Opportunities for improving cancer care management through primary care-oncology relationships.

80 Background: Improvements in the management of care transitions between primary care and oncology are critical for achieving optimal care quality and outcomes for cancer patients and survivors. We examine relationships between innovative PC practices and oncologists to inform and strengthen PC-oncology interfaces in diverse healthcare settings. Methods: Comparative case studies of 14 innovative PC practices throughout the United States examined strategies for providing cancer survivorship care. Field researchers observed each practice for 10-12 days, recording fieldnotes and conducting key informant and formal, semi-structured interviews with clinicians and staff. We extracted all data related to PC-oncology relationships and then collaboratively identified patterns to characterize these relationships through an inductive “immersion/crystallization” analysis process. Results: Nine of the 14 practices discussed either formal or informal PC-oncology relationships. Nearly all practices with existing formal PC-oncology relationships were embedded within healthcare systems. Private, independent practices had more informal relationships between individual PC physicians and specific oncologists. Practices with formal relationships noted ease of communication and transfer of patient information, timeliness in patient referrals, and direct access to oncologists; while practices with informal relationships noted the benefits of having close engagement with specific oncologists. Regardless of relationship type, remaining challenges include lack of clarity about roles 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 the strengths of both formal and informal PC-oncology relationships to improve care for cancer patients and survivors.

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Understanding primary care-oncology relationships within a changing healthcare environment

BMC Family Practice ◽

10.1186/s12875-019-1056-y ◽

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.

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Improving Quality in Primary Care: A Model for Change

International Journal of Business and Management Research ◽

10.37391/ijbmr.090310 ◽

2021 ◽

Vol 9 (3) ◽

pp. 320-329

Author(s):

Dr. Jose A. PonceVega ◽

Dr. Irene A. Williams

Keyword(s):

Primary Care ◽

Health Care ◽

Quality Improvement ◽

Health Care Quality ◽

Target Population ◽

The United States ◽

Care Quality ◽

Structured Interviews ◽

Health Care Leaders ◽

Care Facilities

Health care spending accounts for 17.7% of the gross domestic product in the United States, and it is expected to continue rising at an annual rate of 5.3%. Despite high costs, health care quality lags behind other high-income countries; yet, over 70% of change initiatives fail. The purpose of this multiple case study was to explore strategies primary care leaders use for implementing quality improvement initiatives to improve patient outcomes and reduce waste in primary care facilities. The target population consisted of 3 health care leaders of 3 primary care facilities in southern California who successfully implemented quality improvement initiatives. The conceptual framework for this study was Kotter’s 8-step of change management. Data were collected through face-to-face semi-structured interviews with senior health care leaders, document review, and quality reports. Patterns were identified through a rigorous process of data familiarization, data coding, and theme development and revision. Interpretations from the data were subjected to member-checking to ensure trustworthiness of the findings. Four themes emerged from this study: communication, leadership support, inclusive decision-making, and employee recognition.

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Uninsured Children With Psychosocial Problems: Primary Care Management

PEDIATRICS ◽

10.1542/peds.106.s3.930 ◽

2000 ◽

Vol 106 (Supplement_3) ◽

pp. 930-936 ◽

Cited By ~ 1

Author(s):

Thomas K. McInerny ◽

Peter G. Szilagyi ◽

George E. Childs ◽

Richard C. Wasserman ◽

Kelly J. Kelleher

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Professionals ◽

Mental Health Problems ◽

Psychosocial Problems ◽

The United States ◽

Behavior Study ◽

Care Practices ◽

Uninsured Children ◽

Primary Care Practices

Objective. Nearly 14% of children in the United States are uninsured. We compared the prevalence of psychosocial problems and mental health services received by insured and uninsured children in primary care practices. Methods. The Child Behavior Study was a cohort study conducted by Pediatric Research in Office Settings and the Ambulatory Sentinel Practice Network. Four hundred one primary care clinicians enrolled an average sample of 55 consecutive children (4–15 years old) per clinician. Results. Of the 13 401 visits to clinicians with 3 or more uninsured patients, 12 518 were by insured children (93.4%) and 883 were by uninsured children (6.6%). A higher percentage of adolescents, Hispanic children, those with unmarried parents, and those with less educated parents were uninsured. According to clinicians, uninsured children and insured children had similar rates of psychosocial problems (19%) and severe psychosocial problems (2%). For children with a clinician-identified psychosocial problem, we found no differences in clinician-reported counseling, medication use, or referral to mental health professionals. Conclusions. Among children served in primary care practices, uninsured children have similar prevalence of clinician-identified psychosocial and mental health problems compared with insured children. Within their practices, clinicians managed uninsured children much the same way as insured children.psychosocial problems, uninsured children, pediatrics, family medicine, primary care.

