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 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 New teams in general practice

2018 ◽  
Vol 11 (9) ◽  
pp. 506-512 ◽  
Author(s):  
Kamila Hawthorne ◽  
Ben Jackson ◽  
Danielle Fisher
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Continuity Of Care ◽  
Healthcare Professionals ◽  
Hospital Admissions ◽  
Healthcare Outcomes ◽  
Complex Patients ◽  
Primary Care Teams ◽  
A Priority ◽  
Parallel Stream

The NHS is seriously under-doctored, with general practice being one of the worst-affected specialties. GPs are a highly trusted and valued profession by patients. In addition, the ‘gatekeeping’ function and continuity of care they provide is critical to the efficiency of the services as a whole, keeps hospital admissions down, and produces better healthcare outcomes for communities and populations. Major efforts are being made to recruit new GPs and retain existing GPs, but there are serious implications for the future of primary care, and general practice in particular, as GPs struggle to cope with increased workloads. Increasing the number of GPs in the workforce is critical, and this work continues as a priority. However, a parallel stream of work has developed to consider ways in which tasks ‘traditionally’ undertaken by a GP might be diverted to new healthcare professionals within primary care teams, freeing up GPs to concentrate on the care and management of their more complex patients.

scholarly journals Nurse perspectives on the implementation of routine telemonitoring for high-risk diabetes patients in a primary care setting

2016 ◽  
Vol 18 (01) ◽  
pp. 3-13 ◽  
Author(s):  
Bonnie M. Vest ◽  
Victoria M. Hall ◽  
Linda S. Kahn ◽  
Arvela R. Heider ◽  
Nancy Maloney ◽  
...  
Keyword(s):  
Primary Care ◽  
High Risk ◽  
Real World ◽  
Hospital Admissions ◽  
Lessons Learned ◽  
Diabetic Patients ◽  
Structured Interviews ◽  
Economic Context ◽  
Care Practices ◽  
Primary Care Practices

Aims The purpose of this qualitative evaluation was to explore the experience of implementing routine telemonitoring (TM) in real-world primary care settings from the perspective of those delivering the intervention; namely the TM staff, and report on lessons learned that could inform future projects of this type. Background Routine TM for high-risk patients within primary care practices may help improve chronic disease control and reduce complications, including unnecessary hospital admissions. However, little is known about how to integrate routine TM in busy primary care practices. A TM pilot for diabetic patients was attempted in six primary care practices as part of the Beacon Community in Western New York. Methods Semi-structured interviews were conducted with representatives of three TM agencies (n=8) participating in the pilot. Interviews were conducted over the phone or in person and lasted ~30 min. Interviews were audio-taped and transcribed. Analysis was conducted using immersion-crystallization to identify themes. Findings TM staff revealed several themes related to the experience of delivering TM in real-world primary care: (1) the nurse–patient relationship is central to a successful TM experience, (2) TM is a useful tool for understanding socio-economic context and its impact on patients’ health, (3) TM staff anecdotally report important potential impacts on patient health, and (4) integrating TM into primary care practices needs to be planned carefully. Conclusions This qualitative study identified challenges and unexpected benefits that might inform future efforts. Communication and integration between the TM agency and the practice, including the designation of a point person within the office to coordinate TM and help address the broader contextual needs of patients, are important considerations for future implementation. The role of the TM nurse in developing trust with patients and uncovering the social and economic context within which patients manage their diabetes was an unexpected benefit.

scholarly journals P084: Waiting makes me sick: is it time for formal triage in primary care?

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S106-S106
Author(s):  
J. MacKay ◽  
P.R. Atkinson ◽  
M. Howlett ◽  
E. Palmer ◽  
J. Fraser ◽  
...  
Keyword(s):  
Primary Care ◽  
Wait Time ◽  
Patient Survey ◽  
Wait Times ◽  
Cross Sectional ◽  
Triage System ◽  
Care Appointment ◽  
Open Scheduling ◽  
Primary Care Practices ◽  
Advanced Access

Introduction: Patient morbidity and mortality are influenced by delay in access to care and lack of continuity of care. Patients frequently present to the emergency department (ED) for care despite being registered with a primary care (PC) provider. Advanced access is an open scheduling system promoted by the College of Family Physicians of Canada that triages primary care (PC) patients to be seen within 24 hours, reducing care delay. We wished to determine the prevalence of formal triage systems in PC appointment allocation. Methods: We performed linked cross sectional surveys to quantify the number of ambulatory patients presenting to a tertiary urban ED (with an annual census of 56,000 visits) who felt unable to access primary care. PC practices were also surveyed to assess use of formal triage methods and measure access using the metric of time to third next available appointment. Descriptive statistics were calculated. Results: In the patient survey, 381 of 580 patients consented to participate. Of those, 324 patients reported reasons for their ED visit. Perception that wait time for PC was “too long” was reported in 73/324 (23%); 86% reported wait times of greater than 48 hours. The PC practice response rate was 63.8% (46/ 72). The mean time to third next available appointment was 7.7 (95% CI 4.9-10.5) days (median 5 days, range 0-50 days). No PC practice reported utilizing a formal triage system when booking appointments. Conclusion: No primary care practices in the surveyed region used a formal triage system to allocate appointments, despite a range of wait times that extended up to 50 days. The safety of primary care appointment allocation may be improved with introduction of a formal triage system, especially if overall wait times cannot be reduced.

