Development of a stepwise tool to aide primary health care professionals in the process of deprescribing in older persons

Objective: The aim of this study was to develop and validate a stepwise tool to aid primary health care professionals in the process of deprescribing potentially inappropriate medication in older persons. Methods: We carried out a systematic review to identify previously published tools. A composite proposal of algorithm was made by following the steps from clinical experience to deprescribe medications. A 2-round electronic Delphi method was conducted to establish consensus. Eighteen experts from different countries (Colombia, Spain and Argentina) accepted to be part of the panel representing geriatricians, internists, endocrinologist, general practitioners, pharmacologists, clinical pharmacists, family physicians and nurses. Panel members were asked to mark a Likert Scale from 1 to 9 points (1= strongly disagree, 9= strongly agree). The content validity‏ ratio, item-level content validity, and Fleiss’ Kappa statistics was measured to establish reliability. The same voting method was used for round 2. Results: A 7-question algorithm was proposed. Each question was part of a domain and conduct into a decision. In round 1, a consensus was not reached but statements were grouped and organized. In round 2, the tool met consensus. The inter-rater reliability was between substantial and almost perfect for questions with Kappa=0.77 (95% CI 0.60-0.93), for domains with Kappa= 0.73 (95%CI 0.60-0.86) and for decisions with Kappa= 0.97 (95%CI 0.90-1.00). Conclusions: This is a novel tool that captures and supports healthcare professionals in clinical decision-making for deprescribing potentially inappropriate medication. This includes patient’s and caregiver’s preferences about medication. This tool will help to standardize care and provide guidance on the prescribing/deprescribing process of older persons’ medications. Also, it provides a holistic way to reduce polypharmacy and inappropriate medications in clinical practice.

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How primary health care professionals and residents assess issues related to the oral health of older persons?

Gerodontology ◽

10.1111/j.1741-2358.2009.00355.x ◽

2011 ◽

Vol 28 (1) ◽

pp. 37-43 ◽

Cited By ~ 2

Author(s):

Aline Blaya Martins ◽

Fernando Neves Hugo ◽

Betina Soldateli Paim ◽

Liese Ilha ◽

Paula Güntzel ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Oral Health ◽

Health Care Professionals ◽

Older Persons ◽

Primary Health

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A systems approach to learning, practice and reflection in emergency primary health care: Student perspectives

Australasian Journal of Paramedicine ◽

10.33151/ajp.11.3.13 ◽

2014 ◽

Vol 11 (3) ◽

Author(s):

Daniel Mellifont ◽

Nigel Barr ◽

Peter Dunn

Keyword(s):

Health Care ◽

Decision Making ◽

Primary Health Care ◽

Online Survey ◽

Clinical Decision Making ◽

Systems Approach ◽

Clinical Decision ◽

Post Intervention ◽

Learning And Teaching ◽

Primary Health

IntroductionClinical decision making skills are essential for professional practice in primary emergency healthcare and are an intended outcome of clinical and professional programs. This article documents an interdisciplinary exploration of learning and teaching of clinical decision making and critical dialectical reflection (the systems approach) at The University of the Sunshine Coast (USC), Australia.MethodsUsing an online survey we explored students’ perspectives on how working with the systems approach impacted upon their confidence and capacity to engage in emergency clinical scenarios.ResultsUSC’s systems approach, integrated with a focus on critical reflection and case-based learning, is strongly associated with improved student confidence to engage in emergency primary health care scenarios. Most participants reported increased confidence post intervention and believed that the systems approach helped them to improve their capacity for other critical components.ConclusionThis study indicates the beneficial nature of a systems approach to the learning and teaching of clinical decision-making. The tool could be further developed, to improve perceived ability to communicate more effectively.

