scholarly journals Upskilling the Primary Care Workforce in Cancer Survivorship

2018 ◽  
Vol 4 (Supplement 2) ◽  
pp. 132s-132s
Author(s):  
J. Emery ◽  
K. Smith ◽  
M. Shibaoka ◽  
M. Barrett
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Community Of Practice ◽  
Cancer Survivorship ◽  
Nurse Practitioners ◽  
Online Survey ◽  
Online Discussions ◽  
Real Patient ◽  
Allied Health Professionals ◽  
Primary Care Practitioners

Introduction/background: There is a rapidly increasing population of people living with and beyond cancer due to ageing and improvements in detection and treatment. This has impacted on the complexity of the primary care practitioners' role in managing cancer survivorship. The Massive Open Online Course (MOOC) was developed to address this need for a sustainable education model. Aim/Objectives: The Cancer Survivorship for Primary Care Practitioners program aims to enhance the knowledge and skills in the transition of survivors from oncology treatment into shared care. The Victorian Comprehensive Cancer Centre's (VCCC) goal was to develop a freely accessible, relevant, flexible, evidence based and sustainable resource for a global audience. Methods: Aimed at primary healthcare practitioners including general practitioners, nurses (general practice nurses, community nurses and nurse practitioners) and allied health professionals; the program was developed to adhere to best practice survivorship care in the areas of: survivorship fundamentals; communication and coordination of care; promoting self-management, psychosocial and community-based support; surveillance, long term and late effects; and new and emergent technologies. The MOOC is contextualised in the narrative of a patient story and includes a series of real patient stories, interactive presentations, interviews, readings, online discussions, quizzes and peer reviewed assessments. Alumni from the program will contribute to a growing community of practice and contribute to the teaching and quality improvement of the program. An online survey will be distributed to all participants before and after their completion of the program. Paired tests will be conducted and compared for the participant craft groups that attend the MOOC. We will measure the effect of participation in either the MOOC and/or workshop on confidence, knowledge and intention to change practice. Results: A description of the sustainable MOOC delivery model and evaluation results from the first cohort will be presented. Conclusion: The program will deliver an innovative and sustainable professional development opportunity for PCPs in response to the evolving population health landscape. Alumni from the program will contribute to a growing community of practice and contribute to the teaching and quality improvement of the program.

A Comparison of Perceptions of Reassurance in Patients with Nontraumatic Neck Pain and Whiplash-Associated Disorders in Consultations with Primary Care Practitioners—An Online Survey

Pain Medicine ◽  
2020 ◽  
Vol 21 (12) ◽  
pp. 3377-3386
Author(s):  
Alma Viviana Silva Guerrero ◽  
Jenny Setchell ◽  
Annick Maujean ◽  
Michele Sterling
Keyword(s):  
Primary Care ◽  
Neck Pain ◽  
Structural Damage ◽  
Online Survey ◽  
Detailed Comparison ◽  
Primary Care Providers ◽  
Care Providers ◽  
Convenience Sample ◽  
Primary Care Practitioners ◽  
Pain Symptoms

Abstract Objectives Neck pain remains highly prevalent and costly worldwide. Although reassurance has been recommended as a first line of treatment, specific advice on the best ways to provide reassurance has not been provided due to lack of evidence. Pain symptoms and experiences differ between patients with whiplash-associated disorder (WAD) and those with nontraumatic neck pain (NTNP). The aims of this study were to 1) identify and compare the concerns, fears, and worries of patients with WAD and NTNP; and 2) determine if patients believe their concerns are addressed by primary care providers. Methods These questions were investigated through an online survey, with a convenience sample of 30 participants with NTNP and 20 with WAD. Results A thematic analysis of survey responses resulted in the following seven themes related to common concerns, and two regarding how well concerns were addressed. Common concerns expressed by both groups shared four themes: 1) further structural damage, 2) psychological distress, 3) concerns about the future, and 4) hardships that eventuate. Theme 5), pain/disability is long term, was specific to WAD. Themes 6), pain is current or reoccurring, and 7), interference with daily life, were specific to NTNP. Regarding how well patient concerns were addressed, two overarching themes were common to both conditions: 1) concerns were addressed, with both groups sharing the subthemes “successful treatment,” “reassurance,” and “trust”; and 2) concerns were not addressed, where all subthemes were shared with the exception of two unique to NTNP. Conclusions This detailed comparison provides information about neck pain patients’ concerns and fears, while providing health practitioners support for selecting strategies to promote reassurance appropriately for individual patient needs. Our findings from patients’ perspectives enhance the understanding for providing reassurance for neck pain as proposed by our analysis.

