scholarly journals Access to Primary Care and Internet Searches for Walk-In Clinics and Emergency Departments in Canada: Observational Study Using Google Trends and Population Health Survey Data

10.2196/13130 ◽  
2019 ◽  
Vol 5 (4) ◽  
pp. e13130 ◽  
Author(s):  
Joseph Ssendikaddiwa ◽  
Ruth Lavergne
Keyword(s):  
Primary Care ◽  
Survey Data ◽  
Health Survey ◽  
Relative Frequency ◽  
Google Trends ◽  
Medical Provider ◽  
After Hours ◽  
Access To Primary Care ◽  
Survey Responses ◽  
Over Time

Background Access to primary care is a challenge for many Canadians. Models of primary care vary widely among provinces, including arrangements for same-day and after-hours access. Use of walk-in clinics and emergency departments (EDs) may also vary, but data sources that allow comparison are limited. Objective We used Google Trends to examine the relative frequency of searches for walk-in clinics and EDs across provinces and over time in Canada. We correlated provincial relative search frequencies from Google Trends with survey responses about primary care access from the Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries and the 2016 Canadian Community Health Survey. Methods We developed search strategies to capture the range of terms used for walk-in clinics (eg, urgent care clinic and after-hours clinic) and EDs (eg, emergency room) across Canadian provinces. We used Google Trends to determine the frequencies of these terms relative to total search volume within each province from January 2011 to December 2018. We calculated correlation coefficients and 95% CIs between provincial Google Trends relative search frequencies and survey responses. Results Relative search frequency of walk-in clinic searches increased steadily, doubling in most provinces between 2011 and 2018. Relative frequency of walk-in clinic searches was highest in the western provinces of British Columbia, Alberta, Saskatchewan, and Manitoba. At the provincial level, higher walk-in clinic relative search frequency was strongly positively correlated with the percentage of survey respondents who reported being able to get same- or next-day appointments to see a doctor or a nurse and inversely correlated with the percentage of respondents who reported going to ED for a condition that they thought could have been treated by providers at usual place of care. Relative search frequency for walk-in clinics was also inversely correlated with the percentage of respondents who reported having a regular medical provider. ED relative search frequencies were more stable over time, and we did not observe statistically significant correlation with survey data. Conclusions Higher relative search frequency for walk-in clinics was positively correlated with the ability to get a same- or next-day appointment and inversely correlated with ED use for conditions treatable in the patient’s regular place of care and also with having a regular medical provider. Findings suggest that patient use of Web-based tools to search for more convenient or accessible care through walk-in clinics is increasing over time. Further research is needed to validate Google Trends data with administrative information on service use.

Using Google Trends to track walk-in clinic and emergency department searches over time and across provinces in Canada (Preprint)

2019 ◽  
Author(s):  
Joseph Ssendikaddiwa ◽  
Ruth Lavergne
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
British Columbia ◽  
Emergency Departments ◽  
Google Trends ◽  
Care Seeking ◽  
Primary Care Access ◽  
Care Access ◽  
After Hours ◽  
Over Time

BACKGROUND Access to primary care is a challenge for many Canadians. Models of primary care vary widely across provinces, including arrangements for same day and after-hours access. Use of walk-in clinics and emergency departments may also vary, but data sources that allow comparison are limited. OBJECTIVE We use Google Trends to examine searches for walk-in clinics and emergency departments across provinces and over time in Canada, and compare results to other information about primary care access. METHODS We developed search strategies to capture the range of terms used for walk-in clinics (e.g. urgent care clinic, after-hours clinic) and emergency departments (e.g. ER, emergency room) across Canadian provinces. We used Google Trends to determine the frequencies of these terms relative to total search volume, and standardized search frequencies to allow comparisons across provinces and over time (2011-2018). We explored how care seeking captured by Google Trends correlates with other sources of data on primary care access by province. RESULTS Manitoba, British Columbia, and Nova Scotia had highest search frequency for emergency departments, and Saskatchewan, Alberta, and Ontario had the lowest. Searches for walk-in clinics were most common in the western provinces of British Columbia, Alberta, and Saskatchewan. Relative search frequency for walk-in clinics increased steadily, doubling in most provinces between 2011 and 2018. Higher search frequency for walk-in clinics was correlated with ability to get a same or next-day appointment and inversely correlated with both ED use for conditions treatable in patients’ regular place of care and having a regular medical provider. Emergency department searches were not correlated with survey data. CONCLUSIONS Search frequencies may reflect patient care seeking but may also be impacted by news coverage and other events, especially in the case of emergency department searches. We observe substantial interprovincial variation, and marked growth in the frequency of searches for walk-in clinics. Google Searches for walk-in clinics correlate with other measures of access, and appear to correspond to differences in policies related to walk-in clinics, advanced access, and after-hours care between provinces.

