Naught for Your Comfort: Quality of Primary Care for People with Long-Term Conditions

2014 ◽  
pp. 81-93
Author(s):  
Tom Heller
Keyword(s):  
Primary Care ◽  
Long Term Conditions ◽  
Quality Of Primary Care

scholarly journals A randomised controlled trial, cost-effectiveness and process evaluation of the implementation of self-management for chronic gastrointestinal disorders in primary care, and linked projects on identification and risk assessment

2018 ◽  
Vol 6 (1) ◽  
pp. 1-154 ◽  
Author(s):  
David G Thompson ◽  
Sarah O’Brien ◽  
Anne Kennedy ◽  
Anne Rogers ◽  
Peter Whorwell ◽  
...  
Keyword(s):  
Risk Assessment ◽  
Primary Care ◽  
Assessment Tool ◽  
Controlled Trial ◽  
Self Management ◽  
Gastrointestinal Disorders ◽  
Management Support ◽  
Long Term Conditions

BackgroundChronic gastrointestinal disorders are major burdens in primary care. Although there is some evidence that enhancing self-management can improve outcomes, it is not known if such models of care can be implemented at scale in routine NHS settings and whether or not it is possible to develop effective risk assessment procedures to identify patients who are likely to become chronically ill.ObjectivesWhat is the clinical effectiveness and cost-effectiveness of an intervention to enhance self-management support for patients with chronic conditions when translated from research settings into routine care? What are the barriers and facilitators that affect the implementation of an intervention to enhance self-management support among patients, clinicians and organisations? Is it possible to develop methods to identify patients at risk of long-term problems with functional gastrointestinal disorders in primary care? Data sources included professional and patient interviews, patient self-report measures and data on service utilisation.DesignA pragmatic, two-arm, practice-level cluster Phase IV randomised controlled trial evaluating outcomes and costs associated with the intervention, with associated process evaluation using interviews and other methods. Four studies around identification and risk assessment: (1) a general practitioner (GP) database study to describe how clinicians in primary care record consultations with patients who experience functional lower gastrointestinal symptoms; (2) a validation of a risk assessment tool; (3) a qualitative study to explore GPs’ views and experiences; and (4) a second GP database study to investigate patient profiles in irritable bowel syndrome, inflammatory bowel disease and abdominal pain.SettingSalford, UK.ParticipantsPeople with long-term conditions and professionals in primary care.InterventionsA practice-level intervention to train practitioners to assess patient self-management capabilities and involve them in a choice of self-management options.Main outcome measuresPatient self-management, care experience and quality of life, health-care utilisation and costs.ResultsNo statistically significant differences were found between patients attending the trained practices and those attending control practices on any of the primary or secondary outcomes. The intervention had little impact on either costs or effects within the time period of the trial. In the practices, self-management tools failed to be normalised in routine care. Full assessment of the predictive tool was not possible because of variable case definitions used in practices. There was a lack of perceived clinical benefit among GPs.LimitationsThe intervention was not implemented fully in practice. Assessment of the risk assessment tool faced barriers in terms of the quality of codting in GP databases and poor recruitment of patients.ConclusionsThe Whole system Informing Self-management Engagement self-management (WISE) model did not add value to existing care for any of the long-term conditions studied.Future workThe active components required for effective self-management support need further study. The results highlight the challenge of delivering improvements to quality of care for long-term conditions. There is a need to develop interventions that are feasible to deliver at scale, yet demonstrably clinically effective and cost-effective. This may have implications for the piloting of interventions and linking implementation more clearly to local commissioning strategies.Trial registrationCurrent Controlled Trial ISRCTN90940049.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 1. See the NIHR Journals Library website for further project information.

FRAILTY AND SARCOPAENIA TRIALS IN PRIMARY CARE – IDENTIFYING AND OVERCOMING KEY BARRIERS TO SUCCESSFUL CLINICIAN PARTICIPATION

2015 ◽  
pp. 1-2
Author(s):  
A. SINCLAIR
Keyword(s):  
Primary Care ◽  
Target Population ◽  
Population Based ◽  
Care Staff ◽  
Long Term Conditions ◽  
Primary Care Research ◽  
Wide Range ◽  
Primary Care Practitioners ◽  
Primary Care Staff

Primary care research involving older people brings together a wide range of primary care practitioners. Key areas of activity include: health promotion, disease prevention, screening and early diagnosis, as well as the management of common and long-term conditions such as frailty and sarcopaenia which are under-researched domains of health in this setting. Few interventional studies have identified frail or sarcopaenic patients as the target population based on recent definitions of either condition. Several barriers to successful research in the primary care area exist and overcoming such barriers is not straightforward but involves a multidimensional approach that attempts to enhance the confidence and opportunity to engage in research of primary care staff and the consideration of factors that allow external leads of research to coordinate their programme.

