scholarly journals Seeking Healthcare During Lockdown: Challenges, Opportunities and Lessons for the Future

2021 ◽  
Author(s):  
Fiona Imlach ◽  
Eileen McKinlay ◽  
Jonathan Kennedy ◽  
Megan Pledger ◽  
Lesley Middleton ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Health Services ◽  
Online Survey ◽  
Influential Factors ◽  
System Level ◽  
Practice Environment ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Practices

Background: In Aotearoa/New Zealand, the first nation-wide coronavirus disease 2019 (COVID-19) lockdown occurred from March 23, 2020 to May 13, 2020, requiring most people to stay at home. Health services had to suddenly change how they delivered healthcare and some services were limited or postponed. This study investigated access to healthcare during this lockdown period, whether patients delayed seeking healthcare and reasons for these delays, focusing on the accessibility of primary care services. Methods: Adults (aged 18 years or older) who had contact with primary care services were invited through social media and email lists to participate in an online survey (n = 1010) and 38 people were recruited for in-depth interviews. We thematically analysed qualitative data from the survey and interviews, reported alongside relevant descriptive survey results. Results: More than half (55%) of survey respondents delayed seeking healthcare during lockdown. Factors at a national or health system-level that could influence delay were changing public service messages, an excessive focus on COVID-19 and urgent issues, and poor service integration. Influential factors at a primary care-level were communication and outreach, use of technology, gatekeeping, staff manner and the safety of the clinical practice environment. Factors that influenced patients’ individual decisions to seek healthcare were the ability to self-manage and self-triage, consciousness of perceived pressure on health services and fear of infection. Conclusion: In future pandemic lockdowns or crises, appropriate access to primary care services can be improved by unambiguous national messages and better integration of services. Primary care practices should adopt rapid proactive outreach to patients, fostering a calm but safe clinical practice environment. More support for patients to self-manage and self-triage appropriately could benefit over-burdened health systems during lockdowns and as part of business as usual in less extraordinary times.

scholarly journals Establishment of a sentinel surveillance network for sexually transmissible infections and blood borne viruses in Aboriginal primary care services across Australia: the ATLAS project

2019 ◽  
Author(s):  
Clare Bradley ◽  
Belinda Hengel ◽  
Katy Crawford ◽  
Salenna Elliott ◽  
Basil Donovan ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Practice ◽  
Health Service ◽  
Health Services ◽  
Clinical Guidelines ◽  
Program Planning ◽  
Sentinel Surveillance ◽  
Surveillance Network ◽  
Care Services ◽  
Primary Care Services

Abstract Background Sexually transmissible infection (STI) and blood-borne virus (BBV) notification data is a mainstay of the Australian National Notifiable Diseases Surveillance System (NNDSS) and is a mandatory requirement in all Australian jurisdictions. The system focuses on STI and BBV diagnoses alone, without testing, treatment or management data, leaving major gaps in the understanding of epidemics, especially among priority populations like Aboriginal and Torres Strait Islander peoples. Further information is required to supplement the NNDSS to better understand epidemics, the impact of interventions and health care delivery against clinical guidelines. Here we describe the rationale, processes and expected outcomes of establishing a national STI and BBV sentinel surveillance network in Aboriginal primary care services—known as the ATLAS network.Methods Researchers invited participation and consultation with Aboriginal Community-Controlled Health Services (ACCHS) clustered in five clinical hubs across four jurisdictions, representative of urban, regional and remote regions. Site-specific participation agreements were developed for each clinical hub and individual ACCHS. De-identified electronic medical record (EMR) data relating to STI and BBV testing, treatment and care are collected passively from each health service via the GRHANITE tm data extraction tool. These data are analysed centrally to inform 12 performance indicators which are included in surveillance reports generated for each health service and clinical hub.Results The ATLAS network currently involves 29 ACCHS representing all five clinical hubs. The ATLAS network provides detailed surveillance reports to individual ACCHS as well as contributing to aggregate comparative analyses at the clinical hub, jurisdictional and national levels. Data derived from the ATLAS network is used to assess clinical practice within each site. Aggregated data will inform clinical guidelines and extend the research potential of participating ACCHS sites. The ATLAS infrastructure can be expanded to include other health services and potentially linked to other data sources using GRHANITE.Conclusions The ATLAS network will supplement the NNDSS and contribute to improved understanding of local, regional and national patterns of clinical care of STI and BBV to inform clinical practice, policy, and program-planning.

scholarly journals Business as Un-usual: Access to mental health and primary care services for people with severe mental illness during the COVID-19 restrictions

2021 ◽  
Author(s):  
Elizabeth Newbronner ◽  
Panagiotis Spanakis ◽  
Ruth Wadman ◽  
Suzanne Crosland ◽  
Paul Heron ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Severe Mental Illness ◽  
Care Services ◽  
Primary Care Services ◽  
Mental Health Support ◽  
Health Support

