Decontamination Steps Vital for General Practice

2020 ◽  
Vol 30 (9) ◽  
pp. 38-41
Author(s):  
Shaun Doak
Keyword(s):  
General Practice ◽  
Face To Face ◽  
Safe Environments

With general practice under increasing pressure to offer face-to-face appointments during the winter months, it is imperative that there is detailed advice available on precautions to provide clean and safe environments for staff and patients

scholarly journals Standing order use in general practice: the views of medicine, nursing and pharmacy stakeholder organisations

2017 ◽  
Vol 9 (1) ◽  
pp. 47 ◽  
Author(s):  
Robyn Taylor ◽  
Eileen McKinlay ◽  
Caroline Morris
Keyword(s):  
General Practice ◽  
General Practitioner ◽  
Access To Health Care ◽  
Timely Manner ◽  
Face To Face ◽  
Standing Order ◽  
Access To Health ◽  
General Practices ◽  
Pharmacy Data ◽  
The Impact

ABSTRACT INTRODUCTION Standing orders are used by many general practices in New Zealand. They allow a practice nurse to assess patients and administer and/or supply medicines without needing intervention from a general practitioner. AIM To explore organisational strategic stakeholders’ views of standing order use in general practice nationally. METHODS Eight semi-structured, qualitative, face-to-face interviews were conducted with participants representing key primary care stakeholder organisations from nursing, medicine and pharmacy. Data were analysed using a qualitative inductive thematic approach. RESULTS Three key themes emerged: a lack of understanding around standing order use in general practice, legal and professional concerns, and the impact on workforce and clinical practice. Standing orders were perceived to extend nursing practice and seen as a useful tool in enabling patients to access medicines in a safe and timely manner. DISCUSSION The variability in understanding of the definition and use of standing orders appears to relate to a lack of leadership in this area. Leadership should facilitate the required development of standardised resources and quality assurance measures to aid implementation. If these aspects are addressed, then standing orders will continue to be a useful tool in general practice and enable patients to have access to health care and, if necessary, to medicines without seeing a general practitioner.

scholarly journals General practice trainee strategies for seeking in-consultation assistance from supervisors, and their perceptions of patient-related barriers to help-seeking: a survey study

2020 ◽  
Author(s):  
Nancy Sturman ◽  
Amanda Tapley ◽  
Mieke van Driel ◽  
Elizabeth Holliday ◽  
Jean Ball ◽  
...  
Keyword(s):  
General Practice ◽  
Help Seeking ◽  
Survey Study ◽  
Just In Time ◽  
Workplace Interventions ◽  
Face To Face ◽  
Frequency Of Use ◽  
Educational Implications ◽  
Perceived Change ◽  
Electronic Messaging

Abstract Background General practice (GP) trainees may seek supervisor assistance when hesitant to complete patient consultations independently. Trainees describe patient-related barriers to this in-consultation help-seeking, despite its key role in supervisory oversight. Little is known, however, about trainee strategies for seeking assistance, or the frequency and associations of trainee concerns about these barriers. Methods Australian GP trainees rated their frequency of use of five specific strategies for obtaining in-consultation assistance, perceived change in patient impressions of their competence after this assistance, and relative trainee comfort presenting patients outside, compared to within, patients’ hearing. Statistical analyses included descriptive statistics and multivariable logistic regression. Results Responses were received from 778 Australian GP trainees (response rate 89%). Help-seeking strategies did not differ between trainees at different training stages, except for greater use of electronic messaging in later stages. In-consultation assistance was most commonly provided by phone between trainee and supervisor consulting rooms, or outside the trainee’s patient’s hearing. Supervisor assistance in the trainee’s room face-to-face with the patient was reported as either never or rarely obtained by 12% of respondents. More trainees (25%) perceived that patient impressions of their competence increased after help-seeking than perceived that these impressions decreased (19%). Most trainees (55%) preferred to present patients outside their hearing. Trainee age was the only variable associated with both patient-related barriers. Conclusion Supervisors appear to have considerable influence over trainee help-seeking barriers and strategies, including whether or not face-to-face in-consultation supervision is sought. In-consultation supervision may actually increase trainee perceptions of patient impressions of their competence. Many supervisors and trainees may benefit from additional educational and workplace interventions to facilitate comfortable and effective trainee help-seeking in front of patients. More work is required to understand the clinical and educational implications of different help-seeking strategies when trainees require ‘just in time’ supervisor assistance.

