scholarly journals The critical components of an electronic care plan tool for primary care: an exploratory qualitative study

2016 ◽  
Vol 23 (2) ◽  
pp. 529
Author(s):  
Lisa Rotenstein ◽  
Suhavi Tucker ◽  
Rose Kakoza ◽  
Lori Tishler ◽  
Adrian Zai ◽  
...  
Keyword(s):  
Primary Care ◽  
Multidisciplinary Care ◽  
Care Team ◽  
Care Plan ◽  
Background Information ◽  
Structured Interviews ◽  
Care Needs ◽  
Patient Centered ◽  
Essential Components ◽  
Critical Components

Background A critical need exists for effective electronic tools that facilitate multidisciplinary care for complex patients in patient-centered medical homes.Objective To identify the essential components of a primary care (PC) based electronic care plan (ECP) tool that facilitates coordination of care for complex patients.Methods Three focus groups and nine semi-structured interviews were conducted at an academic PC practice in order to identify the ideal components of an ECP.Results Critical components of an ECP identified included: 1) patient background information, including patient demographics, care team member designation and key patient contacts, 2) user- and patient-centric task management functionalities, 3) a summary of a patient’s care needs linked to the responsible member of the care team and 4) integration with the electronic medical record. We then designed an ECP mockup incorporating these components.Conclusion Our investigation identified key principles that healthcare software developers can integrate into PC and patient-centered ECP tools.

scholarly journals Needs of patients with dementia and their caregivers in primary care: lessons learned from the Alzheimer plan of Quebec

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Vladimir Khanassov ◽  
Laura Rojas-Rozo ◽  
Rosa Sourial ◽  
Xin Qiang Yang ◽  
Isabelle Vedel
Keyword(s):  
Primary Care ◽  
Unmet Needs ◽  
Social Care ◽  
Phase 1 ◽  
Lessons Learned ◽  
Community Dwelling ◽  
Care Plan ◽  
Phase 2 ◽  
Care Needs ◽  
Health And Social Care

Abstract Background Persons living with dementia have various health and social care needs and expectations, some which are not fully met by health providers, including primary care clinicians. The Quebec Alzheimer plan, implemented in 2014, aimed to cover these needs, but there is no research on the effect this plan had on the needs and expectations of persons living with dementia. The objective of this study is to identify persons living with dementia and caregivers’ met and unmet needs and to describe their experience. Methods This is a sequential mixed methods explanatory design: Phase 1: cross-sectional study to describe the met and unmet health and social care needs of community-dwelling persons living with dementia using Camberwell Assessment of Need of the Elderly and Carers’ Assessment for Dementia tools. Phase 2: qualitative descriptive study to explore and understand the experiences of persons living with dementia and caregivers with the use of social and healthcare services, using semi-structured interviews. Data from phase 1 was analyzed with descriptive statistics, and from phase 2, with inductive thematic analysis. Results from phases 1 and 2 were compared, contrasted and interpreted together. Results The mean total number of needs reported by the patients was 5.03 (4.48 and 0.55 met and unmet needs, respectively). Caregivers had 0.52 met needs (3.16 unmet needs). The main needs for both were memory, physical health, eyesight/hearing/communication, medication, looking after home, money/budgeting. Three categories were mentioned by the participants: Persons living with dementia and caregiver’s attitude towards memory decline, their perception of community health services and of the family medicine practice. Conclusions Our study confirms the findings of other studies on the most common unmet needs of the patients and caregivers that are met partially or not at all. In addition, the participants were satisfied with access to care, and medical services in primary practices, being confident in their family. Our results indicate persons living with dementia and their caregivers need a contact person, a clear explanation of their dementia diagnosis, a care plan, written information on available services, and support for the caregivers.

