scholarly journals Eliciting Preferences of Providers in Primary Care Settings for Post Hospital Discharge Patient Follow-Up

2021 ◽  
Vol 18 (16) ◽  
pp. 8317
Author(s):  
Xin Wang ◽  
Kuimeng Song ◽  
Lijin Chen ◽  
Yixiang Huang ◽  
Stephen Birch
Keyword(s):  
Primary Care ◽  
Hospital Discharge ◽  
Discrete Choice ◽  
Choice Experiment ◽  
Primary Care Providers ◽  
Care Providers ◽  
Post Discharge ◽  
Primary Care Settings ◽  
Follow Up Care

Background: Post-hospital discharge follow-up has been a principal intervention in addressing gaps in care pathways. However, evidence about the willingness of primary care providers to deliver post-discharge follow-up care is lacking. This study aims to assess primary care providers’ preferences for delivering post-discharge follow-up care for patients with chronic diseases. Methods: An online questionnaire survey of 623 primary care providers who work in a hospital group of southeast China. Face-to-face interviews with 16 of the participants. A discrete choice experiment was developed to elicit preferences of primary care providers for post-hospital discharge patient follow-up based on six attributes: team composition, workload, visit pattern, adherence of patients, incentive mechanism, and payment. A conditional logit model was used to estimate preferences, willingness-to-pay was modelled, a covariate-adjusted analysis was conducted to identify characteristics related to preferences, 16 interviews were conducted to explore reasons for participants’ choices. Results: 623 participants completed the discrete choice experiment (response rate 86.4%, aged 33 years on average, 69.5% female). Composition of the follow-up team and adherence of patients were the attributes of greatest relative importance with workload and incentives being less important. Participants were indifferent to follow-up provided by home visit or as an outpatient visit. Conclusion: Primary care providers placed the most importance on the multidisciplinary composition of the follow-up team. The preference heterogeneity observed among primary care providers suggests personalized management is important in the multidisciplinary teams, especially for those providers with relatively low educational attainment and less work experience. Future research and policies should work towards innovations to improve patients’ engagement in primary care settings.

scholarly journals “She Knows Me Best”: A Qualitative Study of Patient and Caregiver Views on the Role of the Primary Care Physician Follow-Up Post-Discharge

2021 ◽  
Author(s):  
Sarah Griffiths ◽  
Gaibrie Stephen ◽  
Tara Kiran ◽  
Karen Okrainec
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Hospital Discharge ◽  
Care Provider ◽  
Primary Care Provider ◽  
Primary Care Providers ◽  
Care Providers ◽  
Post Discharge

Abstract BackgroundPatients with chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are at high-risk of readmission after hospital discharge. There is conflicting evidence however on whether timely follow-up with a primary care provider reduces that risk. The objective of this study is to understand the perspectives of patients with COPD and CHF, and their caregivers, on the role of primary care provider follow-up after hospital discharge.MethodsA qualitative study design with semi-structured interviews was conducted among patients or their family caregivers admitted with COPD or CHF who were enrolled in a multicenter mixed-methods study at three acute care hospitals in Ontario, Canada. Participants were interviewed between December 2017 to January 2019, the majority discharged from hospital at least 30 days prior to their interview. Interviews were analyzed independently by three authors using a deductive directed content analysis, with the fourth author cross-comparing themes.ResultsInterviews with 16 participants (eight patients and eight caregivers) revealed four main themes. First, participants valued visiting their primary care provider after discharge to build upon their longitudinal relationship. Second, primary care providers played a key role in coordinating care. Third, there were mixed views on the ideal time for follow-up, with many participants expressing a desire to delay follow-up to stabilize following their acute hospitalization. Fourth, the link between the post-discharge visit and preventing hospital readmissions was unclear to participants, who often self-triaged based on their symptoms when deciding on the need for emergency care.ConclusionsPatients and caregivers valued in-person follow-up with their primary care provider following discharge from hospital because of the trust established through pre-existing longitudinal relationships. Our results suggest policy makers should focus on improving rates of primary care provider attachment and systems supporting informational continuity.

