scholarly journals Comparing the content and quality of video, telephone, and face-to-face consultations: a non-randomised, quasi-experimental, exploratory study in UK primary care

2019 ◽  
Vol 69 (686) ◽  
pp. e595-e604 ◽  
Author(s):  
Victoria Hammersley ◽  
Eddie Donaghy ◽  
Richard Parker ◽  
Hannah McNeilly ◽  
Helen Atherton ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Technical Problems ◽  
Face To Face ◽  
Information Giving ◽  
Care Services ◽  
Primary Care Services ◽  
Quasi Experimental ◽  
Primary Care Clinicians

BackgroundGrowing demands on primary care services have led to policymakers promoting video consultations (VCs) to replace routine face-to-face consultations (FTFCs) in general practice.AimTo explore the content, quality, and patient experience of VC, telephone (TC), and FTFCs in general practice.Design and settingComparison of audio-recordings of follow-up consultations in UK primary care.MethodPrimary care clinicians were provided with video-consulting equipment. Participating patients required a smartphone, tablet, or computer with camera. Clinicians invited patients requiring a follow-up consultation to choose a VC, TC, or FTFC. Consultations were audio-recorded and analysed for content and quality. Participant experience was explored in post-consultation questionnaires. Case notes were reviewed for NHS resource use.ResultsOf the recordings, 149/163 were suitable for analysis. VC recruits were younger, and more experienced in communicating online. FTFCs were longer than VCs (mean difference +3.7 minutes, 95% confidence interval [CI] = 2.1 to 5.2) or TCs (+4.1 minutes, 95% CI = 2.6 to 5.5). On average, patients raised fewer problems in VCs (mean 1.5, standard deviation [SD] 0.8) compared with FTFCs (mean 2.1, SD 1.1) and demonstrated fewer instances of information giving by clinicians and patients. FTFCs scored higher than VCs and TCs on consultation-quality items.ConclusionVC may be suitable for simple problems not requiring physical examination. VC, in terms of consultation length, content, and quality, appeared similar to TC. Both approaches appeared less ‘information rich’ than FTFC. Technical problems were common and, though patients really liked VC, infrastructure issues would need to be addressed before the technology and approach can be mainstreamed in primary care.

scholarly journals Factors for Supporting Primary Care Physician Engagement With Patient Apps for Type 2 Diabetes Self-Management That Link to Primary Care: Interview Study (Preprint)

2018 ◽  
Author(s):  
Julie Ayre ◽  
Carissa Bonner ◽  
Sian Bramwell ◽  
Sharon McClelland ◽  
Rajini Jayaballa ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Care Physician ◽  
Self Management ◽  
Clinical Tool ◽  
Face To Face ◽  
Care Services ◽  
Primary Care Services ◽  
Potential Benefits

BACKGROUND The health burden of type 2 diabetes can be mitigated by engaging patients in two key aspects of diabetes care: self-management and regular contact with health professionals. There is a clear benefit to integrating these aspects of care into a single clinical tool, and as mobile phone ownership increases, apps become a more feasible platform. However, the effectiveness of online health interventions is contingent on uptake by health care providers, which is typically low. There has been little research that focuses specifically on barriers and facilitators to health care provider uptake for interventions that link self-management apps to the user’s primary care physician (PCP). OBJECTIVE This study aimed to explore PCP perspectives on proposed features for a self-management app for patients with diabetes that would link to primary care services. METHODS Researchers conducted 25 semistructured interviews. The interviewer discussed potential features that would link in with the patient’s primary care services. Interviews were audio-recorded, transcribed, and coded. Framework analysis and the Consolidated Criteria for Reporting Qualitative Research checklist were employed to ensure rigor. RESULTS Our analysis indicated that PCP attitudes toward proposed features for an app were underpinned by perceived roles of (1) diabetes self-management, (2) face-to-face care, and (3) the anticipated burden of new technologies on their practice. Theme 1 explored PCP perceptions about how an app could foster patient independence for self-management behaviors but could also increase responsibility and liability for the PCP. Theme 2 identified beliefs underpinning a commonly expressed preference for face-to-face care. PCPs perceived information was more motivating, better understood, and presented with greater empathy when delivered face to face rather than online. Theme 3 described how most PCPs anticipated an initial increase in workload while they learned to use a new clinical tool. Some PCPs accepted this burden on the basis that the change was inevitable as health care became more integrated. Others reported potential benefits were outweighed by effort to implement an app. This study also identified how app features can be positively framed, highlighting potential benefits for PCPs to maximize PCP engagement, buy-in, and uptake. For example, PCPs were more positive when they perceived that an app could facilitate communication and motivation between consultations, focus on building capacity for patient independence, and reinforce rather than replace in-person care. They were also more positive about app features that were automated, integrated with existing software, flexible for different patients, and included secondary benefits such as improved documentation. CONCLUSIONS This study provided insight into PCP perspectives on a diabetes app integrated with primary care services. This was observed as more than a technological change; PCPs were concerned about changes in workload, their role in self-management, and the nature of consultations. Our research highlighted potential facilitators and barriers to engaging PCPs in the implementation process.

scholarly journals Does Improving Geographic Access to VA Primary Care Services Impact Patients' Patterns of Utilization and Costs?