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Investigating information-seeking behaviors of primary care physicians who care for older depressed patients and their family caregivers: a pilot study

Journal of the Canadian Health Libraries Association / Journal de l Association de bilbiothèques de la santé du Canada ◽

10.5596/c05-041 ◽

2005 ◽

Vol 26 (4) ◽

pp. 111 ◽

Cited By ~ 4

Author(s):

Mary Jo Dorsey ◽

Ellen Detlefsen

Keyword(s):

Primary Care ◽

Pilot Study ◽

Information Seeking ◽

Primary Care Physicians ◽

Care Physician ◽

Structured Interviews ◽

Depressed Patients ◽

Types Of Information ◽

Primary Care Practices ◽

Information Seeking Behaviors

Objective To describe preliminary findings from a study of information-seeking behaviors of primary care physicians who care for elderly and depressed patients, and the correlation between what is sought versus what is provided to the patient and (or) caregiver. Setting Physicians in two large ambulatory primary care practices throughout urban Pittsburgh, Pennsylvania, who take care of geriatric patients. Methods Structured interviews, with common questions, will be conducted with 12 primary care physicians to determine patterns of information-seeking behaviors. Environmental scans of physicians' offices for evidence of their existing information behaviors will complement the information obtained from the interviews. Results This pilot study provides an analysis of the resources primary care physicians use to seek information to provide to patients and caregivers. Analyses show types of information sought, time spent seeking information, and methods used to find information given to patients. Conclusions With mounting evidence of the Internet being used for patient self care, it is essential to understand if primary care physicians understand the scope and breadth of information readily available to their patients. The primary care physician needs to be aware of the types of information made available to their patients and the caregivers who are inclined to obtain information for the patient.

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Staff Perceptions of Implementation of a Team-Based Model of Patient-Centered Primary Care

The International Journal of Person Centered Medicine ◽

10.5750/ijpcm.v4i4.456 ◽

2015 ◽

Vol 4 (4) ◽

pp. 244-250

Author(s):

Sherri L LaVela ◽

Jennifer N Hill

Keyword(s):

Primary Care ◽

Team Building ◽

Organizational Factors ◽

Care Staff ◽

Health Care Staff ◽

Structured Interviews ◽

Implementation Barriers ◽

Patient Centered ◽

Optimal Care ◽

Team Based Care

Objectives. Patient-Aligned Care Teams (PACTs) aim to reorganize primary care by putting the patient at the center of the care team that includes family and health care staff; embodying patient-centered care (PCC). Team members share information, and work together in a synergistic, supportive way to provide optimal care based on mutually negotiated goals to meet patient needs. Our objective was to evaluate the process, barriers, and facilitators to implementing PACT as part of a VA quality improvement effort.Study Design/Methods. Semi-structured interviews were conducted, transcribed verbatim and analyzed with constant comparative techniques using constructs from implementation and organizational frameworks. Respondent demographic and position-level data were also collected. Data were collected in 2013.Results. A purposive sample of 35 key leaders and staff involved in implementing and/or participating in PACT at VA facilities participated. Implementation barriers included: failure to gain staff buy-in for PACT early on and to alleviate existing concerns about time and resources, incongruent performance measurement, and lack of defined role/responsibilities. Implementation facilitators included: training and engaging staff in PCC delivery and support for team-building.Conclusions. Team-based approaches to care have strong literature support; less is known about implementation. This study provides insight into the implementation of team-based care. Implementation of a team-based care model should include staff preparation and support (awareness, education, and encouragement) in advance. Once implemented, continued attention to team-building efforts and staff engagement are needed for sustainability. Healthcare organizations must understand and address multiple organizational factors to successfully implement team-based care that leads to systemic and sustainable PCC delivery.

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Vaccine Hesitancy in Pediatric Primary Care Practices

Qualitative Health Research ◽

10.1177/1049732318782164 ◽

2018 ◽

Vol 28 (13) ◽

pp. 2071-2080 ◽

Cited By ~ 6

Author(s):

Salini Mohanty ◽

Amy Carroll-Scott ◽

Marissa Wheeler ◽

Cecilia Davis-Hayes ◽

Renee Turchi ◽

...

Keyword(s):

Primary Care ◽

Vaccine Hesitancy ◽

Structured Interviews ◽

Vaccine Acceptance ◽

Multiple Strategies ◽

Efficiency And Effectiveness ◽

Care Practices ◽

Barriers And Challenges ◽

Primary Care Practices

Understanding how pediatric practices handle parental vaccine hesitancy is important as it impacts the efficiency and effectiveness of pediatric practices. In total, 21 semi-structured interviews with pediatric practice staff within a primary care network were conducted between May 2012 and March 2013. Thematic analysis focused on the barriers and challenges of vaccine hesitancy and strategies to reduce the burden at the practice level. Barriers and challenges of vaccine hesitancy included time constraints, administrative challenges, financial challenges and strained patient-provider relationships. Strategies to minimize the burden of vaccine hesitancy included training for vaccine counseling, screening for vaccine hesitancy prior to immunization visits, tailored vaccine counseling, and primary care provider visits for follow-up immunization. Pediatric practices reported many challenges when caring for vaccine-hesitant families. Multiple strategies were identified to reduce the burden of vaccine hesitancy, which future studies should explore to determine how effective they are in increasing vaccine acceptance in pediatric practices.

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Willingness of cancer patients to discuss advance directives with admitting doctor or oncologists

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.9539 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. 9539-9539

Author(s):

L. A. Dow ◽

T. J. Smith ◽

R. Matsuyama ◽

E. B. Lamont ◽

V. Ramakrishnan ◽

...

