scholarly journals The Seniors’ Community Hub: An Integrated Model of Care for the Identification and Management of Frailty in Primary Care

Geriatrics ◽  
2021 ◽  
Vol 6 (1) ◽  
pp. 18
Author(s):  
Marjan Abbasi ◽  
Sheny Khera ◽  
Julia Dabravolskaj ◽  
Bernadette Chevalier ◽  
Kelly Parker
Keyword(s):  
Primary Care ◽  
Gait Speed ◽  
Family Physicians ◽  
Community Dwelling ◽  
Integrated Models ◽  
Care Services ◽  
Interprofessional Teamwork ◽  
Team Working ◽  
Centered Care

(1) Background: Integrated models of primary care deliver the comprehensive and preventative approach needed to identify and manage frailty in older people. Seniors’ Community Hub (SCH) was developed to deliver person-centered, evidence-informed, coordinated, and integrated care services to older community dwelling adults living with frailty. This paper aims to describe the SCH model, and to present patient-oriented results of the pilot. (2) Methods: SCH was piloted in an academic clinic with six family physicians. Eligible patients were community dwelling, 65 years of age and older, and considered to be at risk of frailty (eFI > 0.12). Health professionals within the clinic received training in geriatrics and interprofessional teamwork to form the SCH team working with family physicians, patients and caregivers. The SCH intervention consisted of a team-based multi-domain assessment with person-centered care planning and follow-up. Patient-oriented outcomes (EQ-5D-5L and EQ-VAS) and 4-metre gait speed were measured at initial visit and 12 months later. (3) Results: 88 patients were enrolled in the pilot from April 2016–December 2018. No statistically significant differences in EQ-5D-5L/VAS or the 4-metre gait speed were detected in 38 patients completing the 12-month assessment. (4) Conclusions: Future larger scale studies of longer duration are needed to demonstrate impacts of integrated models of primary care on patient-oriented outcomes for older adults living with frailty.

GAIT SPEED AND HANDGRIP STRENGTH AS PREDICTORS OF INCIDENT DISABILITY IN MEXICAN OLDER ADULTS

2014 ◽  
pp. 1-4
Author(s):  
T. LOPEZ-TEROS ◽  
L.M. GUTIERREZ-ROBLEDO ◽  
M.U. PEREZ-ZEPEDA
Keyword(s):  
Older Adults ◽  
Gait Speed ◽  
Daily Living ◽  
Handgrip Strength ◽  
Statistical Significance ◽  
Adverse Outcomes ◽  
Community Dwelling ◽  
Performance Tests ◽  
One Year

Physical performance tests are associated with different adverse outcomes in older people. Theobjective of this study was to test the association between handgrip strength and gait speed with incidentdisability in community-dwelling, well-functioning, Mexican older adults (age ≥70 years). Incident disability wasdefined as the onset of any difficulty in basic or instrumental activities of daily living. Of a total of 133participants, 52.6% (n=70) experienced incident disability during one year of follow-up. Significant associationsof handgrip strength (odds ratio [OR] 0.96, 95% confidence interval [95%CI] 0.93-0.99) and gait speed (OR0.27, 95%CI 0.07-0.99) with incident disability were reported. The inclusion of covariates in the models reducedthe statistical significance of the associations without substantially modifying the magnitude of them. Handgripstrength and gait speed are independently associated with incident disability in Mexican older adults.

scholarly journals Deriving and validating a brief measure of treatment burden to assess person-centered healthcare quality in primary care: a multi-method study

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
David T. Eton ◽  
Mark Linzer ◽  
Deborah H. Boehm ◽  
Catherine E. Vanderboom ◽  
Elizabeth A. Rogers ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Status ◽  
Medication Adherence ◽  
Care Quality ◽  
Community Dwelling ◽  
Self Management ◽  
Treatment Burden ◽  
Person Centered Care ◽  
Centered Care

