scholarly journals Investigating the impact of distance on the use of primary care extended hours

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Jen Murphy ◽  
Mark Elliot ◽  
William Whittaker ◽  
Rathi Ravindrarajah
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Negative Binomial ◽  
Service Providers ◽  
Unmet Need ◽  
Area Deprivation ◽  
Home Practice ◽  
Extended Access ◽  
Gp Services ◽  
The Impact

IntroductionPoor access to general practice services has been attributed to increasing pressure on the health system more widely and low satisfaction among patients. Recent initiatives in England have sought to expand access by the provision of appointments in the evening and at weekends. Services are provided using a hub model. NHS national targets mandate extended opening hours as a mechanism for increasing access to primary care, based on the assumption that unmet need is caused by a lack of appointments at the right time. However, research has shown that other factors affect access to healthcare and it may not simply be appointment availability that limits an individual's ability to access general practice services. ObjectivesTo determine whether distance and deprivation impact on the uptake of extended hours GP services that use a hub practice model. MethodsWe linked a dataset (N = 25,408) concerning extended access appointments covering 158 general practice surgeries in four Clinical Commissioning Groups (CCGs) to the General Practice Patient Survey (GPPS) survey, deprivation statistics and primary care registration data. We used negative binomial regression to estimate associations between distance and deprivation on the uptake of extended hours GP services in the Greater Manchester City Region. Distance was defined as a straight line between the extended hours provider location and the patient's home practice, the English Indices of Multiple Deprivation were used to determine area deprivation based upon the home practice, and familiarity was defined as whether the patient's home practice provided an extended hours service. ResultsThe number of uses of the extended hours service at a GP practice level was associated with distance. After allowing for distance, the number of uses of the service for hub practices was higher than for non-hub practices. Deprivation was not associated with rates of use. ConclusionThe results indicate geographic inequity in the extended hours service. There may be many patients with unmet need for whom the extension of hours via a hub and spoke model does not address barriers to access. Findings may help to inform the choice of hub practices when designing an extended access service. Providers should consider initiatives to improve access for those patients located in practices furthest away from hub practices. This is particularly of importance in the context of closing health inequality gaps.

scholarly journals Geographical factors in access: investigating the impact of distance on the use of primary care extended hours, an administrative data study.

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Jen Murphy ◽  
William Whittaker ◽  
Mark Elliot ◽  
Rathi Ravindrarajah
Keyword(s):  
Primary Care ◽  
Negative Binomial ◽  
Unmet Need ◽  
Negative Binomial Regression ◽  
City Region ◽  
Hub Location ◽  
Barriers To Access ◽  
Access To Primary Care ◽  
The Right ◽  
The Impact

IntroductionNHS national targets mandate extended opening hours of doctors’ surgeries as a mechanism for increasing access to primary care, based on the assumption that unmet need is caused by a lack of appointments at the right time. Research has shown that other factors impact access and it may not simply be availability that limits an individual’s ability to access healthcare. Aims and Objectives To determine whether distance, familiarity and deprivation impact on the uptake of extended hours GP services that use a hub practice model. MethodsWe linked an appointments dataset to publicly available population datasets. With that linked dataset, we used negative binomial regression to model count data relating to uses of the extended hours service in one care commissioning group in the Greater Manchester city region. The dataset included 32,693 appointments across 4 hubs serving 37 practices. ResultsFamiliarity and distance are important in predicting the number of uses of the extended hours service at a GP practice level. For a theoretical pair of practices collocated at the hub location, the model predicts a use rate of 101.2 for the non hub compared with 283.7 for the hub, a 180% uplift. For a pair of non-hub practices, one located the mean distance from the hub, the other located one mile further away, the model predicts 64.8 uses for the nearer practice, and 46.5 uses for the far practice, a 28% penalty. ConclusionThe results indicate geographical inequity in the extended hours service. There may be many patients with unmet need for whom the extension of hours via a hub model does not address barriers to access. Providers should consider whether or not this type of model actually works to facilitate access. This is particularly of importance in the context of closing health inequality gaps.

