scholarly journals Responsibility for follow-up during the diagnostic process in primary care: a secondary analysis of International Cancer Benchmarking Partnership data

2018 ◽  
Vol 68 (670) ◽  
pp. e323-e332 ◽  
Author(s):  
Brian D Nicholson ◽  
Clare R Goyder ◽  
Clare R Bankhead ◽  
Berit S Toftegaard ◽  
Peter W Rose ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Analysis ◽  
Diagnostic Process ◽  
Free Text ◽  
Theory Approach ◽  
Test Results ◽  
Primary Care Practitioners ◽  
Grounded Theory Approach ◽  
Safety Netting

BackgroundIt is unclear to what extent primary care practitioners (PCPs) should retain responsibility for follow-up to ensure that patients are monitored until their symptoms or signs are explained.AimTo explore the extent to which PCPs retain responsibility for diagnostic follow-up actions across 11 international jurisdictions.Design and settingA secondary analysis of survey data from the International Cancer Benchmarking Partnership.MethodThe authors counted the proportion of 2879 PCPs who retained responsibility for each area of follow-up (appointments, test results, and non-attenders). Proportions were weighted by the sample size of each jurisdiction. Pooled estimates were obtained using a random-effects model, and UK estimates were compared with non-UK ones. Free-text responses were analysed to contextualise quantitative findings using a modified grounded theory approach.ResultsPCPs varied in their retention of responsibility for follow-up from 19% to 97% across jurisdictions and area of follow-up. Test reconciliation was inadequate in most jurisdictions. Significantly fewer UK PCPs retained responsibility for test result communication (73% versus 85%, P = 0.04) and non-attender follow-up (78% versus 93%, P<0.01) compared with non-UK PCPs. PCPs have developed bespoke, inconsistent solutions to follow-up. In cases of greatest concern, ‘double safety netting’ is described, where both patient and PCP retain responsibility.ConclusionThe degree to which PCPs retain responsibility for follow-up is dependent on their level of concern about the patient and their primary care system’s properties. Integrated systems to support follow-up are at present underutilised, and research into their development, uptake, and effectiveness seems warranted.

scholarly journals Workarounds and Test Results Follow-up in Electronic Health Record-Based Primary Care

2016 ◽  
Vol 07 (02) ◽  
pp. 543-559 ◽  
Author(s):  
Shailaja Menon ◽  
Daniel Murphy ◽  
Hardeep Singh ◽  
Ashley N. Meyer ◽  
Dean Sittig
Keyword(s):  
Primary Care ◽  
Organizational Support ◽  
Qualitative Content Analysis ◽  
Multivariate Logistic Regression Analysis ◽  
Free Text ◽  
Test Results ◽  
Electronic Health ◽  
Results Management ◽  
Primary Care Practitioners

SummaryElectronic health records (EHRs) have potential to facilitate reliable communication and follow-up of test results. However, limitations in EHR functionality remain, leading practitioners to use workarounds while managing test results. Workarounds can lead to patient safety concerns and signify indications as to how to build better EHR systems that meet provider needs.To understand why primary care practitioners (PCPs) use workarounds to manage test results by analyzing data from a previously conducted national cross-sectional survey on test result management.We conducted a secondary data analysis of quantitative and qualitative data from a national survey of PCPs practicing in the Department of Veterans Affairs (VA) and explored the use of workarounds in test results management. We used multivariate logistic regression analysis to examine the association between key sociotechnical factors that could affect test results follow-up (e.g., both technology-related and those unrelated to technology, such as organizational support for patient notification) and workaround use. We conducted a qualitative content analysis of free text survey data to examine reasons for use of workarounds.Of 2554 survey respondents, 1104 (43%) reported using workarounds related to test results management. Of these 1028 (93%) described the type of workaround they were using; 719 (70%) reported paper-based methods, while 230 (22%) used a combination of paper- and computer-based workarounds. Primary care practitioners who self-reported limited administrative support to help them notify patients of test results or described an instance where they personally (or a colleague) missed results, were more likely to use workarounds (p=0.02 and p=0.001, respectively). Qualitative analysis identified three main reasons for workaround use: 1) as a memory aid, 2) for improved efficiency and 3) for facilitating internal and external care coordination.Workarounds to manage EHR-based test results are common, and their use results from unmet provider information management needs. Future EHRs and the respective work systems around them need to evolve to meet these needs.

