Rates of Switching Antiretroviral Drugs in a Primary Care Service in South Africa before and after Introduction of Tenofovir

Abstract Background Advance care planning (ACP) is a process that enables individuals to describe, in advance, the kind of health care they would want in the future. There is evidence that ACP reduces hospital-based interventions, especially at the end of life. ACP for frail older adults is especially important as this population is more likely to use hospital services but less likely to benefit from resource intensive care. Our study goal was to evaluate whether an approach to ACP developed for frail older adults, known as the Palliative and Therapeutic Harmonization or PATH, demonstrated an improvement in ACP. Methods The PATH approach was adapted to a primary care service for homebound older adults in Vancouver, Canada. This retrospective chart review collected surrogate measures related to ACP from 200 randomly selected patients enrolled in the service at baseline (prior to June 22, 2017), and 114 consecutive patients admitted to the program after implementation of the PATH ACP initiative (October 1, 2017 to May 1, 2018). We compared the following surrogate markers of ACP before and after implementation of the PATH model, chart documentation of: frailty stage, substitute decision-maker, resuscitation decision, and hospitalization decision. A composite ACP documentation score that ascribed one point for each of the above four measures (range 0 to 4) was also compared. For those with documented resuscitation and hospitalization decisions, the study examined patient/ substitute decision-maker expressed preferences for do-not-resuscitate and do-not-hospitalize, before and after implementation. Results We found the following changes in ACP-related documentation before and after implementation: frailty stage (27.0% versus 74.6%, p < .0001); substitute decision-maker (63.5% versus 71.9%, p = 0.128); resuscitation decision documented (79.5% versus 67.5%, p = 0.018); and hospitalization decision documented (61.5% versus 100.0%, p < .0001); mean (standard deviation) composite ACP documentation score (2.32 (1.16) versus 3.14 (1.11), p < .0001). The adjusted odds ratios (95% confidence intervals) for an expressed preference of do-not-resuscitate and do-not-hospitalize after implementation were 0.87 (0.35, 2.15) and 3.14 (1.78, 5.55), respectively. Conclusions Results suggest partial success in implementing the PATH approach to ACP in home-based primary care. Key contextual enablers and barriers are important considerations for successful implementation.

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A national evaluation of the Irish public health counselling in primary care service– examination of initial effectiveness data

BMC Psychiatry ◽

10.1186/s12888-021-03226-x ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Charles Brand ◽

Fiona Ward ◽

Niamh MacDonagh ◽

Sharon Cunningham ◽

Ladislav Timulak

Keyword(s):

Primary Care ◽

Large Scale ◽

Care Service ◽

Outcome Data ◽

Primary Care Service ◽

Observational Research ◽

Research Approach ◽

Growth Curve Analysis ◽

Republic Of Ireland ◽

Post Therapy

Abstract Background The Counselling in Primary Care service (CIPC) is the first and only nationally available public counselling service in the Republic of Ireland. This study provides initial data for the effectiveness of short-term psychotherapy delivered in a primary care setting in Ireland for the first time. Method A practice-based observational research approach was employed to examine outcome data from 2806 clients receiving therapy from 130 therapists spread over 150 primary care locations throughout Ireland. Pre-post outcomes were assessed using the CORE-OM and reliable and clinically significant change proportions. Binary logistic regression examined the effect of pre therapy symptom severity on the log odds of recovering. Six and 12 month follow up data from a subsample of 276 clients were also analysed using growth curve analysis. Results Of 14,156 referred clients, 5356 presented for assessment and 52.3% (N = 2806) consented to participate. Between assessment and post-therapy a large reduction in severity of symptoms was observed- Cohen’s d = 0.98. Furthermore, 47% of clients achieved recovery,a further 15.5% reliably improved, 2.7% reliably deteriorated and34.7% showed no reliable improvement. Higher initial severity was associated with less chance of recovering at post-therapy. Significant gains were maintained between assessment and12 months after therapy- Cohen’s d = 0.50. Conclusions Outcomes for clients in the CIPC service compared favourably with large scale counselling and psychotherapy services in jurisdictions in the U.K., the U.S.A., Norway and Sweden. This study expands the international primary care psychotherapy research base to include the entire Republic of Ireland jurisdiction.

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Providing a primary care service for psychiatric in-patients

Psychiatric Bulletin ◽

10.1192/pb.28.5.167 ◽

2004 ◽

Vol 28 (5) ◽

pp. 167-170 ◽

Cited By ~ 6

Author(s):

Enone Welthagen ◽

Sarah Talbot ◽

Oliver Harrison ◽

Michael Phelan

Keyword(s):

Primary Care ◽

Chronic Conditions ◽

Psychiatric Care ◽

Care Service ◽

Primary Care Service ◽

Clinical Implications ◽

Model Of Care ◽

Wide Range ◽

Set Up ◽

Acute Psychiatric Care

Aims and MethodA prospective descriptive study was set up to evaluate the feasibility, acceptability and activity of an innovative weekly primary care service for patients admitted for acute psychiatric care.ResultsDuring 10 months, 36 clinics were held and 123 appointments were attended. Presenting complaints included a wide range of acute and chronic conditions, affecting all body systems. As well as treating specific complaints, the doctor providing this service undertook considerable health promotion work and gave advice about patient management to junior psychiatrists.Clinical ImplicationsIt appears that there is considerable need for primary care expertise within an acute psychiatric unit, and that a weekly clinic is a feasible model of care.