Staff Perceptions of Implementation of a Team-Based Model of Patient-Centered Primary Care

2015 ◽  
Vol 4 (4) ◽  
pp. 244-250
Author(s):  
Sherri L LaVela ◽  
Jennifer N Hill
Keyword(s):  
Primary Care ◽  
Team Building ◽  
Organizational Factors ◽  
Care Staff ◽  
Health Care Staff ◽  
Structured Interviews ◽  
Implementation Barriers ◽  
Patient Centered ◽  
Optimal Care ◽  
Team Based Care

Objectives. Patient-Aligned Care Teams (PACTs) aim to reorganize primary care by putting the patient at the center of the care team that includes family and health care staff; embodying patient-centered care (PCC). Team members share information, and work together in a synergistic, supportive way to provide optimal care based on mutually negotiated goals to meet patient needs. Our objective was to evaluate the process, barriers, and facilitators to implementing PACT as part of a VA quality improvement effort.Study Design/Methods. Semi-structured interviews were conducted, transcribed verbatim and analyzed with constant comparative techniques using constructs from implementation and organizational frameworks. Respondent demographic and position-level data were also collected. Data were collected in 2013.Results. A purposive sample of 35 key leaders and staff involved in implementing and/or participating in PACT at VA facilities participated. Implementation barriers included: failure to gain staff buy-in for PACT early on and to alleviate existing concerns about time and resources, incongruent performance measurement, and lack of defined role/responsibilities. Implementation facilitators included: training and engaging staff in PCC delivery and support for team-building.Conclusions. Team-based approaches to care have strong literature support; less is known about implementation. This study provides insight into the implementation of team-based care. Implementation of a team-based care model should include staff preparation and support (awareness, education, and encouragement) in advance. Once implemented, continued attention to team-building efforts and staff engagement are needed for sustainability. Healthcare organizations must understand and address multiple organizational factors to successfully implement team-based care that leads to systemic and sustainable PCC delivery.

scholarly journals Are Care Plans Suitable for the Management of Multiple Conditions?

2016 ◽  
Vol 6 (2) ◽  
pp. 103-113 ◽  
Author(s):  
Charlotte E. Young ◽  
Frances M. Boyle ◽  
Allyson J. Mutch
Keyword(s):  
Primary Care ◽  
Patient Preferences ◽  
Care Plan ◽  
Care Practice ◽  
Multiple Chronic Conditions ◽  
Comorbid Conditions ◽  
Care Needs ◽  
Care Plans ◽  
Number Of Patients ◽  
Multiple Conditions

Background Care plans have been part of the primary care landscape in Australia for almost two decades. With an increasing number of patients presenting with multiple chronic conditions, it is timely to consider whether care plans meet the needs of patients and clinicians. Objectives To review and benchmark existing care plan templates that include recommendations for comorbid conditions, against four key criteria: (i) patient preferences, (ii) setting priorities, (iii) identifying conflicts and synergies between conditions, and (iv) setting dates for reviewing the care plan. Design Document analysis of Australian care plan templates published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. Results Sixteen templates were reviewed. All of the care plan templates addressed patient preference, but this was not done comprehensively. Only three templates included setting priorities. None assisted in identifying conflicts and synergies between conditions. Fifteen templates included setting a date for reviewing the care plan. Conclusions Care plans are a well-used tool in primary care practice, but their current format perpetuates a single-disease approach to care, which works contrary to their intended purpose. Restructuring care plans to incorporate shared decision-making and attention to patient preferences may assist in shifting the focus back to the patient and their care needs.

scholarly journals Opportunities for Outpatient Pharmacy Services for Patients with Cystic Fibrosis: Perceptions of Healthcare Team Members

Pharmacy ◽  
2019 ◽  
Vol 7 (2) ◽  
pp. 34 ◽  
Author(s):  
Olufunmilola Abraham ◽  
Ashley Morris
Keyword(s):  
Cystic Fibrosis ◽  
Quality Of Care ◽  
Systems Engineering ◽  
Insurance Coverage ◽  
Multidisciplinary Care ◽  
Care Team ◽  
Healthcare Team ◽  
Care Needs ◽  
Treatment Regimens