2005 ◽  
Vol 42 (1) ◽  
pp. 29-42 ◽  
Author(s):  
John C. Fortney ◽  
Matthew L. Maciejewski ◽  
James J. Warren ◽  
James F. Burgess
Keyword(s):  
Primary Care ◽  
Care Utilization ◽  
Department Of Veterans Affairs ◽  
Community Based ◽  
Care Services ◽  
Primary Care Services ◽  
Catchment Areas ◽  
Quasi Experimental ◽  
Patterns Of Utilization ◽  
Primary Care Utilization

The Department of Veterans Affairs (VA) has been establishing community-based outpatient clinics (CBOCs) across the country to improve veterans' access to and use of primary care services, thereby decreasing the need for costly specialty outpatient and inpatient care. Using a quasi-experimental, pre-post study design, we examined whether the establishment of CBOCs has affected access, use, and costs for VA patients residing in their catchment areas. Most patients residing in CBOC catchment areas did not receive care at CBOCs, resulting in only small increases in primary care utilization. While CBOCs improved veterans' access, they had little impact on overall patterns of utilization and cost.

Telephone consultation in primary care

2018 ◽  
Vol 32 (2) ◽  
pp. 321-337 ◽  
Author(s):  
Francisco Gonzalez ◽  
Blanca Cimadevila ◽  
Julio Garcia-Comesaña ◽  
Susana Cerqueiro ◽  
Eladio Andion ◽  
...  
Keyword(s):  
Primary Care ◽  
Rural Areas ◽  
Public Healthcare ◽  
Telephone Consultation ◽  
Content Type ◽  
Face To Face ◽  
Care Services ◽  
Primary Care Services ◽  
Gender And Age ◽  
Telephone Calls

Purpose The purpose of this paper is to describe and analyze a teleconsultation modality based on a simple telephone call, using either landline or mobile phone, made available to more than two million people. Telecommunication systems are an increasingly common feature in modern healthcare. However, making teleconsultations available to the entire population covered by a public health system is a challenging goal. Design/methodology/approach This retrospective longitudinal observational study analyzed how this modality was used at the primary care level in Galicia, a region in the Northwest of Spain, in 2014 and 2015, focusing on demand, gender and age preferences, rural vs urban population and efficiency. Findings Of 28,472,852 consultations requested in this period, 9.0 percent were telephone consultations. Women requested more telephone consultations (9.9 percent of total consultations) than men (7.7 percent of total consultations). The highest demand occurred for the over 85 age group for both men and women. In both years, 2014 and 2015, the number of telephone consultations per inhabitant was higher in urban (0.53 and 0.69) than in rural areas (0.34 and 0.47). In 10.9 percent of cases, the telephone consultations required further face-to-face consultation. Originality/value Conventional voice telephone calls can efficiently replace conventional face-to-face consultations in primary healthcare in roughly 10 percent of cases. Women are more likely than men to use primary care services in both face-to-face and telephone consultation modalities. Public healthcare systems should consider implementing telephone consultations to deliver their services.

scholarly journals How are clinical commissioning groups managing conflicts of interest under primary care co-commissioning in England? A qualitative analysis

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018422 ◽  
Author(s):  
Valerie Moran ◽  
Pauline Allen ◽  
Imelda McDermott ◽  
Kath Checkland ◽  
Lynsey Warwick-Giles ◽  
...  
Keyword(s):  
Primary Care ◽  
Conflicts Of Interest ◽  
New Governance ◽  
Telephone Surveys ◽  
Face To Face ◽  
Study Approach ◽  
Telephone Interviews ◽  
Care Services ◽  
Primary Care Services