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Evaluation and pilot implementation of essential interventions for the management of hypertension and prevention of cardiovascular diseases in primary health care in the Republic of Tajikistan

F1000Research ◽

10.12688/f1000research.20234.1 ◽

2019 ◽

Vol 8 ◽

pp. 1639 ◽

Cited By ~ 1

Author(s):

Dylan R.J. Collins ◽

Tiina Laatikainen ◽

Mekhri Shoismatuloeva ◽

Isfandiyor Mahmudzoha ◽

Zakriya Rahimov ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Clinical Decision Making ◽

National Level ◽

Clinical Decision ◽

Ethical Review ◽

Primary Health ◽

Essential Interventions ◽

The Republic ◽

Soviet Legacy

Background: Non-communicable diseases (NCDs) are the leading cause of death worldwide and are a major burden in Tajikistan. The health system of Tajikistan is still shaped by the country's Soviet legacy and the pace of reform has been slow, with high patient out-of-pocket expenditure. The aim of this study is to determine the feasibility of implementing and evaluating essential interventions for the management of hypertension and prevention of cardiovascular disease in primary health care in Tajikistan. Methods and analysis: A pragmatic, sequential mixed methods explanatory design, composed of quantitative and qualitative strands will be used with greater weighting of the quantitative strand. A single geographic district was nominated by the Ministry of Health and chosen for implementation. All primary health care centres in the district that meet inclusion criteria will be included; half will be randomly assigned to the intervention arm and half to the control arm. The overall process is organized into seven steps: (1) refresh clinical decision-making tools including open source WHO PEN and HEARTS resources; (2) update training package for primary health care workers; (3) collection of baseline data; (4) training staff in intervention clinics; (5) implementation of protocols and implementation coaching; (6) collection of follow-up data after 12 months; (7) evaluation of results and sharing experience. Ethics and dissemination: Ethical review and approval have been obtained. Findings will be disseminated at the participant level, national level through a national conference of key stakeholders, and internationally through publication in an open-access peer review journal.

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Disaster Management in Rural and Remote Primary Health Care: A Scoping Review

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000200 ◽

2021 ◽

Vol 36 (3) ◽

pp. 362-369

Author(s):

Katie A. Willson ◽

Gerard J. FitzGerald ◽

David Lim

Keyword(s):

Mental Health ◽

Health Care ◽

Primary Health Care ◽

Mental Health Care ◽

Disaster Management ◽

Scoping Review ◽

Health Care Professionals ◽

Disaster Preparedness ◽

Rural And Remote ◽

Primary Health

AbstractObjective:This scoping review aims to map the roles of rural and remote primary health care professionals (PHCPs) during disasters.Introduction:Disasters can have catastrophic impacts on society and are broadly classified into natural events, man-made incidents, or a mixture of both. The PHCPs working in rural and remote communities face additional challenges when dealing with disasters and have significant roles during the Prevention, Preparedness, Response, and Recovery (PPRR) stages of disaster management.Methods:A Johanna Briggs Institute (JBI) scoping review methodology was utilized, and the search was conducted over seven electronic databases according to a priori protocol.Results:Forty-one papers were included and sixty-one roles were identified across the four stages of disaster management. The majority of disasters described within the literature were natural events and pandemics. Before a disaster occurs, PHCPs can build individual resilience through education. As recognized and respected leaders within their community, PHCPs are invaluable in assisting with disaster preparedness through being involved in organizations’ planning policies and contributing to natural disaster and pandemic surveillance. Key roles during the response stage include accommodating patient surge, triage, maintaining the health of the remaining population, instituting infection control, and ensuring a team-based approach to mental health care during the disaster. In the aftermath and recovery stage, rural and remote PHCPs provide long-term follow up, assisting patients in accessing post-disaster support including delivery of mental health care.Conclusion:Rural and remote PHCPs play significant roles within their community throughout the continuum of disaster management. As a consequence of their flexible scope of practice, PHCPs are well-placed to be involved during all stages of disaster, from building of community resilience and contributing to early alert of pandemics, to participating in the direct response when a disaster occurs and leading the way to recovery.