scholarly journals Introducing teledermoscopy of possible skin cancers in general practice in Southern Denmark

2020 ◽  
Vol 37 (4) ◽  
pp. 513-518
Author(s):  
Tine Vestergaard ◽  
Sumangali C Prasad ◽  
Annette Schuster ◽  
Rasa Laurinaviciene ◽  
Anette Bygum ◽  
...  
Keyword(s):  
General Practice ◽  
Diagnostic Accuracy ◽  
Health Care Systems ◽  
Final Diagnosis ◽  
Skin Lesions ◽  
University Hospital ◽  
Predictive Values ◽  
Face To Face ◽  
Skin Cancers ◽  
Care Systems

Abstract Background The increasing incidence of skin cancers poses a burden to health care systems. General practitioners (GPs) play an important role in triaging these diseases and referring relevant patients to specialists. It is challenging to distinguish benign from malignant skin lesions, and GPs may benefit from diagnostic support from teledermoscopy (TD). Objectives To assess whether the introduction of TD in general practice was feasible and might reduce the number of unnecessary referrals to specialists and to assess the diagnostic accuracy and confidence of participating GPs. Methods Fifty general practices in Southern Denmark participated. Adult patients presenting to their GP with suspected skin cancer could be included. Images including dermoscopy were taken by the GP and sent for evaluation by specialized dermatologists at a university hospital. Patients were simultaneously referred for a face-to-face evaluation at the university hospital. Diagnoses proposed by the GPs and by TD were compared to the final diagnoses obtained by histopathology or, if not available, face-to-face evaluation. Results Five hundred and nineteen patients with 600 suspected skin cancers were included. The final diagnosis was benign in 72.3%. The photo quality was good or fair in 90.5%. GPs reported uncertainty about their diagnoses in 41.5% of cases. The GPs’ positive predictive values for any malignancy and for malignant melanoma were 49.5% and 26.3%, respectively. On evaluation by TD, 31.5% of lesions did not need further in-person assessment. Conclusion Useful images of suspicious skin lesions were obtained from general practice, and GPs could benefit from TD to improve their diagnostic accuracy and confidence.

scholarly journals Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care

2019 ◽  
Vol 69 (686) ◽  
pp. e595-e604 ◽  
Author(s):  
Victoria Hammersley ◽  
Eddie Donaghy ◽  
Richard Parker ◽  
Hannah McNeilly ◽  
Helen Atherton ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Technical Problems ◽  
Face To Face ◽  
Information Giving ◽  
Care Services ◽  
Primary Care Services ◽  
Quasi Experimental ◽  
Primary Care Clinicians

BackgroundGrowing demands on primary care services have led to policymakers promoting video consultations (VCs) to replace routine face-to-face consultations (FTFCs) in general practice.AimTo explore the content, quality, and patient experience of VC, telephone (TC), and FTFCs in general practice.Design and settingComparison of audio-recordings of follow-up consultations in UK primary care.MethodPrimary care clinicians were provided with video-consulting equipment. Participating patients required a smartphone, tablet, or computer with camera. Clinicians invited patients requiring a follow-up consultation to choose a VC, TC, or FTFC. Consultations were audio-recorded and analysed for content and quality. Participant experience was explored in post-consultation questionnaires. Case notes were reviewed for NHS resource use.ResultsOf the recordings, 149/163 were suitable for analysis. VC recruits were younger, and more experienced in communicating online. FTFCs were longer than VCs (mean difference +3.7 minutes, 95% confidence interval [CI] = 2.1 to 5.2) or TCs (+4.1 minutes, 95% CI = 2.6 to 5.5). On average, patients raised fewer problems in VCs (mean 1.5, standard deviation [SD] 0.8) compared with FTFCs (mean 2.1, SD 1.1) and demonstrated fewer instances of information giving by clinicians and patients. FTFCs scored higher than VCs and TCs on consultation-quality items.ConclusionVC may be suitable for simple problems not requiring physical examination. VC, in terms of consultation length, content, and quality, appeared similar to TC. Both approaches appeared less ‘information rich’ than FTFC. Technical problems were common and, though patients really liked VC, infrastructure issues would need to be addressed before the technology and approach can be mainstreamed in primary care.