The Impact of COVID-19 on Primary Care General Practice Consultations in a Teaching Hospital in Shanghai, China

2020 ◽  
Author(s):  
Zhongqing Xu ◽  
Jingchun Fan ◽  
Jingjing Ding ◽  
Xianzhen Feng ◽  
Shunyu Tao ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Teaching Hospital ◽  
The Impact

scholarly journals The Cochrane 2018 Review on Brief Interventions in Primary Care for Hazardous and Harmful Alcohol Consumption: A Distillation for Clinicians and Policy Makers

2019 ◽  
Vol 54 (4) ◽  
pp. 417-427 ◽  
Author(s):  
F R Beyer ◽  
F Campbell ◽  
N Bertholet ◽  
J B Daeppen ◽  
J B Saunders ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Alcohol Consumption ◽  
Brief Intervention ◽  
Emergency Care ◽  
Total Duration ◽  
Brief Interventions ◽  
Men And Women ◽  
Harmful Alcohol ◽  
The Impact

Abstract Aims An updated Cochrane systematic review assessed effectiveness of screening and brief intervention to reduce hazardous or harmful alcohol consumption in general practice or emergency care settings. This paper summarises the implications of the review for clinicians. Methods Cochrane methods were followed. Reporting accords with PRISMA guidance. We searched multiple resources to September 2017, seeking randomised controlled trials of brief interventions to reduce hazardous or harmful alcohol consumption in people attending general practice, emergency care or other primary care settings for reasons other than alcohol treatment. Brief intervention was defined as a conversation comprising five or fewer sessions of brief advice or brief lifestyle counselling and a total duration of less than 60 min. Our primary outcome was alcohol consumption, measured as or convertible to grams per week. We conducted meta-analyses to assess change in consumption, and subgroup analyses to explore the impact of participant and intervention characteristics. Results We included 69 studies, of which 42 were added for this update. Most studies (88%) compared brief intervention to control. The primary meta-analysis included 34 studies and provided moderate-quality evidence that brief intervention reduced consumption compared to control after one year (mean difference −20 g/wk, 95% confidence interval −28 to −12). Subgroup analysis showed a similar effect for men and women. Conclusions Brief interventions can reduce harmful and hazardous alcohol consumption in men and women. Short, advice-based interventions may be as effective as extended, counselling-based interventions for patients with harmful levels of alcohol use who are presenting for the first time in a primary care setting.

scholarly journals Exploring the multiple policy objectives for primary care networks: a qualitative interview study with national policy stakeholders

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e038398
Author(s):  
Kath Checkland ◽  
Jonathan Hammond ◽  
Lynsey Warwick-Giles ◽  
Simon Bailey
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Service Delivery ◽  
Service Providers ◽  
National Level ◽  
National Policy ◽  
Document Analysis ◽  
Policy Document ◽  
Qualitative Interview Study ◽  
Policy Objectives

ObjectivesEnglish general practice is suffering a workforce crisis, with general practitioners retiring early and trainees reluctant to enter the profession. To address this, additional funding has been offered, but only through participation in collaborations known as primary care networks (PCNs). This study explored national policy objectives underpinning PCNs and the mechanisms expected to help achieve these, from the perspective of those driving the policy.DesignQualitative semistructured interviews and policy document analysis.Setting and participantsNational-level policy maker and stakeholder interviewees (n=16). Policy document analysis of the Network Contract Direct Enhanced Service draft service specifications.AnalysisInterviews were transcribed, coded and organised thematically according to policy objectives and mechanisms. Thematic data were organised into a matrix so prominent elements can be identified and emphasised accordingly. Themes were considered alongside objectives embedded in PCN draft service delivery requirements.ResultsThree themes of policy objectives and associated mechanisms were identified: (1) supporting general practice, (2) place-based interorganisational collaboration and (3) primary care ‘voice’. Interviewees emphasised and sequenced themes differently, suggesting meeting objectives for one was necessary to realise another. Interviewees most closely linked to primary care emphasised the importance of theme 1. The objectives embedded in draft service delivery requirements primarily emphasised theme 2.ConclusionsThese policy objectives are not mutually exclusive but may imply different approaches to prioritising investment or necessitate more explicit temporal sequencing, with the stabilisation of a struggling primary care sector probably needing to occur before meaningful engagement with other community service providers can be achieved or a ‘collective voice’ is agreed. Multiple objectives create space for stakeholders to feel dissatisfied when implementation details do not match expectations, as the negative reaction to draft service delivery requirements illustrates. Our study offers policy makers suggestions about how confidence in the policy might be restored by crafting delivery requirements so all groups see opportunities to meet favoured objectives.

