scholarly journals Care of Transgender Patients: A General Practice Quality Improvement Approach

Healthcare ◽  
2022 ◽  
Vol 10 (1) ◽  
pp. 121
Author(s):  
Isabel Boyd ◽  
Thomas Hackett ◽  
Susan Bewley
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Standard Of Care ◽  
Population Based ◽  
Improvement Project ◽  
Gender Minority ◽  
Primary Care Population ◽  
Data Collection Instrument ◽  
Audit Standard ◽  
And Gender

Primary care must ensure high quality lifelong care is offered to trans and gender minority patients who are known to have poor health and adverse healthcare experiences. This quality improvement project aimed to interrogate and audit the data of trans and gender minority patients in one primary care population in England. A new data collection instrument was created examining pathways of care, assessments and interventions undertaken, monitoring, and complications. General practitioners identified a sample from the patient population and then performed an audit to examine against an established standard of care. No appropriate primary care audit standard was found. There was inconsistency between multiple UK gender identity clinics’ (GIC) individual recommended schedules of care and between specialty guidelines. Using an international, secondary care, evidence-informed guideline, it appeared that up to two-thirds of patients did not receive all recommended monitoring standards, largely due to inconsistencies between GIC and international guidance. It is imperative that an evidence-based primary care guideline is devised alongside measurable standards. Given the findings of long waits, high rates of medical complexity, and some undesired treatment outcomes (including a fifth of patients stopping hormones of whom more than half cited regret or detransition experiences), this small but population-based quality improvement approach should be replicated and expanded upon at scale.

Recent Trends in the Prescribing of ADHD Medications in Canadian Primary Care

2017 ◽  
Vol 24 (2) ◽  
pp. 301-308 ◽  
Author(s):  
Rachael Morkem ◽  
Scott Patten ◽  
John Queenan ◽  
David Barber
Keyword(s):  
Primary Care ◽  
Age Groups ◽  
Fold Increase ◽  
Population Based ◽  
Adhd Medication ◽  
Fourfold Increase ◽  
School Aged Children ◽  
Medication Prescribing ◽  
And Gender ◽  
Adhd Medications

Objective: The aim of this study was to describe the prevalence and incidence of ADHD medication prescribing, by age and gender, from 2005 to 2015 in Canadian primary care. Method: A population-based retrospective cohort study was conducted to evaluate the prescribing of ADHD medications between 2005 and 2015 using electronic medical record data. Yearly prevalence and incidence of ADHD medication prescribing were calculated for preschoolers (up to 5 years old), school-aged children (6-17 years old), and adults (18-65 years old) along with a description of the types of ADHD medications prescribed between 2005 and 2015. Results: Between 2005 and 2015, there was a 2.6-fold increase in the prevalence of ADHD medication prescribing to preschoolers, a 2.5-fold increase in school-aged children, and a fourfold increase in adults. There was a corresponding rise in incidence of prescribing although this rise was moderate and estimates were much lower compared with prevalence. The most commonly prescribed medication was Methylphenidate (65.0% of all ADHD medications prescribed). Conclusion: Although the prevalence of ADHD has remained stable over time, this study found an increase in the prescribing of ADHD medications in all age groups between 2005 and 2015. Incidence of new prescriptions was small relative to prevalence, suggesting that longer term treatments are being adopted.

scholarly journals 149 Virtual Care: A Quality Improvement Project on the Experience of Paediatricians during the COVID-19 Pandemic

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e102-e104
Author(s):  
Emma McCrady ◽  
Julie Strychowsky ◽  
Jessica Woolfson
Keyword(s):  
Quality Improvement ◽  
Online Survey ◽  
Local Level ◽  
Standard Of Care ◽  
Subject Area ◽  
Future Research ◽  
Improvement Project ◽  
Diagnostic Uncertainty ◽  
Virtual Care ◽  
Practice Efficiency