scholarly journals What happens to patient experience when you want to see a doctor and you get to speak to a nurse? Observational study using data from the English General Practice Patient Survey

BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e018690 ◽  
Author(s):  
Charlotte A M Paddison ◽  
Gary A Abel ◽  
Jenni Burt ◽  
John L Campbell ◽  
Marc N Elliott ◽  
...  
Keyword(s):  
General Practice ◽  
Patient Experience ◽  
Secondary Analysis ◽  
Patient Survey ◽  
Models Of Care ◽  
Unintended Consequences ◽  
Multidisciplinary Teams ◽  
Face To Face ◽  
Patient Reported ◽  
Practice Patient

ObjectivesTo examine patient consultation preferences for seeing or speaking to a general practitioner (GP) or nurse; to estimate associations between patient-reported experiences and the type of consultation patients actually received (phone or face-to-face, GP or nurse).DesignSecondary analysis of data from the 2013 to 2014 General Practice Patient Survey.Setting and participants870 085 patients from 8005 English general practices.OutcomesPatient ratings of communication and ‘trust and confidence’ with the clinician they saw.Results77.7% of patients reported wanting to see or speak to a GP, while 14.5% reported asking to see or speak to a nurse the last time they tried to make an appointment (weighted percentages). Being unable to see or speak to the practitioner type of the patients’ choice was associated with lower ratings of trust and confidence and patient-rated communication. Smaller differences were found if patients wanted a face-to-face consultation and received a phone consultation instead. The greatest difference was for patients who asked to see a GP and instead spoke to a nurse for whom the adjusted mean difference in confidence and trust compared with those who wanted to see a nurse and did see a nurse was −15.8 points (95% CI −17.6 to −14.0) for confidence and trust in the practitioner and −10.5 points (95% CI −11.7 to −9.3) for net communication score, both on a 0–100 scale.ConclusionsPatients’ evaluation of their care is worse if they do not receive the type of consultation they expect, especially if they prefer a doctor but are unable to see one. New models of care should consider the potential unintended consequences for patient experience of the widespread introduction of multidisciplinary teams in general practice.

Student paramedics' views on placements in general practice as part of a degree

2019 ◽  
Vol 11 (12) ◽  
pp. 519-525
Author(s):  
Alyesha Proctor
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Care Pathway ◽  
Structured Interviews ◽  
Learning And Development ◽  
Alternative Care ◽  
Face To Face ◽  
The Uk ◽  
University Degree

Background: Frontline paramedics are increasingly attending to non-emergency problems and calls that could be managed by a primary care provider. Alongside this, there is a growing pressure to manage patients at home or use an alternative care pathway and reduce hospital conveyance. Student paramedic training, including both placement and taught elements at university, should therefore reflect this. However, placement opportunities for student paramedics in primary care settings is variable across the UK. Aim: To explore student paramedics' views on incorporating a placement within general practice as part of their degree and its effects on their learning and development as an autonomous paramedic. Method: A small pedagogic study as part of a postgraduate certificate in academic practice for higher education, involving a case study, qualitative approach using face-to-face, semi-structured interviews and thematic analysis, was carried out. Findings: Student paramedics feel that incorporating a placement in general practice as part of their degree will significantly help in their learning and development as autonomous paramedics. Specifically, they feel it: will help them understand the role of the GP and what the GP expects of them; will help them to focus their assessments and improve confidence in decisions not to convey patients; may lead to better knowledge of alternative care pathways; and, finally, may provide an insight into the role of the paramedic in general practice as a future career opportunity. There are a few reservations about whether students would be able to use the skills and knowledge gained in this setting, as they feel they do not have access to the tools or the authority in a frontline ambulance service. Students would prefer to have a placement in a GP surgery in the final year of their university degree. Conclusion: Placement within a GP surgery for student paramedics should be included as part of a paramedic science degree as a priority. This is necessary, particularly given the changing role of the contemporary paramedic who attends to non-emergency problems.

