scholarly journals A mixed methods evaluation of medication reconciliation in the primary care setting

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0260882
Author(s):  
Michael R. Gionfriddo ◽  
Vanessa Duboski ◽  
Allison Middernacht ◽  
Melissa S. Kern ◽  
Jove Graham ◽  
...  
Keyword(s):  
Primary Care ◽  
Medication Reconciliation ◽  
Response Rate ◽  
Healthcare Delivery ◽  
The United States ◽  
Structured Interviews ◽  
Healthcare Delivery System ◽  
High Quality ◽  
Major Barrier ◽  
Primary Care Settings

Objectives To understand the extent to which behaviors consistent with high quality medication reconciliation occurred in primary care settings and explore barriers to high quality medication reconciliation. Design Fully mixed sequential equal status design including ethnographic observations, semi-structured interviews, and surveys. Setting Primary care practices within an integrated healthcare delivery system in the United States. Participants We conducted 170 observations of patient encounters across 15 primary care clinics, 48 semi-structured interviews with staff, and 10 semi-structured interviews with patients. We also sent out surveys to 2,541 eligible staff with 616 responses (24% response rate) and to 5,132 eligible patients with 577 responses (11% response rate). Results Inconsistency emerged as a major barrier to effective medication reconciliation. This inconsistency was present across a variety of factors such as the lack of standardized workflows for conducting medication reconciliation, a lack of knowledge about medication and the process of medication reconciliation, varying levels of importance ascribed to medication reconciliation, and inadequate integration of medication reconciliation into clinical workflows. Findings were generally consistent across all data collection methods. Conclusion We have identified several barriers which impact the process of medication reconciliation in primary care settings. Our key finding is that the process of medication reconciliation is plagued by inconsistencies which contribute to inaccurate medication lists. These inconsistencies can be broken down into several categories (standardization, knowledge, importance, and inadequate integration) which can be targets for future studies and interventions.

scholarly journals Understanding the Family Doctor Concept in Public Primary Care Clinics in Malaysia: Objectives, Initiatives, Resources, and Expected Outcomes

2020 ◽  
Author(s):  
Aniza Ismail ◽  
Muhammad Alimin Mat Reffien ◽  
Saperi Sulong ◽  
Tengku Putri Zaharah Tengku Bahanuddin ◽  
Noridah Mohd Salleh ◽  
...  
Keyword(s):  
Primary Care ◽  
Human Resources ◽  
Family Doctor ◽  
Healthcare Delivery ◽  
Limiting Factor ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Healthcare Delivery System ◽  
Primary Care Clinics ◽  
Expected Outcomes

Abstract IntroductionFamily Doctor Concept (FDC) was a program introduced at selected public primary care clinics to strengthen family practice in Malaysia. It is a healthcare delivery system approach that strives to achieve “One Family, One Doctor” concept so that the physicians can provide the population with comprehensive, continuous, collaborative, personal, family- and community-oriented services.Methods and materials We collected qualitative data collection via semi-structured interviews with stakeholders (Policymakers, healthcare providers, state- and clinic-level implementers). The data were analyzed using thematic analysis according to the Consolidated criteria for Reporting Qualitative Studies (COREQ) guideline for reporting the findings.ResultsThe 16 stakeholders who participated in this research agreed that the FDC is an approach to deliver integrated, personalized, family-centered, and comprehensive care to clients. However, there were other macro-level and longer-term objectives, such as mapping diseases and improving accessibility. FDC components were related to the objectives, and variation in the implementation was expected to suit different settings. Generally, the stakeholders disagreed on the input requirement, but all cited human resources as a significant limiting factor. There were numerous expected outcomes, which could be divided into short-, intermediate-, and long-term.ConclusionFDC consists of several change initiatives in a complex health care system whereby the capacity building of human resources is critical in achieving the desired outcomes. Thus, there is an urgent need for multiple stakeholders to reach common understanding and building a workable roadmap for successful implementation.

Prerequisites to support high-quality clinical trials in children and young people

2020 ◽  
pp. archdischild-2019-318677
Author(s):  
Steven Hirschfeld ◽  
Florian B Lagler ◽  
Jenny M Kindblom
Keyword(s):  
Clinical Trials ◽  
Healthcare Delivery ◽  
Paediatric Population ◽  
Ecosystem Functions ◽  
Healthcare Delivery System ◽  
High Quality ◽  
Children And Young People ◽  
The Right ◽  
Support Decision Making

