scholarly journals Seeking Care for Hyperglycemia in the Emergency Department: Through the Eyes of the Patient

2020 ◽  
Author(s):  
Justin W. Yan ◽  
Dimah Azzam ◽  
Melanie P. Columbus ◽  
Kristine Van Aarsen ◽  
Selina L. Liu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
Hospital Admission ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Urgent Care ◽  
Care Providers ◽  
Health Care Settings ◽  
Care Systems

Health care systems often provide a range of options of care for patients with illnesses who do not require hospital admission. For individuals with diabetes, these options may include primary care providers, specialized diabetes clinics, and urgent care and walk-in clinics. We explored the reasons why patients choose the Emergency Department over other health care settings when seeking care for hyperglycemia.

scholarly journals Seeking Care for Hyperglycemia in the Emergency Department: Through the Eyes of the Patient

2020 ◽  
Author(s):  
Justin W. Yan ◽  
Dimah Azzam ◽  
Melanie P. Columbus ◽  
Kristine Van Aarsen ◽  
Selina L. Liu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Emergency Department ◽  
Hospital Admission ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Urgent Care ◽  
Care Providers ◽  
Health Care Settings ◽  
Care Systems

Health care systems often provide a range of options of care for patients with illnesses who do not require hospital admission. For individuals with diabetes, these options may include primary care providers, specialized diabetes clinics, and urgent care and walk-in clinics. We explored the reasons why patients choose the Emergency Department over other health care settings when seeking care for hyperglycemia.

scholarly journals Mental Health and Primary Care: Contributing to Mental Health System Transformation in Canada

2017 ◽  
Vol 36 (4) ◽  
pp. 33-67 ◽  
Author(s):  
Nick Kates
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Health Providers ◽  
Care Providers ◽  
System Transformation ◽  
Mental Health Systems ◽  
Care Systems

For 20 years mental health and primary care providers across Canada have been working collaboratively together to improve access to care, provider skills, and patient experience. The new strategic plan of the Mental Health Commission of Canada (MHCC) offers many opportunities for collaborative care to play a role in the transformation of Canada’s mental health systems. To assist the plan, this paper presents principles underlying successful projects and ways that mental health and primary care services can work together more collaboratively, including integrating mental health providers in primary care. It integrates these concepts into a Canadian Model for Collaborative Mental Health Care that can guide future expansion of these approaches, and suggests ways in which better collaboration can address wider issues facing all of Canada’s health care systems.

Satisfaction with Primary Health Care and Confidence in General Practitioners: An Exploratory Comparison of US and UK Students

1993 ◽  
Vol 6 (2) ◽  
pp. 89-98
Author(s):  
Bodo B. Schlegelmilch ◽  
James M. Carman
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Care Providers ◽  
Primary Health ◽  
The Us ◽  
Care Systems ◽  
The Uk ◽  
Oriented System

This paper explores attitudes of university students towards two differently organised health services, ie the National Health Service in the UK and the more market oriented system in the US and analyses the level of confidence placed in primary care providers (GPs/family physicians) in both systems. Although major differences in the perception of the two health care systems are identified, hardly any differences emerge between the two countries in terms of the confidence patients place in their primary care providers.

scholarly journals Inter-clinician eConsults without programmatic incentives or requirements: a qualitative study of primary care provider perspectives

2020 ◽  
Vol 37 (4) ◽  
pp. 525-529 ◽  
Author(s):  
Leah Zallman ◽  
Carolyn F Fisher ◽  
Sofia Ladner ◽  
Kira Mengistu ◽  
Alison B Rapaport ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Focus Groups ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Safety Net ◽  
Care Providers ◽  
Provider Perspectives ◽  
Care Systems ◽  
The Usa