Abstract Background In primary care there is a need for more quality measures of person-centered outcomes, especially ones applicable to patients with multiple chronic conditions (MCCs). The aim of this study was to derive and validate a short-form version of the Patient Experience with Treatment and Self-management (PETS), an established measure of treatment burden, to help fill the gap in quality measurement. Methods Patient interviews (30) and provider surveys (30) were used to winnow items from the PETS (60 items) to a subset targeting person-centered care quality. Results were reviewed by a panel of healthcare providers and health-services researchers who finalized a pilot version. The Brief PETS was tested in surveys of 200 clinic and 200 community-dwelling MCC patients. Surveys containing the Brief PETS and additional measures (e.g., health status, medication adherence, quality of care, demographics) were administered at baseline and follow-up. Correlations and t-tests were used to assess validity, including responsiveness to change of the Brief PETS. Effect sizes (ES) were calculated on mean differences. Results Winnowing and panel review resulted in a 34-item Brief PETS pilot measure that was tested in the combined sample of 400 (mean age = 57.9 years, 50% female, 48% white, median number of conditions = 5). Reliability of most scales was acceptable (alpha > 0.70). Brief PETS scores were associated with age, income, health status, and quality of chronic illness care at baseline (P < .05; rho magnitude range: 0.16–0.66). Furthermore, Brief PETS scores differentiated groups based on marital and education status, presence/absence of a self-management routine, and optimal/suboptimal medication adherence (P < .05; ES range: 0.25–1.00). Declines in patient-reported physical or mental health status over time were associated with worsening PETS burden scores, while improvements were associated with improving PETS burden scores (P < .05; ES range: 0.04–0.44). Among clinic patients, 91% were willing to complete the Brief PETS as part of their clinic visits. Conclusions The Brief PETS (final version: 32 items) is a reliable and valid tool for assessing person-centered care quality related to treatment burden. It holds promise as a means of giving voice to patient concerns about the complexity of disease management.

scholarly journals Uptake and patient and provider communication modality preferences of virtual visits in primary care: a retrospective cohort study in Canada

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e037064 ◽  
Author(s):  
Vess Stamenova ◽  
Payal Agarwal ◽  
Leah Kelley ◽  
Jamie Fujioka ◽  
Megan Nguyen ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Secure Messaging ◽  
Communication Modality ◽  
Care Services ◽  
Virtual Care ◽  
Virtual Visits

ObjectivesTo evaluate the uptake of a platform for virtual visits in primary care, examine patient and physician preferences for virtual communication methods and report on characteristics of visits and patients experience of care.DesignA retrospective cohort study.SettingPrimary care practices within five regions in Ontario, Canada after 18 months of access to virtual care services.Participants326 primary care providers and 14 291 registered patients.InterventionsProviders used a platform that allowed them to connect with their patients through synchronous (audio/video) and/or asynchronous (secure messaging) communication.Main outcome measuresUser-level data from the platforms including patient demographics, practice characteristics, communication modality used, visit characteristics and patients’ satisfaction.ResultsAmong the participants, 44% of registered patients and 60% of registered providers used the platform at least once. Among patient users, 51% completed at least one virtual visit. The majority of virtual visits (94%) involved secure messaging. The most common patient requests were for medication prescriptions (24%) and follow-up from previous appointment (22%). The most common provider request was to follow-up on test results (59%). Providers indicated that 81% of virtual visits required no follow-up for that issue and 99% of patients reported that they would use virtual care services again.ConclusionsWhile there are a growing number of primary care video visit services, our study found that both patients and providers in rostered practices prefer secure messaging over video. Despite fears that virtual visits would be overused by patients, when patients connected with their own primary care provider, many virtual visits appeared to replace in-person visits, and patients did not overwhelm physicians with requests. This approach may improve access and continuity in primary care.

scholarly journals Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care

2019 ◽  
Vol 69 (686) ◽  
pp. e595-e604 ◽  
Author(s):  
Victoria Hammersley ◽  
Eddie Donaghy ◽  
Richard Parker ◽  
Hannah McNeilly ◽  
Helen Atherton ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Technical Problems ◽  
Face To Face ◽  
Information Giving ◽  
Care Services ◽  
Primary Care Services ◽  
Quasi Experimental ◽  
Primary Care Clinicians