ObjectivesFrom April 2015, NHS England (NHSE) started to devolve responsibility for commissioning primary care services to clinical commissioning groups (CCGs). The aim of this paper is to explore how CCGs are managing potential conflicts of interest associated with groups of GPs commissioning themselves or their practices to provide services.DesignWe carried out two telephone surveys using a sample of CCGs. We also used a qualitative case study approach and collected data using interviews and meeting observations in four sites (CCGs).Setting/participantsWe conducted 57 telephone interviews and 42 face-to-face interviews with general practitioners (GPs) and CCG staff involved in primary care co-commissioning and observed 74 meetings of CCG committees responsible for primary care co-commissioning.ResultsConflicts of interest were seen as an inevitable consequence of CCGs commissioning primary care. Particular problems arose with obtaining unbiased clinical input for new incentive schemes and providing support to GP provider federations. Participants in meetings concerning primary care co-commissioning declared conflicts of interest at the outset of meetings. Different approaches were pursued regarding GPs involvement in subsequent discussions and decisions with inconsistency in the exclusion of GPs from meetings. CCG senior management felt confident that the new governance structures and policies dealt adequately with conflicts of interest, but we found these arrangements face limitations. While the revised NHSE statutory guidance on managing conflicts of interest (2016) was seen as an improvement on the original (2014), there still remained some confusion over various terms and concepts contained therein.ConclusionsDevolving responsibility for primary care co-commissioning to CCGs created a structural conflict of interest. The NHSE statutory guidance should be refined and clarified so that CCGs can properly manage conflicts of interest. Non-clinician members of committees involved in commissioning primary care require training in order to make decisions requiring clinical input in the absence of GPs.

A randomized trial of virtual visits in a general medicine practice

2009 ◽  
Vol 15 (3) ◽  
pp. 115-117 ◽  
Author(s):  
Ronald F Dixon ◽  
James E Stahl
Keyword(s):  
Primary Care ◽  
General Medicine ◽  
The Other ◽  
Presenting Problems ◽  
Diagnostic Agreement ◽  
Face To Face ◽  
Desktop Videoconferencing ◽  
Care Services ◽  
Primary Care Services ◽  
Virtual Visits

We compared desktop videoconferencing to conventional face-to-face visits for a range of commonly presenting problems in a general practice. A total of 175 patients were recruited. Patients were randomized to one of two arms of the study. In the first arm, the patients completed a visit (virtual or face-to-face) with a physician; they then completed a second visit via the other modality with another physician. In the second arm of the study, subjects had both visits face-to-face; different physicians conducted the two face-to-face consultations. Patients found virtual visits similar to face-to-face visits on most measures, including time spent with the physician, ease of interaction and personal aspects of the interaction. Physicians were also highly satisfied with the virtual visit modality. The diagnostic agreement between physicians was 84% between face-to-face and virtual visits; it was 80% between the two face-to-face visits. The study suggests that both patients and physicians could benefit if virtual visits were used as an alternative method of accessing primary care services.

scholarly journals Stroke follow-up in primary care: a discourse study on the discharge summary as a tool for knowledge transfer and collaboration

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rune Aakvik Pedersen ◽  
Halfdan Petursson ◽  
Irene Hetlevik ◽  
Henriette Thune
Keyword(s):  
Primary Care ◽  
Health Care ◽  
General Practice ◽  
Discourse Analysis ◽  
Knowledge Transfer ◽  
Health Care Services ◽  
Discharge Summary ◽  
Care Services ◽  
Discharge Summaries

Abstract Background The acute treatment for stroke takes place in hospitals and in Norway follow-up of stroke survivors residing in the communities largely takes place in general practice. In order to provide continuous post stroke care, these two levels of care must collaborate, and information and knowledge must be transferred between them. The discharge summary, a written report from the hospital, is central to this communication. Norwegian national guidelines for treatment of stroke, issued in 2010, therefore give recommendations on the content of the discharge summaries. One ambition is to achieve collaboration and knowledge transfer, contributing to integration of the health care services. However, studies suggest that adherence to guidelines in general practice is weak, that collaboration within the health care services does not work the way the authorities intend, and that health care services are fragmented. This study aims to assess to what degree the discharge summaries adhere to the guideline recommendations on content and to what degree they are used as tools for knowledge transfer and collaboration between secondary and primary care. Methods The study was an analysis of 54 discharge summaries for home-dwelling stroke patients. The patients had been discharged from two Norwegian local hospitals in 2011 and 2012 and followed up in primary care. We examined whether content was according to guidelines’ recommendations and performed a descriptive and interpretative discourse analysis, using tools adapted from an established integrated approach to discourse analysis.  Results We found a varying degree of adherence to the different advice for the contents of the discharge summaries. One tendency was clear: topics relevant here and now, i.e. at the hospital, were included, while topics most relevant for the later follow-up in primary care were to a larger degree omitted. In most discharge summaries, we did not find anything indicating that the doctors at the hospital made themselves available for collaboration with primary care after dischargeof the patient. Conclusions The discharge summaries did not fulfill their potential to serve as tools for collaboration, knowledge transfer, and guideline implementation. Instead, they may contribute to sustain the gap between hospital medicine and general practice.

scholarly journals Setting the scene for paramedics in general practice: What can we expect?

