scholarly journals Do virtual renal clinics improve access to kidney care? an impact evaluation of a virtual clinic in east London

2019 ◽  
Author(s):  
Sally Ann Hull ◽  
Vian Rajabzadeh ◽  
Nicola Thomas ◽  
Sec Hoong ◽  
Gavin Dreyer ◽  
...  
Keyword(s):  
Primary Care ◽  
Impact Evaluation ◽  
Models Of Care ◽  
Service Improvement ◽  
Specialist Services ◽  
Working Practices ◽  
Electronic Health ◽  
Primary Care Clinicians ◽  
The Uk ◽  
Virtual Clinic

Abstract BACKGROUND Evidence from the UK national chronic kidney disease (CKD) audit, identifies deficits in the identification and management of CKD within primary care. Aligning the requirement of GPs for a responsive nephrology service, with the capacity of renal services and the need to prioritise patients with progressive disease requires a re-think of traditional models of care. Utilising the health data in the primary care electronic health record (EHR) to bridge the primary secondary divide is one way forward. METHODS We describe a novel community kidney service based in the renal department at Barts Health NHS Trust and four clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices. RESULTS Analysis of the virtual clinic data shows a rapid rise in referrals. The majority (>80%) do not require a traditional face to face appointment but can be managed with advice to the referring clinician. The wait for a nephrology opinion fell from 64 to 5 days.
The age adjusted referral rate was 2.5 per 1000 registered patients. Primary care clinicians expressed positive views including the rapid response to clinical queries, increased confidence in CKD management, improved access for patients unable to travel to clinic, and reported patient satisfaction. Nephrologists valued seeing the entire clinical record which improved clinical advice, but had concerns about the volume of referrals and changes to working practices. CONCLUSIONS It is feasible to develop ‘virtual’ specialist services using shared access to the primary care EHR.
Such services expand capacity to deliver timely advice based on a review of the entire EHR. To use both specialist and generalist expertise efficiently such services are best supported by community interventions which engage primary care clinicians in a data driven programme of service improvement.

scholarly journals Do virtual renal clinics improve access to kidney care? an impact evaluation of a virtual clinic in east London

2019 ◽  
Author(s):  
Sally Ann Hull ◽  
Vian Rajabzadeh ◽  
Nicola Thomas ◽  
Sec Hoong ◽  
Gavin Dreyer ◽  
...  
Keyword(s):  
Primary Care ◽  
Impact Evaluation ◽  
Models Of Care ◽  
Service Improvement ◽  
Specialist Services ◽  
Working Practices ◽  
Electronic Health ◽  
Primary Care Clinicians ◽  
The Uk ◽  
Virtual Clinic

Abstract BACKGROUND Evidence from the UK national chronic kidney disease (CKD) audit, identifies deficits in the identification and management of CKD within primary care. Aligning the requirement of GPs for a responsive nephrology service, with the capacity of renal services and the need to prioritise patients with progressive disease requires a re-think of traditional models of care. Utilising the health data in the primary care electronic health record (EHR) to bridge the primary secondary divide is one way forward. METHODS We describe a novel community kidney service based in the renal department at Barts Health NHS Trust and four clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices. RESULTS Analysis of the virtual clinic data shows a rapid rise in referrals. The majority (>80%) do not require a traditional face to face appointment but can be managed with advice to the referring clinician. The wait for a nephrology opinion fell from 64 to 5 days.
The age adjusted referral rate was 2.5 per 1000 registered patients. Primary care clinicians expressed positive views including the rapid response to clinical queries, increased confidence in CKD management, improved access for patients unable to travel to clinic, and reported patient satisfaction. Nephrologists valued seeing the entire clinical record which improved clinical advice, but had concerns about the volume of referrals and changes to working practices. CONCLUSIONS It is feasible to develop ‘virtual’ specialist services using shared access to the primary care EHR.
Such services expand capacity to deliver timely advice based on a review of the entire EHR. To use both specialist and generalist expertise efficiently such services are best supported by community interventions which engage primary care clinicians in a data driven programme of service improvement.

