scholarly journals Multicomponent interventions for enhancing primary care: a systematic review

2020 ◽  
Vol 71 (702) ◽  
pp. e10-e21
Author(s):  
Geronimo Jimenez ◽  
David Matchar ◽  
Gerald Choon-Huat Koh ◽  
Josip Car
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Hospital Admissions ◽  
Grey Literature ◽  
Emergency Department Visits ◽  
Narrative Form ◽  
Provider Satisfaction ◽  
Quadruple Aim ◽  
Literature Searches ◽  
Multicomponent Interventions

BackgroundMany countries have implemented interventions to enhance primary care to strengthen their health systems. These programmes vary widely in features included and their impact on outcomes.AimTo identify multiple-feature interventions aimed at enhancing primary care and their effects on measures of system success — that is, population health, healthcare costs and utilisation, patient satisfaction, and provider satisfaction (quadruple-aim outcomes).Design and settingSystematic review and narrative synthesis.MethodElectronic, manual, and grey-literature searches were performed for articles describing multicomponent primary care interventions, providing details of their innovation features, relationship to the ‘4Cs’ (first contact, comprehensiveness, coordination, and continuity), and impact on quadruple-aim outcomes. After abstract and full-text screening, articles were selected and their quality appraised. Results were synthesised in a narrative form.ResultsFrom 37 included articles, most interventions aimed to improve access, enhance incentives for providers, provide team-based care, and introduce technologies. The most consistent improvements related to increased primary care visits and screening/preventive services, and improved patient and provider satisfaction; mixed results were found for hospital admissions, emergency department visits, and expenditures. The available data were not sufficient to link interventions, achievement of the 4Cs, and outcomes.ConclusionMost analysed interventions improved some aspects of primary care while, simultaneously, producing non-statistically significant impacts, depending on the features of the interventions, the measured outcome(s), and the populations being studied. A critical research gap was revealed, namely, in terms of which intervention features to enhance primary care (alone or in combination) produce the most consistent benefits.

scholarly journals Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol

2019 ◽  
Vol 2 ◽  
pp. 11 ◽  
Author(s):  
Emma Nicholson ◽  
Therese McDonnell ◽  
Moayed Hamza ◽  
Michael Barrett ◽  
Christopher Brunsdon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Making ◽  
Hospital Admissions ◽  
Grey Literature ◽  
Future Health ◽  
Exclusion Criteria ◽  
Policy Makers ◽  
Parental Preferences ◽  
Review Protocol

There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to identify the factors that influence parents’ and families’ preferences and decision making when seeking unscheduled paediatric healthcare.  Five databases will be searched for published studies (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and grey literature will also be searched. Inclusion and exclusion criteria will be applied and articles assessed for quality. A narrative approach will be used to synthesise the evidence that emerges from the review. By collating the factors that influence decision-making and attendance at these services, the review can inform future health policies and strategies seeking to expand primary care to support the provision of accessible and responsive care. The systematic review will also inform the design of a discrete choice experiment (DCE) which will seek to determine parental and family preferences for unscheduled paediatric healthcare. Policies that seek to expand primary care and reduce hospital admissions from emergency departments need to be cognisant of the nuanced and complex factors that govern patients’ behaviour.

scholarly journals Medical cannabis for the reduction of opioid dosage in the treatment of non-cancer chronic pain: A systematic review

2020 ◽  
Author(s):  
Babasola Okusanya ◽  
Ibitola O. Asaolu ◽  
John E. Ehiri ◽  
Linda Jepkoeach Kimaru ◽  
Abidemi Okechukwu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Hospital Admissions ◽  
Grey Literature ◽  
Emergency Department Visits ◽  
Original Research ◽  
Medical Cannabis ◽  
Analgesic Effects ◽  
The Past ◽  
Ovid Medline

