scholarly journals Is continuity of primary care declining in England? Practice-level longitudinal study, 2012-2017

2020 ◽  
pp. BJGP.2020.0935
Author(s):  
Peter Tammes ◽  
Richard Morris ◽  
Mairead Murphy ◽  
Chris Salisbury
Keyword(s):  
Primary Care ◽  
Longitudinal Study ◽  
Continuity Of Care ◽  
Multilevel Modelling ◽  
Population Characteristics ◽  
Urban Location ◽  
Practice Level ◽  
Level Data ◽  
Appointment System ◽  
Over Time

Background: Continuity of care is a core principle of primary care and related to improved patient outcomes and reduced healthcare costs. Evidence suggests continuity of care is declining. Aim: (i) to confirm reports of declining continuity of care, (ii) to explore differences in decline according to practice characteristics, (iii) to examine associations between practice populations or appointment provision and changes in continuity of care. Design and Setting: Longitudinal study of aggregated practice-level data from repeated questions in GP-Patient surveys between 2012-2017 on having a preferred GP, seeing this GP always/often (usually), appointment system and practice population characteristics, linked to rural/urban location and deprivation. Method: Multilevel modelling; time (level-1) and practices (level-2). Results: 56.7% of patients had a preferred GP in 2012, declining by 9.4%-points (95%CI -9.6 to -9.2) by 2017. 66.4% of patients with a preferred GP saw this GP usually in 2012, which declined by 9.7%-points (95%CI -10.0 to -9.4) by 2017. This decline was visible in all types of practices, irrespective of baseline continuity, rural/urban location, or deprivation. At practice-level, an increase over time in the percentage of patients reporting good overall experience of making appointments was associated with an increase in both the percentage of patients having a preferred GP, and the percentage of patients being able to see that GP usually. Conclusion: Patients reported a steady decline in continuity of care over time, which should concern clinicians and policymakers. The ability of practices to offer patients a satisfactorily working appointment system could partly counteract this decline.

scholarly journals Patterns of bruising in preschool children—a longitudinal study

2015 ◽  
Vol 100 (5) ◽  
pp. 426-431 ◽  
Author(s):  
Alison M Kemp ◽  
Frank Dunstan ◽  
Diane Nuttall ◽  
M Hamilton ◽  
Peter Collins ◽  
...  
Keyword(s):  
Longitudinal Study ◽  
Preschool Children ◽  
Social Deprivation ◽  
Multilevel Modelling ◽  
Bleeding Disorders ◽  
Prospective Longitudinal Study ◽  
The Mean ◽  
Data Collections ◽  
Prospective Longitudinal ◽  
Over Time

IntroductionThis study aims to identify the prevalence and pattern of bruises in preschool children over time, and explore influential variablesMethodsProspective longitudinal study of children (<6 years) where bruises were recorded on a body chart, weekly for up to 12 weeks. The number and location of bruises were analysed according to development. Longitudinal analysis was performed using multilevel modelling.Results3523 bruises recorded from 2570 data collections from 328 children (mean age 19 months); 6.7% of 1010 collections from premobile children had at least one bruise (2.2% of babies who could not roll over and 9.8% in those who could), compared with 45.6% of 478 early mobile and 78.8% of 1082 walking child collections. The most common site affected in all groups was below the knees, followed by ‘facial T’ and head in premobile and early mobile. The ears, neck, buttocks, genitalia and hands were rarely bruised (<1% of all collections). None of gender, season or the level of social deprivation significantly influenced bruising patterns, although having a sibling increased the mean number of bruises. There was considerable variation in the number of bruises recorded between different children which increased with developmental stage and was greater than the variation between numbers of bruises in collections from the same child over time.ConclusionsThese data should help clinicians understand the patterns of ‘everyday bruising’ and recognise children who have an unusual numbers or distribution of bruises who may need assessment for physical abuse or bleeding disorders.

scholarly journals Population-Based Longitudinal Study of Follow-Up Care for Patients With Colorectal Cancer in Nova Scotia

2012 ◽  
Vol 8 (4) ◽  
pp. 246-252 ◽  
Author(s):  
Robin Urquhart ◽  
Amy Folkes ◽  
Geoffrey Porter ◽  
Cynthia Kendell ◽  
Martha Cox ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Longitudinal Study ◽  
Nova Scotia ◽  
Continuity Of Care ◽  
Guideline Adherence ◽  
Population Based ◽  
Follow Up Care

Transitioning routine follow-up to primary care could potentially increase guideline adherence by improving access to and continuity of care.

scholarly journals Staff perception of Lean, care-giving, thriving and exhaustion: a longitudinal study in primary care

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Monica Kaltenbrunner ◽  
Lars Bengtsson ◽  
Svend Erik Mathiassen ◽  
Hans Högberg ◽  
Maria Engström
Keyword(s):  
Primary Care ◽  
Longitudinal Study ◽  
Job Demands ◽  
Moderated Mediation ◽  
Mediation Effect ◽  
Care Staff ◽  
Job Resources ◽  
Care Giving ◽  
Changes Over Time ◽  
Over Time

