scholarly journals Managing diabetes mellitus with comorbidities in primary healthcare facilities: a qualitative study among physicians in Odisha, India

2020 ◽  
Author(s):  
Sandipana Pati ◽  
Sanghamitra Pati ◽  
Marjan van den Akker ◽  
F. (François) G. Schellevis ◽  
Krushna Sahoo ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Delivery ◽  
Economic Status ◽  
Quality Care ◽  
Holistic Approach ◽  
Multidisciplinary Teams ◽  
Optimal Care ◽  
Allied Health Professionals ◽  
Healthcare Facilities

Abstract Aim To explore the perceived barriers and facilitators in the management of the patients having diabetes with comorbidities by primary care physicians.Methods A qualitative In-Depth Interview study was conducted among the primary care physicians at seventeen urban primary health care centres at Bhubaneswar city of Odisha, India. The digitally recorded interviews were transcribed verbatim and translated into English. The data were analysed using content analysis.Results Barriers related to physicians, patients and health system were identified. Physicians felt lack of necessary knowledge and skills, communication skills and overburdening due to multiple responsibilities to be major barriers to quality care. Patients’ attitude and beliefs along with socio-economic status played an important role in treatment adherence and in the management of their disease conditions. Poor infrastructure, irregular medicine supply, and shortage of skilled allied health professionals were also found to be barriers to optimal care delivery, as was the lack of electronic medical records and personal treatment records.Conclusion Comprehensive guidelines with on the job training for capacity building of the physicians and creation of multidisciplinary teams at primary care level for a more holistic approach towards management of diabetes with comorbidities could be the way forward to optimal delivery of care.

scholarly journals Managing diabetes mellitus with comorbidities in primary healthcare facilities in urban settings: a qualitative study among physicians in Odisha, India

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Sandipana Pati ◽  
Sanghamitra Pati ◽  
Marjan van den Akker ◽  
F. G. Schellevis ◽  
Krushna Chandra Sahoo ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Delivery ◽  
Economic Status ◽  
Quality Care ◽  
Holistic Approach ◽  
Multidisciplinary Teams ◽  
Optimal Care ◽  
Allied Health Professionals ◽  
Healthcare Facilities

Abstract Aim To explore the perceived barriers and facilitators in the management of the patients having diabetes with comorbidities by primary care physicians. Methods A qualitative In-Depth Interview study was conducted among the primary care physicians at seventeen urban primary health care centres at Bhubaneswar city of Odisha, India. The digitally recorded interviews were transcribed verbatim and translated into English. The data were analysed using thematic analysis. Results Barriers related to physicians, patients and health system were identified. Physicians felt lack of necessary knowledge and skills, communication skills and overburdening due to multiple responsibilities to be major barriers to quality care. Patients’ attitude and beliefs along with socio-economic status played an important role in treatment adherence and in the management of their disease conditions. Poor infrastructure, irregular medicine supply, and shortage of skilled allied health professionals were also found to be barriers to optimal care delivery, as was the lack of electronic medical records and personal treatment records. Conclusion Comprehensive guidelines with on the job training for capacity building of the physicians and creation of multidisciplinary teams at primary care level for a more holistic approach towards management of diabetes with comorbidities could be the way forward to optimal delivery of care.

scholarly journals Managing diabetes mellitus with comorbidities in primary healthcare facilities: a qualitative study among physicians in Odisha, India

2020 ◽  
Author(s):  
Sandipana Pati ◽  
Sanghamitra Pati ◽  
Marjan van den Akker ◽  
F. (François) G. Schellevis ◽  
Krushna Sahoo ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Delivery ◽  
Economic Status ◽  
Quality Care ◽  
Holistic Approach ◽  
Multidisciplinary Teams ◽  
Optimal Care ◽  
Allied Health Professionals ◽  
Healthcare Facilities

Abstract AimTo explore the perceived barriers and facilitators in the management of the patients having diabetes with comorbidities by primary care physicians.MethodsA qualitative In-Depth Interview study was conducted among the primary care physicians at seventeen urban primary health care centres at Bhubaneswar city of Odisha, India. The digitally recorded interviews were transcribed verbatim and translated into English. The data were analysed using content analysis.ResultsBarriers related to physicians, patients and health system were identified. Physicians felt lack of necessary knowledge and skills, communication skills and overburdening due to multiple responsibilities to be major barriers to quality care. Patients’ attitude and beliefs along with socio-economic status played an important role in treatment adherence and in the management of their disease conditions. Poor infrastructure, irregular medicine supply, and shortage of skilled allied health professionals were also found to be barriers to optimal care delivery, as was the lack of electronic medical records and personal treatment records.ConclusionComprehensive guidelines with on the job training for capacity building of the physicians and creation of multidisciplinary teams at primary care level for a more holistic approach towards management of diabetes with comorbidities could be the way forward to optimal delivery of care.