scholarly journals A Universal Early Parenting Education Intervention in Community-Based Primary Care Settings: Development and Installation Challenges

2018 ◽  
Vol 8 (4) ◽  
pp. 178 ◽  
Author(s):  
Grainne Hickey ◽  
Sinead McGilloway ◽  
Yvonne Leckey ◽  
Ann Stokes
Keyword(s):  
Primary Care ◽  
Best Practice ◽  
Service Providers ◽  
Practice Change ◽  
Parenting Education ◽  
Local Context ◽  
Programme Implementation ◽  
Community Based ◽  
Early Parenting ◽  
The Impact

Prevention and early intervention programmes, which aim to educate and support parents and young children in the earliest stages of the family lifecycle, have become an increasingly popular policy strategy for tackling intergenerational disadvantage and developmental inequality. Evidence-based, joined-up services are recommended as best practice for achieving optimal outcomes for parents and their children; however, there are persistent challenges to the development, adoption and installation of these kinds of initiatives in community-based primary health care settings. In this paper, we present a description of the design and installation of a multi-stakeholder early parenting education and intervention service model called the Parent and Infant (PIN) programme. This new programme is delivered collaboratively on a universal, area-wide basis through routine primary care services and combines standardised parent-training with other group-based supports designed to educate parents, strengthen parenting skills and wellbeing and enhance developmental outcomes in children aged 0–2 years. The programme design was informed by local needs analysis and piloting to establish an in-depth understanding of the local context. The findings demonstrate that a hospitable environment is central to establishing interagency parenting education and supports. Partnership, relationship-building and strategic leadership are vital to building commitment and buy-in for this kind of innovation and programme implementation. A graduated approach to implementation which provides training/education and coaching as well as organisational and administrative supports for practice change, are also important in creating an environment conducive to collaboration. Further research into the impact, implementation and cost-effectiveness of the PIN programme will help to build an understanding of what works for parents and infants, as well as identifying lessons for the development and implementation of other similar complex prevention and intervention programmes elsewhere. This kind of research coupled with the establishment of effective partnerships involving service providers, parents, researchers and policy makers, is necessary to meeting the challenge of improving family education and enhancing the capacity of family services to help promote positive outcomes for children.

Child Health General Practice Hubs: a service evaluation

2015 ◽  
Vol 101 (4) ◽  
pp. 333-337 ◽  
Author(s):  
Sarah Montgomery-Taylor ◽  
Mando Watson ◽  
Robert Klaber
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Child Health ◽  
Service Evaluation ◽  
High Patient Satisfaction ◽  
Patient Reported ◽  
The Impact ◽  
Lower Capacity ◽  
Inside Out