Children have the right to treatment based on the same quality of information that guides treatment in adults. Without the proper evaluation of medicinal products and devices in paediatric clinical trials that are designed to meet the rigorous standards of the competent authorities, children are discriminated from advances in medicine. There are regulatory, scientific and ethical incentives to address the knowledge gap regarding efficacy and safety of medicines in the paediatric population. High-quality clinical trials involving children of all ages can generate data that will ultimately close the knowledge gaps and support decision making.For clinical trials that enrol children, the needs are specialised and often resource intensive. Prerequisites for successful paediatric clinical trials are personnel with training in both paediatrics and neonatology and expertise in clinical trials in these populations. Moreover, national and international networks for efficient collaboration, dissemination of information, and sharing of resources and expertise are also needed, together with competent, efficient and high-quality local infrastructure with effective processes. Monitoring and oversight bodies with the relevant competence, including expertise in paediatrics, is also an important prerequisite for paediatric clinical trials. Compromise in any of these components will compromise the downstream results.This paper discusses the structures and competences needed in order to perform effective, high-quality paediatric clinical trials with the ultimate goal of better medicines and treatments for children. We propose a model of examining the process as a series of components that each has to be optimised, then all the components are actively optimised to function together as an ecosystem, and the resulting ecosystem functions well with the general research system and the healthcare delivery system.

How Research Will Adapt to HIPAA: A View from Within the Healthcare Delivery System

2002 ◽  
Vol 28 (4) ◽  
pp. 491-502
Author(s):  
Mary L. Durham
Keyword(s):  
Health Information ◽  
Healthcare Delivery ◽  
Healthcare Providers ◽  
The United States ◽  
Personal Health Information ◽  
Personal Health ◽  
Business Associations ◽  
Electronic Information ◽  
Healthcare Delivery System ◽  
Institutional Review

While the new Health Insurance Privacy and Accountability Act (HIPAA) research rules governing privacy, confidentiality and personal health information will challenge the research and medical communities, history teaches us that the difficulty of this challenge pales in comparison to the potential harms that such regulations are designed to avoid. Although revised following broad commentary from researchers and healthcare providers around the country, the HIPAA privacy requirements will dramatically change the way healthcare researchers do their jobs in the United States. Given our reluctance to change, we risk overlooking potentially valid reasons why access to personal health information is restricted and regulated. In an environment of electronic information, public concern, genetic information and decline of public trust, regulations are ever-changing. Six categories of HIPAA requirements stand out as transformative: disclosure accounting/tracking, business associations, institutional review board (IRB) changes, minimum necessary requirements, data de-identification, and criminal and civil penalties.

scholarly journals Regionalization of Emergency Care Conditions: Classifications, Comparisons, and Considerations

2021 ◽  
Author(s):  
Nathan Walton ◽  
Nicholas Mohr
Keyword(s):  
Emergency Care ◽  
Emergency Preparedness ◽  
Systems Of Care ◽  
Healthcare Delivery ◽  
The United States ◽  
Third Party ◽  
Professional Organizations ◽  
Healthcare Delivery System ◽  
Comparative Review ◽  
Core Components

Background: Regionalization is a system of organizing hospitals and providers to optimize care by matching patient needs with the appropriate healthcare resources. Regionalized care has been shown to improve outcomes in trauma, burn, stroke, STEMI, cardiac arrest, and NICU/OB care.Methods: This study was a comprehensive literature review to develop a classification- based, comparative review of existing regionalized systems of care by their components and characteristics. We performed a text-based analysis of the writing of the involved organizations (professional, regulatory, etc.) and interviews with the organizational leaders directly involved with regionalized systems of care. The scope of the review was three-fold: (1) to provide a summation of the available literature and established models of regionalized emergency care, (2) to identify the common core components of regionalized systems, and (3) to apply lessons about regional networks to sepsis care.Results: Regionalization in the US has followed a predictable pattern of development. Systems center on the delivery of time- or volume-sensitive care that is limited due to scarcity of resources, available facilities, or expertise. In response to perceived differential quality or inefficiency, professional organizations have published clinical guidelines and suggested regionalized tiered systems of facilities by resources and expectations of participation. These guidelines are used by government or third party certifying organizations to apply criteria to participating facilities. These efforts have been effective in establishing regionalized networks characterized by eight core components: triage/transfer protocols, resource-stratified networks, prevention/outreach/education, emergency preparedness, rehabilitation, internal/benchmarked data registries, performance improvement, and research.Conclusions: Several national models for regionalized systems of care are gaining traction and improving outcomes within the United States’ healthcare delivery system. Insights from this process hold promise to improve existing systems and establish new ones, notably in sepsis.

scholarly journals Exploring general practitioners’ perceptions about the primary care gatekeeper role in Indonesia

