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 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 191 A classification of primary care pathways in emergency departments: a multi-methods study comprising cross-sectional survey; site visits with observations; semi-structured and informal interviews

2020 ◽  
Vol 37 (12) ◽  
pp. 841.2-842
Author(s):  
Michelle Edwards ◽  
Alison Cooper ◽  
Davies Freya ◽  
Andrew Carson-Stevens ◽  
Thomas Hughes ◽  
...  
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Emergency Departments ◽  
Online Survey ◽  
Local Context ◽  
Framework Analysis ◽  
Front Door ◽  
Care Services ◽  
Primary Care Services

Aims/Objectives/BackgroundWe aim to describe and classify the predominant streaming pathways on arrival in Emergency Departments (EDs) in England and Wales and explain how they operate in different models of emergency department primary care services. Recent policy has encouraged a method whereby nurses stream from the emergency department front door to GPs working in a separate GP service operating within or alongside an ED. However, there is variation in methods of assessing and streaming patients on arrival at EDs. Conflated terminology causes difficulties in assessing relative performance, improving quality or gathering evidence about safety, clinical effectiveness. Our findings present a new classification of current streaming pathways from emergency departments to primary care services.Methods/DesignWe used a multi-stage method approach, including an online survey completed by 77 EDs across England & Wales, interviews with 21 clinical leads, and finally, undertaking case studies of 13 EDs. Qualitative data were triangulated and analysed using a framework analysis approach.Results/ConclusionsThe most common ED pathways to primary care services were: front door streaming before ED registration; streaming inside the ED; or without streaming but GPs selecting patients. Pathways were often adapted, to suit local circumstances such as department layout, patient demand levels, skill mix and interests of GPs practitioners and the accessibility of community primary care services. Pathways to redirect patients with non-urgent primary care problems to community primary care services were also used, with local variation in protocols based on staffing, patient demand and links to community primary care services. Local clinical leads and managers need to consider which pathway(s) may best suit their local context and needs. Consistency of terminology used to describe pathways between EDs and primary care services is necessary for multi-site evaluation, quality improvement and performance measurement.

scholarly journals Adapting primary care for new migrants: a formative assessment

BJGP Open ◽  
2017 ◽  
Vol 1 (1) ◽  
pp. bjgpopen17X100701 ◽  
Author(s):  
Elizabeth Such ◽  
Elizabeth Walton ◽  
Brigitte Delaney ◽  
Janet Harris ◽  
Sarah Salway
Keyword(s):  
Primary Care ◽  
Case Studies ◽  
Online Survey ◽  
Resource Constraints ◽  
Sample Survey ◽  
Service Development ◽  
Care Provision ◽  
Care Services ◽  
Primary Care Services ◽  
The Uk

BackgroundImmigration rates have increased recently in the UK. Migrant patients may have particular needs that are inadequately met by existing primary care provision. In the absence of national guidance, local adaptations are emerging in response to these new demands.AimTo formatively assess the primary care services offered to new migrants and the ways in which practitioners and practices are adapting to meet need.Design & settingOnline survey and case studies of current practice across primary care in the UK. Case studies were selected from mainstream and specialist general practice as well as primary care provision in the third sector.MethodNon-probability sample survey of primary care practitioners (n = 70) with descriptive statistical analysis. Qualitative case studies (n = 8) selected purposively; in-depth exploration of organisational and practitioner adaptations to services. Analysis is structured around the principles of equitable care.ResultsSurvey results indicated that practitioners focused on working with communities and external agencies and adapting processes of, for example, screening, vaccination, and health checks. Lack of funding was cited most frequently as a barrier to service development (n = 51; 73%). Case studies highlighted the prominence partnership working and of an organisational and practitioner focus on equitable care. Adaptations centred on addressing wider social determinants, trauma, and violence, and additional individual needs; and on delivering culturally-competent care.ConclusionDespite significant resource constraints, some primary care services are adapting to the needs of new migrants. Many adapted approaches can be characterised as equity-oriented.

scholarly journals Reorganisation of primary care services during COVID-19 in the Western Cape, South Africa: Perspectives of primary care nurses

2021 ◽  
Vol 63 (1) ◽  
Author(s):  
Talitha Crowley ◽  
Danine Kitshoff ◽  
Frances De Lange-Cloete ◽  
Justine Baron ◽  
Santel De Lange ◽  
...  
Keyword(s):  
South Africa ◽  
Primary Care ◽  
Online Survey ◽  
Healthcare Providers ◽  
Western Cape ◽  
Healthcare Facilities ◽  
Care Services ◽  
Primary Care Services ◽  
Primary Care Nurses ◽  
Postgraduate Diploma

Background: Primary care nurses play a pivotal role in the response to disasters and pandemics. The coronavirus diseases 2019 (COVID-19) pandemic required preventative, diagnostic, and curative measures for persons presenting with symptoms of COVID-19 by healthcare providers, whilst continuing other essential services. We aimed to investigate the reorganisation of primary care services during COVID-19 from the perspectives of primary care nurses in the Western Cape province of South Africa.Methods: We administered an online survey with closed and open-ended questions to professional nurses enrolled for a Postgraduate Diploma in Primary Care Nursing at Stellenbosch University (2020) and alumni (2017–2019) working in the Western Cape. Eighty-three participants completed the questionnaire.Results: The majority of the participants (74.4%) reported that they were reorganising services using a multitude of initiatives in response to the diverse infrastructure, logistics and services of the various healthcare facilities. Despite this, 48.2% of the participants expressed concerns, which mainly related to possible non-adherence of patients with chronic conditions, the lack of promotive and preventative services, challenges with facility infrastructure, and staff time devoted to triage and screening. More than half of the participants (57.8%) indicated that other services were affected by COVID-19, whilst 44.6% indicated that these services were worse than before.Conclusion: Our findings suggest that the very necessary reorganisation of services that took place at the start of the COVID-19 pandemic in South Africa enabled effective management of patients infected with COVID-19. However, the reorganisation of services may have longer-term consequences for primary care services in terms of lack of care for patients with other conditions, as well as preventive and promotive care.

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