Abstract Background Inter-clinician electronic consultation (eConsult) programmes are becoming more widespread in the USA as health care systems seek innovative ways of improving specialty access. Existing studies examine models with programmatic incentives or requirements for primary care providers (PCPs) to participate. Objective We aimed to examine PCP perspectives on eConsults in a system with no programmatic incentive or requirement for PCPs to use eConsults. Methods We conducted seven focus groups with 41 PCPs at a safety-net community teaching health care system in Eastern Massachusetts, USA. Results Focus groups revealed that eConsults improved PCP experience by enabling patient-centred care and enhanced PCP education. However, increased workload and variations in communication patterns added challenges for PCPs. Patients were perceived as receiving timelier and more convenient care. Timelier care combined with direct documentation in the patient record was perceived as improving patient safety. Although cost implications were less clear, PCPs perceived costs as being lowered through fewer unnecessary visits and laboratories. Conclusions Our findings suggest that eConsult systems with no programmatic incentives or requirements for PCPs have the potential to improve care.

scholarly journals Quantification of the resilience of primary care networks by stress testing the health care system

2019 ◽  
Vol 116 (48) ◽  
pp. 23930-23935 ◽  
Author(s):  
Donald Ruggiero Lo Sardo ◽  
Stefan Thurner ◽  
Johannes Sorger ◽  
Georg Duftschmid ◽  
Gottfried Endel ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Care System ◽  
Large Scale ◽  
Health Care Systems ◽  
Primary Care Providers ◽  
Care Providers ◽  
Physician Density ◽  
Care Systems ◽  
Care System

There are practically no quantitative tools for understanding how much stress a health care system can absorb before it loses its ability to provide care. We propose to measure the resilience of health care systems with respect to changes in the density of primary care providers. We develop a computational model on a 1-to-1 scale for a countrywide primary care sector based on patient-sharing networks. Nodes represent all primary care providers in a country; links indicate patient flows between them. The removal of providers could cause a cascade of patient displacements, as patients have to find alternative providers. The model is calibrated with nationwide data from Austria that includes almost all primary care contacts over 2 y. We assign 2 properties to every provider: the “CareRank” measures the average number of displacements caused by a provider’s removal (systemic risk) as well as the fraction of patients a provider can absorb when others default (systemic benefit). Below a critical number of providers, large-scale cascades of patient displacements occur, and no more providers can be found in a given region. We quantify regional resilience as the maximum fraction of providers that can be removed before cascading events prevent coverage for all patients within a district. We find considerable regional heterogeneity in the critical transition point from resilient to nonresilient behavior. We demonstrate that health care resilience cannot be quantified by physician density alone but must take into account how networked systems respond and restructure in response to shocks. The approach can identify systemically relevant providers.

scholarly journals Primary Care Networks and Eritrean Immigrants’ Experiences with Health Care Professionals in Switzerland: A Qualitative Approach

2019 ◽  
Vol 16 (14) ◽  
pp. 2614 ◽  
Author(s):  
Carla Wallimann ◽  
Andreas Balthasar
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Health Professionals ◽  
Health Care Professionals ◽  
Access To Health Care ◽  
Health Care Systems ◽  
European Countries ◽  
Care Providers ◽  
Swiss Health ◽  
Care Systems

Growing migration in European countries has simultaneously increased cultural diversity in health care. Migrants’ equal access to health care systems and migrant friendly health care have therefore become relevant topics. Findings gathered in recent years have mainly focussed on the perspective of care providers, whereas this study includes migrant perspectives. It explores the primary care network of Eritrean immigrants in Switzerland as well as their experiences of interacting with health professionals. Semi-structured face-to-face interviews with intercultural interpreters from Eritrea were conducted. On the basis of a thematic analysis, the study identified the important informal and formal contacts in these Eritrean immigrants’ primary care networks and the specific forms of support each actor provides. In this network, encounters with health professionals were predominately expressed positively. The main barriers reported were language difficulties and intercultural understanding. On the basis of the participants’ statements, six key lessons for practice have been derived. These lessons are specifically important for facilitating Eritrean immigrants’ access to the Swiss health care system. Nevertheless, they are also relevant for other groups of migrants in European countries.