Abstract Primary Subject area Practice/Office Management Background Prior to the COVID-19 pandemic, in-person visits were the standard of care for paediatricians at our centre. With the pandemic onset, virtual care (VC) was adopted at an unprecedented scale and pace. Studies have reported positive patient VC experience; however, few have explored physician experience. This quality improvement (QI) initiative sought to qualify the VC experience of local paediatricians during the pandemic, with the intention of implementing VC clinical practice changes at the department level. Objectives To determine key factors that have supported and challenged the adoption of, and that will support integration of, VC in the future. Design/Methods The Donabedian model for healthcare QI was used to evaluate VC experience through an online survey with a focus on structure, process, and outcome measures. All physicians affiliated with the Department of Paediatrics (generalists and subspecialists in medicine and surgery) were invited to participate via email. Three reminder emails were sent at 2-week intervals. Descriptive statistics were reported. Results The response rate was 32.3% (63 of 195 physicians). The majority of respondents were subspecialists (84.1%), and at academic centres (87.5%) (Table 1). Pre-pandemic, only 30.1% used VC and saw <10% of patients virtually. During March-May 2020, 93.8% transitioned to VC, with > 50% seeing over 75% of patients virtually. By summer 2020, VC use declined, but remained higher than pre-pandemic (53.6% seeing < 25% of patients). OTN and telephone were platforms most used (32.8% and 28.6%, respectively). Most conducted visits from their work location (55.2%) versus home (44.8%). VC experience was considered positive by most physicians (73.6%), and only 18.8% found VC difficult to use despite technical difficulties reported by 41.5% (Figure 1). Physicians with ≤ 5 years in practice were most likely to find VC convenient (93.8%). Challenges with VC included lack of physical exam, diagnostic uncertainty, lower patient volumes, and poor patient VC etiquette. Regardless of practice location, specialty, years in practice, and prior experience, 96% would continue VC to 25% of patients, ideally for patients who live far away (26.4%) and for follow-ups of patients with established diagnoses (21.4%). Conclusion A rapid transition to VC during the COVID-19 pandemic was associated with challenges but also positive experiences. Willingness to continue VC was high. VC experience could be improved with greater patient education and focus on select patient populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for VC at a local level.

Barriers to receipt of novel oral oncolytics: A single-institution quality improvement investigation

2019 ◽  
Vol 26 (2) ◽  
pp. 279-285
Author(s):  
Ann A Wang ◽  
Christopher Tapia ◽  
Yasin Bhanji ◽  
Christopher Campbell ◽  
Daniel Larsen ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Care Center ◽  
Tertiary Care ◽  
Standard Of Care ◽  
Wait Times ◽  
Prescription Data ◽  
Electronic Prescription ◽  
Improvement Project ◽  
Pharmacy Claims ◽  
Oral Oncolytics

Introduction Novel oral oncolytic agents have become the standard of care and first-line therapies for many malignancies. However, issues impacting access to these drugs are not well explored. As part of a quality improvement project in a large tertiary academic institution, we aim to identify potential barriers that delay treatment for patients who are prescribed novel oral oncolytics. Methods This was a retrospective review of adults who were newly prescribed a novel oral oncolytic for Food and Drug Administration-approved indications at a single tertiary care center. Patients were identified via electronic prescription data (e-Scribe). Demographics, insurance information, and prescription dates were extracted from the electronic medical record and pharmacy claims data. Statistical analyses were performed to determine whether time-to-receipt was associated with insurance category, pharmacy transfers, cost assistance, and drug prescribed. Results Of the 270 successfully filled prescriptions, the mean time-to-receipt was 7.3 ± 10.3 days (range: 0–109 days). Patients with Medicare experienced longer time-to-receipt (9.1 ± 13.1 days) compared to patients with commercial insurance (4.4 ± 3.3). Uninsured patients experienced the longest time-to-receipt (15.7 ± 7.8 days) overall. Pharmacy transfers and cost assistance programs were also significantly associated with longer time-to-receipt. Ten prescriptions remained unfilled 90 days after the study period and were considered abandoned. Conclusion Insurance has a significant effect on the time-to-receipt of newly prescribed novel oral oncolytics. Pharmacy transfers and applying for cost assistance are also associated with longer wait times for patients. Our retrospective analysis identifies areas of improvement for future interventions to reduce wait times for patients receiving novel oral oncolytics.

scholarly journals Five-year trajectories of multimorbidity patterns in an elderly Mediterranean population using Hidden Markov Models

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Concepción Violán ◽  
Sergio Fernández-Bertolín ◽  
Marina Guisado-Clavero ◽  
Quintí Foguet-Boreu ◽  
Jose M. Valderas ◽  
...  
Keyword(s):  
Primary Care ◽  
Markov Model ◽  
Hidden Markov Model ◽  
Markov Models ◽  
Cox Regression ◽  
Hidden Markov ◽  
Population Based ◽  
Specific Pattern ◽  
Mediterranean Population ◽  
Primary Care Population

