scholarly journals Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: a qualitative secondary analysis guided by the Behaviour Change Wheel

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Patrick Kierkegaard ◽  
Timothy Hicks ◽  
A. Joy Allen ◽  
Yaling Yang ◽  
Gail Hayward ◽  
...  
Keyword(s):  
Primary Care ◽  
Behaviour Change ◽  
Professional Education ◽  
Primary Care Physicians ◽  
Point Of Care ◽  
Behaviour Change Wheel ◽  
Qualitative Interview Study ◽  
Care Practices ◽  
Willingness To Use ◽  
Primary Care Practices

Abstract Background The purpose of this study is to develop a theory-driven understanding of the barriers and facilitators underpinning physicians’ attitudes and capabilities to implementing SARS-CoV-2 point-of-care (POC) testing into primary care practices. Methods We used a secondary qualitative analysis approach to re-analyse data from a qualitative, interview study of 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify the barriers to implementing SARS-CoV-2 POC testing and identified strategies to address these challenges. Results Several factors underpinned primary care physicians’ attitudes and capabilities to implement SARS-CoV-2 POC testing into practice. First, limited knowledge of the SARS-CoV-2 POC testing landscape and a demanding workload affected physicians’ willingness to use the tests. Second, there was scepticism about the insufficient evidence pertaining to the clinical efficacy and utility of POC tests, which affected physicians’ confidence in the accuracy of tests. Third, physicians would adopt POC tests if they were prescribed and recommended by authorities. Fourth, physicians required professional education and training to increase their confidence in using POC tests but also suggested that healthcare assistants should administer the tests. Fifth, physicians expressed concerns about their limited workload capacity and that extra resources are needed to accommodate any anticipated changes. Sixth, information sharing across practices shaped perceptions of POC tests and the quality of information influenced physician perceptions. Seventh, financial incentives could motivate physicians and were also needed to cover the associated costs of testing. Eighth, physicians were worried that society will view primary care as an alternative to community testing centres, which would change perceptions around their professional identity. Ninth, physicians’ perception of assurance/risk influenced their willingness to use POC testing if it could help identify infectious individuals, but they were also concerned about the risk of occupational exposure and potentially losing staff members who would need to self-isolate. Conclusions Improving primary care physicians’ knowledgebase of SARS-CoV-2 POC tests, introducing policies to embed testing into practice, and providing resources to meet the anticipated demands of testing are critical to implementing testing into practice.

scholarly journals Understanding primary care-oncology relationships within a changing healthcare environment

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jennifer Tsui ◽  
Jenna Howard ◽  
Denalee O’Malley ◽  
William L. Miller ◽  
Shawna V. Hudson ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Transitions ◽  
Formal System ◽  
The United States ◽  
Comparative Case Study ◽  
Health Care Environment ◽  
Optimal Care ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background Management of care transitions from primary care into and out of oncology is critical for optimal care of cancer patients and cancer survivors. There is limited understanding of existing primary care-oncology relationships within the context of the changing health care environment. Methods Through a comparative case study of 14 innovative primary care practices throughout the United States (U.S.), we examined relationships between primary care and oncology settings to identify attributes contributing to strengthened relationships in diverse settings. Field researchers observed practices for 10–12 days, recording fieldnotes and conducting interviews. We created a reduced dataset of all text related to primary care-oncology relationships, and collaboratively identified patterns to characterize these relationships through an inductive “immersion/crystallization” analysis process. Results Nine of the 14 practices discussed having either formal or informal primary care-oncology relationships. Nearly all formal primary care-oncology relationships were embedded within healthcare systems. The majority of private, independent practices had more informal relationships between individual primary care physicians and specific oncologists. Practices with formal relationships noted health system infrastructure that facilitates transfer of patient information and timely referrals. Practices with informal relationships described shared commitment, trust, and rapport with specific oncologists. Regardless of relationship type, challenges reported by primary care settings included lack of clarity about roles and responsibilities during cancer treatment and beyond. Conclusions With the rapid transformation of U.S. healthcare towards system ownership of primary care practices, efforts are needed to integrate strengths of informal primary care-oncology relationships in addition to formal system driven relationships.