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The Use of and Attitude Towards Telehealth in Rural Communities

Australian Journal of Primary Health ◽

10.1071/py07035 ◽

2007 ◽

Vol 13 (3) ◽

pp. 29 ◽

Cited By ~ 4

Author(s):

Emily Mauldon

Keyword(s):

Health Care ◽

Primary Health Care ◽

Health Care Providers ◽

Health Care Professionals ◽

Routine Practice ◽

Care Providers ◽

Urban Hospital ◽

Primary Health ◽

The Impact ◽

Rural Patients

This paper reports on the attitudes of a sample of health care providers towards the use of telehealth to support rural patients and integrate rural primary health and urban hospital care. Telehealth and other information technologies hold the promise of improving the quality of care for people in rural and remote areas and for supporting rural primary health care providers. While seemingly beneficial for rural patients, study participants believed that telehealth remains underused and poorly integrated into their practice. In general, participants thought that telehealth is potentially beneficial but places constraints on their activities, and few actually used it. Published literature usually reports either on the success of telehealth pilot projects or initiatives that are well resourced and do not reflect the constraints of routine practice, or has an international focus limiting its relevance to the Australian context. Because of the paucity of systematic and generalisable research into the effects of the routine use of telehealth to support rural patients, it is unclear why health care professionals choose to provide such services or the costs and benefits they incur in doing so. Research and policy initiatives continue to be needed to identify the impact of telehealth within the context of Australian primary health care and to develop strategies to support its use.

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The situation of nursing education in Latin America and the Caribbean towards universal health

Revista Latino-Americana de Enfermagem ◽

10.1590/1518-8345.2232.2913 ◽

2017 ◽

Vol 25 (0) ◽

Cited By ~ 11

Author(s):

Silvia Helena De Bortoli Cassiani ◽

Lynda Law Wilson ◽

Sabrina de Souza Elias Mikael ◽

Laura Morán Peña ◽

Rosa Amarilis Zarate Grajales ◽

...

Keyword(s):

Health Care ◽

Latin America ◽

Primary Health Care ◽

Nursing Education ◽

Clinical Decision Making ◽

Clinical Experiences ◽

Cross Sectional ◽

Primary Health ◽

The Caribbean ◽

Universal Health

Objective: to assess the situation of nursing education and to analyze the extent to which baccalaureate level nursing education programs in Latin America and the Caribbean are preparing graduates to contribute to the achievement of Universal Health. Method: quantitative, descriptive/exploratory, cross-sectional study carried out in 25 countries. Results: a total of 246 nursing schools participated in the study. Faculty with doctoral level degrees totaled 31.3%, without Brazil this is reduced to 8.3%. The ratio of clinical experiences in primary health care services to hospital-based services was 0.63, indicating that students receive more clinical experiences in hospital settings. The results suggested a need for improvement in internet access; information technology; accessibility for the disabled; program, faculty and student evaluation; and teaching/learning methods. Conclusion: there is heterogeneity in nursing education in Latin America and the Caribbean. The nursing curricula generally includes the principles and values of Universal Health and primary health care, as well as those principles underpinning transformative education modalities such as critical and complex thinking development, problem-solving, evidence-based clinical decision-making, and lifelong learning. However, there is a need to promote a paradigm shift in nursing education to include more training in primary health care.

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Development of the perceptions of preventable adverse events assessment tool (PPAEAT): measurement properties and patients’ mental health status

International Journal for Quality in Health Care ◽

10.1093/intqhc/mzab063 ◽

2021 ◽

Vol 33 (2) ◽

Author(s):

Franziska Maria Keller ◽

Christina Derksen ◽

Lukas Kötting ◽

Martina Schmiedhofer ◽

Sonia Lippke

Keyword(s):

