Realising the full potential of primary care: uniting the ‘two faces’ of generalism

AbstractShielding during the coronavirus pandemic has highlighted the potential of routinely collected primary care records to identify patients with ‘high-risk’ conditions, including severe asthma. We aimed to determine how previous studies have used primary care records to identify and investigate severe asthma and whether linkage to other data sources is required to fully investigate this ‘high-risk’ disease variant. A scoping review was conducted based on the Arksey and O’Malley framework. Twelve studies met all criteria for inclusion. We identified variation in how studies defined the background asthma cohort, asthma severity, control and clinical outcomes. Certain asthma outcomes could only be investigated through linkage to secondary care records. The ability of primary care records to represent the entire known asthma population is unique. However, a number of challenges need to be overcome if their full potential to accurately identify and investigate severe asthma is to be realised.

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Acceptability of physician associate interns in primary care: results from a service evaluation

BMC Family Practice ◽

10.1186/s12875-021-01372-5 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Elizabeth Cottrell ◽

Victoria Silverwood ◽

Alex Strivens-Joyce ◽

Lucy Minshull ◽

John J. Edwards ◽

...

Keyword(s):

Primary Care ◽

Analysis Data ◽

Service Evaluation ◽

Full Potential ◽

Patient Acceptability ◽

Practice Characteristics ◽

Primary Care Workforce ◽

Data Collection And Analysis ◽

Or Practice ◽

Five Practices

Abstract Background Physician associates (PA) form part of the policy-driven response to increased primary care demand and a general practitioner (GP) recruitment and retention crisis. However, they are novel to the primary care workforce and have limitations, for example, they cannot prescribe. The novel 1 year Staffordshire PA Internship (SPAI) scheme, introduced in 2017, was established to support the integration of PAs into primary care. PA interns concurrently worked in primary and secondary care posts, with protected weekly primary care focussed education sessions. This evaluation established the acceptability of PA interns within primary care. Methods All ten PAs from the first two SPAI cohorts, the nine host practices (supervising GPs and practice managers) and host practice patients were invited to participate in the evaluation. A conceptual framework for implementing interventions in primary care informed data collection and analysis. Data were gathered at three time points over the internship from practices, through discussions with the supervising GP and/or practice manager, and from the PAs via discussion groups. To enrich discussion data, PA and practices were sent brief surveys requesting information on PA/practice characteristics and PA primary care roles. Patient acceptability data were collected by the host practices. Participation at every stage was optional. Results By evaluation end, eight PAs had completed the internship. Seven PAs and six practices provided data at every time point. Five practices provided patient acceptability data. Overall PA interns were acceptable to practices and patients, however ambiguity about the PA role and how best to communicate and operationalise PA roles was revealed. An expectation-preparedness gap resulted in PAs needing high levels of supervision early within the internship. SPAI facilitated closure of the expectation-preparedness gap and its funding arrangements made the high supervision requirements more acceptable to practices. Conclusions The test-of-concept SPAI successfully integrated new PAs into primary care. However, the identified challenges risk undermining PAs roles in primary care before they have attained their full potential. Nationally, workforce leaders should develop approaches to support new PAs into primary care, including commitments to longer-term, sustainable, cohesive and appropriately funded schemes, including structured and standardised education and supervision.

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Focus on Chronic Variable Immunodeficiency for Primary Care Practitioners, the Gatekeepers to Optimal Health Outcomes for Primary Immunodeficiency Syndromes

Current Pediatrics Reports ◽

10.1007/s40124-019-00202-8 ◽

2019 ◽

Vol 7 (4) ◽

pp. 130-144

Author(s):

William A. Gerber

Keyword(s):

