Attitudes, perceptions, and behaviours associated with hospital admission avoidance: a qualitative study of high-risk patients in primary care

BackgroundThere is little evidence documenting the attitudes, experiences, and behavioural factors of high-risk patients who are associated with avoiding hospital.AimTo explore the health, healthcare management, and behavioural factors that contribute to enabling high-risk patients to avoid unplanned hospital admissions.Design and settingThis was an in-depth qualitative, primary care, interview study with patients who were registered on the Northumberland High Risk Patient Programme (NHRPP) in Northumberland, UK.MethodThere were 30 participants in this study, of who 21 were high-risk patients and nine were carers, spouses, or relatives. A grounded-theory approach was used to explore themes that emerged from the semi-structured interviews.ResultsParticipants described physical enablers that helped them to avoid hospital including medication, living aids, and resting; however, the benefit of these may be challenged by patient decision making. The strategies that patients used to cope with their health conditions included acceptance, positive reinterpretation, and growth. Participants felt that support networks of family and friends helped them to avoid hospital, although the strain on the spouse should be considered. The majority of patients described having trust and confidence in their healthcare providers, and continuity of care was important to patients.ConclusionReinforcing the importance of the physical enablers, as well as support networks to patients, carers, and healthcare providers, could help patients to avoid hospital. Highlighting the coping strategies that patients use may help patients to manage their health, while promoting continuity of care will also contribute to helping high-risk patients to avoid unplanned hospital admissions.

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Reducing unplanned hospital admissions in Older people with high needs: a review of local practice in a small sample of primary care patients in an inner London borough.

The International Journal of Person Centered Medicine ◽

10.5750/ijpcm.v6i2.561 ◽

2016 ◽

Vol 6 (2) ◽

pp. 108-118

Author(s):

Harriet Selina Anne Sinclair ◽

Alison Furey

Keyword(s):

Primary Care ◽

High Risk ◽

Older People ◽

Social Care ◽

Hospital Admissions ◽

Health Check ◽

Care Needs ◽

Health And Social Care ◽

Risk Patients ◽

Unplanned Hospital Admissions

Background: Older people with complex health and social care needs are a growing group of people with high use of NHS and social services. In particular, this group account for a large number of unplanned hospital admissions a year.Aims: To evaluate the evidence base for preventing unplanned hospital admissions in this group, to identify their characteristics and to undertake a focussed local review of their primary care management.Methods: A literature review, a review of the Southwark CCG data risk stratification tool and a review of high risk patients and their management at a Southwark GP practice.Results: High risk patients have multiple comorbidities and are frequent users of healthcare services. Although there was in general good involvement with social care services, there were certain areas that could be improved upon. For instance, the referral of frequent fallers to falls services and provision of an older person’s annual health check both offer opportunities for primary prevention.Conclusions: An older person’s annual health check would ensure holistic assessment of their health and social care needs and could then be acted upon to ensure that there is the required level of support in place, including a personalised anticipatory care plan and attention to key preventative measures such as falls prevention, exercise, smoking cessation, medicines optimisation and sensory impairment.

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Faculty Opinions recommendation of Six features of Medicare coordinated care demonstration programs that cut hospital admissions of high-risk patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.717348007.792703135 ◽

2012 ◽

Author(s):

Donna Zulman ◽

Emily Jenchura

Keyword(s):

High Risk ◽

Hospital Admissions ◽

Coordinated Care ◽

High Risk Patients ◽

Risk Patients

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How has technology been used to deliver cardiac rehabilitation during the COVID-19 pandemic? An international cross-sectional survey of healthcare professionals conducted by the BACPR

BMJ Open ◽

10.1136/bmjopen-2020-046051 ◽

2021 ◽

Vol 11 (4) ◽

pp. e046051

Author(s):

Alasdair F O'Doherty ◽

Helen Humphreys ◽

Susan Dawkes ◽

Aynsley Cowie ◽

Sally Hinton ◽

...

Keyword(s):

High Risk ◽

Cardiac Rehabilitation ◽

Technology Use ◽

Healthcare Professionals ◽

Hospital Admissions ◽

Well Being ◽

Rehabilitation Service ◽

High Risk Patients ◽

Home Based ◽

Risk Patients

ObjectiveTo investigate whether exercise-based cardiac rehabilitation services continued during the COVID-19 pandemic and how technology has been used to deliver home-based cardiac rehabilitation.DesignA mixed methods survey including questions about exercise-based cardiac rehabilitation service provision, programme diversity, patient complexity, technology use, barriers to using technology, and safety.SettingInternational survey of exercise-based cardiac rehabilitation programmes.ParticipantsHealthcare professionals working in exercise-based cardiac rehabilitation programmes worldwide.Main outcome measuresThe proportion of programmes that continued providing exercise-based cardiac rehabilitation and which technologies had been used to deliver home-based cardiac rehabilitation.ResultsThree hundred and thirty eligible responses were received; 89.7% were from the UK. Approximately half (49.3%) of respondents reported that cardiac rehabilitation programmes were suspended due to COVID-19. Of programmes that continued, 25.8% used technology before the COVID-19 pandemic. Programmes typically started using technology within 19 days of COVID-19 becoming a pandemic. 48.8% did not provide cardiac rehabilitation to high-risk patients, telephone was most commonly used to deliver cardiac rehabilitation, and some centres used sophisticated technology such as teleconferencing.ConclusionsThe rapid adoption of technology into standard practice is promising and may improve access to, and participation in, exercise-based cardiac rehabilitation beyond COVID-19. However, the exclusion of certain patient groups and programme suspension could worsen clinical symptoms and well-being, and increase hospital admissions. Refinement of current practices, with a focus on improving inclusivity and addressing safety concerns around exercise support to high-risk patients, may be needed.