scholarly journals Advanced Access scheduling in general practice and use of primary care: a Danish population-based matched cohort study

BJGP Open ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. bjgpopen20X101091
Author(s):  
Maria Bang ◽  
Henrik Schou Pedersen ◽  
Bodil Hammer Bech ◽  
Claus Høstrup Vestergaard ◽  
Jannik Falhof ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Cohort Study ◽  
Population Based ◽  
Matched Cohort ◽  
Face To Face ◽  
Matched Cohort Study ◽  
Adjusted Incidence Rate ◽  
Advanced Access ◽  
The Impact

BackgroundAdvanced access scheduling (AAS) allows patients to receive care from their GP at the time chosen by the patient. AAS has shown to increase the accessibility to general practice, but little is known about how AAS implementation affects the use of in-hours and out-of-hours (OOH) services.AimTo describe the impact of AAS on the use of in-hours and OOH services in primary care.Design & settingA population-based matched cohort study using Danish register data.MethodA total of 161 901 patients listed in 33 general practices with AAS were matched with 287 837 reference patients listed in 66 reference practices without AAS. Outcomes of interest were use of daytime face-to-face consultations, and use of OOH face-to-face and phone consultations in a 2-year period preceding and following AAS implementation.ResultsNo significant differences were seen between AAS practices and reference practices. During the year following AAS implementation, the number of daytime face-to-face consultations was 3% (adjusted incidence rate ratio [aIRR] = 1.03; 95% confidence interval [CI] = 0.99 to 1.07) higher in the AAS practices compared with the number in the reference practices. Patients listed with an AAS practice had 2% (aIRR = 0.98; 95% CI = 0.92 to 1.04) fewer OOH phone consultations and 6% (aIRR = 0.94; 95% CI = 0.86 to 1.02) fewer OOH face-to-face consultations compared with patients listed with a reference practice.ConclusionThis study showed no significant differences following AAS implementation. However, a trend was seen towards slightly higher use of daytime primary care and lower use of OOH primary care.

scholarly journals Evaluation of a ‘drop box’ doorstep assessment service to aid remote assessments for COVID-19 in general practice

2021 ◽  
Vol 10 (1) ◽  
pp. e001081
Author(s):  
Greg Irving ◽  
David Lawson ◽  
Adele Tinsley ◽  
Helen Parr ◽  
Cheryl Whittaker ◽  
...  
Keyword(s):  
Blood Pressure ◽  
General Practice ◽  
Quality Improvement ◽  
Clinical Care ◽  
Vital Signs ◽  
Routine Care ◽  
Significant Shift ◽  
Face To Face ◽  
Remote Assessment ◽  
Objective Recording

COVID-19 is an established threat whose clinical features and epidemiology continues to evolve. In an effort to contain the disease, the National Health Service has adopted a digital first approach in UK general practice resulting in a significant shift away from face-to-face consultations. Consequently, more consultations are being completed without obtaining objective recording of vital signs and face-to-face examination. Some regions have formed hot hubs to facilitate the review of suspected COVID-19 cases and keep their practice site ‘clean’ including the use of doorstep observations in avoiding the risk of face-to-face examination. To support the safe, effective and efficient remote assessment of suspected and confirmed patients with COVID-19, we established a doorstep assessment service to compliment telephone and video consultations. This allows physiological parameters such as temperature, pulse, blood pressure and oxygen saturation to be obtained to guide further triage. Quality improvement methods were used to integrate and optimise the doorstep assessment and measure the improvements made. The introduction of a doorstep assessment service increased the proportion of assessments for patients with suspected COVID-19 in routine care over weeks. At the same time we were able to dramatically reduce face-to-face assessment over a 6-week period by optimising through a range of measures including the introduction of a digital stethoscope. The majority of patients were managed by their own general practitioner following assessment supporting continuity of care. There were no adverse events during the period of observation; no staff absences related to COVID-19. Quality improvement methods have facilitated the successful integration of doorstep assessments into clinical care.

scholarly journals Face-to-face versus telehealth consultations during COVID-19 in australian general practice: comparison of medication prescribing

