Primary prescription adherence for obstructive lung disease in a primary care population

Abstract Background The objective of this study was to determine primary prescription adherence for obstructive lung diseases (e.g., asthma, COPD) in an adult primary care patient population over a 3-year period. Methods A retrospective analysis of electronic medical record and administrative data was performed to determine primary adherence, defined as dispensation of a new prescription within 90 days of the date the prescription was written. Multivariable logistic regression models were used to test predictors of prescription primary adherence. Results Of 13,220 prescriptions for obstructive airway disease, 75.9% (N = 10,038) were filled. In multivariate analysis, depression, certain age groups (18–44 years), higher income quartile were associated with reduced prescription adherence. However, 1–2 ER visits in the previous year (compared to no ER visits), number of ambulatory visits in the previous year, and number of hospitalizations in the previous year, did not increase the likelihood of prescription adherence. Interpretation This study provides important insights about factors associated with prescription nonadherence and is the first study examining primary medication adherence with medications for obstructive lung disease in adults, providing indications of prescription nonadherence patterns among a broad population.

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CONUT: a tool to assess nutritional status. First application in a primary care population

Diagnosis ◽

10.1515/dx-2020-0073 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Maria Salinas ◽

Emilio Flores ◽

Alvaro Blasco ◽

Maite López-Garrigós ◽

Carmen Puche ◽

...

Keyword(s):

Primary Care ◽

At Risk ◽

Clinical Laboratory ◽

Primary Care Patient ◽

Demographic Data ◽

Health Department ◽

Care Patient ◽

Primary Care Population ◽

Primary Care Patients ◽

Conut Score

AbstractObjectivesMalnutrition is an unfavorable prognostic factor associated with an increase in mortality, hospital stays, readmissions and resources consumption. The aim was to screen primary care patients for risk of malnutrition by using the control nutritional (CONUT) score, calculated through total lymphocytes count, serum albumin and total cholesterol, when the three markers were requested, and to compare results between primary care centers (PCC).MethodsThe clinical laboratory located in a 370-bed suburban University Community Hospital serves the Health Department inhabitants (2,34,551), attended in nine PCC. The laboratory information system (LIS) automatically calculated the CONUT score in every primary care patient over 18 years old, when all three laboratory markers were ordered by the General Practitioner. For all primary care patients, we collected demographic data, CONUT index and PCC. We classified results by PCC, and compared them.ResultsThe clinical laboratory received 74,743 requests from primary care. The CONUT score was calculated in 7,155 (12.28%) patients. Nine hundred seventy-six (13.6%) were at risk of malnutrition according to the CONUT score, mainly male (p<0.01) and over 65 (p<0.01). Detected cases of malnutrition were all mild, except 48 patients (4.9%) with moderate, and one (0.1%) with severe risk. The percentage of patients at risk of malnutrition was not significantly different among PCC, with the exception of one with patients at lower malnutrition risk.ConclusionsIt is possible to use CONUT score as a front-line population-wide laboratory marker to screen for the risk for malnutrition in primary care patients that was lower in one PCC.

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Faecal immunochemical test to triage patients with abdominal symptoms for suspected colorectal cancer in primary care: review of international use and guidelines

Family Practice ◽

10.1093/fampra/cmaa043 ◽

2020 ◽

Vol 37 (5) ◽

pp. 606-615 ◽

Cited By ~ 2

Author(s):

Marije van Melle ◽

Samir I S Yep Manzano ◽

Hugh Wilson ◽

Willie Hamilton ◽

Fiona M Walter ◽

...

Keyword(s):

Colorectal Cancer ◽

Primary Care ◽

Primary Care Patient ◽

Care Patient ◽

Bowel Habit ◽

Level Of Evidence ◽

Primary Care Population ◽

Abdominal Symptoms ◽

Primary Care Patients ◽

The Uk

Abstract Background Recently, faecal immunochemical tests (FITs) have been introduced for investigation of primary care patients with low-risk symptoms of colorectal cancer (CRC), but recommendations vary across the world. This systematic review of clinical practice guidelines aimed to determine how FITs are used in symptomatic primary care patients and the underpinning evidence for these guidelines. Methods MEDLINE, Embase and TRIP databases were systematically searched, from 1 November 2008 to 1 November 2018 for guidelines on the assessment of patients with symptoms suggestive of CRC. Known guideline databases, websites and references of related literature were searched. The following questions were addressed: (i) which countries use FIT for symptomatic primary care patients; (ii) in which populations is FIT used; (iii) what is the cut-off level used for haemoglobin in the faeces (FIT) and (iv) on what evidence are FIT recommendations based. Results The search yielded 2433 publications; 25 covered initial diagnostic assessment of patients with symptoms of CRC in 15 countries (Asia, n = 1; Europe, n = 13; Oceania, n = 4; North America, n = 5; and South America, n = 2). In three countries (Australia, Spain and the UK), FIT was recommended for patients with abdominal symptoms, unexplained weight loss, change in bowel habit or anaemia despite a low level of evidence in the symptomatic primary care patient population. Conclusions Few countries recommend FITs in symptomatic patients in primary care either because of limited evidence or because symptomatic patients are directly referred to secondary care without triage. These results demonstrate a clear need for research on FIT in the symptomatic primary care population.

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Nature and type of patient-reported safety incidents in primary care: cross-sectional survey of patients from Australia and England

BMJ Open ◽

10.1136/bmjopen-2020-042551 ◽

2021 ◽

Vol 11 (4) ◽

pp. e042551

Author(s):

Andrea L Hernan ◽

Sally J Giles ◽

Andrew Carson-Stevens ◽

Mark Morgan ◽

Penny Lewis ◽

...