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Improving harm reduction with a naloxone intervention in primary care to prescribe and educate a support person

Journal of Opioid Management ◽

10.5055/jom.2021.0621 ◽

2021 ◽

Vol 17 (2) ◽

pp. 109-113

Author(s):

Julienne K. Kirk, PharmD, CDE, BCPS ◽

Matthew Q. Tran, PharmD ◽

Samantha Pelc, PharmD ◽

Katherine G. Moore, PharmD, BCPS, BCACP

Keyword(s):

Primary Care ◽

High Risk ◽

Family Medicine ◽

Quality Improvement Intervention ◽

Opioid Overdose ◽

Naloxone Administration ◽

Support Person ◽

High Risk Patients ◽

Increased Risk ◽

Risk Patients

Objective: To determine whether a pharmacist-led intervention would increase the number of naloxone prescriptions and naloxone administration education in a primary care family medicine setting.Design: Prospective quality improvement intervention in an academic family medicine clinic.Methods: We surveyed providers about naloxone knowledge, prescribing habits, and prescribing barriers. We identified patients on chronic opioid therapy, through electronic health records for the year 2019. Overdose risk categories based upon morphine milligram equivalent doses and concomitant benzodiazepine use were used to determine patients who met criteria for naloxone. Pharmacists phoned qualified patients to discuss overdose risk and naloxone benefits. Patients who accepted naloxone prescriptions used their local pharmacy through a department-approved standing order set.Results: From the survey results, there were 47 of 54 provider responses, and the majority noted that they do not routinely prescribe naloxone in high-risk patients. The predominant barriers were lack of time during visit and naloxone administration education. The population of patients from chart review included 93 high-risk patients with a mean age of 58 years. During the time of intervention, 71 patients remained eligible for naloxone coprescribing. Of the patients contacted, 29 (40 percent) accepted the intervention prescription, and subsequently, 22 picked up their prescription from the pharmacy. Sixteen received counseling with a support person. Twelve patients had naloxone already at home, and two received counseling with a support person.Conclusion: The naloxone prescribing intervention is achievable. The results of this intervention support identifying patients at increased risk of opioid overdose and offer education of a support person for naloxone in a large academic family medicine clinic.

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Using mHealth tools to improve access, coverage and treatment of uninsured people with high cardiovascular disease risk in Argentina: a study protocol for a pragmatic cluster randomised trial

BMJ Innovations ◽

10.1136/bmjinnov-2017-000255 ◽

2018 ◽

Vol 4 (3) ◽

pp. 135-141 ◽

Cited By ~ 2

Author(s):

Shafika Abrahams-Gessel ◽

Andrea Beratarrechea ◽

Vilma Irazola ◽

Laura Gutierrez ◽

Daniela Moyano ◽

...

Keyword(s):

Cardiovascular Disease ◽

Primary Care ◽

High Risk ◽

Randomised Trial ◽

Text Messages ◽

Cluster Randomised Trial ◽

Cvd Risk ◽

High Risk Patients ◽

Cluster Randomised ◽

Risk Patients

IntroductionCardiovascular disease (CVD) accounts for approximately one-third of Argentina’s deaths. Despite government provision of free primary care health services to the uninsured population, with a focus on non-communicable diseases, screening and management of those with high CVD risk at primary care clinics (PCCs) remain low.Methods and analysisThis pragmatic cluster randomised trial will take place in two provinces of Argentina and will recruit 740 participants. Eight PCCs will be randomised to either the intervention or current practice arm. Community health workers (CHWs) in the intervention arm will be trained to use a set of integrated mHealth tools (a validated risk screening tool mobile application; electronic scheduling system using wireless access to PCCs; and educational text messages) to screen for CVD and to schedule appointments with primary care providers for persons with high CVD risk (≥10%). The primary aims of this study are to determine if the use of mHealth tools will (1) increase attendance of first appointments scheduled by CHWs for persons determined to have high risk for CVD during screening and, (2) lead to an increase in follow-up visits at PCCs by high risk patients. Secondary outcomes include assessing the proportion of high-risk patients receiving appropriate medications and a cost-effective analysis of the intervention.Ethics and disseminationThis study has been approved by the Institutional Review Boards at Partners/Brigham and Women’s Hospital (USA) and the Hospital Italiano de Buenos Aires (Argentina). The open-source software for the mHealth tools will be made publicly available at the end of the study.Trial registration numberNCT02913339.