scholarly journals Long Covid-19: Proposed Primary Care Clinical Guidelines for Diagnosis and Disease Management

2021 ◽  
Vol 18 (8) ◽  
pp. 4350
Author(s):  
Antoni Sisó-Almirall ◽  
Pilar Brito-Zerón ◽  
Laura Conangla Ferrín ◽  
Belchin Kostov ◽  
Anna Moragas Moreno ◽  
...  
Keyword(s):  
Primary Care ◽  
Disease Management ◽  
Signs And Symptoms ◽  
Diagnostic Process ◽  
Press Releases ◽  
Expert Opinions ◽  
Number Of Patients ◽  
Patient Groups

Long COVID-19 may be defined as patients who, four weeks after the diagnosis of SARS-Cov-2 infection, continue to have signs and symptoms not explainable by other causes. The estimated frequency is around 10% and signs and symptoms may last for months. The main long-term manifestations observed in other coronaviruses (Severe Acute Respiratory Syndrome (SARS), Middle East respiratory syndrome (MERS)) are very similar to and have clear clinical parallels with SARS-CoV-2: mainly respiratory, musculoskeletal, and neuropsychiatric. The growing number of patients worldwide will have an impact on health systems. Therefore, the main objective of these clinical practice guidelines is to identify patients with signs and symptoms of long COVID-19 in primary care through a protocolized diagnostic process that studies possible etiologies and establishes an accurate differential diagnosis. The guidelines have been developed pragmatically by compiling the few studies published so far on long COVID-19, editorials and expert opinions, press releases, and the authors’ clinical experience. Patients with long COVID-19 should be managed using structured primary care visits based on the time from diagnosis of SARS-CoV-2 infection. Based on the current limited evidence, disease management of long COVID-19 signs and symptoms will require a holistic, longitudinal follow up in primary care, multidisciplinary rehabilitation services, and the empowerment of affected patient groups.

scholarly journals 46 Primary Care Practitioners Have A High Level of Satisfaction with The Current Breast Referral Pathway but The Majority Would Support A Change to Patient Self-Referral

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
T Russell ◽  
J Cooper ◽  
M McIntyre ◽  
S Ramzi
Keyword(s):  
Primary Care ◽  
Free Text ◽  
Referral Rates ◽  
Care Services ◽  
Primary Care Services ◽  
Level Of Satisfaction ◽  
And Gender ◽  
Primary Care Practitioners ◽  
High Level ◽  
The Impact

Abstract Aim Currently, patients must consult with a primary care practitioner (PCP) prior to being referred to secondary care breast services. A change to patient self-referral would arguably reduce primary care workload, improve access for patients, and allow breast units to allocate resources more appropriately; no data currently supports this. This study aims to explore PCP's views on breast referral, evaluate the community breast workload, and to investigate the impact of COVID-19 on referral rates. Method An electronic survey was designed on SurveyMonkey.com which aimed to collect both quantitative and qualitative data. The weblink to the survey was sent out via two electronic newsletters. Participants were asked: their role and gender, their level of confidence surrounding breast care, details surrounding their breast workload, how they felt COVID-19 had affected their referral rates, their level of satisfaction with the current pathway, and their opinions on a potential change to patient self-referral. Results 79 responses were received. PCPs estimated that 7.0% (median) of their total consultations were regarding a breast-related issue and that COVID-19 had not had a significant impact on the rate of referral to breast units (P = 0.75). 84.8% of PCPs were satisfied with the current referral pathway. Whilst 74.5% felt a change to patient self-referral would benefit patients and primary care services, their free text comments highlighted some of their reservations. Conclusions PCPs have a high level of satisfaction with the current breast referral pathway, but the majority would be open to a change to patient self-referral to specialist breast units.