Enhancing the Safe and Effective Management of Chronic Pain in Accountable Care Organization Primary Care Practices in Kentucky

2016 ◽  
Vol 32 (2) ◽  
pp. 178-185 ◽  
Author(s):  
Selam Wubu ◽  
Laura Lee Hall ◽  
Paula Straub ◽  
Matthew J. Bair ◽  
Jill A. Marsteller ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Primary Care Physicians ◽  
The United States ◽  
Care Organization ◽  
Chronic Pain Management ◽  
Accountable Care ◽  
Care Practices ◽  
Primary Care Practices

Chronic pain is a prevalent chronic condition with significant burden and economic impact in the United States. Chronic pain is particularly abundant in primary care, with an estimated 52% of chronic pain patients obtaining care from primary care physicians (PCPs). However, PCPs often lack adequate training and have limited time and resources to effectively manage chronic pain. Chronic pain management is complex in nature because of high co-occurrence of psychiatric disorders and other medical comorbidities in patients. This article describes a quality improvement initiative conducted by the American College of Physicians (ACP), in collaboration with the Kentucky ACP Chapter, and the Center for Health Services and Outcomes Research at the Johns Hopkins Bloomberg School of Public Health, to enhance chronic pain management in 8 primary care practices participating in Accountable Care Organizations in Kentucky, with a goal of enhancing the screening, diagnosis, and treatment of patients with chronic pain.

scholarly journals Strategies To Implement SARS-CoV-2 Point-of-Care Testing Into Primary Care Settings: A Qualitative Secondary Analysis Guided By The Behaviour Change Wheel

2021 ◽  
Author(s):  
Patrick Kierkegaard ◽  
Timothy Hicks ◽  
A. Joy Allen ◽  
Yaling Yang ◽  
Gail Hayward ◽  
...  
Keyword(s):  
Primary Care ◽  
Behaviour Change ◽  
Point Of Care ◽  
Implementation Strategies ◽  
Intervention Strategies ◽  
Routine Practice ◽  
Behaviour Change Techniques ◽  
Successful Implementation ◽  
Primary Care Settings ◽  
Behaviour Change Wheel

Abstract Background: There is little empirical evidence to inform implementation strategies for introducing SARS-CoV-2 point of care (POC) testing into primary care settings. The purpose of this study is to develop a theory-driven understanding of the behavioural determinants underpinning the implementation of SARS-CoV-2 POC testing in primary care. This will allow identification of potential intervention strategies that could encourage successful implementation of testing into routine practice and facilitate face-to-face consultations.Methods: We used a secondary qualitative analysis approach to re-analyse data from a qualitative study that involved interviewing 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify barriers/enablers to the implementation of SARS-CoV-2 POC testing and identified behaviour change techniques to inform intervention strategies that targeted the barriers/enablers.Results: We identified 10 barriers and enablers to POC implementation under eight Theoretical Domains Framework (TDF): (1) knowledge; (2) behavioural regulation; (3) reinforcement; (4) skills; (5) environmental context and resources; (6) social influence; (7) professional role and identity; and (8) belief about consequences. Linkages with the Behaviour Change Techniques (BCT) taxonomy enabled the identification of intervention strategies to address the social and contextual factors influencing primary care physician’s willingness and capacity to adopt POC testing.Conclusions: A theory-informed approach identified barriers to the adoption of POC tests in primary care as well as guiding implementation strategies to address these challenges.

scholarly journals Potential COVID-19 vaccination opportunities in primary care practices in the United States

2021 ◽  
Author(s):  
Sanjay Basu ◽  
Rebecca Weintraub ◽  
Ishani Ganguli ◽  
Russell Phillips ◽  
Robert Phillips ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Primary Care Physicians ◽  
Medical Expenditure Panel Survey ◽  
Care Delivery ◽  
The United States ◽  
Medical Expenditure ◽  
Care Utilization ◽  
Care Practices ◽  
Primary Care Practices