Routes to diagnosis of heart failure: observational study using linked data in England

Heart ◽  
2017 ◽  
Vol 104 (7) ◽  
pp. 600-605 ◽  
Author(s):  
Alex Bottle ◽  
Dani Kim ◽  
Paul Aylin ◽  
Martin R Cowie ◽  
Azeem Majeed ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
Natriuretic Peptide ◽  
Hospital Admissions ◽  
Practice Research ◽  
Clinical Practice Research Datalink ◽  
Missed Opportunities ◽  
Specialist Referral ◽  
Care Consultation ◽  
Primary Care Practices

ObjectiveTimely diagnosis and management of heart failure (HF) is critical, but identification of patients with suspected HF can be challenging, especially in primary care. We describe the journey of people with HF in primary care from presentation through to diagnosis and initial management.MethodsWe used the Clinical Practice Research Datalink (primary care consultations linked to hospital admissions data and national death registrations for patients registered with participating primary care practices in England) to describe investigation and referral pathways followed by patients from first presentation with relevant symptoms to HF diagnosis, particularly alignment with recommendations of the National Institute for Health and Care Excellence guideline for HF diagnosis.Results36 748 patients had a diagnosis of HF recorded that met the inclusion criteria between 1 January 2010 and 31 March 2013. For 29 113 (79.2%) patients, this was first recorded in hospital. In the 5 years prior to diagnosis, 15 057 patients (41.0%) had a primary care consultation with one of three key HF symptoms recorded, 17 724 (48.2%) attended for another reason and 3967 (10.8%) did not see their general practitioner. Only 24% of those with recorded HF symptoms followed a pathway aligned with guidelines (echocardiogram and/or serum natriuretic peptide test and specialist referral), while 44% had no echocardiogram, natriuretic peptide test or referral.ConclusionsPatients follow various pathways to the diagnosis of HF. However, few appear to follow a pathway supported by guidelines for investigation and referral. There are likely to be missed opportunities for earlier HF diagnosis in primary care.

scholarly journals Are some areas more equal than others? Socioeconomic inequality in potentially avoidable emergency hospital admissions within English local authority areas

2016 ◽  
Vol 22 (2) ◽  
pp. 83-90 ◽  
Author(s):  
Jessica Sheringham ◽  
Miqdad Asaria ◽  
Helen Barratt ◽  
Rosalind Raine ◽  
Richard Cookson
Keyword(s):  
Primary Care ◽  
Local Authority ◽  
Hospital Admissions ◽  
Socioeconomic Inequality ◽  
Area Deprivation ◽  
Term Care ◽  
Emergency Hospital ◽  
Emergency Hospital Admissions ◽  
Administrative Area ◽  
Over Time

Objectives Reducing health inequalities is an explicit goal of England’s health system. Our aim was to compare the performance of English local administrative areas in reducing socioeconomic inequality in emergency hospital admissions for ambulatory care sensitive chronic conditions. Methods We used local authority area as a stable proxy for health and long-term care administrative geography between 2004/5 and 2011/12. We linked inpatient hospital activity, deprivation, primary care, and population data to small area neighbourhoods (typical population 1500) within administrative areas (typical population 250,000). We measured absolute inequality gradients nationally and within each administrative area using neighbourhood-level linear models of the relationship between national deprivation and age–sex-adjusted emergency admission rates. We assessed local equity performance by comparing local inequality against national inequality to identify areas significantly more or less equal than expected; evaluated stability over time; and identified where equity performance was steadily improving or worsening. We then examined associations between change in socioeconomic inequalities and change in within-area deprivation (gentrification). Finally, we used administrative area-level random and fixed effects models to examine the contribution of primary care to inequalities in admissions. Results Data on 316 administrative areas were included in the analysis. Local inequalities were fairly stable between consecutive years, but 32 areas (10%) showed steadily improving or worsening equity. In the 21 improving areas, the gap between most and least deprived fell by 3.9 admissions per 1000 (six times the fall nationally) between 2004/5 and 2011/12, while in the 11 areas worsening, the gap widened by 2.4. There was no indication that measured improvements in local equity were an artefact of gentrification or that changes in primary care supply or quality contributed to changes in inequality. Conclusions Local equity performance in reducing inequality in emergency admissions varies both geographically and over time. Identifying this variation could provide insights into which local delivery strategies are most effective in reducing such inequalities.