Primary Care ◽

Health Outcomes ◽

Primary Immunodeficiency ◽

Full Potential ◽

Healthcare Outcomes ◽

Treatment Protocols ◽

Awareness Campaigns ◽

Symptom Recognition ◽

Optimal Health ◽

Primary Care Practitioners

Abstract Purpose of Review This review sought to assess the extent and causes of suboptimal healthcare outcomes for chronic variable immunodeficiency (CVID). Recent Findings Significant improvements in diagnostic technology and treatment protocols over time were found, leading to reduced morbidity and mortality for those accessing therapies. Treatments continue to be largely non-curative with financing (mainly insurance coverage) an obstacle. Symptom recognition by primary care practitioners (PCP) remains a gating factor to treatment and a widespread and persistent barrier to optimal health outcomes. Summary CVID is a subtype of primary immunodeficiency (PIDD) associated with under-diagnosis. It has emerged as a health issue more prevalent than historically known. No symptom-recognition framework for early detection of CVID has been generally accepted; those proposed for primary immunodeficiencies have shown low sensitivity, low specificity or both. Positive trends in cases diagnosed have been aided by awareness campaigns and international collaborations. However, treatments for CVID will not realize full potential without effective, accepted frameworks for timely identification in the clinic.

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The use of patient-reported outcome measures in primary care: applications, benefits and challenges

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-021-00361-7 ◽

2021 ◽

Vol 5 (S2) ◽

Author(s):

Krista Brower ◽

Margo Schmitt-Boshnick ◽

Michel Haener ◽

Shea Wilks ◽

Allison Soprovich

Keyword(s):

Primary Care ◽

Outcome Measurement ◽

Local Population ◽

Target Population ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Full Potential ◽

System Quality ◽

Allied Health Professionals ◽

Patient Reported

AbstractPROMs use in primary care has expanded from simply describing patient populations to contributing to decision-making, in response to the increasingly complex, ever-changing healthcare environment. In Alberta, primary care is organized into primary care networks (PCNs), where family physicians are grouped geographically and supported by allied health professionals. PCNs implement programs and services in response to local population health needs with frequent evaluation, often incorporating PROMs for this purpose. As PCN programs and services vary greatly across Alberta, so do their use of PROMs. An area of commonality is the use of the EQ-5D-5L instrument; 29 out of 41 PCNs are registered and licensed to use the instrument. It is often administrated by paper, pre- and post-program, and in combination with other specific measures, depending on the program or target population. Some PCNs share programming and therefore outcome measurement, but often the selection, implementation (including training and administration procedures) and evaluation/reporting of PROMs are unique to the PCN. As well, data analysis is largely dependent on the size and capacity of the PCN. Using PROMs for PCN program evaluation supports clinical understanding and complements clinical outcomes. PROMs describe the population attending a program, as well as provide an element of consistency when examining trends across multiple programs or timepoints. This contributes to inquiries and decisions around program development, components, administrative features, resource allocation and delivery. Challenges of PROMs use in primary care include the absence of cohesive data capture technology. This limits data capabilities and presents difficulties with data fidelity, storage, export, and analysis. Additionally, this real-world application lacks a control arm and presents methodological challenges for comparative research purposes. Furthermore, capturing long term patient outcomes poses administrative challenges of multiple follow ups. More research is required into best reporting mechanisms to ensure the data is used to its full potential. To overcome these challenges, leadership and clinician engagement are key. As well, determining consistent PCN PROM reporting requirements will ensure data are comparable across PCNs and contribute to provincial level evaluations, further supporting the movement towards overall health system quality improvement.

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Comparing and improving chronic illness primary care in Sweden and the USA

International Journal of Health Care Quality Assurance ◽

10.1108/ijhcqa-02-2016-0014 ◽

2016 ◽

Vol 29 (5) ◽

pp. 582-595 ◽

Cited By ~ 2

Author(s):

John Øvretveit ◽

Patricia Ramsay ◽

Stephen M. Shortell ◽

Mats Brommels

Keyword(s):

