Primary care-led commissioning: applying lessons from the past to the early development of clinical commissioning groups in England

Abstract Context In the past decade, two changes have affected the pathology residency match. First, the American Osteopathic Association (AOA) Match, which did not offer pathology residency, became accredited under a single graduate medical education (GME) system with the Main Residency Match (MRM), which offers pathology residency. Second, substantially fewer United States senior-year allopathic medical students (US MD seniors) matched into pathology residency. Objective To determine whether there were major changes in the number and percentage of osteopathic students and physicians (DOs) matching into pathology residency programs over the past decade. Methods Pathology match outcomes for DOs from 2011 to 2020 were obtained by reviewing AOA Match data from the National Matching Services and MRM data from the National Resident Matching Program (NRMP). The number of DOs that filled pathology positions in the MRM was divided by the total number of pathology positions filled in the MRM to calculate the percentage of pathology positions taken by DOs. Results Over the past decade, there was a 109% increase in the total number of DOs matching into pathology residency (34 in 2011 vs. 71 in 2020). During this time, there was a 23.3% increase in the total number of pathology positions filled in the MRM (476 in 2011 vs. 587 in 2020). Thus, the percentage of pathology residency positions filled by DOs increased from 7.1% in 2011 to 12.1% in 2020. The substantial increase of DOs in pathology occurred simultaneously with a 94.2% increase in the total number of DOs filling AOA/MRM “postgraduate year 1” (PGY-1) positions (3201 in 2011 vs. 6215 in 2020). Thus, the percentage of DOs choosing pathology residency has remained steady (1.06% in 2011 and 1.14% in 2020). In 2020, pathology had the third lowest percentage of filled PGY-1 residency positions taken by DOs, out of 15 major medical specialties. Conclusion The proportion of DOs choosing pathology residency was stable from 2011 to 2020 despite the move to a single GME accreditation system and the stark decline in US MD seniors choosing pathology. In 2020, a slightly higher percentage of DOs (1.14%) chose pathology residency than US MD seniors (1.13%). Overall, DOs more often choose other medical specialties, including primary care. Additional studies are needed to determine why fewer US MD seniors, but not fewer DOs, are choosing pathology residency.

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Who are we missing with EHR-based smoking cessation treatments? A descriptive study of patients who smoke and do not regularly visit primary care clinics

The Journal of Smoking Cessation ◽

10.1017/jsc.2020.21 ◽

2020 ◽

Vol 15 (4) ◽

pp. 175-180

Author(s):

Margaret Nolan ◽

Deejay Zwaga ◽

Danielle McCarthy ◽

Christian Kastman ◽

Timothy Baker ◽

...

Keyword(s):

Primary Care ◽

Care Provider ◽

Primary Care Provider ◽

The United States ◽

Primary Care Visit ◽

Patient Portal ◽

The Past ◽

Healthcare Settings ◽

Care Visit ◽

Tobacco Treatment

AbstractIntroductionMost tobacco treatment efforts target healthcare settings, because about 75% of smokers in the United States visit a primary care provider annually. Yet, 25% of patients may be missed by such targeting.AimsTo describe patients who smoke but infrequently visit primary care – their characteristics, rates of successful telephone contact, and acceptance of tobacco treatment.MethodsTobacco Cessation Outreach Specialists ‘cold-called’ those without a primary care visit in the past year, offering tobacco dependence treatment. Age, sex, insurance status, race, ethnicity, electronic health record (EHR) patient-portal status and outreach outcomes were reported.ResultsOf 3,407 patients identified as smokers in a health system registry, 565 (16.6%) had not seen any primary care provider in the past year. Among 271 of those called, 143 (53%) were successfully reached and 33 (23%) set a quit date. Those without visits tended to be younger, male, some-day versus every-day smokers (42 vs. 44 years, P = 0.004; 48% vs. 40% female, P = 0.0002, and 21% vs. 27% some-day, P = 0.003), and less active on the EHR patient portal (33% vs. 40%, P = 0.001).ConclusionsA substantial proportion of patients who smoke are missed by traditional tobacco treatment interventions that require a primary care visit, yet many are receptive to quit smoking treatment offers.

