Implementing International Board-Certified Lactation Consultants Intervention into Routine Care: Barriers and Recommendations

2012 ◽  
Vol 3 (4) ◽  
pp. 131-137 ◽  
Author(s):  
Scott Hartman ◽  
Josephine Barnett ◽  
Karen A. Bonuck
Keyword(s):  
Primary Care ◽  
Low Income ◽  
Healthcare Providers ◽  
Routine Care ◽  
System Level ◽  
Healthcare Team ◽  
Call To Action ◽  
Department Of Health ◽  
Lactation Consultants ◽  
Breastfeeding Education

The Surgeon General’s 2011 Call to Action on Breastfeeding (U. S. Department of Health and Human Services, 2011) encourages greater use of International Board-Certified Lactation Consultants (IBCLCs) to increase breastfeeding rates. The objective was to examine IBCLCs’ experiences as part of a routine, primary-care based team serving low income, minority populations, and to elicit their recommendations for implementing IBCLC support as routine in prenatal care. Using a predesigned interview guide, a debriefing session was held with three IBCLCs who served as interventionists in two NIH-funded randomized controlled trials (RCTs) of breastfeeding promotion interventions. Themes were identified through coding and analysis of the session transcript. The results indicated that healthcare provider (HCP) support for breastfeeding was undermined by inadequate education and experience, often resulting in support "in name only." In addition, IBCLCs rapport and expertise—with both women and the healthcare team—helped overcome individual- and system-level barriers to breastfeeding. IBCLCs’ acceptance and integration into the primary-care team validated their work and increased their effectiveness. IBCLCs comments suggest that mothers cannot rely solely upon their healthcare providers for breastfeeding education and support. IBCLCs integrated into routine antenatal and postpartum care are pivotal to encouraging and reinforcing a woman’s choice to breastfeed through education, as well as emotional and skill-based support.

scholarly journals Operational failures and how they influence the work of GPs: a qualitative study in primary care

2020 ◽  
Vol 70 (700) ◽  
pp. e825-e832
Author(s):  
Carol Sinnott ◽  
Alexandros Georgiadis ◽  
Mary Dixon-Woods
Keyword(s):  
Primary Care ◽  
Work Environment ◽  
Information Transfer ◽  
Healthcare Providers ◽  
Comparison Method ◽  
Care Work ◽  
System Level ◽  
Structured Interviews ◽  
Qualitative Interview Study ◽  
Operational Failures

BackgroundOperational failures, defined as inadequacies or errors in the information, supplies, or equipment needed for patient care, are known to be highly consequential in hospital environments. Despite their likely relevance for GPs’ experiences of work, they remain under-explored in primary care.AimTo identify operational failures in the primary care work environment and to examine how they influence GPs’ work.Design and settingQualitative interview study in the East of England.MethodSemi-structured interviews were conducted with GPs (n = 21). Data analysis was based on the constant comparison method.ResultsGPs reported a large burden of operational failures, many of them related to information transfer with external healthcare providers, practice technology, and organisation of work within practices. Faced with operational failures, GPs undertook ‘compensatory labour’ to fulfil their duties of coordinating and safeguarding patients’ care. Dealing with operational failures imposed significant additional strain in the context of already stretched daily schedules, but this work remained largely invisible. In part, this was because GPs acted to fix problems in the here-and-now rather than referring them to source, and they characteristically did not report operational failures at system level. They also identified challenges in making process improvements at practice level, including medicolegal uncertainties about delegation.ConclusionOperational failures in primary care matter for GPs and their experience of work. Compensatory labour is burdensome with an unintended consequence of rendering these failures largely invisible. Recognition of the significance of operational failures should stimulate efforts to make the primary care work environment more attractive.

scholarly journals Influencers on deprescribing practice of primary healthcare providers in Nova Scotia: An examination using behavior change frameworks

2020 ◽  
Vol 4 ◽  
pp. 239920262092250
Author(s):  
Natalie Kennie-Kaulbach ◽  
Rachel Cormier ◽  
Olga Kits ◽  
Emily Reeve ◽  
Anne Marie Whelan ◽  
...  
Keyword(s):  
Primary Care ◽  
Nova Scotia ◽  
Behavior Change ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Primary Care Providers ◽  
System Level ◽  
Care Providers ◽  
Behavior Change Wheel ◽  
Primary Healthcare Providers