Cystic fibrosis (CF) is one of the most common life-threatening, genetic conditions. People with CF follow complex, time-consuming treatment regimens to manage their chronic condition. Due to the complexity of the disease, multidisciplinary care from CF Foundation (CFF)-accredited centers is recommended for people with CF. These centers include several types of healthcare professionals specializing in CF; however, pharmacists are not required members. The purpose of this study was to identify the outpatient care needs of people living with CF that pharmacists could address to improve their quality of care. Healthcare members from a CFF accredited center and pharmacists were recruited to participate in semi-structured, audio-recorded interviews. Prevalent codes were identified and data analysis was conducted, guided by the systems engineering initiative for patient safety (SEIPS) model. The objective was to understand the medication and pharmacy-related needs of patients with CF and care team perspectives on pharmacists providing support for these patients. From the themes that emerged, pharmacists can provide support for people living with CF (medication burden, medication access, medication education) and the CF care team (drug monitoring and adherence, prior authorizations and insurance coverage, refill history). Pharmacists are well-positioned to address these difficulties to improve quality of care for people living with cystic fibrosis.

Building quality chronic illness care: implementation of a web-based care plan

2020 ◽  
Vol 26 (2) ◽  
pp. 173
Author(s):  
Shiva Vasi ◽  
Jenny Advocat ◽  
Akuh Adaji ◽  
Grant Russell
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Disease Management ◽  
New Technologies ◽  
Participant Observation ◽  
Care Plan ◽  
Structured Interviews ◽  
Structured Approach

Structured, multidisciplinary approaches to chronic disease management (CDM) in primary care, supported by eHealth tools, show improved clinical outcomes, yet the uptake of eHealth tools remains low. The adoption of cdmNet, an eHealth tool for chronic disease management, in general practice settings, was explored. This was a qualitative case study in three general practice clinics in Melbourne, Australia. Methods included non-participant observation, reflexive note taking and semi-structured interviews with GPs, non-GP clinical staff, administrative staff and patients with chronic conditions. Data were analysed iteratively and results were reviewed at regular team meetings. Findings highlighted the significance of clinical and organisational routines in determining practice readiness for embedding innovations. In particular, clinical routines that supported a structured approach to CDM involving team-based care, allocation of resources, training and leadership were fundamental to facilitating the adoption of the eHealth tool. Non-GP roles were found to be key in developing routines that facilitated the adoption of cdmNet within a structured approach to CDM. Practice managers, administrators and clinicians should first focus on routinising processes in primary care practices that support structured and team-based processes for CDM because without these processes, new technologies will not be embedded.

scholarly journals Facilitating equal access to primary care for all: work experiences of health mediators in a primary health care model programme in Hungary

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Cintia Katona ◽  
Éva Gutási ◽  
Magor Papp ◽  
Orsolya Varga ◽  
Karolina Kósa
Keyword(s):  
Primary Care ◽  
Personal Characteristics ◽  
Local Communities ◽  
Programme Evaluation ◽  
Care Team ◽  
Primary Care Team ◽  
Work Experiences ◽  
Care Model ◽  
Structured Interviews ◽  
Disadvantaged Population