2020 ◽  
Author(s):  
Joko Mulyanto ◽  
Yudhi Wibowo ◽  
Dionne S. Kringos
Keyword(s):  
Primary Care ◽  
General Practitioners ◽  
Work Experience ◽  
Healthcare Delivery ◽  
Care Facility ◽  
Personal Factors ◽  
Healthcare Delivery System ◽  
Cross Sectional ◽  
And Performance

Abstract Background In the current healthcare delivery system funded by National Health Insurance (NHI) in Indonesia, the gatekeeper role of primary care services is critical to ensuring equal healthcare access for the population. To be effective, gatekeeping relies on the performance of general practitioners (GPs). However, the perceptions held by Indonesian GPs about their gatekeeper role are not yet well documented. This study describes the self-perceived knowledge, attitudes and performance of Indonesian GPs with respect to the gatekeeper role and explores associated factors. Methods We conducted a cross-sectional study of all primary care facilities (N = 75) contracted by the regional NHI office in the Banyumas district. The 73 participating GPs completed a written questionnaire that assessed their knowledge, attitudes and performance in relation to the gatekeeper role. Personal and facility characteristics were analysed in a generalised linear model as possible associating factors.Results GPs scored relatively high in the domains of knowledge and performance but scored lower in their attitudes towards the gatekeeper role of primary care. In the full-adjusted model, no factors were significantly associated with the knowledge score. Work experience as GPs, private or civil service employment status and rural or urban location of the primary care facility were linked to attitude scores. Full- or part-time employment and type of facility were factors associated with the performance score. Conclusion GPs in Indonesia are knowledgeable and report that they adequately perform their function as gatekeepers in primary care. However, their attitudes towards the gatekeeper function are less positive. Attitudes and performance with respect to the primary care gatekeeper role are likely influenced more by contextual factors such as location and type of facility than by personal factors. Efforts to address contextual issues could include improvements in practice standards for privately practising physicians and public information campaigns about gatekeeping regulations. Such efforts will be crucial to improving the gatekeeper role of primary care in Indonesia and assuring efficient access to high-quality care for all.

scholarly journals Provision of services in primary care for type 2 diabetes: a qualitative study with patients, GPs, and nurses in the East of England

2020 ◽  
Vol 70 (698) ◽  
pp. e668-e675
Author(s):  
Hajira Dambha-Miller ◽  
Simon J Griffin ◽  
Ann Louise Kinmonth ◽  
Jenni Burt
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Care Provision ◽  
Structured Interviews ◽  
High Quality ◽  
Face To Face ◽  
Healthcare Experiences ◽  
Provision Of Services ◽  
The Impact

BackgroundThere is little evidence on the impact of national pressures on primary care provision for type 2 diabetes from the perspectives of patients, their GPs, and nurses.AimTo explore experiences of primary care provision for people with type 2 diabetes and their respective GPs and nurses.Design and settingA qualitative primary care interview study in the East of England.MethodSemi-structured interviews were conducted, between August 2017 and August 2018, with people who have type 2 diabetes along with their respective GPs and nurses. Purposive sampling was used to select for heterogeneity in glycaemic control and previous healthcare experiences. Interviews were audio-recorded and analysed thematically. The consolidated criteria for reporting qualitative research were followed.ResultsThe authors interviewed 24 patients and 15 GPs and nurses, identifying a changing landscape of diabetes provision owing to burgeoning pressures that were presented repeatedly. Patient responders wanted GP-delivered care with continuity. They saw GPs as experts best placed to support them in managing diabetes, but were increasingly receiving nurse-led care. Nurses reported providing most of the in-person care, while GPs remained accountable but increasingly distanced from face-to-face diabetes care provision. A reluctant acknowledgement surfaced among GPs, nurses, and their patients that only minimum care standards could be maintained, with aspirations for high-quality provision unlikely to be met.ConclusionType 2 diabetes is a tracer condition that reflects many aspects of primary care. Efforts to manage pressures have not been perceived favourably by patients and providers, despite some benefits. Reframing expectations of care, by communicating solutions to both patients and providers so that they are understood, managed, and realistic, may be one way forward.

Symptoms and Signs of Hemochromatosis in HFE C282Y Homozygotes Identified by Screening in Primary Care.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 1545-1545 ◽  
Author(s):  
Gordon D. McLaren ◽  
Christine E. McLaren ◽  
Paul C. Adams ◽  
James C. Barton ◽  
David M. Reboussin ◽  
...  
Keyword(s):  
Primary Care ◽  
Transferrin Saturation ◽  
Joint Stiffness ◽  
Chronic Fatigue ◽  
The United States ◽  
Newly Diagnosed ◽  
Control Subjects ◽  
Primary Care Settings ◽  
Clinical Conditions ◽  
Symptoms And Signs