Evaluation of coordination of cancer care between designated cancer hospitals and primary care providers: Results from a nationwide survey in Japan.

2018 ◽  
Vol 36 (7_suppl) ◽  
pp. 84-84
Author(s):  
Taro Tomizuka ◽  
Tomone Watanabe ◽  
Satoru Kamitani ◽  
Takahiro Higashi
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Care Coordination ◽  
Cancer Care ◽  
Critical Path ◽  
Primary Care Providers ◽  
Care Providers ◽  
Follow Up Care ◽  
Cancer Specialist

84 Background: To improve coordination of cancer care between cancer specialist hospitals and primary care providers (PCPs), the Japanese government accredited cancer specialist hospitals, so called “designated cancer care hospitals (DCCHs)” and introduced “Cancer care coordination instruction fee” which PCPs can receive if they share a cancer critical path (Japanese version of Survivorship Care Plans) of each cancer patient with DCCHs. We sought to assess the current status of coordination of cancer care in Japan and communication between DCCHs and PCPs from PCPs’ point of view. Methods: A cross-sectional mail survey was administered to randomly selected clinic-based PCPs (4,000 clinics) from a nation-wide database of medical institutions authorized by Ministry of Health, Labour and Welfare Japan to treat patients with health insurance (87,869 clinics). The survey evaluated how much PCPs provided cancer follow-up care and how well DCCHs coordinated care and communicated with PCPs in cancer survivorship. Results: 1,873 PCPs returned the questionnaire (response rate: 46.8%). 1,223 (65.3%) answered to provide cancer follow-up care in outpatient setting. Most of the PCPs which provided cancer follow-up care evaluated the care coordination and support by DCCHs were satisfactory (946, 77.4%) but the degree of good evaluation varied by region (highest: 91.3%, lowest: 45.8%). In regression analysis, provision of palliative care by PCPs (OR 1.52 95%CI 1.05-2.17) and use of cancer critical path (OR 2.10 95%CI 1.63-2.71) were significantly correlated with better evaluation of communication and care coordination. Conclusions: DCCHs communicated well with PCPs and PCPs were satisfied with the communication and care coordination by DCCHs. Provision of palliative care by PCPs and use of cancer critical path are likely to lead good care coordination in cancer care.

scholarly journals Preferences for Physician Roles in Follow-up Care During Survivorship: Do Patients, Primary Care Providers, and Oncologists Agree?

2018 ◽  
Vol 34 (2) ◽  
pp. 184-186 ◽  
Author(s):  
Archana Radhakrishnan ◽  
M. Chandler McLeod ◽  
Ann S. Hamilton ◽  
Kevin C. Ward ◽  
Steven J. Katz ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Care Providers ◽  
Follow Up Care ◽  
Physician Roles

The use of electronic health record systems to create treatment summaries and survivorship care plans.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 56-56
Author(s):  
Katherine Ramsey Gilmore ◽  
David K Choi ◽  
Patricia Chapman ◽  
Paula A. Lewis-Patterson ◽  
Guadalupe R. Palos ◽  
...  
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Survivorship Care ◽  
Care Providers ◽  
Treatment Summaries ◽  
Care Plans ◽  
Patient Level ◽  
Follow Up Care ◽  
Electronic Health