Delivery of Survivorship Care by Primary Care Physicians: The Perspective of Breast Cancer Patients

2009 ◽  
Vol 27 (6) ◽  
pp. 933-938 ◽  
Author(s):  
Jun J. Mao ◽  
Marjorie A. Bowman ◽  
Carrie T. Stricker ◽  
Angela DeMichele ◽  
Linda Jacobs ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Primary Care Physicians ◽  
Multivariate Regression ◽  
Care Delivery ◽  
Postmenopausal Breast Cancer ◽  
The United States ◽  
Cancer Therapies ◽  
Survivorship Care ◽  
General Care

Purpose Most of the 182,460 women diagnosed with breast cancer in the United States this year will become long-term survivors. Helping these women transition from active treatment to survivorship is a challenge that involves both oncologists and primary care physicians (PCPs). This study aims to describe postmenopausal breast cancer survivors' (BCS) perceptions of PCP-related survivorship care. Patients and Methods We conducted a cross-sectional survey of 300 BCSs seen in an outpatient breast oncology clinic at a large university hospital. The primary outcome measure was a seven-item self-reported measure on perceived survivorship care (Cronbach's α = .89). Multivariate regression analyses were used to identify factors associated with perceived care delivery. Results Overall, BCSs rated PCP-related survivorship care as 65 out of 100 (standard deviation = 17). The areas of PCP-related care most strongly endorsed were general care (78%), psychosocial support (73%), and health promotion (73%). Fewer BCSs perceived their PCPs as knowledgeable about cancer follow-up (50%), late effects of cancer therapies (59%), or treating symptoms related to cancer or cancer therapies (41%). Only 28% felt that their PCPs and oncologists communicated well. In a multivariate regression analysis, nonwhite race and level of trust in the PCP were significantly associated with higher perceived level of PCP-related survivorship care (P = .001 for both). Conclusion Although BCSs perceived high quality of general care provided by their PCPs, they were not as confident with their PCPs' ability to deliver cancer-specific survivorship care. Interventions need to be tested to improve oncology-primary care communication and PCP knowledge of cancer-specific survivorship care.

scholarly journals Does Informatics Enable or Inhibit the Delivery of Patient-centred, Coordinated, and Quality-assured Care: a Delphi Study

2015 ◽  
Vol 24 (01) ◽  
pp. 22-29 ◽  
Author(s):  
H. Liyanage ◽  
S-T. Correa ◽  
C. Kuziemsky ◽  
A. L. Terry ◽  
S. de Lusignan
Keyword(s):  
Primary Care ◽  
Health Care Professionals ◽  
Delphi Study ◽  
Care Delivery ◽  
Quality Care ◽  
Care Providers ◽  
Coordinated Care ◽  
International Panel ◽  
Other Information ◽  
Core Concepts

Summary Background: Primary care delivers patient-centred and coordinated care, which should be quality-assured. Much of family practice now routinely uses computerised medical record (CMR) systems, these systems being linked at varying levels to laboratories and other care providers. CMR systems have the potential to support care. Objective: To achieve a consensus among an international panel of health care professionals and informatics experts about the role of informatics in the delivery of patient-centred, coordinated, and quality-assured care.Method: The consensus building exercise involved 20 individuals, five general practitioners and 15 informatics academics, members of the International Medical Informatics Association Primary Care Informatics Working Group. A thematic analysis of the literature was carried out according to the defined themes. Results:The first round of the analysis developed 27 statements on how the CMR, or any other information system, including paper-based medical records, supports care delivery. Round 2 aimed at achieving a consensus about the statements of round one. Round 3 stated that there was an agreement on informatics principles and structures that should be put in place. However, there was a disagreement about the processes involved in the implementation, and about the clinical interaction with the systems after the implementation. Conclusions: The panel had a strong agreement about the core concepts and structures that should be put in place to support high quality care. However, this agreement evaporated over statements related to implementation. These findings reflect literature and personal experiences: whilst there is consensus about how informatics structures and processes support good quality care, implementation is difficult.