Keyword(s):

Primary Care ◽

Primary Care Patient ◽

Care Patient ◽

System Level ◽

Service Improvement ◽

Cross Sectional ◽

Positive Effects ◽

Contributory Factors ◽

Safety Incident ◽

Patient Reported

BackgroundPatient engagement in safety has shown positive effects in preventing or reducing adverse events and potential safety risks. Capturing and utilising patient-reported safety incident data can be used for service learning and improvement.ObjectiveThe aim of this study was to characterise the nature of patient-reported safety incidents in primary care.DesignSecondary analysis of two cross sectional studies.ParticipantsAdult patients from Australian and English primary care settings.MeasuresPatients’ self-reported experiences of safety incidents were captured using the validated Primary Care Patient Measure of Safety questionnaire. Qualitative responses to survey items were analysed and categorised using the Primary Care Patient Safety Classification System. The frequency and type of safety incidents, contributory factors, and patient and system level outcomes are presented.ResultsA total of 1329 patients (n=490, England; n=839, Australia) completed the questionnaire. Overall, 5.3% (n=69) of patients reported a safety incident over the preceding 12 months. The most common incident types were administration incidents (n=27, 31%) (mainly delays in accessing a physician) and incidents involving diagnosis and assessment (n=16, 18.4%). Organisation of care accounted for 27.6% (n=29) of the contributory factors identified in the safety incidents. Staff factors (n=13, 12.4%) was the second most commonly reported contributory factor. Where an outcome could be determined, patient inconvenience (n=24, 28.6%) and clinical harm (n=21, 25%) (psychological distress and unpleasant experience) were the most frequent.ConclusionsThe nature and outcomes of patient-reported incidents differ markedly from those identified in studies of staff-reported incidents. The findings from this study emphasise the importance of capturing patient-reported safety incidents in the primary care setting. The patient perspective can complement existing sources of safety intelligence with the potential for service improvement.

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Lean Workflow changes may contribute to Improved primary care patient satisfaction

Value in Health ◽

10.1016/j.jval.2015.03.1520 ◽

2015 ◽

Vol 18 (3) ◽

pp. A261

Author(s):

P. Chen

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Primary Care Patient ◽

Care Patient

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Impact of Primary Care Patient Visits on Racial and Ethnic Disparities in Preventive Care in the United States

The Journal of the American Board of Family Medicine ◽

10.3122/jabfm.2007.06.070053 ◽

2007 ◽

Vol 20 (6) ◽

pp. 587-597 ◽

Cited By ~ 34

Author(s):

K. Fiscella ◽

K. Holt

Keyword(s):

United States ◽

Primary Care ◽

Preventive Care ◽

Primary Care Patient ◽

Ethnic Disparities ◽

The United States ◽

Care Patient ◽

Racial And Ethnic Disparities

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Evaluation of the First Contact Physiotherapy (FCP) model of primary care: Patient characteristics and outcomes

Physiotherapy ◽

10.1016/j.physio.2021.08.002 ◽

2021 ◽

Author(s):

S. Stynes ◽

K.P. Jordan ◽

J.C. Hill ◽

G. Wynne-Jones ◽

E. Cottrell ◽

...

Keyword(s):

Primary Care ◽

Primary Care Patient ◽

Patient Characteristics ◽

Care Patient ◽

First Contact

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Use of a Deprescribing Tool in an Interdisciplinary Primary-Care Patient-Aligned Care Team

The Senior Care Pharmacist ◽

10.4140/tcp.n.2022.34 ◽

2022 ◽

Vol 37 (1) ◽

pp. 34-43

Author(s):

Makayla W. Nelson ◽

Tara N. Downs ◽

Gina M. Puglisi ◽

Brent A. Simpkins ◽

Amy Schmelzer Collier

Keyword(s):

Primary Care ◽

Adverse Drug Events ◽

Primary Care Patient ◽

Care Patient ◽

Care Team ◽

Record System ◽

Cost Avoidance ◽

Increased Risk ◽

Medication Reviews ◽

Va Health Care System

Objective: To pilot the VIONE approach in a single Primary Care Patient Aligned Care Team (PACT). The authors aim for the Clinical Pharmacy Specialist (CPS) to perform 20 comprehensive medication reviews (CMRs) and the pilot PACT physician (PCP) to complete 200 VIONE discontinuations. Cost avoidance and CPS recommendations will also be analyzed. Polypharmacy is associated with increased risk of adverse drug events, falls, hospitalizations, and death. VIONE is a deprescribing tool that assists providers in identifying inappropriate medications. Design: Quality Improvement Setting: Single VA Health Care System (VAHCS) Participants: High-risk veterans in pilot PACT Interventions: The CPS educated the PCP regarding VIONE methodology and assisted with CMRs. When deprescribing was warranted, VIONE discontinuation reasons were selected in the Computerized Patient Record System (CPRS). Data were electronically stored in a national dashboard. Results: The authors identified 231 veterans at risk for polypharmacy-related adverse events. The PCP and CPS were able to reach 99 veterans and make 136 medication discontinuations between September 1, 2019, and March 1, 2020. The CPS performed 20 CMRs, resulting in 90 deprescribing recommendations. Thirty-eight CPS recommendations were accepted and contributed $18,835.95 to the sum annualized cost avoidance of $21,904.80. Conclusion: The VIONE methodology was successfully implemented in the pilot PACT. The utilization of the CPS was associated with an increased average number of medication discontinuations per veteran and contributed to cost avoidance.

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