Complex wound care by a nurse practitioner in primary care: a quality improvement evaluation on healing rates, costs and patient satisfaction

Complex wounds are a major burden for healthcare professionals. Patients with complex wounds are often referred to hospitals or wound expertise centres. Complex wound care could be organised in primary care, but very little published evidence for this is available. In this study, members of a primary healthcare organisation were interviewed to ascertain how the wound care was organised. Patient characteristics and data regarding wound care, healing rates and costs were collected from medical records. Patients filled in a questionnaire concerning accessibility, communication, medical counselling and the overall experience of their treatment. This study followed 25 patients with a total of 42 wounds. Some 82% of the wounds were healed within a mean treatment duration of 9.7 weeks. Mean treatment costs were calculated at €155 (£130) for healed patients. Patients were generally very satisfied with their treatment, illustrated by an overall 8.7 out of 10 scoring on an amended survey based on the Consumer Quality Index. Treating complex wounds in primary care seemed adequate, with high patient satisfaction and tolerable costs.

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Centers specializing in primary care for women consistently deliver preventive services and have high patient satisfaction

PsycEXTRA Dataset ◽

10.1037/e556292006-028 ◽

2005 ◽

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Preventive Services ◽

High Patient Satisfaction

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Leucocyte- and platelet-rich fibrin as a rescue therapy for small-to-medium-sized complex wounds of the lower extremities

Burns & Trauma ◽

10.1186/s41038-019-0149-0 ◽

2019 ◽

Vol 7 ◽

Cited By ~ 8

Author(s):

Kadri Ozer ◽

Ozlem Colak

Keyword(s):

Soft Tissue ◽

Wound Care ◽

Rescue Therapy ◽

Lower Extremities ◽

Complete Healing ◽

Interquartile Range ◽

Time Saving ◽

Platelet Rich Fibrin ◽

Complex Wound ◽

Complex Wounds

Abstract Background Generally, advanced wound care resources are applied for complex wounds that pose a challenge to the medical and nursing teams. In this report, the use of leukocyte- and platelet-rich fibrin (L-PRF) is emphasized for complex wounds as an alternative, simple, inexpensive, time-saving process that does not require hospitalization and has a healing potential over that of bare soft tissue, including bone, tendon, and ligaments. The aim of this study is to extend the use of L-PRF in small-to-moderate-sized complex wounds of lower extremities in which L-PRF maintains the sensitive structures viable. Methods Between January 2016 and December 2017, 17 small-to-moderate-sized complex wounds of lower extremities treated with L-PRF were recruited from the plastic and reconstructive surgery clinic in Aydin State Hospital, Turkey. The treatment was administered twice per week in the outpatient clinic. Depending on the size and extension of the complex wound, two to five blood samples were collected into 8.5 ml dry, glass vacuum tubes with no anticoagulant, and samples were immediately centrifuged at 1630×g for 5 min to obtain L-PRF. Complete healing was defined as the day of complete wound epithelialization. Results The median values of the initial wound size and wound duration were 12 cm2 (interquartile range, 6 to 23 cm2) and 8 months before first admission (interquartile range, 4 to 18 months), respectively. All wounds showed significant improvements after L-PRF therapy and full closure after a median of 18 months, with an interquartile range of 11 to 34 months of L-PRF applications. There were recurrences of wounds during the first 6 months after therapy. No adverse events were observed. Conclusions Our results add to the growing evidence that L-PRF treatments protect and maintain bare soft tissue structures viable, facilitate the formation of granulation tissue and epithelization, and remarkably reduce the need for additional soft tissue surgeries in small-to-medium-sized complex wounds.

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Primary care nurses who convey warmth and caring enhance patient satisfaction with care

PsycEXTRA Dataset ◽

10.1037/e504432010-020 ◽

2009 ◽

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Satisfaction With Care ◽

Primary Care Nurses ◽

Patient Satisfaction With Care

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Erratum to: Patient characteristics and quality dimensions related to patient satisfaction

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzaa161 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Mikael Rahmqvist ◽

Ana-Claudia Bara

Keyword(s):

Patient Satisfaction ◽

Patient Characteristics ◽

Quality Dimensions

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22. Patient Satisfaction Remains Unchanged Following Implementation of an Antibiotic Stewardship Intervention in Primary Care

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa417.021 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S11-S12

Author(s):

Zachary Hostetler ◽

Keith W Hamilton ◽

Leigh Cressman ◽

McWelling H Todman ◽

Ebbing Lautenbach ◽

...