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Health Literacy in Primary Care: Reflections and Suggestions for Physicians, Researchers, and Administrators

American Journal of Lifestyle Medicine ◽

10.1177/15598276211041283 ◽

2021 ◽

pp. 155982762110412

Author(s):

Anne Sprogell ◽

Allison R. Casola ◽

Amy Cunningham

Keyword(s):

Primary Care ◽

Health Literacy ◽

Primary Care Physician ◽

Healthcare System ◽

Primary Care Physicians ◽

Care Physician ◽

Health Records ◽

The Past ◽

Personal Bias ◽

Concept Of Health

As the healthcare system evolves, it is becoming more complicated for physicians and patients. Patients might have had one doctor in the past, but now are likely to regularly see several specialists along with their primary care physician. Patients can access their health records online, which increases transparency and accountability, but adds more information they have to interpret. This is the concept of health literacy—the ability to obtain, process, and act upon information regarding one’s health. This article will characterize health literacy in primary care and provide three areas that primary care physicians and researchers can direct their focus in order to increase health literacy among patients: community engagement, trainee education, and examination of personal bias.

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Inconsistent Condom Use among Public Primary Care Patients with Tuberculosis in South Africa

The Scientific World JOURNAL ◽

10.1100/2012/501807 ◽

2012 ◽

Vol 2012 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Gladys Matseke ◽

Karl Peltzer ◽

Julia Louw ◽

Pamela Naidoo ◽

Gugu Mchunu ◽

...

Keyword(s):

South Africa ◽

Primary Care ◽

Condom Use ◽

Multivariable Analysis ◽

High Rate ◽

Consistent Condom ◽

Consistent Condom Use ◽

Inconsistent Condom ◽

The Past ◽

Inconsistent Condom Use

The high rate of HIV infections among tuberculosis (TB) patients in South Africa calls for urgent HIV reduction interventions in this subpopulation. While correct and consistent condom use is one of the effective means of HIV prevention among sexually active people, there is insufficient research on condom use among TB patients in South Africa. The aim of this paper was to determine the prevalence of inconsistent condom use among public primary care TB patients and its associated factors using a sample of 4900 TB patients from a cross-sectional survey in three health districts in South Africa. Results indicated that when asked about their consistency of condom use in the past 3 months, 63.5% of the participants reported that they did not always use condoms. In the multivariable analysis, being married (OR=1.66; 95% CI 1.25–2.20) or cohabitating or separated, divorced, or widowed (OR=3.67; 1.85–7.29), lower educational level (OR=0.66; 0.46–0.94), greater poverty (OR=1.60; 1.25–2.20), not having HIV status disclosed (OR=0.34; 0.25–0.48), sexual partner on antiretroviral treatment (OR=0.38; 0.23–0.60), and partner alcohol use before sex (OR=1.56; 1.30–1.90) were significantly associated with inconsistent condom use in the past 3 months. The low proportion of consistent condom use among TB patients needs to be improved.

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Catchment areas: A model for the future or a relic of the past?

Psychiatric Bulletin ◽

10.1192/pb.19.6.340 ◽

1995 ◽

Vol 19 (6) ◽

pp. 340-342

Author(s):

John M. Kellett

Keyword(s):

Primary Care ◽

Catchment Area ◽

Geriatric Medicine ◽

The Past ◽

Restrictive Practice ◽

Primary Care Teams ◽

Specialist Services ◽

Catchment Areas ◽

The Future

The shift of power from specialist services to the primary care teams has forced the former to examine the value of their hallowed traditions. In psychiatry, and geriatric medicine, the catchment area is a favoured restrictive practice, enabling demand to be regulated to suit the resources of each team. It is time to decide whether this is a practice to be defended and retained or whether, like many other restrictive practices, it is harmful to the consumer.