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Uptake and detection rate of a stepwise cardiometabolic disease detection program in primary care—a cohort study

European Journal of Public Health ◽

10.1093/eurpub/ckz201 ◽

2019 ◽

Vol 30 (3) ◽

pp. 402-407

Author(s):

Daphne M Stol ◽

Monika Hollander ◽

Ilse F Badenbroek ◽

Mark M J Nielen ◽

François G Schellevis ◽

...

Keyword(s):

Risk Factors ◽

Primary Care ◽

Cohort Study ◽

High Risk ◽

Newly Diagnosed ◽

Additional Risk ◽

High Risk Patients ◽

Detection Program ◽

Risk Patients

Abstract Background Early detection and treatment of cardiometabolic diseases (CMD) in high-risk patients is a promising preventive strategy to anticipate the increasing burden of CMD. The Dutch guideline ‘the prevention consultation’ provides a framework for stepwise CMD risk assessment and detection in primary care. The aim of this study was to assess the outcome of this program in terms of newly diagnosed CMD. Methods A cohort study among 30 934 patients, aged 45–70 years without known CMD or CMD risk factors, who were invited for the CMD detection program within 37 general practices. Patients filled out a CMD risk score (step 1), were referred for additional risk profiling in case of high risk (step 2) and received lifestyle advice and (pharmacological) treatment if indicated (step 3). During 1-year follow-up newly diagnosed CMD, prescriptions and abnormal diagnostic tests were assessed. Results Twelve thousand seven hundred and thirty-eight patients filled out the risk score of which 865, 6665 and 5208 had a low, intermediate and high CMD risk, respectively. One thousand seven hundred and fifty-five high-risk patients consulted the general practitioner, in 346 of whom a new CMD was diagnosed. In an additional 422 patients a new prescription and/or abnormal diagnostic test were found. Conclusions Implementation of the CMD detection program resulted in a new CMD diagnosis in one-fifth of high-risk patients who attended the practice for completion of their risk profile. However, the potential yield of the program could be higher given the considerable number of additional risk factors—such as elevated glucose, blood pressure and cholesterol levels—found, requiring active follow-up and presumably treatment in the future.

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Clinical assessment for high-risk patients with non-alcoholic fatty liver disease in primary care and diabetology practices

Alimentary Pharmacology & Therapeutics ◽

10.1111/apt.15830 ◽

2020 ◽

Vol 52 (3) ◽

pp. 513-526 ◽

Cited By ~ 4

Author(s):

Zobair M. Younossi ◽

Kathleen E. Corey ◽

Naim Alkhouri ◽

Mazen Noureddin ◽

Ira Jacobson ◽

...

Keyword(s):

Primary Care ◽

Liver Disease ◽

High Risk ◽

Fatty Liver ◽

Clinical Assessment ◽

Fatty Liver Disease ◽

Alcoholic Fatty Liver ◽

High Risk Patients ◽

Risk Patients ◽

Alcoholic Fatty Liver Disease

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The impact of COVID-19 on chronic care according to providers: a qualitative study among primary care practices in Belgium

BMC Family Practice ◽

10.1186/s12875-020-01326-3 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Katrien Danhieux ◽

Veerle Buffel ◽

Anthony Pairon ◽

Asma Benkheil ◽

Roy Remmen ◽

...

Keyword(s):

Primary Care ◽

High Risk ◽

Qualitative Study ◽

Chronic Care ◽

Self Management ◽

Management Support ◽

High Risk Patients ◽

Risk Patients ◽

Care Practices ◽

Primary Care Practices

Abstract Background The COVID-19 pandemic affects the processes of routine care for chronic patients. A better understanding helps to increase resilience of the health system and prepare adequately for next waves of the pandemic. Methods A qualitative study was conducted in 16 primary care practices: 6 solo working, 4 monodisciplinary and 7 multidisciplinary. Twenty-one people (doctors, nurses, dieticians) were interviewed, using semi-structured video interviews. A thematic analysis was done using the domains of the Chronic Care Model (CCM). Results Three themes emerged: changes in health care organization, risk stratification and self-management support. All participating practices reported drastic changes in organization with a collective shift towards COVID-19 care, and reduction of chronic care activities, less consultations, and staff responsible for self-management support put on hold. A transition to digital support did not occur. Few practitioners had a systematic approach to identify and contact high-risk patients for early follow-up. A practice with a pre-established structured team collaboration managed to continue most chronic care elements. Generally, practitioners expected no effects of the temporary disruption for patients, although they expressed concern about patients already poorly regulated. Conclusion Our findings show a disruption of the delivery of chronic care in the Belgium prim care context. In such contexts, the establishment of the CCM can facilitate continuity of care in crisis times. Short term actions should be directed to facilitate identifying high-risk patients and to develop a practice organization plan to organize chronic care and use digital channels for support, especially to vulnerable patients, during next waves of the epidemic.

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