scholarly journals Do virtual renal clinics improve access to kidney care? an impact evaluation of a virtual clinic in east London

2019 ◽  
Author(s):  
Sally Ann Hull ◽  
Vian Rajabzadeh ◽  
Nicola Thomas ◽  
Sec Hoong ◽  
Gavin Dreyer ◽  
...  
Keyword(s):  
Primary Care ◽  
Impact Evaluation ◽  
Models Of Care ◽  
Service Improvement ◽  
Specialist Services ◽  
Working Practices ◽  
Electronic Health ◽  
Primary Care Clinicians ◽  
The Uk ◽  
Virtual Clinic

Abstract BACKGROUND Evidence from the UK national chronic kidney disease (CKD) audit, identifies deficits in the identification and management of CKD within primary care. Aligning the requirement of GPs for a responsive nephrology service, with the capacity of renal services and the need to prioritise patients with progressive disease requires a re-think of traditional models of care. Utilising the health data in the primary care electronic health record (EHR) to bridge the primary secondary divide is one way forward. METHODS We describe a novel community kidney service based in the renal department at Barts Health NHS Trust and four clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices. RESULTS Analysis of the virtual clinic data shows a rapid rise in referrals. The majority (>80%) do not require a traditional face to face appointment but can be managed with advice to the referring clinician. The wait for a nephrology opinion fell from 64 to 5 days.
The age adjusted referral rate was 2.5 per 1000 registered patients. Primary care clinicians expressed positive views including the rapid response to clinical queries, increased confidence in CKD management, improved access for patients unable to travel to clinic, and reported patient satisfaction. Nephrologists valued seeing the entire clinical record which improved clinical advice, but had concerns about the volume of referrals and changes to working practices. CONCLUSIONS It is feasible to develop ‘virtual’ specialist services using shared access to the primary care EHR.
Such services expand capacity to deliver timely advice based on a review of the entire EHR. To use both specialist and generalist expertise efficiently such services are best supported by community interventions which engage primary care clinicians in a data driven programme of service improvement.

scholarly journals Do virtual renal clinics improve access to kidney care? A preliminary impact evaluation of a virtual clinic in East London

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
S. A. Hull ◽  
V. Rajabzadeh ◽  
N. Thomas ◽  
S. Hoong ◽  
G. Dreyer ◽  
...  
Keyword(s):  
Primary Care ◽  
Impact Evaluation ◽  
Service Improvement ◽  
Proactive Management ◽  
Specialist Services ◽  
Timely Access ◽  
Primary Care Record ◽  
Working Practices ◽  
Electronic Health ◽  
Primary Care Clinicians

Abstract Background Early identification of people with CKD in primary care, particularly those with risk factors such as diabetes and hypertension, enables proactive management and referral to specialist services for progressive disease. The 2019 NHS Long Term Plan endorses the development of digitally-enabled services to replace the ‘unsustainable’ growth of the traditional out-patient model of care.Shared views of the complete health data available in the primary care electronic health record (EHR) can bridge the divide between primary and secondary care, and offers a practical solution to widen timely access to specialist advice. Methods We describe an innovative community kidney service based in the renal department at Barts Health NHS Trust and four local clinical commissioning groups (CCGs) in east London. An impact evaluation of the changes in service delivery used quantitative data from the virtual CKD clinic and from the primary care electronic health records (EHR) of 166 participating practices. Survey and interview data from health professionals were used to explore changes to working practices. Results Prior to the start of the service the general nephrology referral rate was 0.8/1000 GP registered population, this rose to 2.5/1000 registered patients by the second year of the service. The majority (> 80%) did not require a traditional outpatient appointment, but could be managed with written advice for the referring clinician. The wait for specialist advice fell from 64 to 6 days. General practitioners (GPs) had positive views of the service, valuing the rapid response to clinical questions and improved access for patients unable to travel to clinic. They also reported improved confidence in managing CKD, and high levels of patient satisfaction. Nephrologists valued seeing the entire primary care record but reported concerns about the volume of referrals and changes to working practices. Conclusions ‘Virtual’ specialist services using shared access to the complete primary care EHR are feasible and can expand capacity to deliver timely advice. To use both specialist and generalist expertise efficiently these services require support from community interventions which engage primary care clinicians in a data driven programme of service improvement.