Aims: To explore: how satisfied people with severe mental illness (SMI) are with the support received during the pandemic; understand any difficulties encountered when accessing both mental health and primary care services; consider ways to mitigate these difficulties; and assess the perceived need for future support from mental health services. Materials and Methods: A representative sample was drawn from a large transdiagnostic clinical cohort of people with SMI, which was recruited between April 2016 and March 2020. The sample was re-surveyed a few months after the beginning of the restrictions. Descriptive frequency statistics were used to analyse the quantitative data. The free text responses were analysed thematically. Results: 367 participants responded to the survey. Two thirds were receiving support from mental health services with the rest supported in primary care or self-managing. A quarter thought they would need more mental health support in the coming year. Half had needed to used community mental health services during the pandemic and the majority had been able to get support. A minority reported that their mental health had deteriorated but they had either not got the supported they wanted or had not sought help. The biggest service change was the reduction in face-to-face appointments and increasing use of phone and video call support. Nearly half of those using mental health services found this change acceptable or even preferred it; acceptability was influenced by several factors. Participants were more likely to be satisfied with support received when seen in person. Discussion: Although most participants were satisfied with the mental health support they had received, a minority were not. This, couple with findings on future need for mental health support has implications for post pandemic demand on services. Remote care has brought benefits but also risks that it could increase inequalities in access to services.

scholarly journals A Qualitative Study of Patients’ Perceptions of Dental Care in Primary Health Care

2020 ◽  
Author(s):  
Heriberto F. Sanchez ◽  
Andrea Maria D. Vargas ◽  
Marcos Azeredo F. Werneck ◽  
Efigênia F. Ferreira
Keyword(s):  
Primary Care ◽  
Oral Health ◽  
Qualitative Study ◽  
Health Services ◽  
Citizen Participation ◽  
Care Services ◽  
Primary Health ◽  
Primary Care Services ◽  
Belo Horizonte ◽  
The City

Knowledge of patients' views can contribute to the strengthening of health services. The aim of this study is to describe the patients' perception of a public oral health service, contributing to evaluations in health services. This is a qualitative study in which a focus group was conducted, with the participation of six patients of the oral health system in the city of Belo Horizonte, MG, Brazil, all with a minimum experience of three years of using the service. A theoretical model with dimensions aimed at assessing integrality and primary care services was used. In conducting the research, a semi-structured script was used. The data were analyzed by content analysis. The most representative categories for evaluating oral health actions in primary care are the health unit; the welcoming and its relation with the creation of the bond; service with a strong emphasis on the humanized relationship between professional and patient and on teamwork and; as a highlight, citizen participation, based on the recognition of a “system” that prevents the proper functioning of services and that must be fought with citizenship. Patients’ perceptions can be used to assess oral health in primary care from the perspective of those who actually use health services, seeking ultimately to constantly improve them. Knowledge of patients' perceptions may enable organizations to know their performance, through assessment methodologies based on the established perceptions.

scholarly journals Referrals from primary care to community mental health teams: what’s missing?

2019 ◽  
Vol 11 (4) ◽  
pp. 334
Author(s):  
Cath Allwood ◽  
Anthony O'Brien ◽  
Paul Glue
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Community Mental Health ◽  
Health Services ◽  
Poor Quality ◽  
Care Services ◽  
Primary Care Services ◽  
Retrospective Audit ◽  
Electronic Referral

ABSTRACT INTRODUCTIONTransfer of care from primary to specialist mental health services almost always requires a referral by hardcopy letter or sent via a structured electronic form. The quality and content of referrals can vary, leading to delays in treatment. AIMThe aim of the research was to explore the quality and content of referral letters received by two urban New Zealand community mental health teams. METHODSA retrospective audit of 4 months’ worth of referrals (n=92) from primary care to specialist mental health services was undertaken using an audit tool created from a review of literature. RESULTSThe audit identified gaps in the information provided by referrers, including a lack of evidence of treatment in primary care before referral, risk information, information relating to physical health concerns or co-existing problems, evidence of client consent to referral, and recording of ethnicity. Thirty-seven percent of referrals were considered to be of poor quality. Compared to hardcopy letters, referrals generated by an electronic referral system were of a better quality and contained more information. More than 40% of referrals were not accepted, although the reasons for this were not assessed as part of this audit. DISCUSSIONBetter integration of primary and secondary mental health care by using electronic referral templates may reduce the number of inappropriate or incomplete referrals. Referrals from primary care to specialist mental health services vary in content and quality, with many falling below a level that specialist services can accept. This impacts on the efficacy of services and ultimately on patients’ journeys between primary and secondary care. Development of a standard referral template for use by primary care services may improve the quality of referrals.

scholarly journals Psychiatry Residents' Perceptions and Reported Practices in Providing Primary Care

2017 ◽  
Vol 9 (2) ◽  
pp. 237-240 ◽  
Author(s):  
Lisa M. Wehr ◽  
Erik R. Vanderlip ◽  
Patrick H. Gibbons ◽  
Jess G. Fiedorowicz
Keyword(s):  
Primary Care ◽  
Online Survey ◽  
Psychiatry Residents ◽  
Medical Conditions ◽  
Residency Programs ◽  
Care Services ◽  
Preventive Counseling ◽  
Primary Care Services ◽  
Primary Care Specialty ◽  
Improve Health