AbstractRapid, widespread COVID-19 vaccination is critical to pandemic mitigation and recovery. To help policymakers interested in further enhancing primary care delivery of COVID-19 vaccines, it is important to estimate the absolute number of vaccination opportunities, and identify how these opportunities may fall disproportionately among different communities given the unequal way that COVID-19 falls upon communities of color, low-income, and rural communities. To quantify the potential benefits of greater primary care engagement in vaccination efforts, we estimated the number of potential vaccination opportunities (PVOs) in primary care in the remaining calendar months of year 2021, and the possible uptake if we supplied enough vaccine to primary care practices to fulfill their opportunities. To estimate how many potential vaccination opportunities (PVOs) may occur in primary care, we used three sets of data, analyzing the latest available waves of the following: (i) the National Ambulatory Medical Care Survey (NAMCS, 2016, N = 677 providers); (ii) the National Health Interview Survey (NHIS, 2018, N = 29,839 individuals in 29,839 households); and (iii) the Medical Expenditure Panel Survey (MEPS, 2018, N = 40,025 individuals in 14,500 households). Per the NAMCS data, which provide a nationally-representative sample of ambulatory care visits, primary care physicians normally provide 40.2 million primary care visits per month. The majority of the primary care utilization is absorbed by those aged 16 to 64 years old who are not otherwise priority groups (i.e., not having chronic diseases as defined by ACIP) but the second large group of visits are those with a chronic disease (27.2% of all visits). As compared to the NAMCS data providing an estimate of care from the perspective of providers, the overall sample in NHIS provides a view of primary care access and utilization from a population perspective. Per NHIS, 34% of the civilian US population saw a generalist physician in the prior calendar year, or 109.8 million people. Overall, we would estimate that over the latter half of calendar year 2021, approximately 15 million potential vaccine opportunities per month would be available through US primary care practices.

scholarly journals From Screening to Therapy: Anti-HCV Screening and Linkage to Care in a Network of General Practitioners and a Private Gastroenterology Practice

Pathogens ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1570
Author(s):  
David Petroff ◽  
Olaf Bätz ◽  
Katrin Jedrysiak ◽  
Anja Lüllau ◽  
Jan Kramer ◽  
...  
Keyword(s):  
Primary Care ◽  
Hepatitis C ◽  
Secondary Care ◽  
Primary Care Physicians ◽  
Linkage To Care ◽  
Drop Out ◽  
Hcv Rna ◽  
Care Practices ◽  
Hcv Screening ◽  
Primary Care Practices

(1) Background: Low rates of hepatitis C virus (HCV) diagnosis and sub-optimal linkage to care constitute barriers toward eliminating the infection. In 2012/2013, we showed that HCV screening in primary care detects unknown cases. However, hepatitis C patients may not receive further diagnostics and therapy because they drop out during the referral pathway to secondary care. Thus, we used an existing network of primary care physicians and a practice of gastroenterology to investigate the pathway from screening to therapy. (2) Methods: HCV screening was prospectively included in a routine check-up of primary care physicians who cooperated regularly with a private gastroenterology practice. Anti-HCV-positive patients were referred for further specialized diagnostics and treatment if indicated. (3) Results: Seventeen primary care practices screened 1875 patients. Twelve individuals were anti-HCV-positive (0.6%), six of them reported previous antiviral HCV therapy, and one untreated patient was HCV-RNA-positive (0.05% of the population). None of the 12 anti-HCV-positive cases showed up at the private gastroenterology practice. Further clinical details of the pathway from screening to therapy could not be analyzed. (4) Conclusions: The linkage between primary and secondary care appears to be problematic in the HCV setting even among cooperating partners, but robust conclusions require larger datasets.

scholarly journals Strategies to implement SARS-CoV-2 point-of-care testing into primary care settings: A qualitative secondary analysis guided by the Behaviour Change Wheel

2021 ◽  
Author(s):  
Patrick Kierkegaard ◽  
Timothy Hicks ◽  
A. Joy Allen ◽  
Yaling Yang ◽  
Gail Hayward ◽  
...  
Keyword(s):  
Primary Care ◽  
Behaviour Change ◽  
Point Of Care ◽  
Implementation Strategies ◽  
Intervention Strategies ◽  
Routine Practice ◽  
Behaviour Change Techniques ◽  
Successful Implementation ◽  
Primary Care Settings ◽  
Behaviour Change Wheel