Abstract Background A Primary Care Model Programme was implemented in Hungary between 2013 and 2017 in order to increase access of disadvantaged population groups to primary care and to offer new preventive services for all clients. In a country with single-handed practices, four group practices or GP clusters were created in the Programme. Six GPs comprised one cluster who together employed nonmedical health professionals and nonprofessional health mediators, the latter recruited from the serviced communities, many of them of Roma ethnicity. Health mediators were tasked by improving access of the local communities – including its vulnerable Roma members – to existing and new services. Health mediators were interviewed about their work experiences, motivation, and overall opinion as members of the clusters as part of the Programme evaluation. Methods As part of the Programme evaluation, structured interviews were conducted with all 40 health mediators employed at the time in the Programme. Interviews were transcribed and content analysis was carried out. Results Three themes emerged from the transcripts. The first focused on the health mediators’ personal characteristics such as motivation to join the Programme, the way their job increased their self-esteem, social status and health consciousness. Domains of the second theme of their work included importance of on-the-job training and of their insider knowledge of local communities, as well as their pride to have become members of the primary care team. The third theme covered overall functioning of the Programme of which they had mostly positive opinions, notwithstanding some criticism regarding procurement. Conclusions Health mediators had earlier worked in various European countries specifically to improve access of Roma ethnic groups to health services but the Hungarian Model Programme was globally the first in which health mediators as non-professional workers became equal members of the primary care team as employees. Their contribution and overwhelmingly positive experiences, along with their useful insights for improvement call for the establishment and funding of health mediator positions in primary care especially in areas with large numbers of disadvantaged Roma populations.

scholarly journals The challenge of involving elderly patients in primary care by using an electronic communication tool with their professionals: a mixed methods study

2017 ◽  
Vol 24 (3) ◽  
pp. 275
Author(s):  
Catharina Carolina De Jong ◽  
Wynand J.G. Ros ◽  
Mia Van Leeuwen ◽  
Guus Schrijvers
Keyword(s):  
Primary Care ◽  
Elderly Patients ◽  
Electronic Communication ◽  
Care Plan ◽  
Communication Tool ◽  
Structured Interviews ◽  
Limited Participation ◽  
Important Barrier ◽  
Informal Carers ◽  
E Mail

Background: Elderly patients in primary care often have multiple health problems,with different healthcare professionals involved. For consistency in care, it is required that communication amongst professionals and patient-systems (patient and informal-carers) be well tuned. Electronic-communication can make it easier for patient-system to be active in care.Objective: To examine whether an e-communication tool (Congredi) designed for professionals, including a care plan and secure e-mail, is usable for patient-systems and what their experiences are.Methods: In a multi-method study, home-dwelling elderly patients with two or more professionals were invited to use Congredi; data were gathered from the system after 42 weeks. Also semi-structured interviews were undertaken with patient-systems with topics retrieved from literature. Analysis took place by two researchers independently; the themes were extracted together by consensus.Results: Data about actual use of the tool were gathered from 22 patients. Four profiles of Congredi-users were distinguished, varying in intensity of use. Data from  interviews with members of patient-systems (n = 7) showed that they were motivated and able to use Congredi. Barriers in daily use were limited participation of professionals, unanswered e-mail and not being alerted about actions. Despite limitations, patient-systems retained their motivation.Conclusion: Congredi was usable for patient-systems. The barriers found seem not to be tool-related but primarily user-related. An important barrier for daily use was limited active participation of involved professionals in a complete feedback loop. Potential for future implementation was found, as patient-systems were intrinsically motivated for better feedback with the professionals, even though in this study it only partly met their expectations.

Exploring Occupational Therapists' Experiences in U.S. Primary Care Settings: A Qualitative Study

2021 ◽  
Vol 76 (1) ◽  
Author(s):  
Stephanie A. Rouch ◽  
Tara C. Klinedinst ◽  
Jennifer S. White ◽  
Natalie E. Leland
Keyword(s):  
Primary Care ◽  
Occupational Therapy ◽  
Occupational Therapists ◽  
The United States ◽  
Care Team ◽  
Primary Care Team ◽  
Patient Centered ◽  
Care Experience ◽  
Centered Care ◽  
And Behavior