Primary Care ◽

Primary Healthcare ◽

Chronic Illnesses ◽

Care Staff ◽

Easy Access ◽

Full Potential ◽

Primary Care Center ◽

Content Type ◽

Health Technologies ◽

The Usa

Purpose – The purpose of this paper is to identify opportunities for improving primary care services for people with chronic illnesses by comparing how Sweden and US services use evidence-based practices (EBPs), including digital health technologies (DHTs). Design/methodology/approach – A national primary healthcare center (PHCC) heads surveys in 2012-2013 carried out in both countries in 2006. Findings – There are large variations between the two countries. The largest, regarding effective DHT use in primary care centers, were that few Swedish primary healthcare compared to US heads reported having reminders or prompts at the point of care (38 percent Sweden vs 84 percent USA), despite Sweden’s established electronic medical records (EMR). Swedish heads also reported 30 percent fewer centers receiving laboratory results (67 percent Sweden vs 97 percent USA). Regarding following other EBPs, 70 percent of Swedish center heads reported their physicians had easy access to diabetic patient lists compared to 14 percent in the USA. Most Swedish PHCC heads (96 percent) said they offered same day appointment compared to 36 percent in equivalent US practices. Practical implications – There are opportunities for improvement based on significant differences in effective practices between the countries, which demonstrates to primary care leaders that their peers elsewhere potentially provide better care for people with chronic illnesses. Some improvements are under primary care center control and can be made quickly. There is evidence that people with chronic illnesses in these two countries are suffering unnecessarily owing to primary care staff failing to provide proven EBP, which would better meet patient needs. Public finance has been invested in DHT, which are not being used to their full potential. Originality/value – The study shows the gaps between current and potential proven effective EBPs for services to patients with chronic conditions. Findings suggest possible explanations for differences and practical improvements by comparing the two countries. Many enhancements are low cost and the proportionate reduction in suffering and costs they bring is high.

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Nursing Practice in Primary Care and Patients’ Experience of Care

Journal of Primary Care & Community Health ◽

10.1177/2150131917747186 ◽

2018 ◽

Vol 9 ◽

pp. 215013191774718 ◽

Cited By ~ 6

Author(s):

Roxane Borgès Da Silva ◽

Isabelle Brault ◽

Raynald Pineault ◽

Maud-Christine Chouinard ◽

Alexandre Prud’homme ◽

...

Keyword(s):

Primary Care ◽

Health Care Organizations ◽

Full Potential ◽

Cross Sectional ◽

Nursing Role ◽

Experience Of Care ◽

Patient Questionnaires ◽

Patients Experience ◽

Sectional Analysis

Purpose: Nurses are identified as a key provider in the management of patients in primary care. The objective of this study was to evaluate patients’ experience of care in primary care as it pertained to the nursing role. The aim was to test the hypothesis that, in primary health care organizations (PHCOs) where patients are systematically followed by a nurse, and where nursing competencies are therefore optimally used, patients’ experience of care is better. Method: Based on a cross-sectional analysis combining organizational and experience of care surveys, we built 2 groups of PHCOs. The first group of PHCOs reported having a nurse who systematically followed patients. The second group had a nurse who performed a variety of activities but did not systematically follow patients. Five indicators of care were constructed based on patient questionnaires. Bivariate and multivariate linear mixed models with random intercepts and with patients nested within were used to analyze the experience of care indicators in both groups. Results: Bivariate analyses revealed a better patient experience of care in PHCOs where a nurse systematically followed patients than in those where a nurse performed other activities. In multivariate analyses that included adjustment variables related to PHCOs and patients, the accessibility indicator was found to be higher. Conclusion: Results indicated that systematic follow-up of patients by nurses improved patients’ experience of care in terms of accessibility. Using nurses’ scope of practice to its full potential is a promising avenue for enhancing both patients’ experience of care and health services efficiency.

