Effect and acceptability of AKI education using peer review audit in primary care

2018 ◽  
Vol 68 (suppl 1) ◽  
pp. bjgp18X696977
Author(s):  
Mufaza Asrar ◽  
Joanna McKinnell ◽  
Nitin Kolhe ◽  
Lynn Woods ◽  
Sally Bassett ◽  
...  
Keyword(s):  
Primary Care ◽  
Peer Review ◽  
Secondary Care ◽  
Group Discussion ◽  
Risk Groups ◽  
Risk Identification ◽  
Care Staff ◽  
Small Group Teaching ◽  
Post Intervention ◽  
Early Management

BackgroundThis was part of the Southern Derby shire CCG AKI awareness and improved management in primary and secondary care. The programme involved educating the primary care staff (GPs nurses) about AKI, identifying and early management in at risk groups. The secondary care aspect involved protocol development for AKI risk/identification to reduce morbidity.AimAs two-thirds of AKI originates in the community we aimed to increase awareness and knowledge levels of AKI in primary care via a CCG wide education programme. This included nephrology a peer review audit of cases with an evaluation of the programme’s acceptability and impact.MethodOver a 12month period, peer review audit sessions were delivered to GPs and the primary care MDT. These sessions consisted of a short presentation by a consultant nephrologist followed by discussion of cases. Qualitative feedback was collected from all participants. Web-based, CCG-wide questionnaires incorporating factual and clinical questions were used to assess baseline and post-intervention knowledge level.Results93% of participants (94 responses) found the peer review audit sessions useful, particularly the presence of nephrologist. 45% of participants were anxious about group discussion of cases, although 36% thought they were the most useful component of the sessions. Formal presentations were ranked as the most popular format of receiving education. 996 individuals completed the questionnaires. At baseline 61% were GPs, 27% practice nurses and 8% Advanced Practitioners, with similar proportions at 1yr. Exposure to AKI teaching, self-reported awareness and confidence levels were higher in the second questionnaire and there was a significant improvement in test scores.ConclusionPrimary care education can improve knowledge and awareness of AKI. Small group teaching with involvement of a nephrologist was popular. These results suggest that there is a need to tailor education styles to individual preferences, and peer review audit may not be universally acceptable in primary care.

scholarly journals Dementia case-finding in hospitals: a qualitative study exploring the views of healthcare professionals in English primary care and secondary care

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020521 ◽  
Author(s):  
Anne-Marie Burn ◽  
Jane Fleming ◽  
Carol Brayne ◽  
Chris Fox ◽  
Frances Bunn
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Secondary Care ◽  
Healthcare Professionals ◽  
Hospital Staff ◽  
Case Finding ◽  
Care Staff ◽  
Dementia Case ◽  
Primary Care Staff ◽  
Views Of Healthcare Professionals

ObjectivesIn 2012–2013, the English National Health Service mandated hospitals to conduct systematic case-finding of people with dementia among older people with unplanned admissions. The method was not defined. The aim of this study was to understand current approaches to dementia case-finding in acute hospitals in England and explore the views of healthcare professionals on perceived benefits and challenges.DesignQualitative study involving interviews, focus groups and thematic content analysis.SettingPrimary care and secondary care across six counties in the East of England.ParticipantsHospital staff involved in dementia case-finding and primary care staff in the catchment areas of those hospitals.ResultsWe recruited 23 hospital staff and 36 primary care staff, including 30 general practitioners (GPs). Analysis resulted in three themes: (1) lack of consistent approaches in case-finding processes, (2) barriers between primary care and secondary care which impact on case-finding outcomes and (3) perceptions of rationale, aims and impacts of case-finding. The study shows that there were variations in how well hospitals recorded and reported outcomes to GPs. Barriers between primary care and secondary care, including GPs’ lack of access to hospital investigations and lack of clarity about roles and responsibilities, impacted case-finding outcomes. Staff in secondary care were more positive about the initiative than primary care staff, and there were conflicting priorities for primary care and secondary care regarding case-finding.ConclusionsThe study suggests a more evidence-based approach was needed to justify approaches to dementia case-finding. Information communicated to primary care from hospitals needs to be comprehensive, appropriate and consistent before GPs can effectively plan further investigation, treatment or care. Follow-up in primary care further requires access to options for postdiagnostic support. There is a need to evaluate the outcomes for patients and the economic impact on health and care services across settings.