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Roll-over test in primigravidae attending a public primary care service

Sao Paulo Medical Journal ◽

10.1590/s1516-31801997000500004 ◽

1997 ◽

Vol 115 (5) ◽

pp. 1533-1536

Author(s):

Luiz Francisco Marcopito

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Roc Curve ◽

Operating Characteristic ◽

Care Setting ◽

Care Service ◽

Primary Care Service ◽

Pregnancy Induced Hypertension ◽

Predictive Values ◽

Induced Hypertension

OBJECTIVE:To determine the roll-over test (ROT) performance in predicting pregnancy-induced hypertension (PIH) in primigravidae aged 15-29 years in a public primary care service. METHOD: Prospective cohort study enrolling 369 consecutive and initially normotensive primigravidae. The ROT was applied within 28-32 weeks of pregnancy. PIH was defined as diastolic blood pressure (DBP) 90 mm Hg or systolic blood pressure (SBP) 140 mm Hg, or a rise in DBP 15 mm Hg or a rise in SBP 30 mm Hg. The ROT prognostic properties were calculated, and a receiver operating characteristic (ROC) curve was constructed. RESULTS: For the 20 mm Hg cutoff point, sensitivity was 20% and specificity was 93%. Positive and negative predictive values were, respectively, 23% and 92%, for a PIH cumulative incidence of 9.5%. With other cutoff points, the ROC curve showed a poor discriminatory value of the test. CONCLUSION: The ROT was not useful for predicting PIH in a primary prenatal care setting.

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Characteristics of Patients Using Different Patient Portal Functions and the Impact on Primary Care Service Utilization and Appointment Adherence: Retrospective Observational Study

Journal of Medical Internet Research ◽

10.2196/14410 ◽

2020 ◽

Vol 22 (2) ◽

pp. e14410 ◽

Cited By ~ 6

Author(s):

Xiang Zhong ◽

Jaeyoung Park ◽

Muxuan Liang ◽

Fangyun Shi ◽

Pamela R Budd ◽

...

Keyword(s):

Primary Care ◽

Service Utilization ◽

Care Delivery ◽

Care Service ◽

Primary Care Service ◽

Patient Portal ◽

Patient Portals ◽

Appointment Adherence ◽

Primary Care Patients ◽

The Impact

Background Patient portals are now widely available and increasingly adopted by patients and providers. Despite the growing research interest in patient portal adoption, there is a lack of follow-up studies describing the following: whether patients use portals actively; how frequently they use distinct portal functions; and, consequently, what the effects of using them are, the understanding of which is paramount to maximizing the potential of patient portals to enhance care delivery. Objective To investigate the characteristics of primary care patients using different patient portal functions and the impact of various portal usage behaviors on patients’ primary care service utilization and appointment adherence. Methods A retrospective, observational study using a large dataset of 46,544 primary care patients from University of Florida Health was conducted. Patient portal users were defined as patients who adopted a portal, and adoption was defined as the status that a portal account was opened and kept activated during the study period. Then, users were further classified into different user subgroups based on their portal usage of messaging, laboratory, appointment, and medication functions. The intervention outcomes were the rates of primary care office visits categorized as arrived, telephone encounters, cancellations, and no-shows per quarter as the measures of primary care service utilization and appointment adherence. Generalized linear models with a panel difference-in-differences study design were then developed to estimate the rate ratios between the users and the matched nonusers of the four measurements with an observational window of up to 10 quarters after portal adoption. Results Interestingly, a high propensity to adopt patient portals does not necessarily imply more frequent use of portals. In particular, the number of active health problems one had was significantly negatively associated with portal adoption (odds ratios [ORs] 0.57-0.86, 95% CIs 0.51-0.94, all P<.001) but was positively associated with portal usage (ORs 1.37-1.76, 95% CIs 1.11-2.22, all P≤.01). The same was true for being enrolled in Medicare for portal adoption (OR 0.47, 95% CI 0.41-0.54, P<.001) and message usage (OR 1.44, 95% CI 1.03-2.03, P=.04). On the impact of portal usage, the effects were time-dependent and specific to the user subgroup. The most salient change was the improvement in appointment adherence, and patients who used messaging and laboratory functions more often exhibited a larger reduction in no-shows compared to other user subgroups. Conclusions Patients differ in their portal adoption and usage behaviors, and the portal usage effects are heterogeneous and dynamic. However, there exists a lack of match in the patient portal market where patients who benefit the most from patient portals are not active portal adopters. Our findings suggest that health care delivery planners and administrators should remove the barriers of adoption for the portal beneficiaries; in addition, they should incorporate the impact of portal usage into care coordination and workflow design, ultimately aligning patients’ and providers’ needs and functionalities to effectively deliver patient-centric care.

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