Abstract This study aimed to analyse the trajectories and mortality of multimorbidity patterns in patients aged 65 to 99 years in Catalonia (Spain). Five year (2012–2016) data of 916,619 participants from a primary care, population-based electronic health record database (Information System for Research in Primary Care, SIDIAP) were included in this retrospective cohort study. Individual longitudinal trajectories were modelled with a Hidden Markov Model across multimorbidity patterns. We computed the mortality hazard using Cox regression models to estimate survival in multimorbidity patterns. Ten multimorbidity patterns were originally identified and two more states (death and drop-outs) were subsequently added. At baseline, the most frequent cluster was the Non-Specific Pattern (42%), and the least frequent the Multisystem Pattern (1.6%). Most participants stayed in the same cluster over the 5 year follow-up period, from 92.1% in the Nervous, Musculoskeletal pattern to 59.2% in the Cardio-Circulatory and Renal pattern. The highest mortality rates were observed for patterns that included cardio-circulatory diseases: Cardio-Circulatory and Renal (37.1%); Nervous, Digestive and Circulatory (31.8%); and Cardio-Circulatory, Mental, Respiratory and Genitourinary (28.8%). This study demonstrates the feasibility of characterizing multimorbidity patterns along time. Multimorbidity trajectories were generally stable, although changes in specific multimorbidity patterns were observed. The Hidden Markov Model is useful for modelling transitions across multimorbidity patterns and mortality risk. Our findings suggest that health interventions targeting specific multimorbidity patterns may reduce mortality in patients with multimorbidity.

scholarly journals Enhancing primary care services for diverse sexual and gender minority populations: a developmental study protocol

BMJ Open ◽  
2020 ◽  
Vol 10 (2) ◽  
pp. e032787 ◽  
Author(s):  
Cathleen Willging ◽  
Miria Kano ◽  
Amy Elizabeth Green ◽  
Robert Sturm ◽  
Marisa Sklar ◽  
...  
Keyword(s):  
Primary Care ◽  
Focus Groups ◽  
Study Protocol ◽  
Practice Guidelines ◽  
Nominal Group ◽  
Developmental Study ◽  
Patient Needs ◽  
Gender Minority ◽  
Sexual And Gender Minority ◽  
And Gender

IntroductionCompared with heterosexual, cisgender populations, sexual and gender minority (SGM) people are more likely to suffer from serious health conditions and insufficient access to health services. Primary care is at the frontlines of healthcare delivery; yet, few clinics have resources or mechanisms in place to meet SGM patient needs. This developmental study protocol focuses on reducing health disparities among SGM patients by identifying, adapting and developing SGM practice guidelines/recommendations and implementation strategies for primary care clinics in urban and rural New Mexico. Using input from patients, healthcare advocates and providers, and researchers, the study will pilot a practice parameter and implementation toolkit to promote SGM-specific cultural competence at multiple service delivery levels.Methods and analysisWe will recruit providers/staff from four Federally Qualified Health Centers (FQHCs) serving ethnically and geographically diverse communities. Incorporating the Implementation of Change Model and an intersectionality perspective, data collection includes a systematic review of SGM-specific practice guidelines/recommendations, focus groups and semistructured interviews, quantitative surveys and the Nominal Group Technique (NGT) with providers/staff. We will categorise guidelines/recommendations identified through the review by shared elements, use iterative processes of open and focused coding to analyse qualitative data from focus groups, interviews and the NGT, and apply descriptive statistics to assess survey data. Findings will provide the foundation for the toolkit. Focus groups with SGM patients will yield supplemental information for toolkit refinement. To investigate changes in primary care contexts following the toolkit’s pilot, we will undertake systematic walkthroughs and document review at the FQHCs, analysing these data qualitatively to examine SGM inclusiveness. The structured data-informed Plan-Do-Study-Act method will enable further revision of the toolkit. Finally, focus groups, interviews and quantitative surveys with providers/staff will highlight changes made in the FQHCs to address SGM patient needs, barriers to sustainment of changes, satisfaction, acceptability, usability and feasibility of the toolkit.Ethics and disseminationThe study has been reviewed and approved by the Pacific Institute for Research and Evaluation Institutional Review Board. Informed consent will be obtained from all participants before their involvement in research activities begins. Study results will be actively disseminated through peer-reviewed journals, conference presentations, social media and the internet, and community/stakeholder engagement activities.

scholarly journals Applying the Diabetes Quality Improvement Project Indicators in the Indian Health Service Primary Care Setting

Diabetes Care ◽  
2001 ◽  
Vol 24 (1) ◽  
pp. 22-26 ◽  
Author(s):  
K. J. Acton ◽  
R. Shields ◽  
S. Rith-Najarian ◽  
B. Tolbert ◽  
J. Kelly ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Health Service ◽  
Care Setting ◽  
Primary Care Setting ◽  
Quality Improvement Project ◽  
Indian Health Service ◽  
Improvement Project ◽  
Indian Health
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