scholarly journals A Retrospective Analysis of Provider-to-Patient Secure Messages: How Much Are They Increasing, Who Is Doing the Work, and Is the Work Happening After Hours? (Preprint)

2019 ◽  
Author(s):  
Frederick North ◽  
Kristine E Luhman ◽  
Eric A Mallmann ◽  
Toby J Mallmann ◽  
Sidna M Tulledge-Scheitel ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Care Physician ◽  
Work Hours ◽  
Patient Portal ◽  
Secure Messaging ◽  
After Hours ◽  
Over Time

BACKGROUND Patient portal registration and the use of secure messaging are increasing. However, little is known about how the work of responding to and initiating patient messages is distributed among care team members and how these messages may affect work after hours. OBJECTIVE This study aimed to examine the growth of secure messages and determine how the work of provider responses to patient-initiated secure messages and provider-initiated secure messages is distributed across care teams and across work and after-work hours. METHODS We collected secure messages sent from providers from January 1, 2013, to March 15, 2018, at Mayo Clinic, Rochester, Minnesota, both in response to patient secure messages and provider-initiated secure messages. We examined counts of messages over time, how the work of responding to messages and initiating messages was distributed among health care workers, messages sent per provider, messages per unique patient, and when the work was completed (proportion of messages sent after standard work hours). RESULTS Portal registration for patients having clinic visits increased from 33% to 62%, and increasingly more patients and providers were engaged in messaging. Provider message responses to individual patients increased significantly in both primary care and specialty practices. Message responses per specialty physician provider increased from 15 responses per provider per year to 53 responses per provider per year from 2013 to 2018, resulting in a 253% increase. Primary care physician message responses increased from 153 per provider per year to 322 from 2013 to 2018, resulting in a 110% increase. Physicians, nurse practitioners, physician assistants, and registered nurses, all contributed to the substantial increases in the number of messages sent. CONCLUSIONS Provider-sent secure messages at a large health care institution have increased substantially since implementation of secure messaging between patients and providers. The effort of responding to and initiating messages to patients was distributed across multiple provider categories. The percentage of message responses occurring after hours showed little substantial change over time compared with the overall increase in message volume.

Where Are They Now?

2020 ◽  
pp. 57-91
Author(s):  
Melinda Lundquist Denton ◽  
Richard Flory
Keyword(s):  
Data Collection ◽  
Emerging Adults ◽  
Survey Data ◽  
Religious Traditions ◽  
Religious Lives ◽  
Survey Responses ◽  
Changes Over Time ◽  
Over Time

Building on the foundation laid in Chapter 2, this chapter focuses specifically on the religious lives of emerging adults. Survey responses from multiple waves of data collection are used to show changes over time. The chapter focuses on change and continuity in the religious lives of emerging adults, while also showing how different religious traditions have fared in terms of influencing the lives of emerging adults. Taken together, the survey data show an overarching story of decline; yet under the surface there is movement both toward and away from religion.

Accountable Care in Transitions (ACTion): A Team-Based Approach to Reducing Hospital Utilization in a Patient-Centered Medical Home

2017 ◽  
Vol 31 (2) ◽  
pp. 175-182 ◽  
Author(s):  
Emily M. Hawes ◽  
Jennifer N. Smith ◽  
Nicole R. Pinelli ◽  
Rayhaan Adams ◽  
Gretchen Tong ◽  
...  
Keyword(s):  
Primary Care ◽  
Medical Home ◽  
Patient Centered Medical Home ◽  
Medical Provider ◽  
Care Needs ◽  
Patient Centered ◽  
Access To Primary Care ◽  
Transition Points ◽  
The Impact

Background: There is limited data describing the role of the patient-centered medical home (PCMH) in successful transitions programs and more information is needed to determine the transition points where pharmacist involvement is most impactful. Methods: A family medicine center developed a multidisciplinary outpatient-based transitions program focused on reducing emergency department (ED) and hospital use in medically complex patients. Key team members were a medical provider, clinical pharmacist practitioner (CPP), and care manager. The objective was to evaluate the impact of the program by comparing utilization before and after the intervention and to identify patient and process characteristic predictors of 30-day rehospitalizations. Results: Of the 268 patients included, the mean time to follow-up appointment attended was 11.6 (11.8) days after discharge. The majority of patients (72%) saw their primary care provider at follow-up. Patients experiencing the multidisciplinary intervention had lower 30-day rehospitalizations at 7, 14, and 30 days postdischarge with significance achieved at 14 and 30 days. Compared to before the intervention, reductions in both ED visits and hospitalizations as well as increases in clinic visits were seen at 1, 3, and 6 months. CPP involvement was associated with lower rehospitalizations (7.7% vs 18.8%; P = .04). Conclusion: A multidisciplinary outpatient-based transitions program embedded in the PCMH increased access to primary care and reduced hospital and ED utilization. Face-to-face CPP involvement significantly lowered rehospitalizations. This program describes a standardized approach to complex care needs with defined roles, a model that may be generalizable and reproduced in other medical homes.

scholarly journals A Retrospective Analysis of Provider-to-Patient Secure Messages: How Much Are They Increasing, Who Is Doing the Work, and Is the Work Happening After Hours?

