scholarly journals Improving Care for the Frail in Nova Scotia: An Implementation Evaluation of a Frailty Portal in Primary Care Practice

2018 ◽  
Vol 8 (2) ◽  
pp. 112-123 ◽  
Author(s):  
Beverley Lawson ◽  
Tara Sampalli ◽  
Grace Warner ◽  
Fred Burge ◽  
Paige Moorhouse ◽  
...  
Keyword(s):  
Primary Care ◽  
Nova Scotia ◽  
Nurse Practitioners ◽  
Financial Incentives ◽  
Central Zone ◽  
Care Practice ◽  
Successful Implementation ◽  
Care Planning ◽  
Care Plans ◽  
Frail Patients

Background: Understanding and addressing the needs of frail patients has been identified as an important strategy by the Nova Scotia Health Authority (NSHA). Primary care (PC) providers are in a key position to aid in the identification of, and response to frailty as part of routine care. Unlike singular chronic conditions such as diabetes and hypertension which garner a disease-based approach and identification as part of standard practice, frailty is only just emerging as a concept for PC. The web-based Frailty Portal was developed to aid in the identification of, assessment and care planning for frail patients in PC practice. In this study we assess the implementation feasibility and impact of the Frailty Portal by: (1) identifying factors influencing the Frailty Portal’s use in community PC practice, and (2) examination of the immediate impact of the ‘Frailty Portal’ on frail patients, their caregivers and PC providers. Methods: A convergent mixed method approach was implemented among PC providers in community-based practice in the NSHA, Central Zone. Quantitative and qualitative data were collected concurrently over a 9-month period. A sample of patients who underwent assessment and/or their caregiver were approached for survey participation. Results: Fourteen community PC providers (10 family physicians, 4 nurse practitioners) completed 48 patient assessments and completed or begun 41 care plans; semi-structured interviews were conducted among 9 providers. Nine patients and 5 caregivers participated in the survey. PC providers viewed frailty as an important concept but implementation challenges were met, primarily with respect to the time required for use and lack of fit with traditional practice routines. Additional barriers included tool usability and accessibility, training and care planning steps, and privacy. Impacts of the tools use with respect to confidence and knowledge showed early promise. Conclusion: This feasibility study highlights the need for added health system supports, resources and financial incentives for successful implementation of the Frailty Portal in community PC practice. We suggest future implementation integrate the Frailty Portal to practice electronic medical records (EMRs) and target providers with largely geriatric practice populations and those practicing within interdisciplinary, collaborative primary healthcare (PHC) teams.

scholarly journals Primary Care Practice Environment and Burnout Among Nurse Practitioners

2021 ◽  
Author(s):  
Cilgy M. Abraham ◽  
Katherine Zheng ◽  
Allison A. Norful ◽  
Affan Ghaffari ◽  
Jianfang Liu ◽  
...  
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Primary Care Practice ◽  
Care Practice ◽  
Practice Environment

scholarly journals IMPACT OF GERIATRIC INTERPROFESSIONAL TRAINING ON ADVANCE CARE PLANNING IN GERIATRIC PRIMARY CARE

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S151-S152
Author(s):  
Maureen E Barrientos ◽  
Anna Chodos ◽  
Alicia Neumann ◽  
Yvonne Troya ◽  
Pei Chen
Keyword(s):  
Primary Care ◽  
Social Work ◽  
Advance Care Planning ◽  
Health Resources ◽  
The United States ◽  
Care Practice ◽  
Care Planning ◽  
Office Visits ◽  
Advance Care ◽  
Telephone Calls

Abstract Currently, an important measure of Advance Care Planning (ACP), Advance Health Care Directives (AHCD) documentation rate, is at 33% for older adults in the United States. To address this disparity, geriatric faculty in an academic geriatric primary care practice aimed to train geriatrics fellows and other interprofessional (IP) learners to engage patients in ACP. As part of a Geriatric Workforce Enhancement Program funded by the Health Resources and Services Administration, geriatrics faculty and the Medical Legal Partnership for Seniors based at University of California Hastings College of Law provided ACP training to fellows and IP learners, including social work interns. In practice, the fellows and social work interns collaborated to incorporate ACP into patient visits and follow-up telephone calls. To monitor ACP progress, research staff reviewed patients’ electronic health records and performed descriptive analysis of the data. In 21 months, 4 geriatrics fellows built a panel of 59 patients who on average had 3 office visits and 7 telephone calls per person. Prior to clinic enrollment, 12 (20.3%) patients had preexisting AHCD, and 47 lacked AHCD documentation. After ACP intervention, 42 of 47 patients without AHCD documentation engaged in ACP discussion. Of those who engaged in ACP discussion, 24 completed AHCD, raising AHCD completion rate to 61%, or 36 patients in the panel of 59. ACP is a complex process that benefits from skilled communication among interprofessional providers and patients. Findings underscore the potential advantages of IP training and engaging patients in ACP discussion in an academic primary care setting.