Keyword(s):

Primary Care ◽

Cancer Patients ◽

Advance Directives ◽

Primary Care Doctor ◽

Structured Interviews ◽

Common Misconception ◽

Primary Care Doctors ◽

Aggressive Care ◽

Hospice Palliative Care ◽

Seriously Ill

9539 Background: Many seriously ill cancer patients do not discuss prognosis or advance directives (ADs), which may lead to aggressive care at end of life (Harrison & Smith, JAMA 2008). Ten years ago, cancer patients did not want to discuss ADs with their oncologist (ONC), but would discuss them with an admitting doctor (Lamont JPM 2000).We assessed if this still held. Methods: We administered semi-structured interviews to cancer inpatients on the VCUHS Hematology-Oncology service. 55/63 consecutive patients accrued. Information was collected regarding ADs and knowledge of hospice/palliative care. Results: Of those enrolled, 22/55 (40%) reported having ADs. Only 2/55 had discussed ADs with their oncologist. Only 12/55 (22%) would want to discuss ADs with their ONC. But when specifically asked, 22/55 (40%) of patients would prefer to discuss ADs with their oncologist, and 40% with their primary care doctor. 86% would discuss ADs with the admitting doctor. There was no difference in doctor preference based upon prior AD completion. The preference not to discuss ADs with the oncologist was often because they felt their family could make the decisions, or that it was only necessary “If it got serious.” There was a common misconception that ADs mean death is imminent and lead to termination of care. Conclusions: Most patients (86%) are willing to discuss ADs with an admitting doctor, but only a small number (22%) want to discuss with their ONC. However, most patients will discuss ADs and 40% actually prefer their ONC if ADs are discussed. We therefore need to train primary care doctors, house staff, hospitalists, and oncologists to have these difficult discussions. [Table: see text] No significant financial relationships to disclose.

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Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting

Primary Health Care Research & Development ◽

10.1017/s1463423616000190 ◽

2016 ◽

Vol 18 (01) ◽

pp. 3-13 ◽

Cited By ~ 7

Author(s):

Bonnie M. Vest ◽

Victoria M. Hall ◽

Linda S. Kahn ◽

Arvela R. Heider ◽

Nancy Maloney ◽

...

Keyword(s):

Primary Care ◽

High Risk ◽

Real World ◽

Hospital Admissions ◽

Lessons Learned ◽

Diabetic Patients ◽

Structured Interviews ◽

Economic Context ◽

Care Practices ◽

Primary Care Practices

Aims The purpose of this qualitative evaluation was to explore the experience of implementing routine telemonitoring (TM) in real-world primary care settings from the perspective of those delivering the intervention; namely the TM staff, and report on lessons learned that could inform future projects of this type. Background Routine TM for high-risk patients within primary care practices may help improve chronic disease control and reduce complications, including unnecessary hospital admissions. However, little is known about how to integrate routine TM in busy primary care practices. A TM pilot for diabetic patients was attempted in six primary care practices as part of the Beacon Community in Western New York. Methods Semi-structured interviews were conducted with representatives of three TM agencies (n=8) participating in the pilot. Interviews were conducted over the phone or in person and lasted ~30 min. Interviews were audio-taped and transcribed. Analysis was conducted using immersion-crystallization to identify themes. Findings TM staff revealed several themes related to the experience of delivering TM in real-world primary care: (1) the nurse–patient relationship is central to a successful TM experience, (2) TM is a useful tool for understanding socio-economic context and its impact on patients’ health, (3) TM staff anecdotally report important potential impacts on patient health, and (4) integrating TM into primary care practices needs to be planned carefully. Conclusions This qualitative study identified challenges and unexpected benefits that might inform future efforts. Communication and integration between the TM agency and the practice, including the designation of a point person within the office to coordinate TM and help address the broader contextual needs of patients, are important considerations for future implementation. The role of the TM nurse in developing trust with patients and uncovering the social and economic context within which patients manage their diabetes was an unexpected benefit.

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Memory care approaches to better leverage capacity of dementia specialists: a narrative synthesis

Neurodegenerative Disease Management ◽

10.2217/nmt-2020-0038 ◽

2021 ◽

Author(s):

Jenny Lam ◽

Soeren Mattke

Keyword(s):

Primary Care ◽

Local Context ◽

Narrative Synthesis ◽

Structured Interviews ◽

Memory Care ◽

Memory Clinics ◽

Alternative Approaches ◽

Optimal Approach ◽

Primary Care Practices ◽

And Training

Prior research suggests that a scarcity of dementia specialists could hamper access to disease-modifying Alzheimer’s treatments. We describe alternative approaches on how to leverage specialist time for memory care in this narrative synthesis based on 17 semi-structured interviews and a targeted literature review on memory care approaches that leverage specialist time. We identified four types of approaches: community primary care practices empowered with better tools and training; primary care memory clinics; specialty memory clinics and; specialty memory centers. Several approaches to use specialist time efficiently have been implemented and some but not all evaluated. The optimal approach may depend on the local context.

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