scholarly journals Biochemistry study day

2006 ◽  
Vol 5 (2) ◽  
pp. 58-59
Author(s):  
Dr Alan Taylor ◽  
Professor Ian S Young ◽  
Dr Padmanna Negali ◽  
Dr Richard Neary ◽  
Dr Cathy Hay
Keyword(s):  
Primary Care ◽  
General Hospital ◽  
Bowel Disease ◽  
Secondary Care ◽  
Clinical Biochemistry ◽  
Care Staff ◽  
Inaugural Lecture ◽  
Education Centre ◽  
Primary Care Staff ◽  
Young Professor

A Biochemistry study day was held on 1st March 2006 at Furness General Hospital (FGH), courtesy of the Education Centre and Astra Zeneca. Dr Alan Taylor, consultant chemical pathologist, reports on the meeting for the Journal. He describes the contribution of Professor Ian S Young, Professor of Medicine and Clinical Biochemistry at Queens University Belfast. His lecture on the origins of atheroma, which in a masterly way condensed many years of research into one hour, ranks alongside Dr Denis Burkitt’s lecture on the origins of bowel disease (the inaugural lecture in the new theatre at FGH in 1986) and Professor Nick Hales’s on the origins of diabetes (presented in 1998 at FGH). The topics selected for the study day were designed for primary care staff in particular, because they have overtaken secondary care as the main users of clinical biochemistry services.

scholarly journals Processing discharge summaries in general practice: a qualitative interview study with GPs and practice managers

BJGP Open ◽  
2019 ◽  
Vol 3 (1) ◽  
pp. bjgpopen18X101625 ◽  
Author(s):  
Rachel A Spencer ◽  
Sarah Rodgers ◽  
Ndeshi Salema ◽  
Stephen M Campbell ◽  
Anthony J Avery
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Hospital Discharge ◽  
Secondary Care ◽  
Human Error ◽  
Transitions Of Care ◽  
Care Staff ◽  
Geographical Regions ◽  
Qualitative Interview Study ◽  
Discharge Summaries

BackgroundDischarge summaries are essential for communicating patient information from secondary care to general practice on hospital discharge. Although there has been extensive research into their design and completion in secondary care, very little is known about primary care processing of these documents.AimTo explore what general practice staff think are the factors associated with failure to respond to actions requested in discharge summaries and what practices do to mitigate this.Design & settingSemi-structured interviews were undertaken with primary care staff in three geographical regions of England.MethodInterviews with 10 practice managers and 10 GPs (one of each at each of the 10 practices) were undertaken to explore management of discharge summaries.ResultsFive themes emerged from the interviews. The 'secondary care factors' theme describes participants’ perspectives on the design of summaries, which are inconsistent and often require improvement. The 'safety features of processing systems' theme focuses on document handling in primary care. A theme devoted to 'medicines reconciliation' followed. 'Error and harm as a result of faulty processing' is a theme describing ‘human error’ and other factors that participants believed contributed to failure to respond to requested actions. Finally, the 'strategies for safety improvement' theme describes initiatives to prevent failures of safer transitions of care.ConclusionCorrect processing of discharge summaries is essential to ensure patients experience a safe transition of care and not just a hospital discharge. Based on the interview findings, strategies to mitigate against faults in the processing of discharge summaries have been suggested to enhance safer transitions of care.

Early intervention and dementia care: innovation and impact

2014 ◽  
Vol 15 (1) ◽  
pp. 34-45 ◽  
Author(s):  
Viniti Seabrooke ◽  
Alisoun Milne
Keyword(s):  
Primary Care ◽  
Early Intervention ◽  
Secondary Care ◽  
Third Sector ◽  
Dementia Care ◽  
Post Intervention ◽  
Content Type ◽  
Early Intervention Services ◽  
Care Project ◽  
The Impact

Purpose – This study aims to systematically evaluate the impact and effectiveness of two early intervention services in NW Kent. Design/methodology/approach – Data were gathered via evaluation questionnaires for both projects; these included quantitative post-intervention data and qualitative comments. Data on referrals to secondary care and a specialist third sector organisation were also collected for the primary care project. Findings – Findings from the primary care project indicate that targeting a specific age cohort of patients can be effective in terms of: early identification of dementia-related concerns, the provision of support, appropriate referrals to secondary care, and increased referrals to a third sector dementia service. At the end of the project most practitioners felt they were better informed about dementia, more committed to facilitating early diagnosis, and had gained confidence in using a screening tool (the General Practitioner Assessment of Cognition Test). Evidence from evaluating the Carers Group suggests that attendance helped members manage emotional difficulties, increased understanding of dementia, and enhanced coping skills. They also felt less isolated and knew how to access support services. Practical implications – The projects offer two models of intervention: how a proactive third sector agency can work with primary care professionals to enhance commitment to dementia case finding and the provision of group support to relatives of those in receipt of a recent dementia diagnosis. Originality/value – The study provides insights into early intervention in dementia care how to evaluate impact of effectiveness.