scholarly journals Telemedicine in The Context of Covid-19- A Qualitative Study of Cancer Patients and Clinicians

2021 ◽  
Author(s):  
Dylan Chan Tai Kong ◽  
Ashfaq Chauhan ◽  
Anaïs Tiffany Ah Leung ◽  
Melvin Chin
Keyword(s):  
Qualitative Study ◽  
Theory Approach ◽  
Structured Interviews ◽  
Hospital Data ◽  
Metropolitan Regions ◽  
Theoretical Sampling ◽  
Proper Training ◽  
Grounded Theory Approach

Abstract Background:Prior to the Covid-19 pandemic, telemedicine was only used to deliver health care to patients living in remote areas of Australia. However, the spread of the Covid-19 virus pushed the widespread uptake of telemedicine across Australia, including in metropolitan regions. This qualitative study will explore the medical oncology (MO) patient and clinician experience of telemedicine in a metropolitan setting as a result of Covid-19.Method:Participants were selected and invited to participate by theoretical sampling from MO clinicians and patients attending MO clinics at Prince of Wales Hospital. Data was collected by in-depth semi-structured interviews. Thematic analysis was performed to analyse the interview data. Transcripts were coded using the grounded theory approach to identify overarching themes.Results:Twelve participants were recruited to the study. Most participants viewed the adoption of telemedicine positively because it was considered as convenient, efficient and could be used in order to reduce the spread of Covid-19. Nonetheless, participants complained about the poor implementation of telemedicine, technical difficulties and lack of proper training. Finally, providers expressed mixed views over the lack of personal interaction and the lack of physical examination from telemedicine. However, both clinicians and patients viewed telemedicine as acceptable to be used in the context of routine follow-ups.Conclusion:Although some operational improvements are necessary, the role of telemedicine in the follow up of MO patients seems likely to continue beyond Covid-19.

scholarly journals Development of an interactive, web-based shared care plan to facilitate the follow-up care of colorectal cancer patients

2019 ◽  
Author(s):  
Jane Taggart ◽  
Melvin Chin ◽  
Winston Liauw ◽  
Alex Dolezal ◽  
John Plahn ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Information ◽  
Shared Care ◽  
Care Plan ◽  
Web Based ◽  
Care Plans ◽  
Cancer Services ◽  
Follow Up Care ◽  
Primary Care Practitioners

Abstract Introduction A shared model of care between cancer services and primary health care is safe and acceptable and can address the increasing demands on cancer services for long term follow-up. This paper describes the challenges developing an interactive shared care plan for colorectal cancer follow-up care that supports collaboration between the care team and patient. Methods A systematic literature review was undertaken to identify web-based care plans for follow-up cancer care that would inform the implementation of a system to share an individualised care plan. We conducted individual consultations with 25 key informants/stakeholders to understand the requirements and challenges of establishing the web-based care plan and to identify the technical options to share the care plan. This was followed by a structured group consultation with 13 key stakeholders to obtain agreement on the model of care and the technical solution to share the care plan. Results We identified five web-based shared care plans for cancer follow-up care. These systems supported the creation and/or access to view or share the care plan via internet log-in, email or hard copy. None of the SCP had interactive functionalities to support collaboration and none of the included papers reported formalised models of shared care between cancer services and primary care. The challenges identified included the security, privacy and sharing of patient information between public health services and primary health care and poor integration of clinical information systems. A primary care practitioners’ care planning system was selected for the pilot as it addressed the challenge of sharing clinical information between the public health system and external clinicians, partially addressed integration (integrated with the primary care clinical information systems but did not integrate with the cancer centre systems), supported collaboration between the care team and patient and was relatively inexpensive. Conclusion Primary care shared care planning systems seem a suitable option for sharing clinical information between a cancer service and primary care practitioners. We plan to evaluate the feasibility and acceptability of this interactive shared care plan to support shared cancer follow-up care.