scholarly journals Methods and Effectiveness of Communication Between Hospital Allied Health and Primary Care Practitioners: a Systematic Narrative Review

2020 ◽  
Author(s):  
Jacinta Sheehan ◽  
Kate Laver ◽  
Anoo Bhopti ◽  
Miia Rahja ◽  
Tim Usherwood ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Professionals ◽  
Information Technologies ◽  
Allied Health ◽  
Allied Health Professionals ◽  
Multidisciplinary Communication ◽  
Gold Standard Method ◽  
Health Information Technologies ◽  
Primary Care Practitioners

Abstract Background There is a compelling rationale that effective communication between hospital allied health professionals and primary care practitioners could improve quality and continuity of patient care. It is not known which methods of communication are used, nor how effectively they facilitate the transition of care when a patient is discharged home from hospital. Our systematic review aims to investigate the methods and effectiveness of communication between hospital allied health professionals and primary care practitioners. Method Systematic review of quantitative and qualitative studies with narrative synthesis. Medline, CINAHL, EMBASE, PsycInfo and Proquest Nursing and Allied Health Sources were searched from January 2003 until January 2020 for studies that examined hospital allied health professionals communicating with primary care practitioners. Risk of bias in the different study designs were appraised using recognised tools and a content analysis conducted of the methodologies used. Results From the located 12,281 papers (duplicates removed), 24 studies met the inclusion criteria with hospital allied health professionals communicating in some form with primary care practitioners. There was, however, limited literature investigating the methods and/or the effectiveness of communication between hospital allied health professionals and primary care practitioners.Conclusion There is currently no 'gold standard' method or measure of communication between hospital allied health professionals and primary care practitioners. There is an urgent need to develop and evaluate multidisciplinary communication with enhanced health information technologies to improve collaboration across healthcare settings and facilitate continuity of integrated people-centred care.Registration: www.crd.york.uk PROSPERO CRD42019120410

scholarly journals Barriers to the use of trained interpreters in consultations with refugees in four resettlement countries: a qualitative analysis using normalisation process theory

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Anne MacFarlane ◽  
Susann Huschke ◽  
Kevin Pottie ◽  
Fern R. Hauck ◽  
Kim Griswold ◽  
...  
Keyword(s):  
Primary Care ◽  
Online Survey ◽  
Routine Care ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Cross Sectional ◽  
Interpreter Use ◽  
Funding Sources ◽  
Barriers To Implementation ◽  
Primary Care Practitioners

Abstract Background Increasing numbers of primary care practitioners in refugee resettlement countries are providing care to refugees. Access to trained interpreters is a priority for these practitioners, but there are many barriers to the implementation of interpreted consultations in routine care. There is a lack of international, theoretically informed research. The purpose of this paper is to understand barriers to interpreter use in primary care consultations in four resettlement countries using Normalisation Process Theory. Method We conducted a cross-sectional online survey with networks of primary care practitioners (PCPs) who care for refugees in Australia, Canada, Ireland and the US (n = 314). We analysed qualitative data from the survey about barriers to interpreter use (n = 178). We completed an inductive thematic analysis, iteratively developed a Normalisation Process Theory (NPT)-informed coding frame and then mapped the emergent findings onto the theory’s construct about enacting interpreted consultations. Results In all four countries, the use of an interpreter presented communication and interaction challenges between providers and patients, which can impede the goals of primary care consultations. Primary care practitioners did not always have confidence in interpreted consultations and described poor professional practice by some interpreters. There was variation across countries, and inconsistency within countries, in the availability of trained interpreters and funding sources. Conclusion There are shared and differential barriers to implementation of interpreted consultations in a consistent and sustained way in the four countries studied. These findings can be used to inform country-specific and international level policies and interventions focusing on improving skills and resources for interpreted consultations to improve implementation of interpreted primary care consultations.

Constructing a framework for quality activity in primary care

2013 ◽  
Vol 37 (1) ◽  
pp. 98 ◽  
Author(s):  
G. A. Roshan Perera ◽  
Anthony C. Dowell ◽  
Caroline J. Morris
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
New Zealand ◽  
Clinical Care ◽  
Care Practice ◽  
Quality Improvement Activity ◽  
Practice Level ◽  
Theoretical Approaches ◽  
Primary Care Practitioners ◽  
Competing Priorities