scholarly journals Understanding primary care-oncology relationships within a changing healthcare environment

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Jennifer Tsui ◽  
Jenna Howard ◽  
Denalee O’Malley ◽  
William L. Miller ◽  
Shawna V. Hudson ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Transitions ◽  
Formal System ◽  
The United States ◽  
Comparative Case Study ◽  
Health Care Environment ◽  
Optimal Care ◽  
Care Practices ◽  
Primary Care Practices

Abstract Background Management of care transitions from primary care into and out of oncology is critical for optimal care of cancer patients and cancer survivors. There is limited understanding of existing primary care-oncology relationships within the context of the changing health care environment. Methods Through a comparative case study of 14 innovative primary care practices throughout the United States (U.S.), we examined relationships between primary care and oncology settings to identify attributes contributing to strengthened relationships in diverse settings. Field researchers observed practices for 10–12 days, recording fieldnotes and conducting interviews. We created a reduced dataset of all text related to primary care-oncology relationships, and collaboratively identified patterns to characterize these relationships through an inductive “immersion/crystallization” analysis process. Results Nine of the 14 practices discussed having either formal or informal primary care-oncology relationships. Nearly all formal primary care-oncology relationships were embedded within healthcare systems. The majority of private, independent practices had more informal relationships between individual primary care physicians and specific oncologists. Practices with formal relationships noted health system infrastructure that facilitates transfer of patient information and timely referrals. Practices with informal relationships described shared commitment, trust, and rapport with specific oncologists. Regardless of relationship type, challenges reported by primary care settings included lack of clarity about roles and responsibilities during cancer treatment and beyond. Conclusions With the rapid transformation of U.S. healthcare towards system ownership of primary care practices, efforts are needed to integrate strengths of informal primary care-oncology relationships in addition to formal system driven relationships.

Primary Care Physicians' Views of Routine Follow-Up Care of Cancer Survivors

2009 ◽  
Vol 27 (20) ◽  
pp. 3338-3345 ◽  
Author(s):  
M. Elisabeth Del Giudice ◽  
Eva Grunfeld ◽  
Bart J. Harvey ◽  
Eugenia Piliotis ◽  
Sunil Verma
Keyword(s):  
Primary Care ◽  
Cancer Survivors ◽  
Primary Care Physicians ◽  
Mail Survey ◽  
Patient Specific ◽  
Urban Centers ◽  
Optimal Care ◽  
Adult Cancer Survivors ◽  
Follow Up Care

Purpose Routine follow-up of adult cancer survivors is an important clinical and health service issue. Because of a lack of evidence supporting advantages of long-term follow-up care in oncology clinics, there is increasing interest for the locus of this care to be provided by primary care physicians (PCPs). However, current Canadian PCP views on this issue have been largely unknown. Methods A mail survey of a random sample of PCPs across Canada, stratified by region and proximity to urban centers, was conducted. Views on routine follow-up of adult cancer survivors and modalities to facilitate PCPs in providing this care were determined. Results A total of 330 PCPs responded (adjusted response rate, 51.7%). After completion of active treatment, PCPs were willing to assume exclusive responsibility for routine follow-up care after 2.4 ± 2.3 years had elapsed for prostate cancer, 2.6 ± 2.6 years for colorectal cancer, 2.8 ± 2.5 years for breast cancer, and 3.2 ± 2.7 years for lymphoma. PCPs already providing this care were willing to provide exclusive care sooner. The most useful modalities PCPs felt would assist them in assuming exclusive responsibility for follow-up cancer care were (1) a patient-specific letter from the specialist, (2) printed guidelines, (3) expedited routes of rereferral, and (4) expedited access to investigations for suspected recurrence. Conclusion With appropriate information and support in place, PCPs reported being willing to assume exclusive responsibility for the follow-up care of adult cancer survivors. Insights gained from this survey may ultimately help guide strategies in providing optimal care to these patients.

scholarly journals Breast Cancer Care in California and Ontario: Primary Care Protections Greatest Among the Most Socioeconomically Vulnerable Women Living in the Most Underserved Places

2017 ◽  
Vol 8 (3) ◽  
pp. 127-134 ◽  
Author(s):  
Kevin M. Gorey ◽  
Caroline Hamm ◽  
Isaac N. Luginaah ◽  
Guangyong Zou ◽  
Eric J. Holowaty
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Health Insurance ◽  
Cancer Care ◽  
Primary Care Physicians ◽  
Rate Ratio ◽  
Adjuvant Radiation ◽  
Breast Cancer Care ◽  
Optimal Care ◽  
Cancer Data