scholarly journals Influence of organization and demographic characteristics of primary care practices on continuity of care: analysis of a retrospective cohort from 287 primary care practices covering about 6 million people in Catalonia

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ermengol Coma ◽  
Núria Mora ◽  
Paula Peremiquel-Trillas ◽  
Mència Benítez ◽  
Leonardo Méndez ◽  
...  
Keyword(s):  
Primary Care ◽  
Continuity Of Care ◽  
Pearson Correlation ◽  
Health Provider ◽  
Linear Regression Models ◽  
Bivariate Correlation ◽  
Study Results ◽  
Care Practices ◽  
Primary Care Practices ◽  
Care Index

Abstract Background There is evidence that an ongoing patient-physician relationship is associated with improved health outcomes and more efficient health systems. The main objective of this study is to describe the continuity of care in primary healthcare in Catalonia (Spain) and to analyze whether the organization of primary care practices (PCP) or their patients’ sociodemographic characteristics play a role in its continuity of care. Methods Four indices were used to measure continuity of care: Usual Provider Index (UPC), Modified Modified Continuity Index (MMCI), Continuity of Care Index (COC), and Sequential Continuity Index (SECON). The study was conducted on 287 PCP of the Catalan Institute of Health (Institut Català de la Salut—ICS). Each continuity of care index was calculated at the patient level (3.2 million patients and 35.5 million visits) and then aggregated at the PCP level. We adjusted linear regression models for each continuity index studied, considering the result of the index as an independent variable and demographic and organizational characteristics of the PCP as explanatory variables. Pearson correlation tests were used to compare the four continuity of care indices. Results Indices’ results were: UPC: 70,5%; MMCI: 73%; COC: 53,7%; SECON: 60,5%. The continuity of care indices had the highest bivariate correlation with the percentage of appointments booked with an assigned health provider (VISUBA variable: the lower the value, the higher the visits without an assigned health provider, and thus an organization favoring immediate consultation). Its R2 ranged between 56 and 63%, depending on the index. The multivariate model which explained better the variability of continuity of care indices (from 49 to 56%) included the variables VISUBA and rurality with a direct relationship; while the variables primary care physician leave days and training practices showed an inverse relationship. Conclusion Study results suggest that an organization of primary care favoring immediate consultation is related to a lower continuity of patient care.

Maintaining Continuity in Service: An Empirical Examination of Primary Care Physicians

2020 ◽  
Vol 22 (5) ◽  
pp. 1088-1106
Author(s):  
Vishal Ahuja ◽  
Carlos A. Alvarez ◽  
Bradley R. Staats
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Health Outcomes ◽  
Continuity Of Care ◽  
The United States ◽  
Problem Definition ◽  
Curvilinear Relationship ◽  
Health Administration ◽  
Empirical Examination ◽  
The Relationship

Problem definition: In many service operations, customers have repeated interactions with service providers. This creates two important questions for service design. First, how important is it to maintain the continuity of service for individuals? Second, because maintaining continuity is costly and, at times, operationally impractical for both the organization (because of potentially lower utilization) and providers (because of high effort required), should certain customer types, such as those with complex needs, be prioritized for continuity? These questions are particularly important in healthcare services where patients with chronic conditions visit primary care offices repeatedly. Therefore, we explore these questions in the context of diabetes, a chronic disease. Academic/practical relevance: Although the operations management (OM) and healthcare literatures suggest that higher continuity is better for health outcomes, the possibility that one could have too much continuity has not been explored. We draw on literature on continuity of care from the healthcare literature and learning effects from the OM literature to theorize and then show a curvilinear relationship. In addition, we further the literature on continuity by examining different categories for prioritization. Methodology: We use a detailed and comprehensive data set from the Veterans Health Administration, the largest integrated healthcare delivery system in the United States, which permits us to control for potential sources of heterogeneity. We analyze over 300,000 patients over an 11-year period who suffer from diabetes, a chronic disease whose successful management requires continuity of care, as well as kidney disease, a major complication of diabetes. We use an empirical approach to quantify the relationship between continuity of care and three important health outcomes: inpatient visits, length of stay, and readmission rate. We conduct extensive robustness checks and sensitivity analyses to validate our findings. Results: We find that continuity of care is related to improvements in all three health outcomes. Moreover, we find that the gains are not linearly improving in continuity, but rather the relationship is curvilinear, whereby outcomes improve and then decline in increasing continuity of care, suggesting that there may be value in having multiple providers. Additionally, we find that continuity of care is even more important for patients suffering from more complex conditions. Managerial implications: Identifying the amount of continuity of care to provide and determining which individuals to prioritize are both of interest to practitioners and policymakers because they can help in designing appropriate policies for staffing and work allocation.

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