Patient's medication information and its special characteristics: a case study of a Finnish primary care organisation

Background Consistent and standardized coding for chronic conditions is associated with better care; however, coding may currently be limited in electronic medical records (EMRs) used in Canadian primary care.Objectives To implement data management activities in a community-based primary care organisation and to evaluate the effects on coding for chronic conditions.Methods Fifty-nine family physicians in Toronto, Ontario, belonging to a single primary care organisation, participated in the study. The organisation implemented a central analytical data repository containing their EMR data extracted, cleaned, standardized and returned by the Canadian Primary Care Sentinel Surveillance Network (CPCSSN), a large validated primary care EMR-based database. They used reporting software provided by CPCSSN to identify selected chronic conditions and standardized codes were then added back to the EMR. We studied four chronic conditions (diabetes, hypertension, chronic obstructive pulmonary disease and dementia). We compared changes in coding over six months for physicians in the organisation with changes for 315 primary care physicians participating in CPCSSN across Canada.Results Chronic disease coding within the organisation increased significantly more than in other primary care sites. The adjusted difference in the increase of coding was 7.7% (95% confidence interval 7.1%–8.2%, p < 0.01). The use of standard codes, consisting of the most common diagnostic codes for each condition in the CPCSSN database, increased by 8.9% more (95% CI 8.3%–9.5%, p < 0.01).Conclusions Data management activities were associated with an increase in standardized coding for chronic conditions. Exploring requirements to scale and spread this approach in Canadian primary care organisations may be worthwhile.

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Implementation of cancer screening in rural primary care practices after joining an accountable care organisation: a multiple case study

Family Medicine and Community Health ◽

10.1136/fmch-2021-001326 ◽

2021 ◽

Vol 9 (4) ◽

pp. e001326

Author(s):

Heather Nelson-Brantley ◽

Edward F Ellerbeck ◽

Stacy McCrea-Robertson ◽

Jennifer Brull ◽

Jennifer Bacani McKenney ◽

...

Keyword(s):

Primary Care ◽

Cancer Screening ◽

Multiple Case Study ◽

Accountable Care ◽

Rural Primary Care ◽

Care Organisation ◽

Multiple Case ◽

Care Practices ◽

Primary Care Practices

ObjectiveTo describe common strategies and practice-specific barriers, adaptations and determinants of cancer screening implementation in eight rural primary care practices in the Midwestern United States after joining an accountable care organisation (ACO).DesignThis study used a multiple case study design. Purposive sampling was used to identify a diverse group of practices within the ACO. Data were collected from focus group interviews and workflow mapping. The Consolidated Framework for Implementation Research (CFIR) was used to guide data collection and analysis. Data were cross-analysed by clinic and CFIR domains to identify common themes and practice-specific determinants of cancer screening implementation.SettingThe study included eight rural primary care practices, defined as Rural-Urban Continuum Codes 5–9, in one ACO in the Midwestern United States.ParticipantsProviders, staff and administrators who worked in the primary care practices participated in focus groups. 28 individuals participated including 10 physicians; one doctor of osteopathic medicine; three advanced practice registered nurses; eight registered nurses, quality assurance and licensed practical nurses; one medical assistant; one care coordination manager; and four administrators.ResultsWith integration into the ACO, practices adopted four new strategies to support cancer screening: care gap lists, huddle sheets, screening via annual wellness visits and information spread. Cross-case analysis revealed that all practices used both visit-based and population-based cancer screening strategies, although workflows varied widely across practices. Each of the four strategies was adapted for fit to the local context of the practice. Participants shared that joining the ACO provided a strong external incentive for increasing cancer screening rates. Two predominant determinants of cancer screening success at the clinic level were use of the electronic health record (EHR) and fully engaging nurses in the screening process.ConclusionsJoining an ACO can be a positive driver for increasing cancer screening practices in rural primary care practices. Characteristics of the practice can impact the success of ACO-related cancer screening efforts; engaging nurses to the fullest extent of their education and training and integrating cancer screening into the EHR can optimise the cancer screening workflow.