Perspectives of Physicians and Nurse Practitioners on Primary Care Practice

2013 ◽  
Vol 368 (20) ◽  
pp. 1898-1906 ◽  
Author(s):  
Karen Donelan ◽  
Catherine M. DesRoches ◽  
Robert S. Dittus ◽  
Peter Buerhaus
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Primary Care Practice ◽  
Care Practice

PHYSICIAN'S ASSISTANTS

PEDIATRICS ◽  
1975 ◽  
Vol 55 (2) ◽  
pp. 256-256
Author(s):  
W. J. Bicknell
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Nurse Practitioners ◽  
Financial Incentives ◽  
Health Care Services ◽  
Educational Systems ◽  
American Health Care System ◽  
Physician Visits ◽  
Traditional Patterns ◽  
The U.S

The U.S. primary-care assistant seems lost in a vicious circle: problems in the American health-care system (high cost and hospital orientation, lack of satisfaction for patient and provider with primary-health-care services, and the related maldistribution of physicians)—problems which might be mitigated by utilising physicians' assistants and nurse practitioners—themselves militate against effective use of such assistants. Financial incentives, educational systems, and traditional patterns of behavior and expectation all work in the opposite direction; all favour decisions which virtually preclude good primary care—maximum hospital usage, short physician visits, minimal delegation to non-physicians. There will have to be a substantial change in the U.S. system before physicians' assistants and nurse practitioners can begin to function well, and can hope to contribute to the quality, accessibility, and cost-effectiveness of primary care.

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.

The advance care planning nurse facilitator: describing the role and identifying factors associated with successful implementation

2019 ◽  
Vol 25 (6) ◽  
pp. 564 ◽  
Author(s):  
Jeremy Rogers ◽  
Charlotte Goldsmith ◽  
Craig Sinclair ◽  
Kirsten Auret
Keyword(s):  
Primary Care ◽  
Advance Care Planning ◽  
Successful Implementation ◽  
Care Planning ◽  
Process Data ◽  
Factors Associated ◽  
Patient Screening ◽  
Advance Care ◽  
Additional Process ◽  
Role Description

Advance care planning (ACP) has been shown to improve end-of-life care, yet uptake remains limited. Interventions aimed at increasing ACP uptake have often used a ‘specialist ACP facilitator’ model. The present qualitative study appraised the components of an ACP facilitator intervention comprising nurse-led patient screening and ACP discussions, as well as factors associated with the successful implementation of this model in primary care and acute hospital settings across rural and metropolitan Western Australia. Semistructured interviews were undertaken with 17 health professionals who were directly or indirectly involved in the facilitator ACP intervention among patients with severe respiratory disease. Additional process data (nurse facilitator role description, agreements with participating sites) were used to describe the nurse facilitator role. The interview data identified factors associated with successful implementation, including patient factors, health professional factors, ACP facilitator characteristics and the optimal settings for the intervention. The primary care setting was seen as most appropriate, and time limitations were a key consideration. Factors associated with successful implementation included trusting relationships between the nurse facilitator and referring doctor, as well as opportunities for meaningful encounters with patients. This study suggests a model of ACP nurse facilitation based in primary care may be an acceptable and effective method of increasing ACP uptake.

Synchronizing advance directives among patients across a health system.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 233-233
Author(s):  
Sherri Rauenzahn Cervantez ◽  
Sadiyah Hotakey ◽  
Amanda Hernandez ◽  
Stephanie Warren ◽  
Jennifer Quintero ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health System ◽  
Advance Care Planning ◽  
Primary Care Clinic ◽  
Care Planning ◽  
Care Clinic ◽  
Care Plans ◽  
Palliative Oncology ◽  
Advance Care

233 Background: Advance directives (ADs) are legal tools that direct treatment or decision making and appoint a surrogate decision-maker (health care proxy). The presence of ADs is associated with decreased rates of hospitalization, use of life-sustaining treatment, and deaths in a hospital setting. Additionally, completed ADs lead to increased use of hospice or palliative care, more positive family outcomes, improved quality of life for patients, and reduced costs for healthcare. Despite the benefits of advance care planning, only 18-36% of adults have completed advance care plans. The aims of our pilot study were to 1) implement a synchronized system for advance care planning across the UT Health San Antonio health system and 2) improve advance care planning rates in a primary care clinic and palliative oncology clinic. Methods: During a 10-month prospective period, system processes for advance care planning were reviewed with identification of three primary drivers for advance care plan completion: a) electronic/EMR processes, b) clinical workflows and training, and c) patient resources and education. As a result of this quality improvement initiative, standardized forms, resources, and processes for obtaining advance care plans were implemented in the selected clinics. Results: At baseline, the primary care clinic had 84/644 (13%) patients and the palliative oncology clinic had 25/336(7%) with completed advance care plans. With the implementation of a standardized process, 108 patients (23% increase in rate of completion) in the primary clinic and 56 patients (71% increase in rate of completion) in the palliative oncology setting completed advance care planning (ACP). Additionally, there was a 5-fold increase in billing of ACP CPT codes within the clinics during the first 6 months compared to the prior full year. Conclusions: While this quality improvement pilot initiative was limited to two clinics, the synchronized modifications suggest that the system changes could be expanded to other clinics in our UT health system to promote ACP discussions, completion of plans, and ultimately improved patient care.