“We Had to Keep Pushing”: Caregivers' Perspectives on Autism Screening and Referral Practices of Black Children in Primary Care

2018 ◽  
Vol 56 (5) ◽  
pp. 321-336 ◽  
Author(s):  
Sarah Dababnah ◽  
Wendy E. Shaia ◽  
Karen Campion ◽  
Helen M. Nichols
Keyword(s):  
Primary Care ◽  
Primary Healthcare ◽  
Racial Bias ◽  
Healthcare Providers ◽  
Black Children ◽  
Autism Spectrum ◽  
Theory Approach ◽  
Early Intervention Services ◽  
Primary Healthcare Providers

Abstract Black children with autism spectrum disorder (ASD) are diagnosed later than their White peers, are more likely to be misdiagnosed, and are less likely to receive early intervention services or a developmental evaluation by three years old. Using a grounded theory approach, we solicited the perspectives of parents and other primary caregivers of Black children with ASD on barriers and facilitators to ASD screening and referrals in primary care. A socioeconomically diverse sample of 22 female caregivers participated. Four themes emerged. First, while some caregivers noted their child's primary healthcare providers facilitated a timely ASD diagnosis, other participants reported these providers ignored early concerns about child developmental delays. Second, many participants felt racial bias negatively impacted caregiver-primary healthcare provider interactions. Third, legal/custodial issues slowed caregivers' abilities to follow up on referrals from their primary healthcare providers. Finally, caregivers described denial, shame, and stigma relating to ASD in the Black community as possible factors for delayed follow up to referrals. Differences based on socioeconomic status are discussed. Efforts to improve family-centered, culturally relevant care for all Black caregivers raising children with or at-risk for ASD are needed, particularly for those families experiencing the multiple effects of poverty.

scholarly journals Dementia Diagnosis and Challenges in Minority Populations

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 161-162
Author(s):  
Halima Amjad ◽  
Marcela Blinka ◽  
Jennifer Aufill ◽  
Quincy Samus
Keyword(s):  
Primary Care ◽  
Minority Groups ◽  
The United States ◽  
Theory Approach ◽  
Clinical Practices ◽  
Structured Interviews ◽  
Starting Point ◽  
Care Relationships ◽  
Grounded Theory Approach ◽  
Poor Memory

Abstract Alzheimer’s disease and related dementias are underdiagnosed in the United States, with potentially higher rates of underdiagnosis among minority groups. Our objective was to examine perceptions of dementia, the utility and timeliness of diagnosis, and experiences obtaining diagnosis and care in minorities. We recruited 17 family caregivers of African American (n=11), Latino (n=3), and Asian (n=3) persons with dementia (PWD) to complete surveys and semi-structured interviews. Caregivers were mostly female (n=14), children of PWD (n=14), and had greater than high school education (n=16). Mean PWD age at diagnosis was 76 years (range 63-90) with mean 17 months from symptom observation to diagnosis (range 0.5-36 months). Interview themes were coded using a grounded theory approach. Emerging themes related to concerns prior to diagnosis, diagnosis experiences, timeliness of diagnosis, ways to improve diagnosis and care, familiarity with dementia, and stigma. Poor memory was the most common early concern; caregivers also noted behavioral symptoms, weight loss, family stress, and PWD vulnerability. Caregivers recalled key moments when they knew something was wrong. Primary care was the most frequent starting point in diagnosis; longstanding primary care relationships both facilitated and hindered diagnosis. Nine of the 17 caregivers felt diagnosis was delayed. Caregivers preferred clinicians who were forthcoming with the diagnosis and what to expect and noted the importance of family meetings or counseling. Prior experience or knowledge of dementia was common. Caregiver perspectives and experiences elicited in this study may be translated to interventions and clinical practices that proactively detect and address dementia in minorities.

