Do the incentive payments in the new NHS contract for primary care reflect likely population health gains?

Background: Vertigo is defined as an illusion of motion caused by a mismatch of information between the visual, vestibular and somatosensory systems. The most common diagnosis associated with whirling vertigo is benign paroxysmal positional vertigo (BPPV), which affects approximately 3.4% of patients older than 60 years of age. Objective: This paper aims to educate primary care providers on how to diagnose BPPV by performing canalith repositioning maneuvers at the initial point of care. Timely treatment of BPPV in the primary care office is believed to reduce healthcare costs by way of limiting unnecessary diagnostic testing and lowering referrals for specialty care. Immediate treatment is also believed to improve the quality of healthcare delivery for the vertigo patient by reducing morbidity and resolving the condition without the need for referrals or imaging. Population Health: A review of the literature finds that delayed diagnosis and treatment of BPPV is associated with a host of deleterious effects on patients. Population health impacts include increased rates of anxiety and depression; loss of work and/or change of career paths; inappropriate use of medications or emergency care resources; decreased access to healthcare services; increased healthcare costs; and reduced quality of care. Diagnosis: A history of positional vertigo and evidence of nystagmus with Dix-Hallpike positioning confirms the diagnosis. A detailed description of the performance of this test is elucidated. Treatment: The observed nystagmus is analyzed and classified based on directionality. Treatment can be initiated immediately with canalith repositioning maneuvers.

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The Role of Primary Care in Population and Community Health: Pragmatic Approaches to Integration

The Practical Playbook II ◽

10.1093/med/9780190936013.003.0012 ◽

2019 ◽

pp. 101-108

Author(s):

Julie Wood ◽

Kevin Grumbach

Keyword(s):

Primary Care ◽

Community Health ◽

Population Health ◽

Health Management ◽

Parks And Recreation ◽

Centered Care ◽

Care Models ◽

Primary Care Clinicians ◽

Family Centered

This chapter looks at the role of primary health care in community health. Primary care, it argues, has built on its historical roots of holistic family-centered care to embrace the broader concept of population health. The chapter looks at the evolution of care models from patient/family-centered to panel management (the sum of patients being cared for by a primary care practice), to community health management. This broader concept of health necessitates collaboration with partners outside the clinical practice, including public health professionals, policymakers, schools, housing, parks and recreation, law enforcement, transportation, and food systems. The chapter describes the population and community framework and its historical role in the development of primary care, and then turns to the proposal of pragmatic approaches that busy primary care clinicians and care teams can use to integrate population health approaches into their practices.

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Overview: The Accelerating Movement of Partnerships for Health

The Practical Playbook II ◽

10.1093/med/9780190936013.003.0001 ◽

2019 ◽

pp. 3-6

Author(s):

J. Lloyd Michener ◽

Brian C. Castrucci ◽

Don W. Bradley ◽

Edward L. Hunter ◽

Craig W. Thomas

Keyword(s):

Public Health ◽

United States ◽

Primary Care ◽

Population Health ◽

The United States ◽

Improve Population Health ◽

Second Development ◽

Working Together ◽

General Desire

Chapter 1 provides an introduction to the history and background to a general desire to try to find ways to improve population health through primary care and public health. The first Practical Playbook derived from an internet-based initiative that sought to find, assemble, assess, and share stories of how communities and agencies across the United States were working together to improve health. This text is the second development from that, after the realization that a completely new text was needed that would build on the experiences of the broadening array of sites and sectors and provide a concise set of tools, methods, and examples that support multi-sector partnerships to improve population health. The chapter then outlines the coverage of the rest of the chapters.

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Proactive Population Health Strategy to Offer Tobacco Dependence Treatment to Smokers in a Primary Care Practice Network

Journal of General Internal Medicine ◽

10.1007/s11606-019-05079-3 ◽

2019 ◽

Vol 34 (8) ◽

pp. 1571-1577

Author(s):

Sara Kalkhoran ◽

Elizabeth M. Inman ◽

Jennifer H. K. Kelley ◽

Jeffrey M. Ashburner ◽

Nancy A. Rigotti

Keyword(s):

Primary Care ◽

Population Health ◽

Primary Care Practice ◽

Tobacco Dependence ◽

Care Practice ◽

Tobacco Dependence Treatment ◽

Health Strategy ◽

Practice Network

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The Evolving Role of Medical Assistants in Primary Care Practice: Divergent and Concordant Perspectives from MAs and Family Physicians

Medical Care Research and Review ◽

10.1177/1077558720966148 ◽

2020 ◽

pp. 107755872096614

Author(s):

Erin P. Fraher ◽

Allison Cummings ◽

Dana Neutze

Keyword(s):

Primary Care ◽

Patient Education ◽

Population Health ◽

Low Cost ◽

Family Physicians ◽

Direct Patient Care ◽

Care Practice ◽

Medical Assistants ◽

Care Practices ◽

Primary Care Practices

Medical assistants (MAs) are a flexible and low-cost resource for primary care practices and their roles are swiftly transforming. We surveyed MAs and family physicians in primary care practices in North Carolina to assess concordance in their perspectives about MA roles, training, and confidence in performing activities related to visit planning; direct patient care; documentation; patient education, coaching or counseling; quality improvement; population health and communication. For most activities, we did not find evidence of role confusion between MAs and physicians, physician resistance to delegate tasks to properly trained MAs, or MA reluctance to pursue training to take on new roles. Three areas emerged where the gap between the potential and actual implementation of MA role transformation could be narrowed—population health and panel management; patient education, coaching, and counseling; and scribing. Closing these gaps will become increasingly important as our health care system moves toward value-based models of care.

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