Background: Better health care among Canada’s socioeconomically vulnerable versus America’s has not been fully explained. We examined the effects of poverty, health insurance and the supply of primary care physicians on breast cancer care. Methods: We analyzed breast cancer data in Ontario (n = 950) and California (n = 6300) between 1996 and 2000 and followed until 2014. We obtained socioeconomic data from censuses, oversampling the poor. We obtained data on the supply of physicians, primary care and specialists. The optimal care criterion was being diagnosed early with node negative disease and received breast conserving surgery followed by adjuvant radiation therapy. Results: Women in Ontario received more optimal care in communities well supplied by primary care physicians. They were particularly advantaged in the most disadvantaged places: high poverty neighborhoods (rate ratio = 1.65) and communities lacking specialist physicians (rate ratio = 1.33). Canadian advantages were explained by better health insurance coverage and greater primary care access. Conclusions: Policy makers ought to ensure that the newly insured are adequately insured. The Medicaid program should be expanded, as intended, across all 50 states. Strengthening America’s system of primary care will probably be the best way to ensure that the Affordable Care Act’s full benefits are realized.

scholarly journals Barriers to End-of-life Discussions in the Primary Care Setting

2020 ◽  
pp. 12-15
Author(s):  
Devon Boydstun ◽  
Shandra Basil ◽  
JIll Porter ◽  
Anand Gupta
Keyword(s):  
Primary Care ◽  
End Of Life ◽  
Primary Care Physicians ◽  
Care Setting ◽  
Primary Care Setting ◽  
Age Difference ◽  
Advanced Directives ◽  
Healthcare Facilities ◽  
Number Of Patients ◽  
Study Population

Background: The Patient Self Determination Act was passed in 1991 and requires healthcare facilities to present patients with information regarding advanced directives. Since that time, there has been no improvement in the number of patients reported to have had such discussions. Numerous barriers to these discussions exist both on the patient and provider side. This study aims to identify barriers to end of life discussions among providers in the primary care setting. Methods: The study population included practicing primary care physicians in the OhioHealth system. They were administered an anonymous questionnaire addressing demographic information and questions specific to end of life discussions and what barriers exist. Results: A majority of primary care physicians reported engaging in end of life discussions with their patients. A majority of physicians cited lack of time as a barrier to having these discussions. There was a statistically significant age difference among primary care physicians who reported they have end of life discussions with their patients and among these physicians there was a statistically significant increase in their level of comfort having these discussions. Conclusion: Primary care physicians further into their career reported having end of life discussions more frequently and felt more comfortable doing so. Additionally, physicians cite lack of time as the most common barrier to holding end of life discussions.

scholarly journals Road to Better Work-Life Balance? Lean Redesigns and Daily Work Time among Primary Care Physicians

2021 ◽  
Author(s):  
Dorothy Y. Hung ◽  
Gabriela Mujal ◽  
Anqi Jin ◽  
Su-Ying Liang
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Care Delivery ◽  
Office Visits ◽  
Interrupted Time Series Analysis ◽  
Work Time ◽  
Lean Implementation ◽  
Daily Work ◽  
The Impact ◽  
Physician Work

Abstract Purpose To assess the impact of Lean primary care redesigns on the amount of time that physicians spent working each day. Methods This observational study was based on 92 million time-stamped Epic® EHR access logs captured among 317 primary care physicians in a large ambulatory care delivery system. Seventeen clinic facilities housing 46 primary care departments were included for study. We conducted interrupted time series analysis to monitor changes in physician work patterns over 6 years. Key measures included total daily work time; time spent on “desktop medicine” outside the exam room; time spent with patients during office visits; time still working after clinic, i.e., after seeing the last patient each day; and remote work time. Results The amount of time that physicians spent on desktop EHR activities throughout the day, including after clinic hours, decreased by 10.9% (95% CI: −22.2, −2.03) and 8.3% (95% CI: −13.8, −2.12), respectively, during the first year of Lean implementation. Total daily work hours among physicians, which included both desktop activity and time in office visits, decreased by 20% (95% CI: −29.2, −9.60) by the third year of Lean implementation. Conclusions These findings suggest that Lean redesign may be associated with time savings for primary care physicians. However, since this was an observational analysis, further study is warranted (e.g., randomized trial) —to determine the impact of Lean interventions on physician work experiences.

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