Background: Deprescribing is a complex process requiring consideration of behavior change theory to improve implementation and uptake. Aim: The aim of this study was to describe the knowledge, attitudes, beliefs, and behaviors that influence deprescribing for primary healthcare providers (family physicians, nurse practitioners (NPs), and pharmacists) within Nova Scotia using the Theoretical Domains Framework version 2 (TDF(v2)) and the Behavior Change Wheel. Methods: Interviews and focus groups were completed with primary care providers (physicians, NPs, and pharmacists) in Nova Scotia, Canada. Coding was completed using the TDF(v2) to identify the key influencers. Subdomain themes were also identified for the main TDF(v2) domains and results were then linked to the Behavior Change Wheel—Capability, Opportunity, and Motivation components. Results: Participants identified key influencers for deprescribing including areas related to Opportunity, within TDF(v2) domain Social Influences, such as patients and other healthcare providers, as well as Physical barriers (TDF(v2) domain Environmental Context and Resources), such as lack of time and reimbursement. Conclusion: Our results suggest that a systematic approach to deprescribing in primary care should be supported by opportunities for patient and healthcare provider collaborations, as well as practice and system level enhancements to support sustainability of deprescribing practices.

Presenting primary care teams to the public: a qualitative exploration of general practice websites

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X697049
Author(s):  
Helen Anderson ◽  
Joy Adamson ◽  
Yvonne Birks
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Nurse Practitioners ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Patient Choice ◽  
Healthcare Team ◽  
Sufficient Information ◽  
The Public ◽  
Professional Groups

BackgroundIncreasing demand and expanded primary care provision, coupled with a reduced GP workforce present challenges for primary care. New workforce models aim to reduce general practitioner workload by directing patients to a variety of alternative clinicians. Concurrently, the principle of patient choice in relation to healthcare providers has gained prominence. It is, therefore, necessary to provide patients with sufficient information to negotiate access to appropriate primary healthcare professionals.AimTo explore how practice websites present three exemplar healthcare professional groups (GPs, advanced nurse practitioners [ANPs], and practice nurses [PNs]) to patients and the implications for informing appropriate consultation choices.MethodQualitative thematic analysis of a sample of general practice websites. 79 accessible websites from a district in England were thematically analysed in relation to professional representation and signposting of the three identified professional groups.ResultsInformation about each group was incomplete, inconsistent and sometimes inaccurate across the majority of general practice websites. There was a lack of coherence and strategy in representation and direction of website users towards appropriate primary healthcare practitioners.ConclusionLimited and unclear representation of professional groups on general practice websites may have implications for the direction of patients to the wider clinical healthcare team. Patients may not have appropriate information to make choices about consulting with different healthcare practitioners. This constitutes a missed opportunity to signpost patients to appropriate clinicians and enhance understanding of different professional roles. Potential for websites to disseminate information to the public is not being maximised.

The role of app-based remote patient monitoring in reducing primary care clinician workload during the COVID pandemic: A prospective observational real world feasibility study.

2021 ◽  
Author(s):  
Sachin Shailendra Shah ◽  
Afsana Safa ◽  
Kuldhir Johal ◽  
Dillon Obika ◽  
Sophie Valenine
Keyword(s):  
Primary Care ◽  
Patient Monitoring ◽  
Healthcare Providers ◽  
Routine Care ◽  
Full Time ◽  
Remote Patient Monitoring ◽  
Full Time Equivalent ◽  
Phone Calls ◽  
Medium Risk ◽  
Remote Patient

Abstract Background COVID-19 has placed unprecedented strain on healthcare providers, in particular, primary care services. GP practices have to effectively manage patients remotely preserving social distancing. We aim to assess an app-based remote patient monitoring solution in reducing the workload of a clinician. Primary care COVID patients in West London deemed medium risk where recruited into the virtual ward. Patients were monitored for 14 days by telephone or by both the Huma app and telephone. Information on number of phone calls, duration of phone calls and duration of time spent reviewing the app data recorded.Results The amount of time spent reviewing one patient on the telephone only arm of the study was 490 minutes, compared with 280 minutes spent reviewing one patient who was monitored via both the Huma app and telephone. Based on employed clinicians monitoring patients, this equates to a 0.04 reduction of full-time equivalent staffing I.e. for every 100 patients, it would require 4 less personal to remotely monitor them. There was no difference in mortality or adverse events between the two groups.Conclusion App-based remote patient monitoring clearly holds large economic benefit to COVID-19 patients. In wake of further waves or future pandemics, and even in routine care, app-based remote monitoring patients could free up vital resources in terms of clinical team’s time, allowing a better reallocation of services.