ObjectiveTo evaluate the impact of an integrated child health system.DesignMixed methods service evaluation.Setting and patientsChildren, young people and their families registered in Child Health General Practitioner (GP) Hubs where groups of GP practices come together to form ‘hubs’.InterventionsHospital paediatricians and GPs participating in joint clinics and multidisciplinary team (MDT) meetings in GP practices, a component of an ‘Inside-Out’ change known as ‘Connecting Care For Children (CC4C)’.Main outcome measuresCases seen in clinic or discussed at MDT meetings and their follow-up needs. Hospital Episode data: outpatient and inpatient activity and A&E attendance. Patient-reported experience measures and professionals’ feedback.ResultsIn one hub, 39% of new patient hospital appointments were avoided altogether and a further 42% of appointments were shifted from hospital to GP practice. In addition, there was a 19% decrease in sub-specialty referrals, a 17% reduction in admissions and a 22% decrease in A&E attenders. Smaller hubs running at lower capacity in early stages of implementation had less impact on hospital activity. Patients preferred appointments at the GP practice, gained increased confidence in taking their child to the GP and all respondents said they would recommend the service to family and friends. Professionals valued the improvement in knowledge and learning and, most significantly, the development of trust and collaboration.ConclusionsChild Health GP Hubs increase the connections between secondary and primary care, reduce secondary care usage and receive high patient satisfaction ratings while providing learning for professionals.

scholarly journals Advanced Access scheduling in general practice and use of primary care: a Danish population-based matched cohort study

BJGP Open ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. bjgpopen20X101091
Author(s):  
Maria Bang ◽  
Henrik Schou Pedersen ◽  
Bodil Hammer Bech ◽  
Claus Høstrup Vestergaard ◽  
Jannik Falhof ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Cohort Study ◽  
Population Based ◽  
Matched Cohort ◽  
Face To Face ◽  
Matched Cohort Study ◽  
Adjusted Incidence Rate ◽  
Advanced Access ◽  
The Impact

BackgroundAdvanced access scheduling (AAS) allows patients to receive care from their GP at the time chosen by the patient. AAS has shown to increase the accessibility to general practice, but little is known about how AAS implementation affects the use of in-hours and out-of-hours (OOH) services.AimTo describe the impact of AAS on the use of in-hours and OOH services in primary care.Design & settingA population-based matched cohort study using Danish register data.MethodA total of 161 901 patients listed in 33 general practices with AAS were matched with 287 837 reference patients listed in 66 reference practices without AAS. Outcomes of interest were use of daytime face-to-face consultations, and use of OOH face-to-face and phone consultations in a 2-year period preceding and following AAS implementation.ResultsNo significant differences were seen between AAS practices and reference practices. During the year following AAS implementation, the number of daytime face-to-face consultations was 3% (adjusted incidence rate ratio [aIRR] = 1.03; 95% confidence interval [CI] = 0.99 to 1.07) higher in the AAS practices compared with the number in the reference practices. Patients listed with an AAS practice had 2% (aIRR = 0.98; 95% CI = 0.92 to 1.04) fewer OOH phone consultations and 6% (aIRR = 0.94; 95% CI = 0.86 to 1.02) fewer OOH face-to-face consultations compared with patients listed with a reference practice.ConclusionThis study showed no significant differences following AAS implementation. However, a trend was seen towards slightly higher use of daytime primary care and lower use of OOH primary care.

scholarly journals Improving the Management of Atrial Fibrillation in General Practice: Protocol for a Mixed Methods Study (Preprint)

2020 ◽  
Author(s):  
Simon de Lusignan ◽  
F D Richard Hobbs ◽  
Harshana Liyanage ◽  
Filipa Ferreira ◽  
Manasa Tripathy ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Primary Care ◽  
General Practice ◽  
Real World ◽  
Early Recognition ◽  
Phase 1 ◽  
Second Phase ◽  
National Guidelines ◽  
Sentinel Network ◽  
The Impact