Importance: Occupational therapy's scope of practice aligns with the goals of comprehensive primary care set forth by the 2010 Patient Protection and Affordable Care Act (Pub. L. 111-148). To successfully integrate occupational therapy into primary care, we must understand occupational therapy practitioners' experiences in this setting. Objective: To explore facilitators of, barriers to, and recommendations for integrating occupational therapy into primary care. Design: A descriptive qualitative design that incorporated semistructured interviews, member checking sessions, and deductive thematic analysis. Interviews were structured to capture occupational therapists' experiences of and recommendations for practicing in primary care. Setting: Primary care. Participants: A purposive sample of licensed occupational therapists with at least 6 mo primary care experience in the United States. Results: Seven participants reported 1 to 8 yr of experience in primary care. Four themes emerged that contextualized the experiences of occupational therapists in primary care. The first theme captured the process of gaining entry onto the primary care team. Once structurally embedded on the team, the second and third themes, respectively, captured barriers and facilitators to navigating team-based care and providing patient-centered care. The fourth theme reflected participants' vision and ideas of how to expand reach nationally to promote consistent integration of occupational therapy into primary care. Conclusion and Relevance: Given the important role of an interprofessional primary care team in improving population health, this study is timely in that it explored occupational therapists' experiences in this emerging practice area. What This Article Adds: Occupational therapists in this study used their skills, resources, and networks to become part of a primary care team. They indicated that they contributed to positive outcomes through working with patients on self-management, functional problem solving, and behavior change.

scholarly journals Sarcopenia screening in elderly in primary health care: nurse knowledge and practices

2020 ◽  
Vol 73 (suppl 3) ◽  
Author(s):  
Rutielle Ferreira Silva ◽  
Maria do Livramento Fortes Figueiredo ◽  
Juan José Tirado Darder ◽  
Ana Maria Ribeiro dos Santos ◽  
Maria Antonieta Rubio Tyrrell
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
The Elderly ◽  
Care Plan ◽  
Structured Interviews ◽  
Care Nurse ◽  
Primary Health ◽  
Primary Health Care Nurses ◽  
Nurse Knowledge

ABSTRACT Objective: Describe the knowledge and practices of the Primary Health Care nurse on sarcopenia screening in the elderly. Methods: Qualitative study conducted with 24 Primary Health Care nurses. The data was collected through semi-structured interviews, recorded and later transcribed. The speeches were grouped in thematic categories, later analyzed, supported by Paulo Freire’s reference. Results: The findings showed that the primary care nurses’ knowledge of sarcopenia screening in the elderly was incipient and fragile. This reality is reflected in a gap in practice, although some instruments already require the registration of characteristics indicative of sarcopenia, such as the evaluation of the calf circumference. Final Considerations: The need to train nurses to perform sarcopenia screening and to implement a promotional and preventive care plan, which will result in improving the quality of life of the elderly assisted in Primary Care, was highlighted.

scholarly journals Evaluating integrated care for people with complex needs

2020 ◽  
Vol 26 (1) ◽  
pp. 46-53
Author(s):  
Panagiotis Kasteridis ◽  
Anne Mason ◽  
Andrew Street
Keyword(s):  
Primary Care ◽  
Integrated Care ◽  
Models Of Care ◽  
Care Team ◽  
Future Research ◽  
Complex Care ◽  
Care Needs ◽  
Complex Needs ◽  
Care Models ◽  
Integrated Care Models

Objectives As part of the Vanguard programme, two integrated care models were introduced in South Somerset for people with complex care needs: the Complex Care Team and Enhanced Primary Care. We assessed their impact on a range of utilization measures and mortality. Methods We used monthly individual-level linked primary and secondary care data from April 2014 to March 2018 to assess outcomes before and after the introduction of the care models. The analysis sample included 564 Complex Care Team and 841 Enhanced Primary Care cases that met specific criteria. We employed propensity score methods to identify out-of-area control patients and difference-in-differences analysis to isolate the care models’ impact. Results We found no evidence of significantly reduced utilization in any of the Complex Care Team or Enhanced Primary Care cohorts. The death rate was significantly lower only for those in the first Enhanced Primary Care cohort. Conclusions The integrated care models did not significantly reduce utilization nor consistently reduce mortality. Future research should test longer-term outcomes associated with the new models of care and quantify their contribution in the context of broader initiatives.

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