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Contribution of primary care organisation and specialist care provider to variation in GP referrals for suspected cancer: ecological analysis of national data

BMJ Quality & Safety ◽

10.1136/bmjqs-2019-009469 ◽

2019 ◽

Vol 29 (4) ◽

pp. 296-303 ◽

Cited By ~ 3

Author(s):

Christopher Burton ◽

Luke O'Neill ◽

Phillip Oliver ◽

Peter Murchie

Keyword(s):

Primary Care ◽

Cancer Detection ◽

Secondary Care ◽

Detection Rate ◽

Fast Track ◽

Referral Rate ◽

Cancer Detection Rate ◽

Care Organisation ◽

General Practices ◽

Primary Care Organisation

ObjectivesTo examine how much of the variation between general practices in referral rates and cancer detection rates is attributable to local health services rather than the practices or their populations.DesignEcological analysis of national data on fast-track referrals for suspected cancer from general practices. Data were analysed at the levels of general practice, primary care organisation (Clinical Commissioning Group) and secondary care provider (Acute Hospital Trust) level. Analysis of variation in detection rate was by multilevel linear and Poisson regression.Setting6379 group practices with data relating to more than 50 cancer cases diagnosed over the 5 years from 2013 to 2017.OutcomesProportion of observed variation attributable to primary and secondary care organisations in standardised fast-track referral rate and in cancer detection rate before and after adjustment for practice characteristics.ResultsPrimary care organisation accounted for 21% of the variation between general practices in the standardised fast-track referral rate and 42% of the unadjusted variation in cancer detection rate. After adjusting for standardised fast-track referral rate, primary care organisation accounted for 31% of the variation in cancer detection rate (compared with 18% accounted for by practice characteristics). In areas where a hospital trust was the main provider for multiple primary care organisations, hospital trusts accounted for the majority of the variation attributable to local health services (between 63% and 69%).ConclusionThis is the first large-scale finding that a substantial proportion of the variation between general practitioner practices in referrals is attributable to their local healthcare systems. Efforts to reduce variation need to focus not just on individual practices but on local diagnostic service provision and culture at the interface of primary and secondary care.

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Transforming a run down general practice into a leading edge primary care organisation with the help of the EFQM excellence model

International Journal of Health Care Quality Assurance ◽

10.1108/09526860210442029 ◽

2002 ◽

Vol 15 (6) ◽

pp. 255-267 ◽

Cited By ~ 14

Author(s):

Sue Jackson ◽

Richard Bircher

Keyword(s):

Primary Care ◽

General Practice ◽

Leading Edge ◽

Care Organisation ◽

Primary Care Organisation

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Using positive deviance to improve timely access in primary care

BMJ Open Quality ◽

10.1136/bmjoq-2020-001228 ◽

2021 ◽

Vol 10 (4) ◽

pp. e001228

Author(s):

MaryBeth DeRocher ◽

Sam Davie ◽

Tara Kiran

Keyword(s):

Primary Care ◽

Positive Deviance ◽

Promising Practices ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Secure Messaging ◽

Care Organisation ◽

Appointment Schedule ◽

Timely Access ◽

Primary Care Organisation

BackgroundImproving timely access in primary care is a continued challenge in many countries. We used positive deviance to try and identify best practices for achieving timely access in our primary care organisation in Toronto, Canada.MethodsSemistructured interviews were used to identify practice strategies used by physicians who successfully maintained a low third next available appointment (TNA) (positive deviants, n=6). We then conducted a cross-sectional survey to understand the prevalence of identified promising practices among all physicians (n=70) in the practice. We used χ2 testing to understand whether uptake of promising practices among survey respondents was different for those with a median TNA of 7 days or less vs a median TNA over 7 days.ResultsWe identified seven promising practice strategies used by positive deviants: adjusting the appointment template based on demand; reviewing the appointment schedule in advance; max-packing of visits; using phone, email and secure messaging; customising care for complex patients; managing planned absences; and involving the interprofessional team. 65 of 70 physicians responded to the survey on promising practices. Uptake of the promising practices was variable among survey respondents. In general, we found no association between uptake of promising practices and median TNA. One exception was that those with a median TNA of 7 or less were more likely to review the schedule in advance to potentially mitigate a visit using phone/email (62% vs 31%, p=0.0159).ConclusionPromising practices used by a small group of physicians (‘positive deviants’) to maintain good access were generally not associated with timely access among a larger sample of physicians in the practice. Our findings highlight the difficulty of untangling physician practice style and its contribution to timely access in primary care.

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