BACKGROUND Atrial fibrillation (AF) is one of the commonest arrhythmias observed in general practice. The thromboembolic complications of AF include transient ischemic attack, stroke, and pulmonary embolism. Early recognition of AF can lead to early intervention with managing the risks of these complications. OBJECTIVE The primary aim of this study is to investigate if patients are managed in general practice according to current national guidelines. In addition, the study will evaluate the impact of direct oral anticoagulant use with respect to AF complications in a real-world dataset. The secondary aims of the study are to develop a dashboard that will allow monitoring the management of AF in general practice and evaluate the usability of the dashboard. METHODS The study was conducted in 2 phases. The initial phase was a quantitative analysis of routinely collected primary care data from the Oxford Royal College of General Practitioners Research and Surveillance Center (RCGP RSC) sentinel network database. AF cases from 2009 to 2019 were identified. The study investigated the impact of the use of anticoagulants on complications of AF over this time period. We used this dataset to examine how AF was managed in primary care during the last decade. The second phase involved development of an online dashboard for monitoring management of AF in general practice. We conducted a usability evaluation for the dashboard to identify usability issues and performed enhancements to improve usability. RESULTS We received funding for both phases in January 2019 and received approval from the RCGP RSC research committee in March 2019. We completed data extraction for phase 1 in May 2019 and completed analysis in December 2019. We completed building the AF dashboard in May 2019. We started recruiting participants for phase 1 in May 2019 and concluded data collection in July 2019. We completed data analysis for phase 2 in October 2019. The results are expected to be published in the second half of 2020. As of October 2020, the publications reporting the results are under review. CONCLUSIONS Results of this study will provide an insight into the current trends in management of AF using real-world data from the Oxford RCGP RSC database. We anticipate that the outcomes of this study will be used to guide the development and implementation of an audit-based intervention tool to assist practitioners in identifying and managing AF in primary care. INTERNATIONAL REGISTERED REPORT RR1-10.2196/21259

Varicose veins are a risk factor for deep venous thrombosis in general practice patients

VASA ◽  
2012 ◽  
Vol 41 (5) ◽  
pp. 360-365 ◽  
Author(s):  
Müller-Bühl ◽  
Leutgeb ◽  
Engeser ◽  
N. Achankeng ◽  
Szecsenyi ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Risk Factor ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Potential Risk ◽  
Varicose Veins ◽  
Medical Attention ◽  
Increased Risk ◽  
The Impact

Background: The role of varicose veins (VV) as a risk factor for development of deep venous thrombosis (DVT) is still controversial. The aim of this study in primary care was to determine the impact of varicosity as a potential risk factor for developing DVT. Patients and methods: During the observation period between 01-Jan-2008 and 01-Jan-2011, all cases with VV (ICD code I83.9) and DVT (ICD codes I80.1 - I80.9) were identified out of the CONTENT primary care register (Heidelberg, Germany). The exposure of VV and DVT was based solely on ICD coding without regarding the accuracy of the diagnosis. The covariates age, gender, surgery, hospitalization, congestive heart failure, malignancy, pregnancy, hormonal therapy, and respiratory infection were extracted for each patient. Multivariate binary logistic regression was performed in order to assess potential risk factors for DVT. The SAS procedure “PROC GENMOD” (SAS version 9.2, 64-bit) was parameterised accordingly. A potential cluster effect (patients within practices) was regarded in the regression model. Results: There were 132 out of 2,357 (5.6 %) DVT episodes among patients with VV compared to 728 out of 80,588 (0.9 %) in the patient cohort without VV (p < 0.0001). An increased risk of DVT was associated with previous DVT (adjusted odds ratio (OR): 9.07, 95 % confidence interval (CI): 7.78 - 10.91), VV (OR 7.33 [CI 6.14 - 8.74]), hospitalization during the last 6 months (OR 1.69 [CI 1.29 - 2.22]), malignancy (OR 1.55 [CI 1.19 - 2.02]), and age (OR 1.02 [CI 1.01 - 1.03]). Conclusions: There are strong associations between VV and DVT in a general practice population with documented VV. Special medical attention is required for patients with VV, a history of previous venous thromboembolism, comorbid malignancy, and recent hospital discharge, particularly those with a combination of these factors.

Sign in / Sign up

Export Citation Format

Share Document