BackgroundGrowing demands on primary care services have led to policymakers promoting video consultations (VCs) to replace routine face-to-face consultations (FTFCs) in general practice.AimTo explore the content, quality, and patient experience of VC, telephone (TC), and FTFCs in general practice.Design and settingComparison of audio-recordings of follow-up consultations in UK primary care.MethodPrimary care clinicians were provided with video-consulting equipment. Participating patients required a smartphone, tablet, or computer with camera. Clinicians invited patients requiring a follow-up consultation to choose a VC, TC, or FTFC. Consultations were audio-recorded and analysed for content and quality. Participant experience was explored in post-consultation questionnaires. Case notes were reviewed for NHS resource use.ResultsOf the recordings, 149/163 were suitable for analysis. VC recruits were younger, and more experienced in communicating online. FTFCs were longer than VCs (mean difference +3.7 minutes, 95% confidence interval [CI] = 2.1 to 5.2) or TCs (+4.1 minutes, 95% CI = 2.6 to 5.5). On average, patients raised fewer problems in VCs (mean 1.5, standard deviation [SD] 0.8) compared with FTFCs (mean 2.1, SD 1.1) and demonstrated fewer instances of information giving by clinicians and patients. FTFCs scored higher than VCs and TCs on consultation-quality items.ConclusionVC may be suitable for simple problems not requiring physical examination. VC, in terms of consultation length, content, and quality, appeared similar to TC. Both approaches appeared less ‘information rich’ than FTFC. Technical problems were common and, though patients really liked VC, infrastructure issues would need to be addressed before the technology and approach can be mainstreamed in primary care.

scholarly journals A descriptive study of pain treatment and its follow-up in primary care of elderly patients after orthopaedic care

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Gabriella Caleres ◽  
Patrik Midlöv ◽  
Åsa Bondesson ◽  
Sara Modig
Keyword(s):  
Primary Care ◽  
Elderly Patients ◽  
Pain Treatment ◽  
Nursing Home Residents ◽  
Descriptive Study ◽  
Pain Medication ◽  
Community Dwelling ◽  
Orthopaedic Care ◽  
Care Of Elderly

Abstract Background Pain treatment post orthopaedic care in the elderly is complicated and requires careful follow-up. Current guidelines state all patients prescribed opioids should have a plan for gradual reduction, with the treatment progressively reduced and ended if any pain remains after more than three months. How this works in primary care remains to be explored. The aim was to describe pain treatment and its follow-up in primary care of elderly patients after orthopaedic care. Methods In this descriptive study, medical case histories were collected for patients ≥ 75 years, which were enrolled at two rural primary care units in southern Sweden, and were discharged from orthopaedic care. Pain medication follow-up plans were noted, as well as current pain medication at discharge as well as two, six and twelve weeks later. Results We included a total of 49 community-dwelling patients with medication aid from nurses in municipality care and nursing home residents, ≥ 75 years, discharged from orthopaedic care. The proportion of patients prescribed paracetamol increased from 28/49 (57%) prior to admission, to 38/44 (82%) after 12 weeks. The proportion of patients prescribed opioids increased from 5/49 (10%) to 18/44 (41%). Primary care pain medication follow-up plans were noted for 16/49 patients (33%). Conclusions Many patients still used pain medication 12 weeks after discharge, and follow-up plans were quite uncommon, which may reflect upon lacking follow-up of these patients in primary care.

Primary care and all-cause mortality in urban China: a mixed-level analysis

2020 ◽  
Author(s):  
Quan Zhang
Keyword(s):  
Primary Care ◽  
Mortality Risk ◽  
Health Care Access ◽  
Community Dwelling ◽  
Urban China ◽  
Community Level ◽  
Promoting Effect ◽  
Primary Care Supply ◽  
The Impact

Abstract Background There is still a lack of evidence focusing on primary care supply in developing countries where the educational achievement of primary care practitioners is relatively low. Objectives By using a nationally representative longitudinal and prospective cohort study, this study examined whether primary care supply, measured by the availability and the number of community health centres (CHCs), was associated with 4-year mortality risk among community-dwelling participants aged 45 and above in urban China. Methods Using the 2011 and 2015 waves of the China Health and Retirement Longitudinal Survey (CHARLS), we conducted a longitudinal mixed-level logistic analysis to study the impact of the availability and the number of CHC on 4-year follow-up mortality risk, after adjusting community- and individual-level covariates. Results Individuals living in communities with CHC were 31% less likely to die during the 4-year follow-up (P &lt; 0.05) conditional on community-level characteristics, including the basic facilities availability, population size and physical area, and individuals’ socio-demographic and health characteristics and health behaviours. Also, an increased number of community-level CHC was shown to decrease residents’ 4-year mortality risk significantly (odds ratio = 0.82, P &lt; 0.05). Furthermore, the association was more pronounced among adults aged 65 and above. Conclusion This study provides additional evidence of the health-promoting effect of primary care supply among urban residents in China. Improving primary care coverage in China should be necessary to improve health care access, thus promoting population health.

scholarly journals A háziorvosok teljesítményének minőségi értékelése. Mi a probléma a háziorvosi indikátorokkal?