Abstract Background: Medical cannabis (MC) is currently being used as an adjunct to opiates given its analgesic effects and potential to reduce opiate addiction. This review assessed if MC used in combination with opioids to treat non-cancer chronic pain would reduce opioid dosage.Methods: Four databases - Ovid (Medline), Psyc-INFO, PubMed, Web of Science, and grey literature – were searched to identify original research that assessed the effects of MC on non-cancer chronic pain in humans. The search yielded 4,316 articles and 24 reports from the databases and grey literature, respectively. Results: Nine studies involving 7,222 participants were included. There was a 64%-75% reduction in opioid dosage when used in combination with MC. Use of MC for opioid substitution was reported by 32%-59.3% of patients with non-cancer chronic pain. One study reported a slight decrease in mean hospital admissions in the past calendar year (P=.53) and decreased mean emergency department visits in the past calendar year (P=.39) for patients who received MC as an adjunct to opioids in the treatment of non-cancer chronic pain compared to those who did not receive MC. Conclusions: While this review indicated the likelihood of reducing opioid dosage when used in combination with MC, the optimal MC dosage to achieve opioid dosage reduction remains unknown. More research is needed to elucidate whether MC used in combination with opioids in the treatment of non-cancer chronic pain is associated with health consequences that are yet unknown.Systematic review registration: This systematic review was not registered.

scholarly journals Factors that influence family and parental preferences and decision making for unscheduled paediatric healthcare: a systematic review protocol

2019 ◽  
Vol 2 ◽  
pp. 11
Author(s):  
Emma Nicholson ◽  
Therese McDonnell ◽  
Moayed Hamza ◽  
Michael Barrett ◽  
Christopher Brunsdon ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Decision Making ◽  
Hospital Admissions ◽  
Grey Literature ◽  
Future Health ◽  
Exclusion Criteria ◽  
Policy Makers ◽  
Parental Preferences ◽  
Review Protocol

There is a plethora of factors that dictate where parents and families choose to seek unscheduled healthcare for their child; and the complexity of these decisions can present a challenge for policy makers and healthcare planners as these behaviours can have a significant impact on resources in the health system. The systematic review will seek to identify the factors that influence parents’ and families’ preferences and decision making when seeking unscheduled paediatric healthcare.  Five databases will be searched for published studies (CINAHL, PubMed, SCOPUS, PsycInfo, EconLit) and grey literature will also be searched. Inclusion and exclusion criteria will be applied and articles assessed for quality. A narrative approach will be used to synthesise the evidence that emerges from the review. By collating the factors that influence decision-making and attendance at these services, the review can inform future health policies and strategies seeking to expand primary care to support the provision of accessible and responsive care. The systematic review will also inform the design of a discrete choice experiment (DCE) which will seek to determine parental and family preferences for unscheduled paediatric healthcare. Policies such as Sláintecare that seek to expand primary care and reduce hospital admissions from emergency departments need to be cognisant of the nuanced and complex factors that govern patients’ behaviour.

scholarly journals The role of health technologies in primary care interventions: A systematic review (Preprint)

2020 ◽  
Author(s):  
Geronimo Jimenez ◽  
David Matchar ◽  
Gerald Koh Choon Huat ◽  
MJJ Rianne van der Kleij ◽  
Niels H. Chavannes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Digital Health ◽  
Grey Literature ◽  
Chronically Ill ◽  
Prescribing Practices ◽  
Health Technologies ◽  
Monitoring Technologies ◽  
Multicomponent Interventions