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0132
Author(s):  
Nasir Wabe ◽  
Judith Thomas ◽  
Gorkem Sezgin ◽  
Muhammad Kashif Sheikh ◽  
Emma Gault ◽  
...  
Keyword(s):  
General Practice ◽  
Outcome Measure ◽  
Anatomical Therapeutic Chemical ◽  
System Level ◽  
Secondary Outcome ◽  
Secondary Outcome Measure ◽  
Face To Face ◽  
Significant Difference ◽  
Australian General Practice ◽  
Medication Prescribing

BackgroundThere has been a precipitous rise telehealth use in general practice during the COVID-19 pandemic. Understanding differences between face-to-face and telehealth consulting is an important component for planning the future use of telehealth services beyond the pandemic. However, there is limited evidence on whether telehealth consulting impacts medication prescribing under pandemic circumstances.AimTo compare medication prescribing in face-to-face versus telehealth consultations during the COVID-19 pandemic in Australian general practice.Design and SettingThis multisite, retrospective observational study used de-identified routinely collected electronic health data extracted from 806 general practices in Victoria and New South Wales (NSW), Australia between April-December 2020.MethodThe primary outcome measure was whether at least one medication was prescribed following a telehealth or face-to-face consultation. Data are reported by medication and for each of the Anatomical Therapeutic Chemical (ATC) Classification System level one groups. The secondary outcome measure was first-time prescribing. Telehealth included both telephone and video consultations.ResultsA total of 13,608,216 consultations satisfied the inclusion criteria (61% face-to-face and 39% telehealth). Most telehealth consultations were conducted via telephone (97.8%). Overall, 39.3% of face-to-face and 33.0% of telehealth consultations prescribed at least one medication– a statistically significant difference (adjusted OR 1.38; 95% CI 1.379–1.381). The prescribing rate was greater for face-to-face vs telehealth consultations for all drug groups except ATC level 1N (nervous system).ConclusionUnder COVID-19 restrictions in the states of Victoria and NSW, Australia, medication prescribing was higher in face-to-face consultations when compared to telehealth consultations in the study population.

scholarly journals Email Consultations Between Patients and Doctors in Primary Care: Content Analysis

10.2196/18218 ◽  
2020 ◽  
Vol 22 (11) ◽  
pp. e18218
Author(s):  
Helen Atherton ◽  
Anne-Marie Boylan ◽  
Abi Eccles ◽  
Joanna Fleming ◽  
Clare R Goyder ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Content Analysis ◽  
Communication Technologies ◽  
Face To Face ◽  
The United Kingdom ◽  
Wide Range ◽  
The Face ◽  
And Function

Background Increasingly, consultations in health care settings are conducted remotely using a range of communication technologies. Email allows for 2-way text-based communication, occurring asynchronously. Studies have explored the content and nature of email consultations to understand the use, structure, and function of email consultations. Most previous content analyses of email consultations in primary care settings have been conducted in North America, and these have shown that concerns and assumptions about how email consultations work have not been realized. There has not been a UK-based content analysis of email consultations. Objective This study aims to explore and delineate the content of consultations conducted via email in English general practice by conducting a content analysis of email consultations between general practitioners (GPs) and patients. Methods We conducted a content analysis of anonymized email consultations between GPs and patients in 2 general practices in the United Kingdom. We examined the descriptive elements of the correspondence to ascertain when the emails were sent, the number of emails in an email consultation, and the nature of the content. We used a normative approach to analyze the content of the email consultations to explore the use and function of email consultation. Results We obtained 100 email consultations from 85 patients, which totaled 262 individual emails. Most email users were older than 40 years, and over half of the users were male. The email consultations were mostly short and completed in a few days. Emails were mostly sent and received during the day. The emails were mostly clinical in content rather than administrative and covered a wide range of clinical presentations. There were 3 key themes to the use and function of the email consultations: the role of the GP and email consultation, the transactional nature of an email consultation, and the operationalization of an email consultation. Conclusions Most cases where emails are used to have a consultation with a patient in general practice have a shorter consultation, are clinical in nature, and are resolved quickly. GPs approach email consultations using key elements similar to that of the face-to-face consultation; however, using email consultations has the potential to alter the role of the GP, leading them to engage in more administrative tasks than usual. Email consultations were not a replacement for face-to-face consultations.

Sign in / Sign up

Export Citation Format

Share Document