Abstract Background There is little empirical evidence to inform implementation strategies for introducing SARS-CoV-2 point of care (POC) testing into primary care settings. The purpose of this study is to develop a theory-driven understanding of the behavioural determinants underpinning the implementation of SARS-CoV-2 POC testing in primary care. This will allow identification of potential intervention strategies that could encourage successful implementation of testing into routine practice and facilitate face-to-face consultations. Methods We used a secondary qualitative analysis approach to re-analyse data from a qualitative study that involved interviewing 22 primary care physicians from 21 primary care practices across three regions in England. We followed the three-step method based on the Behaviour Change Wheel to identify barriers/enablers to the implementation of SARS-CoV-2 POC testing and identified behaviour change techniques to inform intervention strategies that targeted the barriers/enablers. Results We identified 10 barriers and enablers to POC implementation under eight Theoretical Domains Framework (TDF): (1) knowledge; (2) behavioural regulation; (3) reinforcement; (4) skills; (5) environmental context and resources; (6) social influence; (7) professional role and identity; and (8) belief about consequences. Linkages with the Behaviour Change Techniques (BCT) taxonomy enabled the identification of intervention strategies to address the social and contextual factors influencing primary care physician’s willingness and capacity to adopt POC testing. Conclusions A theory-informed approach identified barriers to the adoption of POC tests in primary care as well as guiding implementation strategies to address these challenges.

scholarly journals Beliefs and practices among primary care physicians during the first wave of the COVID-19 pandemic in Baden-Wuerttemberg (Germany): an observational study 

2020 ◽  
Author(s):  
Catharina Roth ◽  
Amanda Breckner ◽  
Sophia Moellinger ◽  
Simon Schwill ◽  
Frank Peters-Klimm ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Insurance ◽  
Primary Care Physicians ◽  
Statutory Health Insurance ◽  
Contact Point ◽  
Beliefs And Practices ◽  
Contact Points ◽  
Care Practices ◽  
Primary Care Practices ◽  
Insurance Physicians

Abstract Background During the first wave of the COVID-19 pandemic various ambulatory health care models (SARS-CoV-2 contact points) were organised in a short period in Baden-Wuerttemberg, a region in Southern Germany. The aim of these SARS-CoV-2 contact points was to ensure medical treatment for patients with (suspected) and without SARS-CoV-2 infection. The present study aimed to assess the beliefs and practices of primary care physicians who either led a SARS-CoV-2 contact point or a primary care practice in Baden-Wuerttemberg during the first wave of the COVID-19 pandemic.Methods This cross-sectional study was based on a paper-based questionnaire in primary care physicians during the first wave of the pandemic. Participants were identified via the web page of the Association of Statutory Health Insurance Physicians Baden-Wuerttemberg. The questionnaire was distributed between June and July 2020. It measured knowledge, practices, self-efficacy and fears towards SARS-CoV-2, using newly developed questions. Data was descriptively analysed.Results 155 participants (92 leads of SARS-CoV-2 contact points/ 63 leads of primary care practices) completed the questionnaire. About half participants of both groups did not fear an own infection with the novel virus (between 50.8% and 65.2%), however about 75 % feared financial loss. Knowledge was gained using various sources; main sources were the Association of Statutory Health Insurance Physicians (between 79.3% and 82.5%) and the German Society for Hygiene and Microbiology (RKI) (between 88.9% and 94.6%). SARS-CoV-2 contact points treated on average more patients with (suspected) COVID-19 (mean 431.59) than primary care practices (mean 83.8) (p<0.001). Leads of SARS-CoV-2 contact point felt more confident to perform anamnestic/diagnostic procedures (p<0.001). The same was found for the confidence level regarding decision-making concerning the further treatment (p<0.001). Several prevention measures to contain the spread of SARS-CoV-2 were adopted.Conclusion Although primary care physicians rose to the challenges of the SARS-CoV-2 pandemic addressing their fears is essential. Next to adequate remuneration for COVID-19 care, support in the clinical and administrative management as well as a robust organisation of care are key issues to prevent exhaustion in the challenge of a prolonged response to the SARS-CoV-2 pandemic.Trial registration The study has been prospectively registered at the German Clinical Trial Register (DRKS00022224).

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