scholarly journals Paramedic independent prescribing in primary care: seven steps to success

2020 ◽  
Vol 2 (6) ◽  
pp. 292-299 ◽  
Author(s):  
Judith Edwards ◽  
Melaine Coward ◽  
Nicola Carey
Keyword(s):  
Primary Care ◽  
Scope Of Practice ◽  
Service Development ◽  
Potential Barriers ◽  
Independent Prescribing ◽  
Early Adoption ◽  
Independent Case ◽  
The Uk ◽  
To Receive ◽  
Significant Milestone

Paramedic practice is evolving and the number of advanced paramedics in primary care roles in the UK has risen dramatically. Recent legislation granting paramedics independent prescribing rights means UK paramedics are the first worldwide to receive this extension in scope of practice – a significant milestone for the paramedic profession. Paramedic prescribing capability is expected to increase autonomy for independent case management and enhance capacity for service development. However, local and national success is likely to depend on skilful implementation and avoidance of historical barriers. This article aims to raise awareness of potential barriers to early adoption of paramedic independent prescribing in primary care. It identifies common pitfalls prior to training and provides seven practical steps for paramedics considering pursuing non-medical prescribing training.

scholarly journals Systemic glucocorticoid usage in dogs under primary veterinary care in the UK: prevalence and risk factors

2019 ◽  
Vol 185 (4) ◽  
pp. 108-108 ◽  
Author(s):  
Doaa A Elkholly ◽  
Dan O’Neill ◽  
Andrea K Wright ◽  
Kennedy Mwacalimba ◽  
Laura S Nolan ◽  
...  
Keyword(s):  
Primary Care ◽  
Medium Size ◽  
Age Group ◽  
Systemic Glucocorticoid ◽  
Oral Preparation ◽  
Systemic Glucocorticoids ◽  
Study Population ◽  
Long Acting ◽  
The Uk ◽  
To Receive

Glucocorticoids are widely used in primary care veterinary practices. The study aimed to quantify the usage of systemic glucocorticoids (SGC) in dogs in the UK using primary care treatment records recorded during 2013 in the VetCompass Programme. From a study population of 455 557 dogs, 28 472 dogs (6.2 per cent, 95 per cent CI 6.2 to 6.3) received a total of 50 971 SGC therapy events in 2013. Prednisolone represented the most frequently used oral preparation (27 362 events, 90.0 per cent of oral events). Dexamethasone sodium phosphate was the most commonly used injectable agent (12 796 events, 62.7 per cent of injectable events). The most common breed treated was Staffordshire Bull Terriers (2236/28 472 dogs, 7.9 per cent, 95 per cent CI 7.5 to 8.2) and within-breed prevalence of SGC usage was 2236/32 635, 6.9 per cent, 95 per cent CI 6.6 to 7.1. The most commonly treated age group was dogs older than eight years (8931/28472, 31.4 per cent) and the most commonly treated bodyweight group was 10.01–20.0 kg (7918/28 472, 27.8 per cent). Dexamethasone and prednisolone were the most commonly prescribed SGC. Short-acting and intermediate-acting injectable SGC were more commonly used compared with long-acting injectable SGC. Older and medium size dogs were most likely to receive SGC and certain breeds appeared predisposed. These data can provide a useful benchmark for glucocorticoid usage and highlight the benefits from ‘Big Data’ analyses.

Paramedic independent prescribing: a qualitative study of early adopters in the UK

2021 ◽  
Vol 6 (1) ◽  
pp. 30-37
Author(s):  
Karen Stenner ◽  
Suzanne van Even ◽  
Andy Collen
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
High Volume ◽  
Urgent Care ◽  
Multidisciplinary Teams ◽  
Framework Analysis ◽  
Early Adopters ◽  
Independent Prescribing ◽  
Controlled Drugs ◽  
The Uk

Background: Paramedics working in advanced practice roles in the UK can now train to prescribe medicine. This is anticipated to benefit patient access to medicines and quality of care where there is a national shortage of doctors, particularly in primary care.Aim: To explore the experience of paramedics who are early adopters of independent prescribing in a range of healthcare settings in the UK.Design and setting: A qualitative study involving interviews between May and August 2019, with paramedics in the UK who had completed a prescribing programme.Methods: Individual interviews with a purposive sample of paramedics recruited via social media and regional paramedic networks. Interviews covered experiences, benefits and challenges of the prescribing role. A framework analysis approach was used to identify key themes.Results: Participants were 18 advanced paramedics working in primary care, emergency departments, urgent care centres and rapid response units. All participants reported being adequately prepared to prescribe. Key benefits of prescribing included improving service capacity, efficiency and safety, and facilitating advanced clinical roles. Challenges included technological problems, inability to prescribe controlled drugs and managing expectations about the prescribing role. Concerns were raised about support and role expectations, particularly in general practice.Conclusion: Paramedic prescribing is most successful in settings with a high volume of same-day presentations and urgent and emergency care. It facilitated advanced roles within multidisciplinary teams. Concerns indicate that greater consideration for support infrastructure and workforce planning is required within primary care to ensure paramedics meet the entry criteria for a prescribing role.