Prescribing practice: an overview of the principles

2021 ◽  
Vol 30 (17) ◽  
pp. 1016-1022
Author(s):  
Aby Mitchell ◽  
Reuben Pearce
Keyword(s):  
Hospital Admissions ◽  
Healthcare Services ◽  
Valuable Resource ◽  
Long Term Conditions ◽  
Legal Principles ◽  
Nurse Prescribing ◽  
Prescribing Practice ◽  
Hospital Stays

Nurse prescribing has become a well-established aspect of advanced clinical practice working alongside key NHS principles and drivers to address the increasing complexities in patient care and the demands on the health service. Prescribing practice is governed by ethical and legal principles to ensure a holistic patient-centred approach. It has been recognised as a valuable resource that could effectively transform healthcare services to reduce hospital admissions and long hospital stays and improve the quality of life for patients with long-term conditions and multiple comorbidities. This article will provide an overview of prescribing practice.

scholarly journals Improving the Care of People with Long-Term Conditions in Primary Care: Protocol for the Enhance Pilot Trial

2015 ◽  
Vol 5 (1) ◽  
pp. 135-149 ◽  
Author(s):  
Emma L. Healey ◽  
Clare Jinks ◽  
Valerie A. Tan ◽  
Carolyn A. Chew-Graham ◽  
Sarah A. Lawton ◽  
...  
Keyword(s):  
Primary Care ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Pilot Trial ◽  
Integrated Approach ◽  
Long Term Conditions ◽  
Delivery Of Care ◽  
Care Protocol ◽  
Engagement Assessment

Background Long-term conditions (LTCs) are important determinants of quality of life and healthcare expenditure worldwide. Whilst multimorbidity is increasingly the norm in primary care, clinical guidelines and the delivery of care remain focused on single diseases, resulting in poorer clinical outcomes. Osteoarthritis, and anxiety and/or depression frequently co-occur with other LTCs, yet are seldom prioritized by the patient or clinician, resulting in higher levels of disability, poorer prognosis, and increased healthcare costs. Objective To examine the feasibility and acceptability of an integrated approach to LTC management, tackling the under-diagnosis and under-management of osteoarthritis-related pain and anxiety and/or depression in older adults with other LTCs in primary care. Design The ENHANCE study is a pilot stepped-wedge cluster randomized controlled trial to test the feasibility and acceptability of a nurse-led ENAHNCE LTC review consultation for identifying, assessing, and managing joint pain, and anxiety and/or depression in patients attending LTC reviews. Specific objectives (process evaluation and research outcomes) will be achieved through a theoretically informed mixed-methods approach using participant self-reported questionnaires, a medical record review, an ENHANCE EMIS template, qualitative interviews, and audio recordings of the ENHANCE LTC review. Discussion Success of the pilot trial will be measured against the level of the primary care team engagement, assessment of training delivery, and degree of patient recruitment and retention. Patient satisfaction and treatment fidelity will also be explored. ISRCTN registry number: 12154418.

scholarly journals Effect of family practice contract services on the quality of primary care in Guangzhou, China: a cross-sectional study using PCAT-AE

BMJ Open ◽  
2018 ◽  
Vol 8 (11) ◽  
pp. e021317 ◽  
Author(s):  
Lina Li ◽  
Chenwen Zhong ◽  
Jie Mei ◽  
Yuan Liang ◽  
Li Li ◽  
...  
Keyword(s):  
Primary Care ◽  
Family Practice ◽  
Assessment Tool ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Quality Of Primary Care ◽  
Care Assessment ◽  
First Contact

ObjectiveCurrent healthcare reform in China has an overall goal of strengthening primary care and establishing a family practice system based on contract services. The objective of this study was to determine whether contracting a general practitioner (GP) could improve quality of primary care.DesignA cross-sectional study using two-stage sampling conducted from June to September 2014. Propensity score matching (PSM) was employed to control for confounding between patients with and without contracted GP.SettingThree community health centres in Guangzhou, China.Participants698 patients aged 18–89 years.Main outcome measuresThe quality of primary care was measured using a validated Chinese version of primary care assessment tool (PCAT). Eight domains are included (first contact utilisation, accessibility, continuity, comprehensiveness, coordination, family-centredness, community orientation and cultural competence from patient’s perceptions).ResultsA total of 692 effective samples were included for data analysis. After PSM, 94 pairs of patients were matched between the patients with and without contracted GPs. The total PCAT score, continuity (3.12 vs 2.68, p<0.01), comprehensiveness (2.31 vs 2.04, p<0.01) and family-centredness (2.11 vs 1.79, p<0.01) were higher in patients who contracted GPs than those did not. However, the domains of first contact utilisation (2.74 vs 2.87, p=0.14) and coordination (1.76 vs 1.93, p<0.05) were lower among patients contracted with GPs than in those who did not.ConclusionOur findings demonstrated that patients who had a contracted GP tend to experience higher quality of primary care. Our study provided evidence for health policies aiming to promote the implementation of family practice contract services. Our results also highlight further emphases on the features of primary care, first contact services and coordination services in particular.

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