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The New Edition of the Guide to Clinical Preventive Services

PEDIATRICS ◽

10.1542/peds.97.5.733 ◽

1996 ◽

Vol 97 (5) ◽

pp. 733-735

Author(s):

Modena Wilson ◽

Donald M. Berwick ◽

Carolyn DiGuiseppi

Keyword(s):

Primary Care ◽

Positive Reaction ◽

Task Force ◽

Preventive Services ◽

Negative Reaction ◽

The Past ◽

The Us ◽

Clinical Preventive Services ◽

Clinical Prevention ◽

And Training

Preventive services compose a large portion of primary care pediatrics, and pediatricians by their nature and training seem extraordinarily disposed toward clinical prevention. Therefore, when the first edition of the Guide to Clinical Preventive Services appeared in 1989 from the US Preventive Services Task Force (USPSTF), the negative reaction of the organized pediatric community was disappointing. The second edition of that guide has just been released, and we three pediatricians, who have worked hard during the past 5 years as members and staff of the second task force, hope for a far more positive reaction from our colleagues this time around.

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Some Design Problems in Inertia Navigation

Journal of the Royal Aeronautical Society ◽

10.1017/s0368393100069777 ◽

1958 ◽

Vol 62 (574) ◽

pp. 704-722 ◽

Cited By ~ 1

Author(s):

W. Cawood

Keyword(s):

Early Development ◽

Development Stage ◽

Design Problems ◽

Performance Specification ◽

The Past ◽

Inertial Systems

Until the past few years inertia navigation has been a little known subject due to a cloak of security; but recently a number of informative reports and articles have been published, notably those by Adams, Schnerb, and Klass, all published during 1956. Moreover, many of the components of inertial systems have emerged from the early development stage, during which they were largely monitored by military agencies, and may now be purchased with a guaranteed performance specification.

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Interaction between Antibiotic Resistance, Resistance Genes, and Treatment Response for Urinary Tract Infections in Primary Care

Journal of Clinical Microbiology ◽

10.1128/jcm.00143-19 ◽

2019 ◽

Vol 57 (9) ◽

Cited By ~ 5

Author(s):

Hanley J. Ho ◽

Mei Xuan Tan ◽

Mark I. Chen ◽

Thean Yen Tan ◽

Seok Hwee Koo ◽

...

Keyword(s):

Primary Care ◽

Antibiotic Resistance ◽

Resistance Genes ◽

Urine Culture ◽

Early Symptom ◽

Content Type ◽

Symptom Resolution ◽

Factors Associated ◽

The Past ◽

Amoxicillin Clavulanate

ABSTRACTGiven increasing antimicrobial resistance, we aimed to determine antibiotic susceptibility and presence of resistance genes in uropathogens in primary care, factors associated with resistance to commonly prescribed antibiotics, and effect of treatment on early symptom resolution. We conducted a prospective study of primary care patients with urinary tract infection (UTI) symptoms and culture-confirmed UTI in Singapore from 2015 to 2016. Cohort characteristics and antimicrobial susceptibility of cultured isolates were analyzed. AmongEnterobacteriaceaeisolates, early symptom resolution (within 3 days) according to antibiotic prescribed and isolate susceptibility and factors associated with antibiotic resistance were evaluated. Of 695 symptomatic patients, 299 were urine culture positive; of these 299 patients, 259 (87%) were female.Escherichia coliwas the most common uropathogen (76%).Enterobacteriaceaeisolates (n = 283) were highly susceptible to amoxicillin-clavulanate (86%), nitrofurantoin (87%), and fosfomycin (98%), but >20% were resistant to ciprofloxacin and co-trimoxazole. Isolates resistant to appropriate indicator antibiotics were further tested to determine proportions positive forblaCTX-M(14/26, 54%), plasmid-mediatedampC(12/24, 50%),qnr(7/69, 10%), andfos(1/6, 17%) resistance genes. A total of 67% of patients given antibiotics with susceptible isolates reported early resolution versus 45% given antibiotics with nonsusceptible isolates (P = 0.001) and 27% not treated (P = 0.018). On multivariable analysis, Indian ethnicity and diabetes mellitus were associated with amoxicillin-clavulanate resistance. Genitourinary abnormalities, UTI in the past 12 months, and hospitalization in the past 6 months were associated with ciprofloxacin and co-trimoxazole resistance. Patients given active empirical antibiotics were most likely to report early symptom resolution, but correlation within vitrosusceptibility was imperfect. Factors associated with resistance may guide the decision to obtain initial urine culture.