56 Background: The Commission on Cancer’s recent mandate stated that accredited programs issue treatment summaries (TSs) with survivorship follow-up care plans (SCPs). ASCO’s model of survivorship care also supports the use of these documents. One of the primary purposes of the documents is to enhance coordination and communication between the oncology team and primary care providers. Here we describe the experience of a survivorship program in using electronic health records (EHR) to develop TSs and SCPs. Methods: An interdisciplinary team at an academic cancer center was appointed to develop clinical tools to facilitate the creation and dissemination of TSs and SCPs. Enhancements were made to an institutional off-the-shelf EHR system that automatically populated available treatment information to the TS. This system used SmartLinks to pull data from the primary source of entry (e.g. surgical history, chemotherapy administered, and cancer stage). Clinicians edited and added pertinent information not automatically generated using one of the 19 disease-specific templates that provided lists of common treatments for various cancers. Electronic routing functions existed to share TSs with external providers through the medical records department. Results: From March-Sept, 2016, 766 SCP were completed by 50 providers in 14 clinics. Reports were created in the EHR to track SCPs and TS metrics. Data was reported from the TS on both a patient level and aggregate level by provider and clinic. Patient level data allowed providers to track incomplete TSs and edit them directly from the report. Of the TSs completed, 528 (69%) have been shared with patients and 261 (34%) have been shared with their community-based providers. Conclusions: EHRs provide a mechanism to successfully create and share TSs and SCPs among team members and primary care providers. They promote patient-provider education and communication about follow-up care. Research is needed to determine how they enhance coordination and ultimately outcomes for long-term survivors.

Abstract WP394: Needs of Stroke Survivors Post Hospital Discharge Stroke Follow-up Call

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Joseph Mojares ◽  
Sherydahn Aldrich ◽  
Maria Novales-Fiel
Keyword(s):  
Primary Care ◽  
Patient Satisfaction ◽  
Hospital Readmissions ◽  
Primary Care Providers ◽  
Phone Call ◽  
Care Providers ◽  
Stroke Patients ◽  
Post Discharge ◽  
Stroke Education

Background: This project attempts to discover the subjective response needs of 30-day post-acute stroke patients and their family members that were treated in two Northern California hospitals. The goal is to determine the functional level of the Stroke Survivor (SS) as measured by the Modified Rankin Scale (mRS) and to identify post-discharge needs. Purpose: The objective of this project is to identify the patient’s mRS score and post-discharge needs. The study includes stroke education reinforcement, primary care physician follow-up, ancillary services follow-up, discern hospital readmissions rates, and increase patient satisfaction. Methods: A list of discharged acute ischemic stroke patients over a three month period was provided to the Stroke Nurse Champion (SNC). A stroke phone call template was created to elicit the patient’s history, diagnosis, and mRS score. Patients with intracranial hemorrhage diagnosis, patients discharged to Skilled Nursing Facilities, and deceased patients were excluded from the study. The SNC performed chart review to determine patient course of hospitalization and stroke care management; places follow-up phone call to patient or family member; and identify the SS needs. When needs were discovered, they were addressed using electronic in-house messaging to patient’s primary care providers and ancillary staff. Results: Of the 63 participants, nine required stroke resource follow-up. The average mRS score of 1.84 revealed the patient’s knowledge of self-management to be 100%. There were 13 cases that needed outpatient therapy and Home Health therapy with mRS >2. The study outcome includes readmission rate of 0.03% (n=2) and stroke patient satisfaction >12.5%. Conclusions: Based on the mRS score, the SS appropriately met the level of care including rehabilitation needs at home. Post discharge needs of SS included psychosocial support, medication modification and appropriate durable medical equipment. Overall, the SS were satisfied with their care with low incidence of hospital readmission due to their stroke education provided during their hospitalization. Further plans for each hospital facility to consider continuing this project or to change the focus to outpatient support services as well.

scholarly journals Use of physician services during the survivorship phase: a multi-province study of women diagnosed with breast cancer

2017 ◽  
Vol 24 (2) ◽  
pp. 81 ◽  
Author(s):  
C. Kendell ◽  
K.M. Decker ◽  
P.A. Groome ◽  
M.L. McBride ◽  
L. Jiang ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
British Columbia ◽  
Nova Scotia ◽  
Cancer Survivors ◽  
Primary Care Providers ◽  
Care Providers ◽  
Follow Up Care ◽  
The Mean