10.2196/16521 ◽  
2020 ◽  
Vol 8 (7) ◽  
pp. e16521 ◽  
Author(s):  
Frederick North ◽  
Kristine E Luhman ◽  
Eric A Mallmann ◽  
Toby J Mallmann ◽  
Sidna M Tulledge-Scheitel ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Nurse Practitioners ◽  
Physician Assistants ◽  
Care Physician ◽  
Work Hours ◽  
Patient Portal ◽  
Secure Messaging ◽  
After Hours ◽  
Over Time

Background Patient portal registration and the use of secure messaging are increasing. However, little is known about how the work of responding to and initiating patient messages is distributed among care team members and how these messages may affect work after hours. Objective This study aimed to examine the growth of secure messages and determine how the work of provider responses to patient-initiated secure messages and provider-initiated secure messages is distributed across care teams and across work and after-work hours. Methods We collected secure messages sent from providers from January 1, 2013, to March 15, 2018, at Mayo Clinic, Rochester, Minnesota, both in response to patient secure messages and provider-initiated secure messages. We examined counts of messages over time, how the work of responding to messages and initiating messages was distributed among health care workers, messages sent per provider, messages per unique patient, and when the work was completed (proportion of messages sent after standard work hours). Results Portal registration for patients having clinic visits increased from 33% to 62%, and increasingly more patients and providers were engaged in messaging. Provider message responses to individual patients increased significantly in both primary care and specialty practices. Message responses per specialty physician provider increased from 15 responses per provider per year to 53 responses per provider per year from 2013 to 2018, resulting in a 253% increase. Primary care physician message responses increased from 153 per provider per year to 322 from 2013 to 2018, resulting in a 110% increase. Physicians, nurse practitioners, physician assistants, and registered nurses, all contributed to the substantial increases in the number of messages sent. Conclusions Provider-sent secure messages at a large health care institution have increased substantially since implementation of secure messaging between patients and providers. The effort of responding to and initiating messages to patients was distributed across multiple provider categories. The percentage of message responses occurring after hours showed little substantial change over time compared with the overall increase in message volume.

scholarly journals Physicians' access to primary care: results from the Canadian Medical Association National Physician Health Survey

2020 ◽  
Vol 55 (3) ◽  
pp. 27-28
Author(s):  
Taylor McFadden ◽  
Christopher Simon ◽  
Bilal Kobeissi ◽  
Caroline Gerin-Lajoie
Keyword(s):  
Primary Care ◽  
Medical Association ◽  
Health Survey ◽  
Physician Health ◽  
Access To Primary Care

scholarly journals Partnering with patients to improve access to primary care

2020 ◽  
Vol 9 (2) ◽  
pp. e000777
Author(s):  
Sam Davie ◽  
Tara Kiran
Keyword(s):  
Primary Care ◽  
Care Practice ◽  
Root Cause ◽  
Patient Voice ◽  
After Hours Care ◽  
Poor Access ◽  
Timely Access ◽  
After Hours ◽  
Access To Primary Care ◽  
Improve Access

Continuity and timely access are hallmarks of high-quality primary care and are important considerations for urgent concerns that present both during the day and after-hours. It can be especially difficult to ensure continuity of primary care after-hours in urban settings where walk-in clinics offer patients easy and convenient access. Patients of our large, multisite primary care practice in inner-city Toronto, Canada were reporting that they were not easily able to access after-hours care from their team without having to use outside services. In partnership with patients, we combined the Model for Improvement with Experience-Based Design methodology to address the issue of poor access to after-hours care. We did a root cause analysis to isolate the causes of the local problem, using a variety of capture tools designed to incorporate the patient voice. Then, patients and providers codesigned two Plan-Do-Study-Act (PDSA) cycles aimed to increase the ease of accessing after-hours care. Key actions included a redesign of our after-hours advertisement and communication of the material in multiple formats. Following these PDSA cycles, the team saw a 26%, 23% and 17% increase in awareness of weekday evening clinics, weekend clinics and after-hours phone services, respectively, and a 16% increase in the proportion of patients reporting that it was very or somewhat easy to get care during the evening, on the weekend or on a holiday from their care team. Measures continued to improve and improvements have been sustained 3 years later. Our success highlights the effectiveness of partnering with patients to improve access to primary care.

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