754 Insomnia and Depression Symptoms in Primary Care Patients Referred for Mental Health Care

SLEEP ◽  
2021 ◽  
Vol 44 (Supplement_2) ◽  
pp. A294-A294
Author(s):  
Ivan Vargas ◽  
Alexandria Muench ◽  
Mark Seewald ◽  
Cecilia Livesey ◽  
Matthew Press ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Primary Care Providers ◽  
Depression Symptoms ◽  
Care Providers ◽  
Mild Depression ◽  
Significant Depression ◽  
Clinically Significant

Abstract Introduction Past epidemiological research indicates that insomnia and depression are both highly prevalent and tend to co-occur in the general population. The present study further assesses this association by estimating: (1) the concurrence rates of insomnia and depression in outpatients referred by their primary care providers for mental health care; and (2) whether the association between depression and insomnia varies by insomnia subtype (initial, middle, and late). Methods Data were collected from 3,174 patients (mean age=42.7; 74% women; 50% Black) who were referred to the integrated care program for assessment of mental health symptoms (2018–2020). All patients completed an Insomnia Severity Index (ISI) and a Patient Health Questionnaire (PHQ-9) during their evaluations. Total scores for the ISI and PHQ-9 were computed. These scores were used to categorize patients into diagnostic groups for insomnia (no-insomnia [ISI < 8], subthreshold-insomnia [ISI 8–14], and clinically-significant-insomnia [ISI>14]) and depression (no-depression [PHQ-914]). Items 1–3 of the ISI were also used to assess the association between depression and subtypes of insomnia. Results Rates of insomnia were as follows: 34.6% for subthreshold-insomnia, 35.5% for clinically-significant insomnia, and 28.9% for mild-depression and 26.9% for clinically-significant-depression. 92% of patients with clinically significant depression reported at least subthreshold levels of insomnia. While the majority of patients with clinical depression reported having insomnia, the proportion of patients that endorsed these symptoms were comparable across insomnia subtypes (percent by subtype: initial insomnia 63%; middle insomnia 61%; late insomnia 59%). Conclusion According to these data, the proportion of outpatients referred for mental health evaluations that endorse treatable levels of insomnia is very high (approximately 70%). This naturally gives rise to at least two questions: how will such symptomatology be addressed (within primary or specialty care) and what affect might targeted treatment for insomnia have on health were it a focus of treatment in general? Support (if any) Vargas: K23HL141581; Perlis: K24AG055602

Presentation and Referral Patterns in Pediatric Closed Hand Fractures

Hand ◽  
2021 ◽  
pp. 155894472110085
Author(s):  
Landis R. Walsh ◽  
Laura C. Nuzzi ◽  
Amir H. Taghinia ◽  
Brian I. Labow
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Pediatric Patients ◽  
Primary Care Providers ◽  
Care Providers ◽  
Referral Patterns ◽  
Old Patients ◽  
Hand Surgeon ◽  
Hand Fractures ◽  
The Mean

Background Although pediatric hand fractures are common and generally have good outcomes, they remain a considerable source of anxiety for non–hand surgeons, who are less familiar with these injuries. We hypothesized that this anxiety may manifest as inefficiency in referral patterns. Methods The records of pediatric patients with isolated, closed hand fractures without concurrent trauma seen at our institution by a hand surgeon between January 2017 and December 2018 were retrospectively reviewed. Results There were 454 patients included; 62.1% were men, and the mean age was 9.6 years at initial encounter. Most patients (89.6%) were treated nonoperatively and incurred few complications (0.5%). Roughly half of all cases (n = 262) initially presented to an outside provider. Of these, 24.0% (n = 64 of 262) were evaluated by 2+ providers before a hand surgeon. Most commonly, these patients were referred from an outside emergency department (ED) to our ED before hand surgeon evaluation (n = 45 of 64). Forty-seven patients required surgery; however, none were performed urgently. Although a greater proportion of 7- to 11-year-old patients saw 2+ providers prior to a hand surgeon ( P = .007), fewer required surgery ( P < .001). Conclusions Pediatric closed hand fractures are mainly treated nonoperatively and nonemergently with generally excellent outcomes. Our data suggest that many patients continue to be referred through the ED or multiple EDs/providers for treatment. These inefficient referral patterns demonstrate the need for better education for ED and primary care providers, as well as better communication between these providers and local pediatric hand surgeons. Advancements in these areas are likely to improve efficiency of care and decrease costs.

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