Introduction. In 2009, the Royal New Zealand College of General Practitioners commissioned the development of a framework to facilitate quality-improvement activity in primary care settings. This paper outlines the development of the framework, which integrates concepts of quality with the reality of practice-based clinical care, and discusses its value for primary care quality improvement. Method. Framework development involved: (1) literature review of theoretical approaches to healthcare quality; (2) field work utilising a mixed methods approach to obtain empirical data; and (3) model design. Results. Primary care practitioners are juggling competing priorities. Models and tools that promote quality-related activity at practice level need to take into account, and incorporate by design, day-to-day clinical and practice functions. Conclusions. The quality framework identifies the components of primary care practice and locates this model within the concepts and activities necessary for quality improvement. It may be used by primary care organisations and practices to facilitate focussed quality-improvement activity and self-directed process review. The framework was developed for, and within a New Zealand primary care setting, and is applicable internationally and within other healthcare settings. What is known about the topic? Primary care practitioners are frequently juggling competing priorities while participating in an array of professional development, quality assurance, and improvement activities, some perceived to be of little relevance to day-to-day clinical care. What does this paper add? The framework integrates concepts of quality with the reality of practice-based clinical care. The function of the framework is to ensure all relevant aspects of practice are considered in a systematic and comprehensive manner to obtain quality improvement. What are the implications for practitioners? The framework is a practical tool that can guide practices and organisational stakeholders to continually deconstruct, examine and reassemble any practice-based clinical care activity. Practices wishing to undertake quality-improvement activity within the context of clinical care may use the framework to guide critical thinking at practice level.

scholarly journals Changes to telehealth practices in primary care in New Brunswick (Canada): A comparative study pre and during the COVID-19 pandemic

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0258839
Author(s):  
Claire Johnson ◽  
Jérémie B. Dupuis ◽  
Pierre Goguen ◽  
Gabrielle Grenier
Keyword(s):  
Primary Care ◽  
Comparative Study ◽  
New Brunswick ◽  
Nurse Practitioners ◽  
Online Survey ◽  
Primary Care Providers ◽  
Care Providers ◽  
Timely Access ◽  
Access To Primary Care

Background During the COVID-19 pandemic, telehealth technologies were used in the primary health care setting in New Brunswick as a means to continue providing care to patients while following public health guidelines. This study aimed to measure these changes and examine if they improved timely access to primary care. A secondary goal was to identify which telehealth technologies were deemed sustainable by primary care providers. Methods This was a comparative study on the use of telehealth technology before and during the COVID-19 pandemic. Between April 2020 and November 2020, 114 active primary care providers (family physicians or nurse practitioners) responded to the online survey. Results The findings illustrated an increase in the use of telehealth technologies. The use of phone consultations increased by 122%, from 43.9% pre-pandemic to 97.6% during the pandemic (p < 0.001). The use of virtual consultation (19.3% pre-pandemic vs. 41.2% during the pandemic, p < 0.001), emails and texts also increased during the pandemic. Whereas the more structural organizational tools (electronic medical charts and reservation systems) remained stable. However, those changes did not coincide with a significant improvement to timely access to care during the pandemic. Many participants (40.1%) wanted to keep phone consultations, and 21.9% of participants wanted to keep virtual consultations as part of their long-term practice. Interpretation The observed increase in the use of telehealth technologies may be sustainable, but it has not significantly improved timely access to primary care in New Brunswick.

scholarly journals Interprofessional advanced access – a quality improvement protocol for expanding access to primary care services

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Isabelle Gaboury ◽  
Mylaine Breton ◽  
Kathy Perreault ◽  
François Bordeleau ◽  
Sarah Descôteaux ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Social Services ◽  
Nurse Practitioners ◽  
Practice Facilitation ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Teams ◽  
Access To Primary Care ◽  
Advanced Access

Abstract Background The Advanced Access (AA) Model has shown considerable success in improving timely access for patients in primary care settings. As a result, a majority of family physicians have implemented AA in their organizations over the last decade. However, despite its widespread use, few professionals other than physicians and nurse practitioners have implemented the model. Among those who have integrated it to their practice, a wide variation in the level of implementation is observed, suggesting a need to support primary care teams in continuous improvement with AA implementation. This quality improvement research project aims to document and measure the processes and effects of practice facilitation, to implement and improve AA within interprofessional teams. Methods Five primary care teams at various levels of organizational AA implementation will take part in a quality improvement process. These teams will be followed independently over PDSA (Plan-Do-Study-Act) cycles for 18 months. Each team is responsible for setting their own objectives for improvement with respect to AA. The evaluation process consists of a mixed-methods plan, including semi-structured interviews with key members of the clinical and management teams, patient experience survey and AA-related metrics monitored from Electronic Medical Records over time. Discussion Most theories on organizational change indicate that practice facilitation should enable involvement of stakeholders in the process of change and enable improved interprofessional collaboration through a team-based approach. Improving access to primary care services is one of the top priorities of the Quebec’s ministry of health and social services. This study will identify key barriers to quality improvement initiatives within primary care and help to develop successful strategies to help teams improve and broaden implementation of AA to other primary care professionals.