scholarly journals Evaluating the delay prior to primary care presentation in lung cancer patients

BJGP Open ◽  
2020 ◽  
pp. BJGPO.2020.0130
Author(s):  
Jalpa Kotecha ◽  
Allan Clark ◽  
Matthew Burton ◽  
Wei Yee Chan ◽  
Di Menzies ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Primary Care ◽  
Secondary Care ◽  
Patient Delay ◽  
Care Staff ◽  
Total Delay ◽  
Voice Change ◽  
Geometric Means ◽  
Early Referral ◽  
Lung Cancer Patients

Background: Little is known about “within-patient delay”, time from first symptom of lung cancer to contacting primary care. Aim: Primary outcomes were length of within-patient delay and the proportion of total delay it represents. Secondary outcomes were factors causing delay and survival. Design and Setting: Newly diagnosed lung cancer oncology patients at two hospitals in Norfolk. Method: Patients completed questionnaires regarding onset of symptoms, whether they had delayed, and their reasons. GPs completed correlating questionnaires. Pathway times and other data were extracted from cancer registry and hospital records and outcomes obtained prospectively. Factors causing delay were compared using ratios of geometric means. Results: In 379 patients, mean within-patient delay and pre-secondary care delay were 188.6 and 241 days (61.4% and 78.5% of total delay respectively). 38.8% patients felt they had delayed. Patient-related causes of delay were denial (ratio of means (ROM) 4.36, p=0.002, 95% CIs 1.71-11.1), anxiety (3.36, 0.026, 1.16-9.76), non-recognition of symptoms (2.80, 0.004, 1.41-5.59) and smoking (1.76, 0.021, 1.09-2.86), respectively. These symptoms were associated with delay: finger swelling/discomfort (ROM=2.72, p=0.009, CIs 1.29-5.74), cough (2.53, <0.001, 1.52-4.19), weight loss (2.41, <0.001, 1.49-3.88), weakness (2.35, 0.001, 1.45-3.83), dyspnoea (2.30, 0.001, 1.40-3.80), voice change (1.90, 0.010, 1.17-3.10) and sputum (1.66, 0.039, 1.03-2.67), respectively, also having more than five symptoms (compared to 1-3) (3.69, <0.001, 2.05-6.64). No overall relation between within-patient delay and survival was seen. Conclusion: Using smoking registers, awareness literature and self-care manuals, primary care staff could liaise with ever-smokers regarding their symptoms, to ensure early referral to secondary care.

scholarly journals Efficacy of Manual Therapy and Transcutaneous Electrical Nerve Stimulation in Cervical Mobility and Endurance in Subacute and Chronic Neck Pain: A Randomized Clinical Trial

2021 ◽  
Vol 10 (15) ◽  
pp. 3245
Author(s):  
Belén Díaz-Pulido ◽  
Yolanda Pérez-Martín ◽  
Daniel Pecos-Martín ◽  
Isabel Rodríguez-Costa ◽  
Milagros Pérez-Muñoz ◽  
...  
Keyword(s):  
Primary Care ◽  
Neck Pain ◽  
Manual Therapy ◽  
Nerve Stimulation ◽  
Transcutaneous Electrical Nerve Stimulation ◽  
Sagittal Plane ◽  
Chronic Neck Pain ◽  
Post Intervention ◽  
Electrical Nerve Stimulation

Neck pain is a frequent health problem. Manual therapy (MT) and transcutaneous electrical nerve stimulation (TENS) are recommended techniques for treatment of mechanical neck disorders (MND) in Spanish Public Primary Care Physiotherapy Services. The aim of this study was to compare the efficacy of MT versus TENS in active mobility and endurance in cervical subacute or chronic neck pain. Ninety patients with MND were randomly allocated to receive ten 30-min sessions of either MT or TENS, in a multi-centered study through 12 Primary Care Physiotherapy Units in the Madrid community. Active cervical range of motion (CD-ROM) and endurance (Palmer and Epler test) were evaluated pre- and post-intervention and at 6-month follow-up. A generalized linear model of repeated measures was constructed for the analysis of differences. Post-intervention MT yielded a significant improvement in active mobility and endurance in patients with subacute or chronic MND, and at 6-month follow-up the differences were only significant in endurance and in sagittal plane active mobility. In the TENS group, no significant improvement was detected. With regard to other variables, MT improved mobility and endurance more effectively than TENS at post-intervention and at 6-month follow-up in the sagittal plane. Only MT generated significant improvements in cervical mobility and endurance in the three movement planes.