Mental Health ◽

Health Care ◽

Patient Safety ◽

Primary Health Care ◽

Adverse Events ◽

Health Care Professionals ◽

Discriminant Validity ◽

Assessment Tool ◽

Primary Health ◽

Item Scale

Abstract Background Patient-centered care and patient involvement have been increasingly recognized as crucial elements of patient safety. However, patient safety has rarely been evaluated from the patient perspective with a quantitative approach aiming at making patient safety and preventable adverse events measurable. Objectives The objectives of this study were to develop and evaluate the psychometric properties of a questionnaire assessing patient safety by perceived triggers of preventable adverse events among patients in primary health-care settings while considering mental health. Methods Two hundred and ten participants were recruited through various digital and print channels and asked to complete an online survey between November 2019 and April 2020. Exploratory factor analysis was performed to identify domains of triggers of preventable adverse events affecting patient safety. Furthermore, a multi-trait scaling analysis was performed to evaluate internal reliability as well as item-scale convergent–discriminant validity. A multivariate analysis of covariance evaluated whether individuals below and above the symptom threshold for depression and generalized anxiety perceive triggers of preventable adverse events differently. Results The five factors determined were information and communication with patients, time constraints of health-care professionals, diagnosis and treatment, hygiene and communication among health-care professionals, and knowledge and operational procedures. The questionnaire demonstrated a good total and subscale internal consistency (α = 0.90, range = 0.75–0.88), good item-scale convergent validity with significant correlations between 0.57 and 0.78 (P < 0.05; P < 0.01) for all items with their associated subscales, and satisfactory item-scale discriminant validity between 0.14 and 0.55 (P > 0.05) with no significant correlations between the items and their competing subscales. The questionnaire further revealed to be a generic measure irrespective of patients’ mental health status. Patients older than 50 years of age perceived a significantly greater threat to their own safety compared to patients below that age. Conclusion The developed Perceptions of Preventable Adverse Events Assessment Tool (PPAEAT) exhibits good psychometric properties, which supports its use in future research and primary health-care practice. Further validation of the PPAEAT in different settings, languages and larger samples is needed. The results of this study need to be considered when assessing patient safety in the context of health-care research.

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The Role of Primary Health Care Professionals

Chronic Kidney Disease in Disadvantaged Populations ◽

10.1016/b978-0-12-804311-0.00031-5 ◽

2017 ◽

pp. 329-335 ◽

Cited By ~ 4

Author(s):

Alfonso M. Cueto-Manzano ◽

Héctor R. Martínez-Ramírez ◽

Laura Cortés-Sanabria ◽

Enrique Rojas-Campos

Keyword(s):

Health Care ◽

Primary Health Care ◽

Health Care Professionals ◽

Primary Health

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District nurses’ experiences of using a clinical decision support system and an assessment tool at elderly care units in primary health care: a qualitative study

Primary Health Care Research & Development ◽

10.1017/s1463423621000530 ◽

2021 ◽

Vol 22 ◽

Author(s):

Annica Lagerin ◽

Lena Törnkvist ◽

Johan Fastbom ◽

Lena Lundh

Keyword(s):

Older Adults ◽

Health Care ◽

Primary Health Care ◽

Decision Support ◽

Clinical Decision Support System ◽

Elderly Care ◽

Medication Use ◽

Clinical Decision ◽

Primary Health ◽

District Nurses

Abstract Aim: The present study aimed to describe the experience of district nurses (DNs) in using a clinical decision support system (CDSS) and the safe medication assessment (SMA) tool during patient visits to elderly care units at primary health care centres. Background: In Swedish primary health care, general practitioners (GPs) prescribe and have the responsibility to regularly review older adults’ medications, while DN (nurses specialised in primary health care) play an important role in assessing older adults’ ability to manage their medications, detecting potential drug-related problems and communicating with patients and GPs about such problems. In a previous feasibility study, we found that DNs who use a combination of a CDSS and the SMA tool identified numerous potentially harmful or dangerous factors and took a number of nursing care actions to improve the safety and quality of patients’ medication use. In telephone interviews, patients indicated that they were positive towards the assessment and interventions. Methods: Individual interviews with seven DNs who worked at six different primary health care centres in Region Stockholm were carried out in 2018. In 2019, an additional group interview was conducted with two of the seven DNs so they could discuss and comment on preliminary findings. Qualitative content analysis was used to analyse the interview transcripts. Findings: Using the tools, the DNs could have a natural conversation about medication use with older adults. They could get a clear picture of the older adults’ medication use and thus obtain information that could facilitate collaboration with GPs about this important component of health care for older adults. However, for the tools to be used in clinical practice, some barriers would have to be overcome, such as the time-consuming nature of using the tools and the lack of established routines for interprofessional collaboration regarding medication discussions.

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