Introduction Oncologists have traditionally been responsible for providing routine follow-up care for cancer survivors; in recent years, however, primary care providers (pcps) are taking a greater role in care during the follow-up period. In the present study, we used a longitudinal multi-province retrospective cohort study to examine how primary care and specialist care intersect in the delivery of breast cancer follow-up care.Methods Various databases (registry, clinical, and administrative) were linked in each of four provinces: British Columbia, Manitoba, Ontario, and Nova Scotia. Population-based cohorts of breast cancer survivors were identified in each province. Physician visits were identified using billings or claims data and were classified as visits to primary care (total, breast cancer–specific, and other), oncology (medical oncology, radiation oncology, and surgery), and other specialties. The mean numbers of visits by physician type and specialty, or by combinations thereof, were examined. The mean numbers of visits for each follow-up year were also examined by physician type.Results The results showed that many women (>64%) in each province received care from both primary care and oncology providers during the follow-up period. The mean number of breast cancer–specific visits to primary care and visits to oncology declined with each follow-up year. Interprovincial variations were observed, with greater surgeon follow-up in Nova Scotia and greater primary care follow-up in British Columbia. Provincial differences could reflect variations in policies and recommendations, relevant initiatives, and resources or infrastructure to support pcp-led follow-up care.Conclusions Optimizing the role of pcps in breast cancer follow-up care might require strategies to change attitudes about pcp-led follow-up and to better support pcps in providing survivorship care.

scholarly journals Coping With the Oncology Workforce Shortage: Transitioning Oncology Follow-Up Care to Primary Care Providers

2010 ◽  
Vol 6 (4) ◽  
pp. 203-205 ◽  
Author(s):  
David Debono
Keyword(s):  
Primary Care ◽  
Primary Care Providers ◽  
Cancer Center ◽  
Care Providers ◽  
Effective Response ◽  
Medical Societies ◽  
Community Oncology ◽  
Follow Up Care ◽  
Oncology Providers

An effective response to the impending shortage of oncology services will require different actions from governmental bodies, academic cancer center leaders, medical societies, and community oncology providers.

Utilization of a psychiatric clinical pharmacist in an integrated behavioral health program of a community health center

2014 ◽  
Vol 4 (6) ◽  
pp. 287-291 ◽  
Author(s):  
Richard J. Silvia
Keyword(s):  
Primary Care ◽  
Behavioral Health ◽  
Primary Care Providers ◽  
Mental Illnesses ◽  
Care Staff ◽  
Care Providers ◽  
Care Clinic ◽  
Collaborative Practice Agreement ◽  
Follow Up Care

Treatment of mental illnesses has slowly shifted to primary care settings over the past decade. As more patients are identified as needing treatment for a mental illness, the availability of behavioral health (BH) practitioners has become more strained, leading to this shift towards primary care treatment. With more patients receiving psychiatric health care from their primary care providers (PCP), a need for dedicated BH practitioners within the primary care setting was developed. This article describes a novel program where a clinical psychiatric pharmacist is utilized as the primary psychiatric provider within an integrated BH program of a busy primary care clinic in a major metropolitan area. Working under a collaborative practice agreement to prescribe, the pharmacist acts as the initial BH contact for the clinic, as well as a liaison between primary care and BH. Patients referred to the pharmacist from primary care are then evaluated and appropriate medication prescribed for their illness. Most patients are followed prospectively by the pharmacist, with more complex patients (i.e., those not appropriate for primary care-based BH treatment) referred to the BH clinic for follow-up care. The pharmacist serves on the intake committee for the BH clinic, and facilitates patient referrals to their clinicians. Preliminary analysis of the program's effectiveness shows positive results. Within the first two months of the program, 28 patients were referred to the pharmacist (including five referred by BH clinic therapists through primary care). Most patients were referred for depression or anxiety, with attention deficit hyperactivity disorder, substance abuse, bipolar disorder, and psychosis also being treated. As such, antidepressants and anxiolytics were the most common agents prescribed, but most every class of psychotherapeutic agents was utilized. Patient wait times to meet with the pharmacist were generally less than a week, with exceptions being found for patients already being prescribed a psychotherapeutic agent by their PCP and being referred to the pharmacist for follow-up care, or for patients being referred by their existing therapist. Initial reviews of the program by patients, primary care staff, and BH staff have been positive, especially in regards to patient access to specialized BH services.

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