scholarly journals 142. Implementing an Antimicrobial Stewardship Program in the Outpatient Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
Travis B Nielsen ◽  
Maressa Santarossa ◽  
Beatrice D Probst ◽  
Laurie Labuszewski ◽  
Jenna Lopez ◽  
...  
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Outpatient Setting ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Antimicrobial Stewardship Program ◽  
Post Intervention ◽  
Stewardship Program

Abstract Background Antimicrobial-resistant infections lead to increased morbidity, mortality, and healthcare costs. Among the most facile modifiable risk factors for developing resistance is inappropriate prescribing. The CDC estimates that 47 million (or ≥30% of) outpatient antibiotic prescriptions in the United States are unnecessary. This has provided impetus for expanding our antimicrobial stewardship program (ASP) into the outpatient setting. Initial goals included the following: continuous evaluation and reporting of antibiotic prescribing compliance; minimize underuse of antibiotics from delayed diagnoses and misdiagnoses; ensure proper drug, dose, and duration; improve the percentage of appropriate prescriptions. Methods To achieve these goals, we first sent a baseline survey to outpatient prescribers, assessing their understanding of stewardship and antimicrobial resistance. Questions were modeled from the Illinois Department of Public Health (IDPH) Precious Drugs & Scary Bugs Campaign. The survey was sent to prescribers at 19 primary care and three immediate/urgent care clinics. Compliance rates for prescribing habits were subsequently tracked via electronic health records and reported to prescribers in accordance with IRB approval. Results Prescribers were highly knowledgeable about what constitutes appropriate prescribing, with verified compliance rates highly concordant with self-reported rates. However, 74% of respondents reported intense pressure from patients to inappropriately prescribe antimicrobials. Compliance rates have been tracked since December 2018 and comparing pre- with post-intervention rates shows improvement in primary care since reporting rates to prescribers in August 2019. Conclusion Reporting compliance rates has been helpful in avoiding inappropriate antimicrobial therapy. However, the survey data reinforce the importance of behavioral interventions to bolster ASP efficacy in the outpatient setting. Going forward, posters modeled off of the IDPH template will be conspicuously exhibited in exam rooms, indicating institutional commitment to the enumerated ASP guidelines. Future studies will allow for comparison of pre- and post-intervention knowledge and prescriber compliance. Disclosures All Authors: No reported disclosures

scholarly journals Referrals to Urgent Dental Centres During the COVID-19 Pandemic: A Multi-Site Analysis Research Project

2021 ◽  
Vol 10 (1) ◽  
pp. 40-45
Author(s):  
Adam Shathur ◽  
Samuel Reeves ◽  
Faizal Sameja ◽  
Vishal Patel ◽  
Allan Jones
Keyword(s):  
Primary Care ◽  
Secondary Care ◽  
Easy Access ◽  
Dental Services ◽  
Care Services ◽  
Dental Practitioners ◽  
Consultation And Referral ◽  
Care Systems ◽  
Access To Primary Care ◽  
The Uk

Introduction: The COVID-19 pandemic enforced the cessation of routine dentistry and the creation of local urgent dental care systems in the UK. General dental practices are obligated by NHS guidance to remain open and provide remote consultation and referral where appropriate to patients having pain or problems. Aims: To compare two urgent dental centres with different triage and referral systems with regard to quality and appropriateness of referrals, and patient management outcomes. Methods: 110 consecutive referrals received by a primary care urgent dental centre and a secondary care urgent dental centre were assessed. It was considered whether the patients referred had access to remote primary care dental services, fulfilled the criteria required to be deemed a dental emergency as mandated by NHS guidance, and what the outcomes of referrals were. Results: At the primary care centre, 100% of patients were referred by general dental practitioners and had access to remote primary care dental services. 95.5% of referrals were deemed appropriate and were seen for treatment. At the secondary care site, 94.5% of referrals were direct from the patient by contacting NHS 111. 40% had received triaging to include ‘advice, analgesia and antimicrobial’ from a general dental practitioner, and 25.5% were deemed appropriate and resulted in treatment. Conclusion: Urgent dental centres face many issues, and it would seem that easy access to primary care services, collaboration between primary care clinicians and urgent dental centres, and training of triaging staff are important in operating a successful system.

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