BACKGROUND Several countries around the world have implemented multicomponent interventions to enhance primary care (PC), as a way of strengthening their health systems to cope with an ageing, chronically ill population, and rising costs. Some of these efforts have included technology-based enhancements as one of their features to support the overall intervention, but their details and impact have not been explored. OBJECTIVE To identify the role of digital/health technologies within wider, multi-feature interventions aimed at enhancing PC, and to describe the type of technologies used, aim and stakeholder, and potential impacts. METHODS A systematic review was performed, following Cochrane guidelines. An electronic search, supplemented with manual and grey literature searches, was conducted to identify multicomponent interventions which included at least one technology-based enhancement. After title/abstract and full text screening, selected articles were assessed for quality based on their study design. A descriptive, narrative synthesis was used for analysis and presentation of results. RESULTS Fourteen out of 37 articles (38%) described the inclusion of a technology-based innovation, as part of their multicomponent interventions to enhance PC. The most common identified technologies were the use of electronic health records, data monitoring technologies and online portals with messaging platforms. The most common aim of these technologies was to improve continuity of care and comprehensiveness, which resulted in increased patient satisfaction, increased PC visits compared to specialist visits, and the provision of more health prevention education and improved prescribing practices. Technologies seem also to increase costs and utilization for some parameters, such as increased consultation costs and increased number of drugs prescribed. CONCLUSIONS Technologies and digital health have not played a major role within comprehensive innovation efforts aimed at enhancing PC, reflecting that these technologies have not yet reached maturity or wider acceptance as a means for improving PC. Stronger policy and financial support is needed, as well as the advocacy of key stakeholders, to encourage the introduction of efficient technological innovations, backed by evidence-based research, so that digital technologies can fulfill the promise of supporting a strong, sustainable primary care.

scholarly journals Medical cannabis for the reduction of opioid dosage in the treatment of non-cancer chronic pain: A systematic review

2020 ◽  
Author(s):  
Babasola Okusanya ◽  
Ibitola O. Asaolu ◽  
John E. Ehiri ◽  
Linda Jepkoeach Kimaru ◽  
Abidemi Okechukwu ◽  
...  
Keyword(s):  
Systematic Review ◽  
Chronic Pain ◽  
Dosage Reduction ◽  
Hospital Admissions ◽  
Grey Literature ◽  
Risk Of Bias ◽  
Emergency Department Visits ◽  
Original Research ◽  
Medical Cannabis ◽  
The Past

Abstract Background: Medical cannabis (MC) is currently being used as an adjunct to opiates given its analgesic effects and potential to reduce opiate addiction. This review assessed if MC used in combination with opioids to treat non-cancer chronic pain would reduce opioid dosage.Methods: Four databases - Ovid (Medline), Psyc-INFO, PubMed, Web of Science, and grey literature – were searched to identify original research that assessed the effects of MC on non-cancer chronic pain in humans. Study eligibility included randomized controlled trials, controlled before-and-after studies, cohort studies, cross-sectional studies, and case reports. All databases were searched for articles published from inception to October 31, 2019. Cochrane’s ROBINS-I tool and the AXIS tool were used for risk of bias assessment. PRISMA guidelines was followed in reporting the systematic review.Results: Nine studies involving 7,222 participants were included. There was a 64%-75% reduction in opioid dosage when used in combination with MC. Use of MC for opioid substitution was reported by 32%-59.3% of patients with non-cancer chronic pain. One study reported a slight decrease in mean hospital admissions in the past calendar year (P=.53) and decreased mean emergency department visits in the past calendar year (P=.39) for patients who received MC as an adjunct to opioids in the treatment of non-cancer chronic pain compared to those who did not receive MC. All included studies had high risk of bias, which was mainly due to their methods. Conclusions: While this review indicated the likelihood of reducing opioid dosage when used in combination with MC, we cannot make a causal inference. Although medical cannabis’s recognized analgesic properties make it a viable option to achieve opioid dosage reduction, the evidence from this review cannot be relied upon to promote MC as an adjunct to opioids in treating non-cancer chronic pain. More so, the optimal MC dosage to achieve opioid dosage reduction remains unknown. Therefore, more research is needed to elucidate whether MC used in combination with opioids in the treatment of non-cancer chronic pain is associated with health consequences that are yet unknown.Systematic review registration: This systematic review was not registered.

scholarly journals Reducing unscheduled hospital care for adults with diabetes following a hypoglycaemic event: which community-based interventions are most effective? A systematic review