Abstract Some patients with hemochromatosis (HC) experience fatigue, heart failure or arrhythmias, diabetes mellitus, liver damage, impotence, or arthritis. We examined self-reported symptoms and clinical conditions in persons homozygous for HFE C282Y, the major HC-associated gene mutation, identified in the Hemochromatosis and Iron Overload Screening (HEIRS) Study, a multi-center, multi-ethnic study in which 101,168 adults were recruited from primary care settings. Non-Hispanic Caucasian C282Y homozygotes were compared to participants without HFE C282Y or H63D alleles (controls) with transferrin saturation (TfS) and serum ferritin (SF) levels in the middle half of gender-specific distributions. Evaluation included a medical history, focused physical examination, and repeat SF. Among 44,082 non-Hispanic Caucasian participants screened at five Field Centers in the United States and Canada, 282 persons homozygous for C282Y were identified, comprising three groups: newly-diagnosed cases with normal (N=64) or elevated (N=131) SF (>200 μg/L in women, >300 μg/L in men), and previously-diagnosed cases (N=87). There were 364 non-Hispanic Caucasian controls. Significant differences were observed for six of 38 outcomes. Previously diagnosed C282Y homozygotes and newly diagnosed homozygotes with elevated SF reported significantly more chronic fatigue than controls (p=0.002). All groups of C282Y homozygotes reported weight loss more often than controls (p<0.001). Excessive thirst was reported more often than controls by newly diagnosed C282Y homozygotes, regardless of SF level (p=0.004), but there was no difference in self-reported history of diabetes. Joint stiffness was more common among newly diagnosed C282Y homozygotes with elevated SF than among control subjects (p<0.001). Swelling or tenderness of the second and third metacarpophalangeal joints and increased pigmentation were also more common among previously diagnosed C282Y homozygotes and newly diagnosed homozygotes with elevated SF than among controls (p=0.001 and p=0.002, respectively). The prevalences of manifestations related to liver or heart disease among C282Y homozygotes were not significantly different from controls. There were no differences among the three groups of C282Y homozygotes in the prevalences of any symptoms or clinical conditions. In summary, some symptoms and conditions associated with HC were more prevalent among C282Y homozygotes than among controls. However, C282Y homozygotes identified by screening in primary care settings did not have a higher prevalence of most symptoms and signs associated with HC than control subjects.

Primary care training for oral surgery: challenges and possibilities

2013 ◽  
Vol 4 (2) ◽  
pp. 64-73 ◽  
Author(s):  
Tara Renton ◽  
Colette Balmer
Keyword(s):  
Primary Care ◽  
Oral Surgery ◽  
Specialist Training ◽  
High Quality ◽  
Primary Care Settings ◽  
Primary Care Training ◽  
Care Training

This article assesses some of the challenges facing provision of high quality oral surgery care within primary care settings. This paper aims to highlight funding, regulation and governance of dental specialist training, and raises some advancing issues that we need to consider.

scholarly journals Factors Hindering the Adoption of Business-to-Consumer (B2C) in Developing Countries: A Case Study of Sudan

2017 ◽  
Vol 9 (4) ◽  
pp. 28-33
Author(s):  
Abdelaziz Musbah ◽  
Mira Kartiwi
Keyword(s):  
Credit Card ◽  
The United States ◽  
Internet Banking ◽  
Internet Security ◽  
Structured Interviews ◽  
Major Barrier ◽  
Adoption Decision ◽  
Business To Consumer ◽  
Two Stages

It has been commonly reported that e-commerce (electronic commerce) offers viable solutions to businesses in meeting the challenges of an environment that is undergoing changes. This study seeks to explore the factors that influence the adoption decision of Business-to-Consumer (B2C) e-commerce, using Sudan as a case study. The mixed method design was adopted in two stages in which both exploratory and descriptive research approaches were undertaken. Data was collected from enterprises by questionnaire and through the analysis of research and semi-structured interviews. The findings revealed that most enterprises in the country are still in the initial stages of adoption of B2C e-commerce despite the wide growth of Internet use among enterprises in Sudan. Many factors could be responsible for the low usage of e-commerce among the enterprises in Sudan. Technical barrier is seen as the major barrier that affects the adoption of B2C e-commerce. However, this is accompanied by regulatory and legal barriers. One of the factors that inhibit e-commerce adoption in SMEs in Sudan is the lack of Internet security. Other factors include limited use of web portals and Internet banking by enterprises. The use of credit card and visa card is prohibited in Sudan due to the sanction from the United States of America. However, these issues resulted in all type of transactions that involves carrying cash. This makes it risky for customer who carry huge sum of money. In order to improve B2C e-commerce adoption technologies, this study plays a significant role to organizations and supporting organizations, especially those operating in countries with a unique situation like Sudan.

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