who often self-triaged based on their symptoms when deciding on the need for emergency care.ConclusionsPatients and caregivers valued in-person follow-up with their primary care provider following discharge from hospital because of the trust established through pre-existing longitudinal relationships. Our results suggest policy makers should focus on improving rates of primary care provider attachment and systems supporting informational continuity.

scholarly journals EP02 How much time do we spend seeing non-inflammatory conditions? A district general hospital’s perspective

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Matthew J Saunders ◽  
Ceril Rhys-Dillon ◽  
Catrin M Jones
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Waiting Times ◽  
Resource Planning ◽  
Primary Care Providers ◽  
General Idea ◽  
Care Providers ◽  
Case Load ◽  
Inflammatory Conditions

Abstract Background With the ever-increasing pressure of outpatient waiting times affecting rheumatology clinics, we were interested to determine the proportion of non-inflammatory conditions seen in our department. The general consensus among rheumatologists is that non-inflammatory conditions should be managed outside of secondary care, although, these should be referred for specialist opinion where the diagnosis is uncertain. Rheumatologists have a general idea of their current outpatient case load, but to provide a more accurate assessment and to assist with resource planning, we analysed our case load over a one-month period. Methods All outpatient follow up and new patient clinics during March 2019 were included in the study. Cancellations and 'did not attends' (DNA) were calculated for statistical analysis, but these patients were excluded from the dataset. Gender and diagnosis data were collected using Rheumatology clinic letters and multiple diagnoses were included if these were deemed to contribute to the original presentation or follow up. The diagnoses were grouped into three broad categories: inflammatory (including rheumatoid arthritis, psoriatic arthritis, undifferentiated arthritis, connective tissue disease, vasculitis, ankylosing spondylitis and rare diseases); non-inflammatory (including osteoarthritis, Ffbromyalgia and non-inflammatory arthralgia) and others (including crystal arthropathy, polymyalgia rheumatica and osteoporosis). The categorisation was based upon the need for patient follow up. Those with inflammatory conditions requiring follow-up, non-inflammatory patients not requiring follow up and others having follow up determined on a case-by-case basis. Results 43 clinics met the criteria for inclusion, providing a cohort of 532 patients. 121 (22.7%) patients cancelled or DNA and these were excluded. There were 73 (17.8%) new patients, with 80 diagnoses, and 338 (82.2%) follow up patients, with 356 diagnoses, of whom 294 (71.5%) were female. Of the New patients, there were 29 (36.25%) working diagnoses of inflammatory conditions, 41 (51.25%) working diagnosis of non-inflammatory conditions and 10 (12.5%) others. Of the follow up patients, there were 268 (75.3%) inflammatory working diagnoses with 33 (9.3%) having a working diagnosis of a non-inflammatory condition plus 55 (15.4%) others. Conclusion More than half of the new patients referred to clinic were diagnosed or suspected to have non-inflammatory conditions. Non-inflammatory conditions rarely required follow up, as reflected by only 9.3% of follow up appointments being allocated to this group. Is this prudent healthcare? Are there alternative ways in which rheumatology teams could work with Primary care to reduce referral rates, enabling earlier diagnosis and treatment in the community for patients with non-inflammatory conditions? Or, is this a valuable service provided by Secondary care, supporting the work of primary care providers? This is a valuable study for our team and further work is now underway within our healthcare community to discuss these findings with primary care teams and to plan accordingly. Disclosures M.J. Saunders None. C. Rhys-Dillon None. C.M. Jones None.

scholarly journals Evaluation of a multidisciplinary lipid clinic to improve the care of individuals with severe lipid conditions: a RE-AIM framework analysis

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Laney K. Jones ◽  
Megan McMinn ◽  
David Kann ◽  
Michael Lesko ◽  
Amy C. Sturm ◽  
...  
Keyword(s):  
Primary Care ◽  
Program Effectiveness ◽  
Primary Care Providers ◽  
Care Providers ◽  
Lipid Levels ◽  
Framework Analysis ◽  
Lipid Clinic ◽  
Adherence Counseling ◽  
Clinically Significant

Abstract Background Individuals with complex dyslipidemia, or those with medication intolerance, are often difficult to manage in primary care. They require the additional attention, expertise, and adherence counseling that occurs in multidisciplinary lipid clinics (MDLCs). We conducted a program evaluation of the first year of a newly implemented MDLC utilizing the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework to provide empirical data not only on program effectiveness, but also on components important to local sustainability and future generalizability. Methods The purpose of the MDLC is to increase the uptake of guideline-based care for lipid conditions. Established in 2019, the MDLC provides care via a centralized clinic location within the healthcare system. Primary care providers and cardiologists were invited to refer individuals with lipid conditions. Using a pre/post-study design, we evaluated the implementation outcomes from the MDLC using the RE-AIM framework. Results In 2019, 420 referrals were made to the MDLC (reach). Referrals were made by 19% (148) of the 796 active cardiology and primary care providers, with an average of 35 patient referrals per month in 2019 (SD 12) (adoption). The MDLC saw 83 patients in 2019 (reach). Additionally, 50% (41/82) had at least one follow-up MDLC visit, and 12% (10/82) had two or more follow-up visits in 2019 (implementation). In patients seen by the MDLC, we found an improved diagnosis of specific lipid conditions (FH (familial hypercholesterolemia), hypertriglyceridemia, and dyslipidemia), increased prescribing of evidence-based therapies, high rates of medication prior authorization approvals, and significant reductions in lipid levels by lipid condition subgroup (effectiveness). Over time, the operations team decided to transition from in-person follow-up to telehealth appointments to increase capacity and sustain the clinic (maintenance). Conclusions Despite limited reach and adoption of the MDLC, we found a large intervention effect that included improved diagnosis, increased prescribing of guideline-recommended treatments, and clinically significant reduction of lipid levels. Attention to factors including solutions to decrease the large burden of unseen referrals, discussion of the appropriate number and duration of visits, and sustainability of the clinic model could aid in enhancing the success of the MDLC and improving outcomes for more patients throughout the system.

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