Abstract Background Lean is commonly adopted in healthcare to increase quality of care and efficiency. Few studies of Lean involve staff-related outcomes, and few have a longitudinal design. Thus, the aim was to examine the extent to which changes over time in Lean maturity are associated with changes over time in care-giving, thriving and exhaustion, as perceived by staff, with a particular emphasis on the extent to which job demands and job resources, as perceived by staff, have a moderated mediation effect. Method A longitudinal study with a correlational design was used. In total, 260 staff at 46 primary care units responded to a web survey in 2015 and 2016. All variables in the study were measured using staff ratings. Ratings of Lean maturity reflect participants’ judgements regarding the entire unit; ratings of care-giving, thriving, exhaustion and job demands and resources reflect participants’ judgements regarding their own situation. Results First, over time, increased Lean maturity was associated with increased staff satisfaction with their care-giving and increased thriving, mediated by increased job resources. Second, over time, increased Lean maturity was associated with decreased staff exhaustion, mediated by decreased job demands. No evidence was found showing that job demands and job resources had a moderated mediation effect. Conclusion The results indicate that primary care staff may benefit from working in organizations characterized by high levels of Lean maturity and that caregiving may also be improved as perceived by staff.

scholarly journals Delineating the trajectories of social and occupational functioning of young people attending early intervention mental health services in Australia: a longitudinal study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020678 ◽  
Author(s):  
Frank Iorfino ◽  
Daniel F Hermens ◽  
Shane, PM Cross ◽  
Natalia Zmicerevska ◽  
Alissa Nichles ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Longitudinal Study ◽  
Early Intervention ◽  
Young People ◽  
Mental Disorders ◽  
Functional Impairment ◽  
Clinical Care ◽  
Occupational Functioning ◽  
Over Time

ObjectivesMental disorders typically emerge during adolescence and young adulthood and put young people at risk for prolonged socioeconomic difficulties. This study describes the longitudinal course of social and occupational functioning of young people attending primary care-based, early intervention services.DesignA longitudinal study of young people receiving mental healthcare.SettingData were collected between January 2005 and August 2017 from a designated primary care-based mental health service.Participants554 young people (54% women) aged 12–32 years.MeasuresA systematic medical file audit collected clinical and functional information at predetermined time intervals (ie, 3 months to 5+ years) using a clinical pro forma. Group-based trajectory modelling (GBTM) was used to identify distinct trajectories of social and occupational functioning over time (median number of observations per person=4; median follow-up time=23 months).ResultsBetween first clinical contact and time last seen, 15% of young people had reliably deteriorated, 23% improved and 62% did not demonstrate substantive change in function. Of the whole cohort, 69% had functional scores less than 70 at time last seen, indicative of ongoing and substantive impairment. GBTM identified six distinct functional trajectories whereby over 60% had moderate-to-serious functional impairment at entry and remained chronically impaired over time; 7% entered with serious impairment and deteriorated further; a quarter were mildly impaired at entry and functionally recovered and only a small minority (4%) presented with serious impairments and functionally improved over time. Not being in education, employment or training, previous hospitalisation and a younger age at baseline emerged as significant predictors of these functional trajectories.ConclusionYoung people with emerging mental disorders have significant functional impairment at presentation for care, and for the majority, it persists over the course of clinical care. In addition to providing clinical care earlier in the course of illness, these data suggest that more sophisticated and more intensive individual-level and organisational strategies may be required to achieve significant and sustained functional improvements.

scholarly journals Predicting declines in perceived relationship continuity using practice deprivation scores: a longitudinal study in primary care

2018 ◽  
Vol 68 (671) ◽  
pp. e420-e426 ◽  
Author(s):  
Louis S Levene ◽  
Richard Baker ◽  
Nicola Walker ◽  
Christopher Williams ◽  
Andrew Wilson ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Outcomes ◽  
Continuity Of Care ◽  
Hospital Admissions ◽  
Patient Survey ◽  
Relationship Continuity ◽  
Confounding Variables ◽  
Linear Slope ◽  
Primary Care Practices ◽  
Over Time

BackgroundIncreased relationship continuity in primary care is associated with better health outcomes, greater patient satisfaction, and fewer hospital admissions. Greater socioeconomic deprivation is associated with lower levels of continuity, as well as poorer health outcomes.AimTo investigate whether deprivation scores predicted variations in the decline over time of patient-perceived relationship continuity of care, after adjustment for practice organisational and population factors.Design and settingAn observational study in 6243 primary care practices with more than one GP, in England, using a longitudinal multilevel linear model, 2012–2017 inclusive.MethodPatient-perceived relationship continuity was calculated using two questions from the GP Patient Survey. The effect of deprivation on the linear slope of continuity over time was modelled, adjusting for nine confounding variables (practice population and organisational factors). Clustering of measurements within general practices was adjusted for by using a random intercepts and random slopes model. Descriptive statistics and univariable analyses were also undertaken.ResultsRelationship continuity declined by 27.5% between 2012 and 2017, and at all deprivation levels. Deprivation scores from 2012 did not predict variations in the decline of relationship continuity at practice level, after accounting for the effects of organisational and population confounding variables, which themselves did not predict, or weakly predicted with very small effect sizes, the decline of continuity. Cross-sectionally, continuity and deprivation were negatively correlated within each year.ConclusionThe decline in relationship continuity of care has been marked and widespread. Measures to maximise continuity will need to be feasible for individual practices with diverse population and organisational characteristics.