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Patient-Centred Point-of-Care Testing: A Life-Changing Technology for Remote Primary Care

10.5772/intechopen.100375 ◽

2021 ◽

Author(s):

Brooke Spaeth ◽

Susan Matthews ◽

Mark Shephard

Keyword(s):

Infectious Disease ◽

Primary Care ◽

Point Of Care ◽

Perinatal Care ◽

Full Potential ◽

Middle Income ◽

Middle Income Countries ◽

Primary Care Settings ◽

Laboratory Services ◽

Operating Theatres

Point-of-care (POC) testing has proven to be a life-changing and transformational technology for patients with acute, chronic, and infectious diseases who live in regional and remote Australia. This technology facilitates patient-centred test results, of equivalent laboratory quality, that are rapidly available to inform clinical and public health decisions with immediate impact on case management. Traditionally, POC testing in high-middle income countries has been most widely used in tertiary or acute care settings to provide rapid diagnostic results for emergency departments, intensive care units, operating theatres and outpatient clinics. However, in low-middle income countries, POC tests are commonly used during antenatal and perinatal care for infectious disease detection, such as Human immunodeficiency virus (HIV) or syphilis, where laboratory services are too expensive, inaccessible, or non-existent. Similarly, the application of POC testing in primary care settings in Australia offers improved healthcare benefits to geographically isolated regional and remote communities, where access to laboratory-based pathology testing is poor and the burden of disease is high. Evidence-based data from research in established primary care POC testing networks for acute chronic, and infectious disease is used to describe the clinical, cultural, and economic effectiveness of POC technologies. Innovative solutions to address current barriers to the uptake of POC testing in primary care settings, which include clinical and cultural governance, high staff turnover, operator training and competency, device connectivity, quality testing, sustainable funding strategies, and the need for regulatory requirements are also discussed. POC testing can provide practical and resourceful opportunities to revolutionise the delivery of pathology services in rural and remote primary care sectors, where the clinical and community need for this technology is greatest. However, several barriers to the scale-up and sustainability of POC testing networks in these settings still exist, and the full potential of POC testing cannot be realised until these limitations are addressed and resolved.

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Acceptability of Physician Associate Interns in Primary Care: Results from a Service Evaluation

10.21203/rs.3.rs-70741/v1 ◽

2020 ◽

Author(s):

Elizabeth Cottrell ◽

Victoria Silverwood ◽

Alex Strivens-Joyce ◽

Lucy Minshull ◽

John J Edwards ◽

...

Keyword(s):

Primary Care ◽

General Practitioner ◽

Secondary Care ◽

Service Evaluation ◽

Full Potential ◽

Primary Care Workforce ◽

Form Part ◽

Care Practices ◽

One Year ◽

Primary Care Practices

Abstract Background: Physician associates (PA) form part of the policy-driven response to increased primary care demand and a general practitioner recruitment and retention crisis. However, they are novel to the primary care workforce, have limitations such as being unable to prescribe and order ionising radiation investigations, and there are very limited directly-relevant data to guide the integration of PAs into primary care. To address this, a novel internship scheme was established in Staffordshire to support PAs entering primary care. This evaluation was designed to establish the acceptability of Physician Associate (PA) Interns within primary care.Methods: The Staffordshire PA Internship (SPAI) scheme was introduced in Staffordshire in 2017. PAs were concurrently working in primary and secondary care posts for one year, with protected weekly education sessions to equip them for work in primary care. Within the nine primary care practices hosting 10 PA interns in the first two cohorts, the PA interns, supervising GPs and practice managers, and patients who attended an appointment with a PA intern were invited to participate in the evaluation.Results: By evaluation end, eight of the ten PAs had completed the internship. Overall PA interns were acceptable to practices and patients, however there was ambiguity about the PA role itself, and how best to communicate this, as well as how to operationalise their roles. An expectation-preparedness gap was identified for PAs working in primary care. This resulted in high levels of supervision required for PA interns early within the internship. The internship provided a platform upon which the expectation-preparedness gap could be closed and made the high supervision requirements more acceptable to practices.Conclusions: This test-of-concept SPAI has highlighted that, to ensure successful integration of new PAs into primary care and to support them to reach their full potential, commitments to longer-term, sustainable, cohesive and appropriately funded schemes, including structured and standardised education and supervision, need to be delivered. Without such investment, there is a risk that acceptability of PAs in primary care, and PAs’ views of primary care careers, will be undermined before the profession has attained its full potential.