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Why care about integrated care? Part 2. Integrated care systems: an irresistible force changing mental health services

BJPsych Advances ◽

10.1192/bja.2020.3 ◽

2020 ◽

pp. 1-12 ◽

Cited By ~ 1

Author(s):

Derek K. Tracy ◽

Frank Holloway ◽

Kara Hanson ◽

Nikita Kanani ◽

Matthew Trainer ◽

...

Keyword(s):

Mental Health ◽

Primary Care ◽

Mental Health Services ◽

Health Services ◽

Integrated Care ◽

Healthcare Delivery ◽

Local Implementation ◽

The Past ◽

Care Systems

SUMMARY Part 1 of this three-part series on integrated care discussed the drivers for change in healthcare delivery in England set out in the NHS Long Term Plan. This second part explores the evolution of mental health services within the wider National Health Service (NHS), and describes important relevant legislation and policy over the past decade, leading up to the 2019 Long Term Plan. We explain the implications of this, including the detail of emerging structures such as integrated care systems (ICSs) and primary care networks (PCNs), and conclude with challenges facing these novel systems. Part 3 will address the practical local implementation of integrated care.

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Primary Care Physicians' Discussion of Emotional Distress and Patient Satisfaction

The International Journal of Psychiatry in Medicine ◽

10.2190/pm.37.3.i ◽

2007 ◽

Vol 37 (3) ◽

pp. 331-345 ◽

Cited By ~ 6

Author(s):

Revital Gross ◽

Shuli Brammli-Greenberg ◽

Hava Tabenkin ◽

Jochanan Benbassat

Keyword(s):

Primary Care ◽

Patient Satisfaction ◽

Emotional Distress ◽

Family Physician ◽

Low Income ◽

Well Being ◽

Satisfaction With Care ◽

The Past ◽

The Family ◽

Patient Satisfaction With Care

Objectives: To assess: a) the prevalence and determinants of self-reported emotional distress in the Israeli population; b) the rate of self-reported discussion of emotional distress with family physicians; and c) the association between such discussions and patient satisfaction with care. Method: Design: Retrospective, cross-sectional survey that was conducted through structured telephone interviews in Hebrew, Arabic, and Russian. This study was part of a larger study assessing patients' perceptions of the quality of health services. Participants: A representative sample of 1,849 Israeli citizens aged 22 to 93 (response rate: 84%). Independent variables: Gender, age, ethnicity (spoken language), education, income, self-reported chronic disease, self-reported episode(s) of emotional distress during the last year, and having discussed emotional distress with the family physician. Outcome measure: satisfaction with care. Results: 28.4% reported emotional distress and 12.5% reported discussion of emotional distress with a primary care physician in the past year. Logistic regression identified female gender, Arab ethnicity, low income, and chronic illness as independent correlates of emotional distress. These as well as Russian speakers and having experienced emotional distress during the past year were identified as independent correlates of discussion of emotional distress with the family physician. Patients who reported discussion of emotional distress with their family physician were significantly more satisfied with care. Conclusions: Encouraging physicians to detect and discuss emotional distress with their patients may increase patient satisfaction with care, and possibly also improve patients' well-being and reduce health care costs.

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