scholarly journals The Royal College of General Practitioners (RCGP) quality improvement initiative using Clinical Practice Research Datalink (CPRD) data: Lessons learned

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703697
Author(s):  
Helen Booth ◽  
Eleanor Yelland ◽  
David Mullett ◽  
Arlene Gallagher ◽  
Shivani Padmanabhan ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Scale Up ◽  
Public Health Research ◽  
Lessons Learned ◽  
Practice Research ◽  
Quality Improvement Initiative ◽  
Clinical Practice Research Datalink ◽  
Case Review ◽  
Real Patient

BackgroundQuality improvement (QI) is a priority for general practice, and GPs are expected to participate and provide evidence of QI activity. Pressures on the primary care workforce require approaches to QI to prioritise efficiency and effectiveness.AimThis project aimed generate and scale up bespoke QI reports for GP practices contributing data to CPRD.MethodCPRD is a UK government research service facilitating public health research using anonymised primary care data. A pilot report was designed with stakeholders and covered two indicators from the RCGP Patient Safety Toolkit. The reports enabled GPs to identify patients needing case review and to benchmark data on practice-level prescribing. Reports for 12 practices, containing real patient data, were sent to GPs and feedback was obtained via interviews. The report was scaled up to 457 practices and a survey sent out to request feedback.ResultsGPs used the reports to review the care of individual patients, and to implement QI actions such as adding flags to patients notes. One participant used the report as evidence for their annual appraisal. Survey response was limited (n = 31.7%) but overwhelmingly positive. Responders highlighted the importance of clinical input when developing indicators and ensuring the tone of the reports is supportive.ConclusionThe collaborative RCGP/CPRD QI reports are unique in their ability to provide benchmarking and case-finding on a national scale. The indicators selected must lead to actionable reports. Clinical input is required to ensure code lists are appropriate and that reports are clinically relevant. CPRD aims to send out two reports annually.

scholarly journals Perceived Barriers to Mobility in a Medical ICU: The Patient Mobilization Attitudes & Beliefs Survey for the ICU

2018 ◽  
Vol 35 (10) ◽  
pp. 1026-1031 ◽  
Author(s):  
Carrie M. Goodson ◽  
Lisa Aronson Friedman ◽  
Earl Mantheiy ◽  
Kevin Heckle ◽  
Annette Lavezza ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Internal Consistency ◽  
Nurse Practitioners ◽  
Work Experience ◽  
Online Survey ◽  
Discriminant Validity ◽  
Quality Improvement Project ◽  
Perceived Barriers ◽  
Clinical Role ◽  
Improvement Project

Purpose: Early mobilization in the intensive care unit (ICU) can improve patient outcomes but has perceived barriers to implementation. As part of an ongoing structured quality improvement project to increase mobilization of medical ICU patients by nurses and clinical technicians, we adapted the existing, validated Patient Mobilization Attitudes & Beliefs Survey (PMABS) for the ICU setting and evaluated its performance characteristics and results. Materials and Methods: The 26-item PMABS adapted for the ICU (PMABS-ICU) was administered as an online survey to 163 nurses, clinical technicians, respiratory therapists, attending and fellow physicians, nurse practitioners, and physician assistants in one medical ICU. We evaluated the overall and subscale (knowledge, attitude, and behavior) scores and compared these scores by respondent characteristics (clinical role and years of work experience). Results: The survey response rate was 96% (155/163). The survey demonstrated acceptable discriminant validity and acceptable internal consistency for the overall scale (Cronbach α: 0.82, 95% confidence interval: 0.76-0.85), with weaker internal consistency for all subscales (Cronbach α: 0.62-0.69). Across all respondent groups, the overall barrier score (range: 1-100) was relatively low, with attending physicians perceiving the lowest barriers (median [interquartile range]: 30 [28-34]) and nurses perceiving the highest (37 [31-40]). Within the first 10 years of work experience, greater experience was associated with a lower overall barrier score (−0.8 for each additional year; P = 0.02). Conclusions: In our medical ICU, across 6 different clinical roles, there were relatively low perceived barriers to patient mobility, with greater work experience over the first 10 years being associated with lower perceived barriers. As part of a structured quality improvement project, the PMABS-ICU may be valuable in assisting to identify specific perceived barriers for consideration in designing mobility interventions for the ICU setting.

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