ABSTRACT Background Patients with psychiatric disorders have higher rates of chronic medical conditions and decreased life expectancy. Integrating medical and psychiatric care is likely to improve health outcomes for these patients. Objective This study examined what proportion of psychiatry residents viewed psychiatry as a primary care specialty, how important they felt it was to provide primary care to patients, and how this perception altered self-reported comfort and practice patterns in providing screening and treatment for select general medical conditions. Methods An online survey was sent to current psychiatry residents of US residency programs. Results A total of 268 residents from 40 programs completed the survey (25% response rate), with 55% (147 of 265) of respondents considering psychiatry to be a primary care specialty. Residents who held this opinion gave higher ratings for the importance of providing preventive counseling and reported counseling a higher percentage of patients on a variety of topics. They also reported screening more patients for several medical conditions. Residents who considered psychiatry to be primary care did not report greater comfort with treating these conditions, with the exception of dyslipidemia. The most commonly cited barrier to integrating primary care services was lack of time. Conclusions Residents' perceptions of psychiatry as a primary care field appears to be associated with a higher reported likelihood of counseling about, and screening for, medical conditions in their patients.

scholarly journals A Qualitative Study of Patients’ Perceptions of Dental Care in Primary Health Care

2020 ◽  
Vol 3 (4) ◽  
Author(s):  
Heriberto F. Sanchez ◽  
◽  
Andrea Maria D. Vargas ◽  
Marcos Azeredo F. Werneck ◽  
Efigênia F. Ferreira
Keyword(s):  
Primary Care ◽  
Oral Health ◽  
Qualitative Study ◽  
Health Services ◽  
Citizen Participation ◽  
Care Services ◽  
Primary Health ◽  
Primary Care Services ◽  
Belo Horizonte ◽  
The City

Knowledge of patients' views can contribute to the strengthening of health services. The aim of this study is to describe the patients' perception of a public oral health service, contributing to evaluations in health services. This is a qualitative study in which a focus group was conducted, with the participation of six patients of the oral health system in the city of Belo Horizonte, MG, Brazil, all with a minimum experience of three years of using the service. A theoretical model with dimensions aimed at assessing integrality and primary care services was used. In conducting the research, a semi-structured script was used. The data were analyzed by content analysis. The most representative categories for evaluating oral health actions in primary care are the health unit; the welcoming and its relation with the creation of the bond; service with a strong emphasis on the humanized relationship between professional and patient and on teamwork and; as a highlight, citizen participation, based on the recognition of a “system” that prevents the proper functioning of services and that must be fought with citizenship. Patients’ perceptions can be used to assess oral health in primary care from the perspective of those who actually use health services, seeking ultimately to constantly improve them. Knowledge of patients' perceptions may enable organizations to know their performance, through assessment methodologies based on the established perceptions.

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.

Contacts with health services during the year prior to suicide death in France (2013-2015)

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
M Laanani ◽  
C Imbaud ◽  
P Tuppin ◽  
C Poulalhon ◽  
F Jollant ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practitioner ◽  
General Population ◽  
Health Services ◽  
Emergency Room ◽  
General Practitioners ◽  
National Health ◽  
Physical Conditions ◽  
Care Services ◽  
Primary Care Services

Abstract Background This study was designed to describe contacts with health services during the year before suicide death in France, and to compare the prevalent mental and physical conditions in these people to those of the general population. Methods Data were extracted from the French National Health Data System (SNDS), which comprises comprehensive claims data for inpatient and outpatient care linked to the national causes-of-death registry. Individuals, national health insurance general scheme beneficiaries (i.e. 76% of the population living in France), aged 15 years or older, who died from suicide in France in 2013-2015 were included. Medical consultations, emergency room visits, and hospitalisations during the year preceding death were collected. Conditions were identified, and standardised prevalence ratios (SPRs) were estimated to compare prevalence rates in suicide decedents with those of the general population. Results The study included 19,144 suicide decedents. Overall, 8.5% of suicide decedents consulted a physician or attended an emergency room on the day of death, 34.1% during the week before death, 60.9% during the month before death. Most contacts involved a general practitioner or an emergency room (46.2% of suicide decedents consulted a general practitioner during the month before death, 16.7% attended an emergency room). During the month preceding suicide, 24.4% of individuals were hospitalised at least once. Mental conditions (36.8% of cases) were 7.9-fold (SPR 95% CI: 7.7-8.1) more prevalent in suicide decedents than in the general population. The highest SPRs among physical conditions were for liver/pancreatic diseases (SPR=3.3, 95% CI: 3.1-3.6) and epilepsy (SPR=2.7, 95% CI: 2.4-3.0). Conclusions General practitioners and emergency departments have frequent contacts with suicide decedents during the last weeks before death and are at the forefront of suicide risk identification and prevention in individuals with mental, but also physical conditions. Key messages Mental and physical conditions are more common among suicide decedents than in the general population, and contacts with primary care services are frequent in the last weeks prior to suicide. Primary care services (general practitioners and emergency rooms) should be targeted for suicide preventive interventions.

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