scholarly journals Mindfulness and the primary care provider

2020 ◽  
Author(s):  
◽  
Alyson Wlasoff
Keyword(s):  
Primary Care ◽  
Nurse Practitioners ◽  
Care Setting ◽  
Primary Care Setting ◽  
Primary Care Providers ◽  
Mindfulness Practice ◽  
Successful Implementation ◽  
Care Providers ◽  
Mindfulness Interventions ◽  
Reducing Stress

Primary care providers (PCPs), including nurse practitioners and primary care physicians, experience significant occupational stress, putting them at risk for chronic stress and burnout. Burnout rates are high amongst PCPs, and results in negative health effects that can impact the personal life of the PCP, as well as professional outcomes and patient care. Mindfulness has been shown to reduce anxiety and burnout symptoms, and improve healthcare provider well-being. Using an integrative literature review methodology outlined by Whittemore and Knafl, this paper explores if a mindfulness practice can reduce stress and burnout symptoms for PCPs. The results are discussed within the context of a primary care setting in Canada. Relevant literature was searched and a selected sample of ten primary research articles was selected for further analysis. Results suggest that mindfulness interventions are effective for reducing stress and burnout symptoms for PCPs, but access to these interventions may be a barrier to successful implementation of a mindfulness practice. In a primary care setting in Canada, PCPs are encouraged to attend mindfulness interventions and incorporate learned components into their practice, thereby increasing patient-centered care. Recommendations for reducing stress and burnout symptoms for PCPs are discussed, and specific strategies for successful implementation of mindfulness interventions are provided.

scholarly journals Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year (the PUPPY Study): Protocol for a Longitudinal Mixed Methods Study (Preprint)

2021 ◽  
Author(s):  
Emily Gard Marshall ◽  
Mylaine Breton ◽  
Benoit Cossette ◽  
Jennifer Isenor ◽  
Maria Mathews ◽  
...  
Keyword(s):  
Primary Care ◽  
Mixed Methods ◽  
Nova Scotia ◽  
Research Ethics ◽  
Health Research ◽  
Health Sciences ◽  
Mixed Methods Study ◽  
Care Practice ◽  
Research Ethics Board ◽  
Unattached Patients

BACKGROUND The COVID-19 pandemic has significantly disrupted primary care in Canada, with many walk-in clinics and family practices initially closing or being perceived as inaccessible; pharmacies remaining open with restrictions on patient interactions; rapid uptake of virtual care; and reduced referrals for lab tests, diagnostics, and specialist care. OBJECTIVE The PUPPY Study (Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year) seeks to understand the impact of the COVID-19 pandemic across the quadruple aims of primary care, with particular focus on the effects on patients without attachment to a regular provider and those with chronic health conditions. METHODS The PUPPY study builds on an existing research program exploring patients’ access and attachment to a primary care practice, pivoted to adapt to the emerging COVID-19 context. We intend to undertake a longitudinal mixed methods study to understand critical gaps in primary care access and coordination, as well as compare prepandemic and postpandemic data across 3 Canadian provinces (Quebec, Ontario, and Nova Scotia). Multiple data sources will be used such as a policy review; qualitative interviews with primary care policymakers, providers (ie, family physicians, nurse practitioners, and pharmacists), and patients (N=120); and medication prescriptions and health care billing data. RESULTS This study has received funding by the Canadian Institutes of Health Research COVID-19 Rapid Funding Opportunity Grant. Ethical approval to conduct this study was granted in Ontario (Queens Health Sciences & Affiliated Teaching Hospitals Research Ethics Board, file 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol 40335) in November 2020, Québec (Centre intégré universitaire de santé et de services sociaux de l'Estrie, project 2020-3446) in December 2020, and Nova Scotia (Nova Scotia Health Research Ethics Board, file 1024979) in August 2020. CONCLUSIONS To our knowledge, this is the first study of its kind to explore the effects of the COVID-19 pandemic on primary care systems, with particular focus on the issues of patient’s attachment and access to primary care. Through a multistakeholder, cross-jurisdictional approach, the findings of the PUPPY study will inform the strengthening of primary care during and beyond the COVID-19 pandemic, as well as have implications for future policy and practice. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/29984

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