Enhancing Lactation Support in the NICU During the COVID-19 Pandemic by Implementing a Primary Care Model

2020 ◽  
Vol 11 (4) ◽  
pp. 192-196
Author(s):  
Jennie Wagner ◽  
Carolyn Delaney ◽  
Sharron Baines
Keyword(s):  
Primary Care ◽  
Healthcare Team ◽  
Lactation Consultant ◽  
Supportive Environment ◽  
Lactation Consultants ◽  
The Family ◽  
Centered Care ◽  
Family Centered ◽  
Care Nursing ◽  
Primary Care Nursing

ObjectiveMeet the needs for additional lactation support in the NICU during the Covid-19 pandemic due to restriction in visitors, hours, and other stressors impacting the Mother and infant dyad.MethodDuring the Covid-19 pandemic, a large southeast U.S. research hospital implemented a new model of providing Lactation Consultation in a Level IV NICU. The Primary Care nursing model utilized in the NICU focuses on the infant and mother's individual needs and assists in the development of a caring and supportive environment.ResultsThe response to the Primary Care Lactation Consultant has well received and has resulted in the early identification of any Lactation concerns. Parents are reassured, knowing whom to contact with questions. The Lactation Consultant can set mutually agreed upon goals with the mother and include input from the other family members and the healthcare team.ConclusionsIn the future, the model and outcomes of Primary Care by Lactation Consultants in the NICU will focus on additional study and evaluation. In the interim, the parents at this facility have benefited from the family-centered care that focuses on the infant and parents.

scholarly journals Access to CKD Care in Rural Communities of India: A Qualitative Study Exploring the Barriers and Facilitators

2019 ◽  
Author(s):  
Tazeen Jafar ◽  
Chandrika Ramakrishnan ◽  
Oommen John ◽  
Abha Tewari ◽  
Benjamin Cobb ◽  
...  
Keyword(s):  
Primary Care ◽  
Rural Communities ◽  
Primary Care Physicians ◽  
Group Discussion ◽  
Healthcare Providers ◽  
Primary Care Providers ◽  
System Level ◽  
Rural India ◽  
Care Providers ◽  
Timely Initiation

Abstract Introduction Chronic kidney disease (CKD) has become a public health challenge globally, especially in lower- and middle- income countries. The implications of adverse social and economic consequences of CKD are particularly grave in a populous country like India where CKD risk factors like diabetes and hypertension are widely prevalent. Although with early detection and timely initiation of interventions CKD progression can be slowed, huge knowledge-practice gap exists. Moreover, factors that influence access to CKD care at the community level have not been studied previously. This study aimed to explore the experiences and views of key stakeholders to identify factors that influence access to CKD care in rural India. We also sought to discern the current practices and preparedness for CKD, understand the facilitators and barriers to CKD care, and feasibility and acceptability of mobile-technology based clinical decision support system (mCDSS) for CKD care in primary care.Methods Using 15 in-depth interviews and one focus group discussion (n=6), we aimed to explore the experiences and views of different stakeholdres from primary healthcare system in rural India. We employed Lévesque’s framework for access to care, and inductive and deductive approaches in the analysis. The interviews were audio-recorded and transcribed verbatim. Using QSR nVivio 11, coding and thematic analysis was undertaken.Results Our study identified barriers in relation to access to CKD care in rural India. Fore most among them was poor knowledge and lack of awareness to CKD among patients as well as primary care physicians. Health system-level barriers like shortages of skilled healthcare professionals and medicines, fragmented referrals pathways with inadequate follow up care were identified. Increasing awareness of CKD among healthcare providers and patients, provision of CKD related supplies, and a system-level approach to care coordination were key facilitators.Conclusions Lack of awareness and knowledge on CKD among primary care providers and patients, and unprepared primary care infrastructure are key barriers for access to CKD care in rural India. There is an urgent need to raise CKD awareness among primary care physicians and patients, improve supplies for diagnostics and medications, and create efficient referral pathways for CKD in primary care.

scholarly journals Presenting the primary care team to the public: a qualitative exploration of general practice websites

2018 ◽  
Vol 68 (668) ◽  
pp. e178-e186 ◽  
Author(s):  
Helen Anderson ◽  
Joy Adamson ◽  
Yvonne Birks
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Nurse Practitioners ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Patient Choice ◽  
Healthcare Team ◽  
Sufficient Information ◽  
The Public ◽  
Professional Groups