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Odds Ratio ◽

Logistic Regression Model ◽

Adjusted Odds Ratio ◽

Primary Care Providers ◽

Mixed Effects ◽

Antibiotic Prescribing ◽

Care Providers ◽

Targeted Intervention

Abstract Background Inappropriate prescription of antibiotics for respiratory tract infections (RTIs) in ambulatory care settings is common, increasing the risk of adverse health outcomes. Behavioral and educational interventions targeting primary care providers (PCPs) have shown promise in reducing inappropriate antibiotic prescribing for RTIs. While one perceived barrier to such interventions is the concern that these adversely impact patient satisfaction, few data exist in this area. Here, we examine whether a recent PCP-targeted intervention that significantly reduced antibiotic prescribing for RTIs was associated with a change in patient satisfaction. Methods The PCP-targeted intervention involved monthly education sessions and peer benchmarking reports delivered to 31 clinics within an academic health system, and was previously shown to reduce antibiotic prescribing. Here, we performed a retrospective, secondary analysis of Press Ganey (PG) surveys associated with the outpatient encounters in the pre- and post-intervention periods. We evaluated the impact on patient perceptions of PCPs based on provider exposure to the intervention using a mixed effects logistic regression model. Results There were 17,416 out of 197,744 encounters (8.8%) with associated PG surveys for the study time period (July 2016 to September 2018). In the multivariate model, patient satisfaction with PCPs was most strongly associated with patient-level characteristics (age, race, health status, education status) and survey-level characteristics (survey response time, patient’s usual provider) (Figure 1). Satisfaction with PCPs did not change following delivery of the provider-based intervention even after adjusting for patient- and survey-level characteristics [adjusted odds ratio (95% CI): 1.005 (0.928, 1.087)]. However, a small increase in satisfaction associated with receiving antibiotics during the entire study period was seen [adjusted odds ratio (95% CI): 1.146 (1.06, 1.244)]. Figure 1: Association of a provider-targeted intervention as well as patient, provider, and practice characteristics with patient satisfaction in a multivariable mixed effects logistic regression model Conclusion Patient perceptions of PCPs remain unchanged following the delivery of a behavioral and educational intervention to primary care providers that resulted in observable decreases in antibiotic prescribing practices for RTIs. Disclosures All Authors: No reported disclosures

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A Unique Case of Replantation of Previously Replanted Fingers

Indian Journal of Plastic Surgery ◽

10.1055/s-0041-1723911 ◽

2021 ◽

Author(s):

Ravindra Bharathi ◽

Praveen Bhardwaj ◽

Vigneswaran Varadharajan ◽

Hari Venkatramani ◽

S Raja Sabapathy

Keyword(s):

Patient Satisfaction ◽

Literature Search ◽

Standard Of Care ◽

Unique Case ◽

High Patient Satisfaction ◽

Finger Amputation ◽

Accepted Standard ◽

Technical Challenges

AbstractReplantation of digital amputations is now the accepted standard of care. However, rarely will a replantation surgeon be presented with amputated fingers which have been previously replanted. In our literature search, we could find only one publication where a replanted thumb suffered amputation and was successfully replanted again. We report the technical challenges and the outcome of replanting two fingers which suffered amputation 40 months after the initial replantation and were successfully replanted again. Replantation was critical since the amputated fingers were the only two complete fingers in that hand which had initially suffered a four-finger amputation. The second-time replantation of previously replanted fingers is reported to allay the concern of the reconstructive surgeon when faced with this unique situation of “repeat amputation of the replanted finger.” Second-time replantation is feasible and is associated with high-patient satisfaction. Replantation must be attempted especially in the event of multiple digit amputations.

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