Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol

There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to identify the factors that influence parents’ and families’ preferences and decision making when seeking unscheduled paediatric healthcare. Five databases will be searched for published studies (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and grey literature will also be searched. Inclusion and exclusion criteria will be applied and articles assessed for quality. A narrative approach will be used to synthesise the evidence that emerges from the review. By collating the factors that influence decision-making and attendance at these services, the review can inform future health policies and strategies seeking to expand primary care to support the provision of accessible and responsive care. The systematic review will also inform the design of a discrete choice experiment (DCE) which will seek to determine parental and family preferences for unscheduled paediatric healthcare. Policies that seek to expand primary care and reduce hospital admissions from emergency departments need to be cognisant of the nuanced and complex factors that govern patients’ behaviour.

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Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol

HRB Open Research ◽

10.12688/hrbopenres.12897.1 ◽

2019 ◽

Vol 2 ◽

pp. 11

Author(s):

Emma Nicholson ◽

Therese McDonnell ◽

Moayed Hamza ◽

Michael Barrett ◽

Christopher Brunsdon ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Decision Making ◽

Hospital Admissions ◽

Grey Literature ◽

Future Health ◽

Exclusion Criteria ◽

Policy Makers ◽

Parental Preferences ◽

Review Protocol

There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to identify the factors that influence parents’ and families’ preferences and decision making when seeking unscheduled paediatric healthcare. Five databases will be searched for published studies (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and grey literature will also be searched. Inclusion and exclusion criteria will be applied and articles assessed for quality. A narrative approach will be used to synthesise the evidence that emerges from the review. By collating the factors that influence decision-making and attendance at these services, the review can inform future health policies and strategies seeking to expand primary care to support the provision of accessible and responsive care. The systematic review will also inform the design of a discrete choice experiment (DCE) which will seek to determine parental and family preferences for unscheduled paediatric healthcare. Policies such as Sláintecare that seek to expand primary care and reduce hospital admissions from emergency departments need to be cognisant of the nuanced and complex factors that govern patients’ behaviour.

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Multicomponent interventions for enhancing primary care: a systematic review

British Journal of General Practice ◽

10.3399/bjgp20x714199 ◽

2020 ◽

Vol 71 (702) ◽

pp. e10-e21

Author(s):

Geronimo Jimenez ◽

David Matchar ◽

Gerald Choon-Huat Koh ◽

Josip Car

Keyword(s):

Systematic Review ◽

Primary Care ◽

Hospital Admissions ◽

Grey Literature ◽

Emergency Department Visits ◽

Narrative Form ◽

Provider Satisfaction ◽

Quadruple Aim ◽

Literature Searches ◽

Multicomponent Interventions

BackgroundMany countries have implemented interventions to enhance primary care to strengthen their health systems. These programmes vary widely in features included and their impact on outcomes.AimTo identify multiple-feature interventions aimed at enhancing primary care and their effects on measures of system success — that is, population health, healthcare costs and utilisation, patient satisfaction, and provider satisfaction (quadruple-aim outcomes).Design and settingSystematic review and narrative synthesis.MethodElectronic, manual, and grey-literature searches were performed for articles describing multicomponent primary care interventions, providing details of their innovation features, relationship to the ‘4Cs’ (first contact, comprehensiveness, coordination, and continuity), and impact on quadruple-aim outcomes. After abstract and full-text screening, articles were selected and their quality appraised. Results were synthesised in a narrative form.ResultsFrom 37 included articles, most interventions aimed to improve access, enhance incentives for providers, provide team-based care, and introduce technologies. The most consistent improvements related to increased primary care visits and screening/preventive services, and improved patient and provider satisfaction; mixed results were found for hospital admissions, emergency department visits, and expenditures. The available data were not sufficient to link interventions, achievement of the 4Cs, and outcomes.ConclusionMost analysed interventions improved some aspects of primary care while, simultaneously, producing non-statistically significant impacts, depending on the features of the interventions, the measured outcome(s), and the populations being studied. A critical research gap was revealed, namely, in terms of which intervention features to enhance primary care (alone or in combination) produce the most consistent benefits.