Dentists’ preferences for diagnosis, management and referral of chronic oro-facial pain: Results from a national survey

2011 ◽  
Vol 71 (6) ◽  
pp. 662-669 ◽  
Author(s):  
Vishal R Aggarwal ◽  
Amy Joughin ◽  
Joanna Zakrzewska ◽  
Priscilla Appelbe ◽  
Martin Tickle
Keyword(s):  
Primary Care ◽  
Facial Pain ◽  
Temporomandibular Disorder ◽  
Postal Questionnaire ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Specialist Services ◽  
Primary Care Practitioners ◽  
Pain Symptoms ◽  
The Uk

Aim: To explore the diagnosis, treatment and referral patterns of chronic oro-facial pain patients by generalist primary care dentists (GDPs) in the UK. Methods: A cross-sectional survey was conducted using a non-stratified random sample of 500 GDPs who were selected from the General Dental Council register. A self-complete postal questionnaire with four hypothetical clinical case scenarios describing sub-types of chronic oro-facial pain (COFP) was used to investigate diagnosis, treatment and referral options of GDPs. Results: Two hundred and twenty (44%) GDPs responded. The majority correctly diagnosed temporomandibular disorder (TMD; 88%) and burning mouth syndrome (BMS; 92%). There was more variation in the diagnosis of the other cases related to persistent oro-facial pain. For TMD there was a clear preference for treatment with occlusal splint therapy, and referral to a temporomandibular joint (TMJ) specialist. The BMS scenario showed drug therapy and referral to an oral medicine specialist to be most popular. The chronic oro-facial pain cases had greater variation in management and choice of psychotherapy was related to duration of pain symptoms. Conclusions: The greater variation in responses to scenarios based on patients with chronic oro-facial pain may reflect the difficulty clinicians face in diagnosing and treating this condition. Management appears to follow a biomedical model and most clinicians chose to refer patients for treatment. There are few specialist services to cater for such referrals, indicating a need to train primary care practitioners in management of chronic COFP, along with the establishment of evidence-based guidelines.

Dental Management of Patients With Acquired and Congenital Bleeding Disorders

2020 ◽  
Vol 9 (2) ◽  
pp. 47-55
Author(s):  
Sukina Moosajee ◽  
Sobia Rafique
Keyword(s):  
Primary Care ◽  
Dental Treatment ◽  
Care Patient ◽  
Bleeding Disorders ◽  
Medical Interventions ◽  
National Priority ◽  
Dental Management ◽  
Specialist Services ◽  
Dental Setting ◽  
The Uk

In an age when people are living longer and medical interventions are continually becoming more advanced, clinicians will need to be aware of systemic disorders and treatments that may cause complications in the dental setting. The Office for National Statistics’ projections state that 26% of the UK population will be aged over 65 years by 2041.1 Therefore, clinicians may often encounter patients who complain of prolonged bleeding following certain procedures, most commonly dental extractions. In the majority of cases, the cause is often a local one, which can be managed using simple local measures. However, poor management can lead to potentially fatal consequences. The aim of this paper is to update clinicians on the dental management of patients with acquired or congenital bleeding disorders, and on how to decide the most appropriate setting for safe dental care. Patient safety in the NHS is a national priority with ever greater measures being put into place to avoid patient harm. Whilst most patients can be successfully treated in primary care, for the provision of safe dental treatment, the clinician may need to make a decision regarding referral to specialist services for all dental treatment, or share care between primary care and specialist services for selected procedures.

scholarly journals Imported malaria in the UK, 2005 to 2016: Estimates from primary care electronic health records