scholarly journals Adapting primary care for new migrants: a formative assessment

BJGP Open ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. bjgpopen17X100701 ◽  
Author(s):  
Elizabeth Such ◽  
Elizabeth Walton ◽  
Brigitte Delaney ◽  
Janet Harris ◽  
Sarah Salway
Keyword(s):  
Primary Care ◽  
Case Studies ◽  
Online Survey ◽  
Resource Constraints ◽  
Sample Survey ◽  
Service Development ◽  
Care Provision ◽  
Care Services ◽  
Primary Care Services ◽  
The Uk

BackgroundImmigration rates have increased recently in the UK. Migrant patients may have particular needs that are inadequately met by existing primary care provision. In the absence of national guidance, local adaptations are emerging in response to these new demands.AimTo formatively assess the primary care services offered to new migrants and the ways in which practitioners and practices are adapting to meet need.Design & settingOnline survey and case studies of current practice across primary care in the UK. Case studies were selected from mainstream and specialist general practice as well as primary care provision in the third sector.MethodNon-probability sample survey of primary care practitioners (n = 70) with descriptive statistical analysis. Qualitative case studies (n = 8) selected purposively; in-depth exploration of organisational and practitioner adaptations to services. Analysis is structured around the principles of equitable care.ResultsSurvey results indicated that practitioners focused on working with communities and external agencies and adapting processes of, for example, screening, vaccination, and health checks. Lack of funding was cited most frequently as a barrier to service development (n = 51; 73%). Case studies highlighted the prominence partnership working and of an organisational and practitioner focus on equitable care. Adaptations centred on addressing wider social determinants, trauma, and violence, and additional individual needs; and on delivering culturally-competent care.ConclusionDespite significant resource constraints, some primary care services are adapting to the needs of new migrants. Many adapted approaches can be characterised as equity-oriented.

scholarly journals A semi-supervised approach for rapidly creating clinical biomarker phenotypes in the UK Biobank using different primary care EHR and clinical terminology systems

JAMIA Open ◽  
2020 ◽  
Author(s):  
Spiros Denaxas ◽  
Anoop D Shah ◽  
Bilal A Mateen ◽  
Valerie Kuan ◽  
Jennifer K Quint ◽  
...  
Keyword(s):  
Primary Care ◽  
Proportional Hazards ◽  
Biomarker Discovery ◽  
Data Extraction ◽  
Cox Proportional Hazards ◽  
Research Quality ◽  
Uk Biobank ◽  
Expert Review ◽  
Cox Proportional Hazards Models ◽  
The Uk

Abstract Objectives The UK Biobank (UKB) is making primary care electronic health records (EHRs) for 500 000 participants available for COVID-19-related research. Data are extracted from four sources, recorded using five clinical terminologies and stored in different schemas. The aims of our research were to: (a) develop a semi-supervised approach for bootstrapping EHR phenotyping algorithms in UKB EHR, and (b) to evaluate our approach by implementing and evaluating phenotypes for 31 common biomarkers. Materials and Methods We describe an algorithmic approach to phenotyping biomarkers in primary care EHR involving (a) bootstrapping definitions using existing phenotypes, (b) excluding generic, rare, or semantically distant terms, (c) forward-mapping terminology terms, (d) expert review, and (e) data extraction. We evaluated the phenotypes by assessing the ability to reproduce known epidemiological associations with all-cause mortality using Cox proportional hazards models. Results We created and evaluated phenotyping algorithms for 31 biomarkers many of which are directly related to COVID-19 complications, for example diabetes, cardiovascular disease, respiratory disease. Our algorithm identified 1651 Read v2 and Clinical Terms Version 3 terms and automatically excluded 1228 terms. Clinical review excluded 103 terms and included 44 terms, resulting in 364 terms for data extraction (sensitivity 0.89, specificity 0.92). We extracted 38 190 682 events and identified 220 978 participants with at least one biomarker measured. Discussion and conclusion Bootstrapping phenotyping algorithms from similar EHR can potentially address pre-existing methodological concerns that undermine the outputs of biomarker discovery pipelines and provide research-quality phenotyping algorithms.