scholarly journals Socioeconomic deprivation and benzodiazepine/Z-drug prescribing: a cross-sectional study of practice-level data in England

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X703229
Author(s):  
Stephanie Soyombo ◽  
Harpal Aujla ◽  
Rhian Stanbrook ◽  
David Capewell ◽  
Mary Shantikumar ◽  
...  
Keyword(s):  
Primary Care ◽  
Univariate Analysis ◽  
Cross Sectional Study ◽  
Socioeconomic Deprivation ◽  
Drug Prescribing ◽  
Cross Sectional ◽  
Practice Level ◽  
Level Data ◽  
Drug Doses ◽  
Age And Sex

BackgroundBenzodiazepines and Z-drugs (such as zopiclone) are widely prescribed in primary care in England. Prescribed for various indications, such as anxiolysis and insomnia, it has been previously reported that an association may exist with deprivation.AimTo determine whether there was an association between benzodiazepine/Z-drug prescribing (overall, and by individual drug) and practice-level socioeconomic deprivation in England.MethodMonthly primary care prescribing data for 2017, as well as practice age and sex profile, were downloaded from NHS Digital. Prescribing was aggregated by year. Drug doses were converted to their milligram-equivalent of diazepam to allow comparison. Practice-level Index of Multiple Deprivation (IMD 2015) scores were obtained from Public Health England. Multiple linear regression was used to examine the association between IMD and prescribing (for all benzodiazepines/Z-drugs, and individually), after adjusting for practice sex (% male) and older age (% >65 years) distribution. Practice-level prescribing was defined as milligrams of diazepam-equivalent per 1000 registered patients in 2017.ResultsOn univariate analysis, overall benzodiazepine prescribing was positively associated with practice-level IMD score, with more prescribing in more deprived practices (P<0.001). After adjusting for practice age and sex profile, IMD score remained an independent predictor of prescribing levels (P<0.001). These associations were consistent for all benzodiazepines/Z-drugs when analysed separately.ConclusionHigher practice-level socioeconomic deprivation, as described by IMD score, was associated with increased benzodiazepine/Z-drug prescribing. This may, in part, be a reflection of an underlying association of the indications for prescribing and socioeconomic deprivation. Further work is required to more accurately define the underlying reasons for these associations.

scholarly journals Heterogeneity in Longitudinal Healthcare Utilisation by Older Adults: A Latent Transition Analysis of the Irish Longitudinal Study on Ageing

2021 ◽  
pp. 089826432110418
Author(s):  
Ann S Doherty ◽  
Ruth Miller ◽  
John Mallett ◽  
Gary Adamson
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Longitudinal Study ◽  
Healthcare Utilisation ◽  
Temporal Changes ◽  
Latent Transition Analysis ◽  
Transition Analysis ◽  
Outpatient Visits ◽  
Healthcare Need ◽  
Over Time

Background Older adults likely exhibit considerable differences in healthcare need and usage. Identifying differences in healthcare utilisation both between and within individuals over time may support future service development. Objectives To characterise temporal changes in healthcare utilisation among a nationally representative sample of community-dwelling older adults. Methods A latent transition analysis of the first three waves of The Irish Longitudinal Study on Ageing (TILDA) ( N = 6128) was conducted. Results Three latent classes of healthcare utilisation were identified, ‘primary care only’; ‘primary care and outpatient visits’ and ‘multiple utilisation’. The classes were invariant across all three waves. Transition probabilities indicated dynamic changes over time, particularly for the ‘primary care and outpatient visits’ and ‘multiple utilisation’ statuses. Discussion Older adults exhibit temporal changes in healthcare utilisation which may reflect changes in healthcare need and disease progression. Further research is required to identify the factors which influence movement between healthcare utilisation patterns.

Enhancing community welfare through improved water quality: a case for applying staggered pollution charges in the river Musi sub-basin of Andhra Pradesh, India

Water Policy ◽  
2005 ◽  
Vol 7 (5) ◽  
pp. 469-483
Author(s):  
Tishya Chatterjee
Keyword(s):  
Andhra Pradesh ◽  
Relevant Literature ◽  
Pollution Prevention ◽  
Economic Benefits ◽  
Environmental Damage ◽  
Marginal Costs ◽  
Community Acceptance ◽  
Level Data ◽  
Over Time

In conditions of severe water-pollution and dormant community acceptance of accumulating environmental damage, the regulator's role goes beyond pollution prevention and more towards remediation and solutions based on the community's long-term expectations of economic benefits from clean water. This paper suggests a method to enable these benefits to become perceptible progressively, through participatory clean-up operations, supported by staggered pollution charges. It analyses the relevant literature on pollution prevention and applies a cost-based “willingness to pay” model, using primary basin-level data of total marginal costs. It develops a replicable demand-side approach imposing charge-standard targets over time in urban-industrial basins of developing countries.

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