BackgroundIncreasing demand and expanded primary care provision, coupled with a reduced GP workforce, present challenges for primary care. New workforce models aim to reduce GP workload by directing patients to a variety of alternative clinicians. Concurrently, the principle of patient choice in relation to healthcare providers has gained prominence. It is, therefore, necessary to provide patients with sufficient information to negotiate access to appropriate primary healthcare professionals.AimTo explore how practice websites present three exemplar healthcare professional groups (GPs, advanced nurse practitioners [ANPs], and practice nurses [PNs]) to patients and the implications for informing appropriate consultation choices.Design and settingQualitative thematic analysis of a sample of general practice websites.MethodIn total, 79 accessible websites from a metropolitan district in the north of England were thematically analysed in relation to professional representation and signposting of the three identified professional groups.ResultsInformation about each group was incomplete, inconsistent, and sometimes inaccurate across the majority of general practice websites. There was a lack of coherence and strategy in representation and direction of website users towards appropriate primary healthcare practitioners.ConclusionLimited and unclear representation of professional groups on general practice websites may have implications for the direction of patients to the wider clinical healthcare team. Patients may not have appropriate information to make choices about consulting with different healthcare practitioners. This constitutes a missed opportunity to signpost patients to appropriate clinicians and enhance understanding of different professional roles. The potential for websites to disseminate information to the public is not being maximised.

A qualitative exploration of the feasibility of incorporating depression apps into integrated primary care clinics

2021 ◽  
Author(s):  
Danae Dinkel ◽  
Jennifer Harsh Caspari ◽  
Louis Fok ◽  
Maxine Notice ◽  
David J Johnson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Management ◽  
Mobile Apps ◽  
Healthcare Providers ◽  
Cost Effective ◽  
Integrated Primary Care ◽  
Healthcare Team ◽  
Structured Interviews ◽  
Potential Cost ◽  
Share Data

Abstract The use of mobile applications or “apps” is beginning to be identified as a potential cost-effective tool for treating depression. While the use of mobile apps for health management appears promising, little is known on how to incorporate these tools into integrated primary care settings—especially from the viewpoints of patients and the clinic personnel. The purpose of this study was to explore patient- and clinic-level perceptions of the use of depression self-management apps within an integrated primary care setting. Patients (n = 17), healthcare providers, and staff (n = 15) completed focus groups or semi-structured interviews in-person or via Zoom between January and July 2020. Participants were asked about barriers and facilitators to app use, how to best integrate it into care, and reviewed pre-selected mental health apps. Data were analyzed using a directed content analysis approach. From a patient perspective, features within the app such as notifications, the provision of information, easy navigation, and a chat/support function as well as an ability to share data with their doctor were desirable. Providers and staff identified integration of app data into electronic health records to be able to share data with patients and the healthcare team as well as clear evidence of effectiveness as factors that could facilitate implementation. All participants who reviewed apps identified at least one of them they would be interested in continuing to use. Overall, patients, healthcare providers, and staff believed depression apps could be beneficial for both patients and the clinic.

scholarly journals A prospective observational real world feasibility study assessing the role of app-based remote patient monitoring in reducing primary care clinician workload during the COVID pandemic

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sachin Shailendra Shah ◽  
Afsana Safa ◽  
Kuldhir Johal ◽  
Dillon Obika ◽  
Sophie Valentine
Keyword(s):  
Primary Care ◽  
Patient Monitoring ◽  
Healthcare Providers ◽  
Routine Care ◽  
Full Time ◽  
Remote Patient Monitoring ◽  
Full Time Equivalent ◽  
Phone Calls ◽  
Novel Coronavirus ◽  
Remote Patient

Abstract Background The novel coronavirus disease in 2019 (COVID-19) has placed unprecedented strain on healthcare providers, in particular, primary care services. General practitioners (GP) have to effectively manage patients remotely preserving social distancing. We aim to assess an app-based remote patient monitoring solution in reducing the workload of a clinician and reflect this as time-saved in an economic context. Primary care COVID patients in West London deemed medium risk were recruited into the virtual ward. Patients were monitored for 14 days by telephone or by both the Huma app and telephone. Information on number of phone calls, duration of phone calls and duration of time spent reviewing the app data was recorded. Results The amount of time spent reviewing one patient in the telephone only arm of the study was 490 min, compared with 280 min spent reviewing one patient who was monitored via both the Huma app and telephone. Based on employed clinicians monitoring patients, this equates to a 0.04 reduction of full-time equivalent staffing I.e. for every 100 patients, it would require 4 less personnel to remotely monitor them. There was no difference in mortality or adverse events between the two groups. Conclusion App-based remote patient monitoring potentially holds large economic benefit to COVID-19 patients. In wake of further waves or future pandemics, and even in routine care, app-based remote monitoring patients could free up vital resources in terms of clinical team’s time, allowing a better reallocation of services.

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