PLoS ONE ◽  
2018 ◽  
Vol 13 (12) ◽  
pp. e0210040
Author(s):  
Hamad Bastaki ◽  
Louise Marston ◽  
Jackie Cassell ◽  
Greta Rait
Keyword(s):  
Primary Care ◽  
Electronic Health Records ◽  
Imported Malaria ◽  
Health Records ◽  
Electronic Health ◽  
The Uk

scholarly journals Health-related welfare prioritisation of canine disorders using electronic health records in primary care practice in the UK

2019 ◽  
Vol 15 (1) ◽  
Author(s):  
Jennifer F. Summers ◽  
Dan G. O’Neill ◽  
David Church ◽  
Lisa Collins ◽  
David Sargan ◽  
...  
Keyword(s):  
Primary Care ◽  
Electronic Health Records ◽  
Primary Care Practice ◽  
Care Practice ◽  
Health Records ◽  
Health Related ◽  
Electronic Health ◽  
The Uk

scholarly journals Changing Epidemiology of Bariatric Surgery in the UK: Cohort Study Using Primary Care Electronic Health Records

2016 ◽  
Vol 26 (8) ◽  
pp. 1900-1905 ◽  
Author(s):  
Helen P. Booth ◽  
◽  
Omar Khan ◽  
Alison Fildes ◽  
A. Toby Prevost ◽  
...  
Keyword(s):  
Bariatric Surgery ◽  
Primary Care ◽  
Cohort Study ◽  
Electronic Health Records ◽  
Health Records ◽  
Electronic Health ◽  
The Uk

scholarly journals Best Paper Selection

2021 ◽  
Vol 30 (01) ◽  
pp. 103-104
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Skin Cancer ◽  
Health Informatics ◽  
Digital Health ◽  
Health Record ◽  
Health Records ◽  
After Hours ◽  
Electronic Health ◽  
Primary Care Clinicians

Adler-Milstein J, Zhao W, Willard-Grace R, Knox M, Grumbach K. Electronic health records and burnout: Time spent on the electronic health record after hours and message volume associated with exhaustion but not with cynicism among primary care clinicians. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7647261/ Brewer LC, Fortuna KL, Jones C, Walker R, Hayes SN, Patten CA, Cooper LA. Back to the Future: Achieving Health Equity Through Health Informatics and Digital Health. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996775/ Reading Turchioe M, Grossman LV, Myers AC, Baik D, Goyal P, Masterson Creber RM. Visual analogies, not graphs, increase patients' comprehension of changes in their health status. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7309237 Tschandl P, Rinner C, Apalla Z, Argenziano G, Codella N, Halpern A, Janda M, Lallas A, Longo C, Josep Malvehy J, Paoli J, Puig S, Rosendahl C, Soyer HP, Zalaudek I, Kittler H. Human-computer collaboration for skin cancer recognition. https://www.nature.com/articles/s41591-020-0942-0

scholarly journals The London memory service audit and quality improvement programme

2019 ◽  
Vol 43 (5) ◽  
pp. 215-220 ◽  
Author(s):  
Laura D. Cook ◽  
Katie E. Nichol ◽  
Jeremy D. Isaacs
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Waiting Times ◽  
Case Note ◽  
Performance Data ◽  
Service Improvement ◽  
Clinical Implications ◽  
Improvement Programme ◽  
The Uk ◽  
Diagnostic Support

Aims and methodMemory services have expanded significantly in the UK, but limited performance data have been published. The aim of this programme was to determine variation in London memory services and address this through service improvement projects. In 2016 London memory services were invited to participate in an audit consisting of case note reviews of at least 50 consecutively seen patients.ResultsTen services participated in the audit, totalling 590 patients. Variation was noted in neuroimaging practice, neuropsychology referrals, diagnosis subtype, non-dementia diagnoses, waiting times and post-diagnostic support. Findings from the audit were used to initiate four service improvement projects.Clinical ImplicationsMemory services should consider streamlining pathways to reduce waiting times, implementing pathways for patients who do not have dementia, monitoring appropriateness of neuroimaging, and working with commissioners and primary care to ensure that access to post-diagnostic interventions is consistent with the updated National Institute for Health and Care Excellence (NICE) dementia guideline.

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