scholarly journals Patients’ views on interactions with practitioners for type 2 diabetes: a longitudinal qualitative study in primary care over 10 years

2017 ◽  
Vol 68 (666) ◽  
pp. e36-e43 ◽  
Author(s):  
Hajira Dambha-Miller ◽  
Barbora Silarova ◽  
Greg Irving ◽  
Ann Louise Kinmonth ◽  
Simon J Griffin
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Descriptive Analysis ◽  
Free Text ◽  
Individual Level ◽  
Face To Face ◽  
Relational Continuity ◽  
Over Time

BackgroundIt has been suggested that interactions between patients and practitioners in primary care have the potential to delay progression of complications in type 2 diabetes. However, as primary care faces greater pressures, patient experiences of patient–practitioner interactions might be changing.AimTo explore the views of patients with type 2 diabetes on factors that are of significance to them in patient–practitioner interactions in primary care after diagnosis, and over the last 10 years of living with the disease.Design and settingA longitudinal qualitative analysis over 10 years in UK primary care.MethodThe study was part of a qualitative and quantitative examination of patient experience within the existing ADDITION-Cambridge and ADDITION-Plus trials from 2002 to 2016. The researchers conducted a qualitative descriptive analysis of free-text comments to an open-ended question within the CARE measure questionnaire at 1 and 10 years after diagnosis with diabetes. Data were analysed cross-sectionally at each time point, and at an individual level moving both backwards and forwards between time points to describe emergent topics.ResultsAt the 1-year follow-up, 311 out of 1106 (28%) participants had commented; 101 out of 380 (27%) participants commented at 10-year follow-up; and 46 participants commented at both times. Comments on preferences for face-to-face contact, more time with practitioners, and relational continuity of care were more common over time.ConclusionThis study highlights issues related to the wider context of interactions between patients and practitioners in the healthcare system over the last 10 years since diagnosis. Paradoxically, these same aspects of care that are valued over time from diagnosis are also increasingly unprotected in UK primary care.

scholarly journals Helpless helpers: primary care therapist self-efficacy working with intimate partner violence and ageing women

2017 ◽  
Vol 18 (4) ◽  
pp. 222-234 ◽  
Author(s):  
Carlie Watson ◽  
Nikki Carthy ◽  
Sue Becker
Keyword(s):  
Primary Care ◽  
Intimate Partner Violence ◽  
Grounded Theory ◽  
Partner Violence ◽  
Intimate Partner ◽  
Theory Approach ◽  
Core State ◽  
Content Type ◽  
Data Coding ◽  
Grounded Theory Approach

Purpose The purpose of this paper is to explore primary care psychological therapists’ experiences of working with mid-life and older women presenting with intimate partner violence (IPV) and develop a theoretical framework using a grounded theory approach to identify the experiences of those practitioners working with this phenomenon. Design/methodology/approach Interviews with 17 practitioners were conducted. The data analysis was informed by a grounded theory approach, which requires three states of data coding: open, axial and selective. Data codes were thematically sorted into causal, contextual, strategic, intervening, interactional and consequential conditions. Findings A core state of therapist helplessness was uncovered. The framework demonstrates that psychological therapists can doubt their ability to work meaningfully with women over 45 years of age experiencing IPV. To avoid the core state of helplessness, therapists use strategies such as avoiding asking questions about partner violence, making assumptions of how patients interpret their own experiences, addressing symptoms rather than the root cause and going above and beyond in attempts to rescue patients. The consequence of therapists’ helplessness often results in burnout. Research limitations/implications The framework identifies barriers in working effectively with IPV and women in the mid-to older-aged populations. Originality/value This study is the first to suggest a framework that is grounded in practitioner experience with capability to transfer to a range of professionals working with mid-to older-aged women such as forensic, medical and specialist psychologists.

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