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Decision support tools to improve cancer diagnostic decision making in primary care: a systematic review

British Journal of General Practice ◽

10.3399/bjgp19x706745 ◽

2019 ◽

Vol 69 (689) ◽

pp. e809-e818 ◽

Cited By ~ 3

Author(s):

Sophie Chima ◽

Jeanette C Reece ◽

Kristi Milley ◽

Shakira Milton ◽

Jennifer G McIntosh ◽

...

Keyword(s):

Systematic Review ◽

Primary Care ◽

Decision Making ◽

Decision Support ◽

Cost Effectiveness ◽

Cancer Diagnosis ◽

Decision Support Tools ◽

Diagnostic Decision ◽

Support Tools ◽

Diagnostic Decision Making

BackgroundThe diagnosis of cancer in primary care is complex and challenging. Electronic clinical decision support tools (eCDSTs) have been proposed as an approach to improve GP decision making, but no systematic review has examined their role in cancer diagnosis.AimTo investigate whether eCDSTs improve diagnostic decision making for cancer in primary care and to determine which elements influence successful implementation.Design and settingA systematic review of relevant studies conducted worldwide and published in English between 1 January 1998 and 31 December 2018.MethodPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were searched, and a consultation of reference lists and citation tracking was carried out. Exclusion criteria included the absence of eCDSTs used in asymptomatic populations, and studies that did not involve support delivered to the GP. The most relevant Joanna Briggs Institute Critical Appraisal Checklists were applied according to study design of the included paper.ResultsOf the nine studies included, three showed improvements in decision making for cancer diagnosis, three demonstrated positive effects on secondary clinical or health service outcomes such as prescribing, quality of referrals, or cost-effectiveness, and one study found a reduction in time to cancer diagnosis. Barriers to implementation included trust, the compatibility of eCDST recommendations with the GP’s role as a gatekeeper, and impact on workflow.ConclusioneCDSTs have the capacity to improve decision making for a cancer diagnosis, but the optimal mode of delivery remains unclear. Although such tools could assist GPs in the future, further well-designed trials of all eCDSTs are needed to determine their cost-effectiveness and the most appropriate implementation methods.

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Reducing unscheduled hospital care for adults with diabetes following a hypoglycaemic event: which community-based interventions are most effective? A systematic review

Journal of Diabetes & Metabolic Disorders ◽

10.1007/s40200-021-00817-z ◽

2021 ◽

Author(s):

Aoife Watson ◽

Donna McConnell ◽

Vivien Coates

Keyword(s):

Systematic Review ◽

Primary Care ◽

Integrated Care ◽

Hospital Care ◽

Hospital Admissions ◽

Community Based Interventions ◽

Community Based ◽

Integrated Care Pathways ◽

Effective Community ◽

Balance Of Care

Abstract Aim To determine which community-based interventions are most effective at reducing unscheduled hospital care for hypoglycaemic events in adults with diabetes. Methods Medline Ovid, CINAHL Plus and ProQuest Health and Medical Collection were searched using both key search terms and medical subject heading terms (MeSH) to identify potentially relevant studies. Eligible studies were those that involved a community-based intervention to reduce unscheduled admissions in adults with diabetes. Papers were initially screened by the primary researcher and then a secondary reviewer. Relevant data were then extracted from papers that met the inclusion criteria. Results The search produced 2226 results, with 1360 duplicates. Of the remaining 866 papers, 198 were deemed appropriate based on titles, 90 were excluded following abstract review. A total of 108 full papers were screened with 19 full papers included in the review. The sample size of the 19 papers ranged from n = 25 to n = 104,000. The average ages within the studies ranged from 41 to 74 years with females comprising 57% of the participants. The following community-based interventions were identified that explored reducing unscheduled hospital care in people with diabetes; telemedicine, education, integrated care pathways, enhanced primary care and care management teams. Conclusions This systematic review shows that a range of community-based interventions, requiring different levels of infrastructure, are effective in reducing unscheduled hospital care for hypoglycaemia in people with diabetes. Investment in effective community-based interventions such as integrated care and patient education must be a priority to shift the balance of care from secondary to primary care, thereby reducing hospital admissions.

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