2018 ◽  
Author(s):  
Kamal Mahtani ◽  
Georgette Eaton ◽  
Matthew Catterall ◽  
Alice Ridley
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Models Of Care ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Workforce ◽  
Clinical Complexity ◽  
Or Practice ◽  
General Practices ◽  
Gp Care

Primary care services in England may be reaching saturation point. Demands to see a GP or practice nurse have increased substantially. Clinical complexity has also increased; patients are living longer, but with more multimorbidity.(1) These demands are mirrored by a decline in the GP workforce, despite political pledges to reverse this.(2) New strategies are needed to tackle the current pressures in general practice and reduce the risks of harm to patients. The NHS England GP Forward View advocates investing and developing new models of care, including expansion of a multidisciplinary, integrated primary care team.(3) These recommendations reflect the findings of the Primary Care Workforce Commission, who highlighted the potential roles for clinical pharmacists, physician associates, and physiotherapists, all substituting into current GP care pathways.(4) The Commission also recommended that general practices should consider more opportunities to use the skills of paramedics in primary care. Specific roles may include running clinics, triaging and managing minor illnesses, as well as provide continuity for patients with complex health needs. Further roles may include assessment and management of requests for same-day urgent home visits, as well as regular visits to homebound patients with long-term conditions.The commision highlighted that these innovative roles should be subject to further evaluation. Nevertheless, historical and current perspectives allow us to model how the role could be fully used.

Paramedic-led acute home visiting services in primary care

2021 ◽  
Vol 13 (6) ◽  
pp. 238-244
Author(s):  
John Burns
Keyword(s):  
Primary Care ◽  
Home Visiting ◽  
Care Home ◽  
Electronic Patient Records ◽  
Face To Face ◽  
Care Services ◽  
Primary Care Services ◽  
Complex Skills ◽  
Ward Rounds ◽  
Opening Up

Home visiting is traditionally carried out by GPs but it is becoming increasingly difficult for GPs to do, and many doctors want it removed from their contract. This is opening up a space for the paramedic profession, with paramedics carrying out home visits and designing future primary care services. Paramedics working within primary care can possess the knowledge, leadership and complex skills needed for home visiting, and some are independent prescribers; they can lead acute home visiting services (AHVS). AHVS require effective triage and access to electronic patient records, are underpinned by robust clinical governance and engage in clinical audits. Future primary care paramedic services could include online, video and face-to-face consultations, care home ward rounds, remote triage and home visiting. However, paramedics' contribution to general practice has not been fully evaluated and it may take time for this to become a norm. Regardless, primary care paramedicine has an opportunity to be innovative, shaking off risk-averse protocols for more enlightened practices, and lead the profession.

Advancing general practice nursing in Australia: roles and responsibilities of primary healthcare organisations

2017 ◽  
Vol 41 (2) ◽  
pp. 127 ◽  
Author(s):  
Riki Lane ◽  
Elizabeth Halcomb ◽  
Lisa McKenna ◽  
Nicholas Zwar ◽  
Lucio Naccarella ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Leadership Development ◽  
Postgraduate Education ◽  
System Level ◽  
Delphi Consensus ◽  
Practice Nurses ◽  
Care Services ◽  
Primary Care Services ◽  
Australian General Practice

Objectives Given increased numbers and enhanced responsibilities of Australian general practice nurses, we aimed to delineate appropriate roles for primary health care organisations (PHCOs) to support this workforce. Methods A two-round online Delphi consensus process was undertaken between January and June 2012, informed by literature review and key informant interviews. Participants were purposively selected and included decision makers from government and professional organisations, educators, researchers and clinicians from five Australian states and territories Results Of 56 invited respondents, 35 (62%) and 31 (55%) responded to the first and second invitation respectively. Participants reached consensus on five key roles for PHCOs in optimising nursing in general practice: (1) matching workforce size and skills to population needs; (2) facilitating leadership opportunities; (3) providing education and educational access; (4) facilitating integration of general practice with other primary care services to support interdisciplinary care; and (5) promoting advanced nursing roles. National concerns, such as limited opportunities for postgraduate education and career progression, were deemed best addressed by national nursing organisations, universities and peak bodies. Conclusions Advancement of nursing in general practice requires system-level support from a range of organisations. PHCOs play a significant role in education and leadership development for nurses and linking national nursing organisations with general practices. What is known about the topic? The role of nurses in Australian general practice has grown in the last decade, yet they face limited career pathways and opportunities for career advancement. Some nations have forged interprofessional primary care teams that use nurses’ skills to the full extent of their scope of practice. PHCOs have played important roles in the development of general practice nursing in Australia and internationally. What does this paper add? This study delineates organisational support roles for PHCOs in strengthening nurses’ roles and career development in Australian general practice. What are the implications for practitioners? Effective implementation of appropriate responsibilities by PHCOs can assist development of the primary care nursing workforce.

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