2016 ◽  
Vol 157 (9) ◽  
pp. 328-335 ◽  
Author(s):  
László Róbert Kolozsvári ◽  
Imre Rurik
Keyword(s):  
Primary Care ◽  
Family Physicians ◽  
Indicator System ◽  
Care Quality ◽  
Proper Solution ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Quality ◽  
Quality Of Primary Care

The Hungarian primary care quality indicator system has been introduced in 2009, and has been continuously developed since then. The system offers extra financing for family physicians who are achieving the expected levels of indicators. There are currently 16 indicators for adult and mixed practices and 8 indicators are used in paediatric care. Authors analysed the influencing factors of the indicators other than those related to the performance of family physicians. Expectations and compliance of patients, quality of outpatient (ambulatory) care services, insufficient flow of information, inadequate primary care softwares which need to be updated could be considered as the most important factors. The level of financial motivations should also be significantly increased besides changes in the reporting system. It is recommended, that decision makers in health policy and financing have to declare clearly their expectations, and professional bodies should find the proper solution. These indicators could contribute properly to the improvement of the quality of primary care services in Hungary. Orv. Hetil., 2016, 157(9), 328–335.

Mortality in Brazilian community-dwelling older adults: 7 years of follow up in primary care

2015 ◽  
Vol 16 (7) ◽  
pp. 804-809 ◽  
Author(s):  
Talita Cristina Barbosa Rezende Ferreira ◽  
Arlete Maria Valente Coimbra ◽  
Glaucia Regina Falsarella ◽  
Lilian Tereza Lavras Costallat ◽  
Ibsen Bellini Coimbra
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Community Dwelling ◽  
Community Dwelling Older Adults

scholarly journals Stroke follow-up in primary care: a discourse study on the discharge summary as a tool for knowledge transfer and collaboration

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rune Aakvik Pedersen ◽  
Halfdan Petursson ◽  
Irene Hetlevik ◽  
Henriette Thune
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Discourse Analysis ◽  
Knowledge Transfer ◽  
Health Care Services ◽  
Discharge Summary ◽  
Care Services ◽  
Discharge Summaries

Abstract Background The acute treatment for stroke takes place in hospitals and in Norway follow-up of stroke survivors residing in the communities largely takes place in general practice. In order to provide continuous post stroke care, these two levels of care must collaborate, and information and knowledge must be transferred between them. The discharge summary, a written report from the hospital, is central to this communication. Norwegian national guidelines for treatment of stroke, issued in 2010, therefore give recommendations on the content of the discharge summaries. One ambition is to achieve collaboration and knowledge transfer, contributing to integration of the health care services. However, studies suggest that adherence to guidelines in general practice is weak, that collaboration within the health care services does not work the way the authorities intend, and that health care services are fragmented. This study aims to assess to what degree the discharge summaries adhere to the guideline recommendations on content and to what degree they are used as tools for knowledge transfer and collaboration between secondary and primary care. Methods The study was an analysis of 54 discharge summaries for home-dwelling stroke patients. The patients had been discharged from two Norwegian local hospitals in 2011 and 2012 and followed up in primary care. We examined whether content was according to guidelines’ recommendations and performed a descriptive and interpretative discourse analysis, using tools adapted from an established integrated approach to discourse analysis.  Results We found a varying degree of adherence to the different advice for the contents of the discharge summaries. One tendency was clear: topics relevant here and now, i.e. at the hospital, were included, while topics most relevant for the later follow-up in primary care were to a larger degree omitted. In most discharge summaries, we did not find anything indicating that the doctors at the hospital made themselves available for collaboration with primary care after dischargeof the patient. Conclusions The discharge summaries did not fulfill their potential to serve as tools for collaboration, knowledge transfer, and guideline implementation. Instead, they may contribute to sustain the gap between hospital medicine and general practice.

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