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Primary care doctors’ understandings of and strategies to tackle health inequalities: a qualitative study

Primary Health Care Research & Development ◽

10.1017/s146342361800052x ◽

2019 ◽

Vol 20 ◽

Cited By ~ 2

Author(s):

Mark Exworthy ◽

Victoria Morcillo

Keyword(s):

Primary Care ◽

Qualitative Study ◽

General Practitioners ◽

Health Inequalities ◽

Full Potential ◽

Comparison Process ◽

Structured Interviews ◽

Policy And Practice ◽

The Social ◽

Primary Care Doctors

AbstractAimTo examine general practitioners’ knowledge of and their role in tackling health inequalities, in relation to their professional responsibilities.BackgroundPrimary care is often seen as being in the frontline of addressing health inequalities and the social determinants of health (SDH).MethodsA qualitative study with a maximum variety sample of English General Practitioners (GPs). In-depth, semi-structured interviews were held with 13 GPs in various geographical settings; they lasted between 30 and 70 min. Interviews were audio-recorded and transcribed. The analysis involved a constant comparison process undertaken by both authors to reveal key themes.FindingsGPs’ understanding of health inequalities reflected numerous perspectives on the SDH and they employ various different strategies in tackling them. This study revealed that GPs’ strategies were changing the nature of (medical) professionalism in primary care. We locate these findings in relation to Gruen’s model of professional responsibility (comprising a distinction between obligation and aspiration, and between patient advocacy, community participation and political involvement). We conclude that these GPs do not exploit the full potential of their contribution to tackling health inequalities. These findings have implication for policy and practice in other practitioners and in other health systems, as they seek to tackle health inequalities.

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Primary Care Shortage in Medically Underserved and Health Provider Shortage Areas: Lessons from Delaware, USA

Journal of Primary Care & Community Health ◽

10.1177/2150132721994018 ◽

2021 ◽

Vol 12 ◽

pp. 215013272199401

Author(s):

Srikrishna Varun Malayala ◽

Deepa Vasireddy ◽

Paavani Atluri ◽

Ram Sanjeev Alur

Keyword(s):

Primary Care ◽

Social Services ◽

Primary Care Physicians ◽

Wait Time ◽

The United States ◽

The State ◽

Medically Underserved ◽

Direct Patient Care ◽

Full Potential ◽

Waiver Program

Objective: To examine the reasons contributing to the physician shortage in the country’s medically underserved areas using the state of Delaware as a focus state. Method: A literature review regarding the shortage of physicians with data compilation from Delaware Department of Public Health (DPH) and Delaware Health and Social services (DHSS) was performed. A review of the “Conrad 30 J1 VISA waiver program,” the most important and primary supplier of physicians to underserved areas of the state was performed. A survey interviewing the physicians recruited through this program to identify any challenges faced by them was designed and conducted. Results: The number of primary care physicians providing direct patient care in Delaware in 2018 had declined about 6% from 2013. The average wait time to see a PCP was 8.2 days in 1998 as compared to 23.5 days in 2018. Forty-six percent of physicians serving in HPSAs in Delaware are IMGs recruited through the J1 VISA waiver program. Eighty percent of these IMGs are actively considering leaving the United States due to anxieties around physician immigration policies, mainly “Immigration backlog.” Conclusion: The existing programs to recruit physicians to underserved areas seem to be inadequate. The state and the hospital systems should be able to utilize the J1 program to its full potential and focus on retaining these physicians after their assigned services. As the challenges of IMGs continue to worsen every day; the medical societies, hospitals, the state and federal government should advocate for policies that resolve these challenges.

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