2021 ◽  
Author(s):  
Aoife Watson ◽  
Donna McConnell ◽  
Vivien Coates
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Integrated Care ◽  
Hospital Care ◽  
Hospital Admissions ◽  
Community Based Interventions ◽  
Community Based ◽  
Integrated Care Pathways ◽  
Effective Community ◽  
Balance Of Care

Abstract Aim To determine which community-based interventions are most effective at reducing unscheduled hospital care for hypoglycaemic events in adults with diabetes. Methods Medline Ovid, CINAHL Plus and ProQuest Health and Medical Collection were searched using both key search terms and medical subject heading terms (MeSH) to identify potentially relevant studies. Eligible studies were those that involved a community-based intervention to reduce unscheduled admissions in adults with diabetes. Papers were initially screened by the primary researcher and then a secondary reviewer. Relevant data were then extracted from papers that met the inclusion criteria. Results The search produced 2226 results, with 1360 duplicates. Of the remaining 866 papers, 198 were deemed appropriate based on titles, 90 were excluded following abstract review. A total of 108 full papers were screened with 19 full papers included in the review. The sample size of the 19 papers ranged from n = 25 to n = 104,000. The average ages within the studies ranged from 41 to 74 years with females comprising 57% of the participants. The following community-based interventions were identified that explored reducing unscheduled hospital care in people with diabetes; telemedicine, education, integrated care pathways, enhanced primary care and care management teams. Conclusions This systematic review shows that a range of community-based interventions, requiring different levels of infrastructure, are effective in reducing unscheduled hospital care for hypoglycaemia in people with diabetes. Investment in effective community-based interventions such as integrated care and patient education must be a priority to shift the balance of care from secondary to primary care, thereby reducing hospital admissions.

scholarly journals LO046: Factors associated with hospital admission following asthma exacerbations: a systematic review

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S46-S46 ◽  
Author(s):  
B.H. Rowe ◽  
N. Arrotta ◽  
J. Hill ◽  
E. Dennett ◽  
M. Harries
Keyword(s):  
Hospital Admissions ◽  
Data Extraction ◽  
Statistical Significance ◽  
Grey Literature ◽  
Included Study ◽  
Significance Level ◽  
Factors Associated ◽  
Admission Rates ◽  
Literature Searches ◽  
Number Of Patients

Introduction: Patients with asthma frequently present to the emergency department (ED) with exacerbations; however, a select number of patients require admission to hospital. The objective of this study was to summarize the evidence regarding asthma-related hospital admissions and factors associated with these admissions following ED presentation. Methods: Comprehensive literature searches were conducted in seven electronic databases (database inception to 2015); manual and grey literature searches were also performed. Studies reporting disposition for adults after ED presentation were included. Study quality was assessed using the Newcastle-Ottawa Scale (NOS); standardized data-collection forms were used for data extraction. Admission proportions and factors associated with admission at a statistical significance level (p<0.05) were reported. Results: Out of an initial 5865 identified articles, 37 articles met full inclusion criteria. Admission proportions were reported in 25/37 studies, ranged from 1% to 37%, and collectively demonstrated a decline of ~9% in admissions between 1993 and 2012. Studies including a >50% Caucasian ethnicity were found to have a median admission proportion of 13% (interquartile range [IQR]= 7, 20) versus studies with >50% non-Caucasian ethnicity at 22% (IQR=20, 28). Age, female sex, and previous hospitalizations for asthma exacerbation were the most individually identifiable factors associated with admission. Presenting features and medication profile were the most frequent domains associated with admission. Conclusion: Admission rates have decreased approximately 9% in a nearly 20-year span and seem to be higher in studies involving mostly non-Caucasian ethnic groups. Demographic factors, markers of severity obtained by history or at ED presentation, and medication profile could be assessed by ED clinicians to effectively discern patients at high risk for admission.

scholarly journals From substance to process: A meta-ethnographic review of how healthcare professionals and patients understand placebos and their effects in primary care