scholarly journals Regulating health professional scopes of practice: comparing institutional arrangements and approaches in the US, Canada, Australia and the UK

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Kathleen Leslie ◽  
Jean Moore ◽  
Chris Robertson ◽  
Douglas Bilton ◽  
Kristine Hirschkorn ◽  
...  
Keyword(s):  
Health Professional ◽  
Health Professionals ◽  
Swot Analysis ◽  
Institutional Arrangements ◽  
Scope Of Practice ◽  
Comparative Case Study ◽  
Specific Reference ◽  
The Public ◽  
The Us ◽  
The Uk

Abstract Background Fundamentally, the goal of health professional regulatory regimes is to ensure the highest quality of care to the public. Part of that task is to control what health professionals do, or their scope of practice. Ideally, this involves the application of evidence-based professional standards of practice to the tasks for which health professional have received training. There are different jurisdictional approaches to achieving these goals. Methods Using a comparative case study approach and similar systems policy analysis design, we present and discuss four different regulatory approaches from the US, Canada, Australia and the UK. For each case, we highlight the jurisdictional differences in how these countries regulate health professional scopes of practice in the interest of the public. Our comparative Strengths, Weaknesses, Opportunities, Threats (SWOT) analysis is based on archival research carried out by the authors wherein we describe the evolution of the institutional arrangements for form of regulatory approach, with specific reference to scope of practice. Results/conclusions Our comparative examination finds that the different regulatory approaches in these countries have emerged in response to similar challenges. In some cases, ‘tasks’ or ‘activities’ are the basis of regulation, whereas in other contexts protected ‘titles’ are regulated, and in some cases both. From our results and the jurisdiction-specific SWOT analyses, we have conceptualized a synthesized table of leading practices related to regulating scopes of practice mapped to specific regulatory principles. We discuss the implications for how these different approaches achieve positive outcomes for the public, but also for health professionals and the system more broadly in terms of workforce optimization.

scholarly journals Development of a Cancer Risk Prediction Tool for Use in the UK Primary Care and Community Settings

2017 ◽  
Vol 10 (7) ◽  
pp. 421-430 ◽  
Author(s):  
Artitaya Lophatananon ◽  
Juliet Usher-Smith ◽  
Jackie Campbell ◽  
Joanne Warcaba ◽  
Barbora Silarova ◽  
...  
Keyword(s):  
Primary Care ◽  
Cancer Risk ◽  
Risk Prediction ◽  
Prediction Tool ◽  
Community Settings ◽  
The Uk

scholarly journals A qualitative exploration of patients’ experiences, needs and expectations regarding online access to their primary care record

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e044221
Author(s):  
Brian McMillan ◽  
Gail Davidge ◽  
Lindsey Brown ◽  
Moira Lyons ◽  
Helen Atherton ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Negative Consequences ◽  
Face To Face ◽  
Primary Care Record ◽  
Online Access ◽  
Additional Support ◽  
The Uk ◽  
Records Access ◽  
Qualitative Exploration

ObjectivesPrimary care records have traditionally served the needs and demands of clinicians rather than those of the patient. In England, general practices must promote and offer registered patients online access to their primary care record, and research has shown benefits to both patients and clinicians of doing so. Despite this, we know little about patients’ needs and expectations regarding online access to their record. This study explored what patients and carers want from online access to their electronic primary care health record, their experiences of using it, how they would like to interact with their record and what support they may need.DesignFocus groups and semistructured interviews using purposive sampling to achieve a good sociodemographic spread. Interviews were digitally audiorecorded, transcribed and coded using an established thematic approach.SettingFocus groups and interviews were conducted in community settings in the UK.ParticipantsFifty-four individuals who were either eligible for the National Health Service Health Check, living with more than one long-term condition or caring for someone else.ResultsParticipants views regarding online access were categorised into four main themes: awareness, capabilities, consequences and inevitability. Participants felt online access should be better promoted, and suggested a number of additional functions, such as better integration with other parts of the healthcare system. It was felt that online access could improve quality of care (eg, through increased transparency) but also have potential negative consequences (eg, by replacing face to face contact). A move towards more online records access was considered inevitable, but participants noted a need for additional support and training in using the online record, especially to ensure that health inequalities are not exacerbated.ConclusionsDiscussions with patients and carers about their views of accessing online records have provided useful insights into future directions and potential improvements for this service.

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