2018 ◽  
Vol 24 (3) ◽  
pp. 315-340 ◽  
Author(s):  
Doug I Hardman ◽  
Adam WA Geraghty ◽  
George Lewith ◽  
Mark Lown ◽  
Clelia Viecelli ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Irritable Bowel Syndrome ◽  
Healthcare Professionals ◽  
Clinical Validity ◽  
Placebo Effects ◽  
Literature Searches ◽  
Irritable Bowel ◽  
Systematic Literature Searches ◽  
Material Substances

Research suggests that a ‘placebo’ can improve conditions common in primary care including pain, depression and irritable bowel syndrome. However, disagreement persists over the definition and clinical relevance of placebo treatments. We conducted a meta-ethnographic, mixed-research systematic review to explore how healthcare professionals and patients understand placebos and their effects in primary care. We conducted systematic literature searches of five databases – augmented by reference chaining, key author searches and expert opinion – related to views on placebos, placebo effects and placebo use in primary care. From a total of 34 eligible quantitative, qualitative and mixed-methods articles reporting findings from 28 studies, 21 were related to healthcare professionals’ views, 11 were related to patients’ views and two were related to both groups. In the studies under review, healthcare professionals reported using placebos at markedly different frequencies. This was highly influenced by how placebos were defined in the studies. Both healthcare professionals and patients predominantly defined placebos as material substances such as ‘inert’ pills, despite this definition being inconsistent with current scientific thinking. However, healthcare professionals also, but less prevalently, defined placebos in a different way: as contextual processes. This better concurs with modern placebo definitions, which focus on context, ritual, meaning and enactivism. However, given the enduring ubiquity of substance definitions, for both healthcare professionals and patients, we question the practical, clinical validity of stretching the term ‘placebo’ towards its modern iteration. To produce ‘placebo effects’, therefore, primary healthcare professionals may be better off abandoning placebo terminology altogether.

scholarly journals Violence in sub-saharan african schools: A scoping review protocol

2020 ◽  
Author(s):  
Delarise Maud Mulqueeny ◽  
Senzelokuhle Mpumelelo Nkabini ◽  
Sabelo Abednego Nxumalo
Keyword(s):  
Systematic Review ◽  
School Violence ◽  
Scoping Review ◽  
Grey Literature ◽  
Relevant Literature ◽  
Future Research ◽  
Psychological Violence ◽  
Gender Based Violence ◽  
Literature Searches ◽  
Sub Saharan

Abstract Background: Violence in schools is an intersectional, multifaceted and complex global phenomenon that impedes gender equality and transformation, disrupts learner progress, familial and school environments and constitutes a public health, educational, social and human rights challenge. According to the United Nations (UN) study on Violence against Children, violence in schools refers to sexual and gender-based violence (GBV), bullying, gang-related violence (GRV), school and community-related violence, verbal, physical and psychological violence that includes fighting and weapons. Literature searches rendered no scoping or systematic results for a complex topic such as violence in SSA schools with catastrophic consequences. Hence, the objective of this scoping review is to map evidence of violence in SSA schools from existing literature over the past decade to summarise findings, identify research gaps, guide future research or determine the feasibility of a systematic review being conducted. Methods: Due to violence in schools being a broad topic our literature searches will include grey literature, unpublished and published studies, empirical studies, all study designs, conference presentations and website content using various keywords to search multiple databases to locate relevant literature. Search engines and electronic databases that will be searched are Google Scholar, PsycINFO (EBSCHO), CINAHL, SCOPUS, EBSCOhost, PsycARTICLES (EBSCO), EMBASE, university libraries, education departments and MEDLINE (EBSCHO). Title and abstract screening will be independently conducted by two screeners to minimise bias. A data charting form, compiled by three screeners using a Google form, will be used to extract relevant information from each article. Two screeners will populate the charting form electronically whilst all four screeners will ensure the charting form is continuously updated. Discussion: We anticipate mapping literature on violence in sub-Saharan African schools. Once summarized, the data will be useful to identify literature gaps, guide future research on school violence or determine the feasibility of a systematic review being conducted.

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